Keywords

Typhoid fever, Ethnopharmacological survey, Gomari airport, Tradomedical practitioners, Plants.

Introduction

Typhoid fever is a global infection [1] which is transmitted by eating food or taking water which is contaminated with the faeces of a person who is infected with and contain the bactirum, Salmonella enterica, Serovar typhi (often called Salmonella typhi) [2,3] The disease , apart from being a cause for concern is also a major public health issue in developing nations (like Asia and Africa), with Nigeria being of primary concern because of poor sanitary conditions and inadequate supply of water [4,5]. According to the World Health Organization (WHO) there are six hundred thousand deaths from typhoid fever annually. [2,6,7] Also, an annual infection rate of 21.6 million was also estimated by WHO [6] with the highest percentage of these rates occurring in Africa and Asia. The large scale and indiscriminate use of antibiotics has led to microorganisms developing resistance, which is an adaptation system in which the microorganisms are no longer responding to drug concentrations to which they were previously susceptible. An unfortunate outcome of the large scale and indiscriminate use of antibiotics is the development of antimicrobial resistance as an adaptive response in which microorganisms begin to tolerate a concentration of drug to which it was previously susceptible. The development of mechanisms which circumvent or inactivate antibiotics is largely due to the versatility of the genes and the way the large number of micororganisms adapt. When plasmids coding for resistance to antibiotics are present in S. typhi, antibiotic resistance occurs. Allied to this issue of resistance is the transfer of plasmids which are resistant from one pathogen to another. Resistance has been observed to be carried out by one plasmid8. This plasmid belongs to incompatibility group H11 and is highly transmissible between similar pathogens. Recent reports suggest that S. typhi will have one of these plasmids which lead to resistance of antibiotics [9-11].

Antibiotic resistance in S. typhi is an emerging and important public health issue because those who use antibiotics to treat diseases are uncompromising in their behaviour. [12-14]. An outbreak in Tajikistan in the late 1990s, accounting for over 24,000 infections was caused by a multidrug resistance (MDR) S. typhi. [15]

A multidrug resistant (MDR) S. typhi strain that was not sensitive to chloramphyenicol and other first line recommended antibiotics like ampicillin and contrimoxaxole was discovered in many areas of Latin America Asia and Africa [14,16]. While there can be resistance to a single antibiotic, the occurrence of multi-drug resistance by this bacterium has worsened the health problems [17]. S. typhi is one of the most resistant organisms with multidrug resistant phenotype in S. typhi. [18] Resistant salmonella and infact other pathogens cause infections which lead to significant morbidity and mortality and make the healthcare cost to skyrocket worldwide. This study was therefore designed to document properly the plant flora that are used for treating typhoid fever by the indigenous people of Gomari Airport Ward in Jere Local Government Area of Borno State and to provide valuable information to encourage the conservation and sustainable utilization of plant wealth occurring in the area, which probably may reduce the cost of treatment. Also the occurrence of multidrug resistance to Salmonella typhi against antibiotics that are commonly used has brought about the need for new antimicrobial remedy from plant- derived medicines that are probably safer than synthetic ones. [3,19]

METHODS

Data collection

Primary data were used for collecting data from each respondent by administering pre-tested, validated and reliable 53 point structured questionnaire called the Instrument. The questionnaire comprised mainly close ended with a few open ended questions. Secondary data were sourced from journals and other periodicals, reference books, textbooks, internet search, library and monographs.

Design

The project was a cross sectional descriptive study. The survey was for four (4) months (19th November, 2013 – 1st March, 2014 = 21 days).

The present study was in Jere LGA, one out of the 27 LGAs in Borno State, Nigeria. It was carved out of Maiduguri Metropolitan Council (MMC) in 1996. [20] It occupies a landmass of 160km=2.21 Within the State, it shares boundaries with Mafa LGA to the east, MMC to the north and Konduga to the South. [22] The climate of Jere comprises cold and hot seasons and minimum temperature ranging from 15o- 20oC, while the maximum temperature ranges from 37o – 45oC. The rainfall is from 500mm to 700mm per annum [23].

Generally, there is a cool-dry season (October – February), hot season (March- June) and a short rainy (wet) season (June/July – September, October) with relative humidity which is low [24]. Generally, the topography is low land, plain and the soil is mostly sandy with short grasses and thorny shrubs. [25,26] There are ten (10) wards in Jere LGA; LGA; this study was carried out in Gomari Airport Ward.

Population/Sample

The population of the registered TMPs in Borno State is not known. [27] However, what remains clear according to the Ministry of Health, is that there is no list of registered TMPs in Borno State bringing all the TMPs together under one umbrella (i.e. there was no sampling frame of TMPs) in the recent past (1-3years) Based on this, a multistage sampling was used to select 10 TMPs in the study area i.e. Gomari Airport Ward using random sampling (balloting).

The plants were identified and authenticated by a plant Taxonomist at the Department of Biological Sciences, University of Maiduguri.

The fidelity level (FL) in % was also calculated to compare data from the study area on plants that are often used. It was calculated using the formula:

Where:

FL % = Fidelity level

Np = No. of TMPs that claim the use of a plant for the treatment of typhoid fever (No. of citations of each plant)

N = Total No. of TMPs in the study area. Source: Adapted from [28,29]

Data analysis

The information obtained from the questionnaire were analyzed using descriptive statistics such as tables, percentage and frequency distribution tables to evaluate the practice of TMPs in the study area. Correlation was assessed by Pearson Test using SPSS version 16.0 of 2007 for all computations.

RESULTS

Validity and reliability of the instrument (Questionnaire)

The validity of the instrument was high and the reliability according to Pearson correlation coefficient (r) also called Cronbach alpha (α) at the end of the study was found to be 0.896.

Plant species, botanical names and local names

A total of twenty two (22) plants belonging to 18 families, 21 genera and 22 species were identified to be used in the treatment of typhoid fever in the study area (Table 1). Their botanical names, families, parts used, their preparation, dosage and administration are shown in Table 1. The family with the largest number of plant species was Caesalpiniaceae (with 5 species). The remaining 17 families had 1 specie each.

Table 1. Medicinal plant, name, family, part used and availability of plant in treatment of typhoid fever in Gomari Airport Ward, Jere Local Government

Most of the medications used involved a mixture of plants with one treated with only a single plant (Table 2). One TMP used only the dried leaves and bark of Pilostigma reticulatum, boiled, cooled then decanted and it was taken and also used as bath.

Table 2. Medicinal plants recipe, part used, method of preparation, dosage, added substances (adjunct), mode of administration, precaution, side effects, receipts and other uses

Fidelity Level (FL)

Cassia occidentalis Linn. (Caesalpinaceae) is the specie with the highest FL (40.00%) as shown in Table 3. All the other plants had FL of 10.00% each.

Table 3. Fidelity level (FL) among TMPs in Gomari Airport Ward, Jere LGA on the most reported plants used in the treatment of typhoid fever

Habitat and status of species

Most of the plants used are trees (41.67 %), followed by shrubs (25.00 %), herbs (16.67 %) under shrub and bushy plant (8.33 % each) [Table 4] spread across Gomari Airport ward in the LGA.

Table 4. Habitat of the medicinal plants used in the treatment of typhoid fever in Gomari Airport Ward, Jere Local Government Area

Socioeconomic characteristics/demographic Data of TMPs

The study revealed that most of the TMPs were men (90.00 %) whilst 10.00 % were women (Tables 5).

Table 5. Biodata of respondents or (Demographic Data of TMPs)

Sources of information/knowledge

All the TMPs’ parents were tradomedical practitioners themselves (100.00 %) as shown in Table 6.

Table 6. Sources of information/knowledge on typhoid fever

Plant Parts, How Used and Obtained

Leaves are the part of the plants most frequently used (80.00 %), followed by the root (50.00 %), bark (20.00) and whole plant (10.00) as shown in Tables 8.

Table 7. Treatment of Typhoid fever in Gomari Airport Ward

Table 8. Evaluation of treatment of typhoid fever

Treatment of typhoid fever, dosages and treatment evaluation

All the TMPs (100 %) had experience in treating typhoid fever. The medications were mainly taken orally (90.00 %), with 30.00 % being applied as baths on the skin and 20.00 % used through inhalation (Table 8) but some applications were prepared from a mixture of plants or ingredients such as milk, (10.00 %).

The reported adverse effects included urine colouration (40,00 %) and dizziness (20.00%) as shown in Table 8. All the TMPs claimed that evidence of treatment was that headache and fever disappeared whilst 90.00% reported that appetite improved. In addition 100% of them reported a high cure rate of typhoid fever and 70.00% of the patients were well in less than 1 week and the remaining 30.00% fully recovered in one week. Treatment failure only occurred if medication was not taken according to specification and no frequency of relapse was reported.

DISCUSSION

The validity of the instrument was high indicating the appropriateness of interpretation made from the results of the questionnaire, according to the context of the instrument as set out in the objectives of the survey and not merely on superficial examination. [30-32]

The result of this survey in which 22 plants were identified is comparable to the result obtained when an ethnobotanical survey of medicinal plants used in the treatment of typhoid fever by the Idoma people of Nigeria was carried out where a total of 21 species belonging to 18 plant families were identified [2]. These species are known plants used as medicine in North East Nigeria [34] and all of them were widely used by the TMPs in Gomari Airport Ward in Jere Local Government Area, Borno State.

In this study area, the use of traditional medicine is widely accepted. This is evident from the number of plant species (22 plants) identified as medicinal. Through the plants identified as medicinal plants species are few compared with 96 medicinal plants identified in Enugu State, Nigeria by [35]; 129 plants in Bolivia by Macia et al.(2005) but more compared with 45 medicinal species identified by [36,37] in Ijesha land, Osun State, Nigeria, 21 plants for antityphoid treatment in Idoma land, Benue State, Nigeria, by [2]; 27 medicinal plants by Ampitan in Biu LGA, Borno State Nigeria and 22 plant species by [38] for diabetes treatment in South Western Region of Nigeria. This result may be because of the location of the LGA in the Sahel Savvanah of the country. [39] The importance of the identified plants to the local community cannot be over emphasized as they make use of them daily and preferred them to the orthodox medicines.39 The use of complimentary and alternative medicine (CAM) for treating typhoid fever is evident by the plants identified.

The use of herbal medicine for the treatment of typhoid fever is evident by the number of plant species identified. It is one way of balancing body systems and has become part of the cultural life and heritage of the people. [39,41] Many communities have therefore, since time immemorial, adopted different traditional methods, using plant and animal parts which are locally available to alleviate their health issues [39,40]. All the plants identified had at least one local name. The vernacular names used by the TMPs were uniform, probably suggesting that these plants are well known as remedies. [2,41,42]

The possible chemical compositions of the identified plants documented from literature may be responsible for the acclaimed antityphoid fever activities by the TMPs. The phytochemical constituents are secondary metabolites which might draw a link between the modern science and the traditional use of the plant.

Psidium guajava L. (Myrtaceae), Vitex doniana, Veronia amygdalina (Wild) Darke (Asteraceae) and Erythrina senegalensis DC. (Papilionoideae), water leaf extracts have been demonstrated by [43] to be effective against Escherichia coli and Salmonella typhi . This is in conformity with the work of (44) who reported that these extracts if properly enhanced and harnessed could be very useful in healthcare delivery system for treatment of diseases. These plants contained phytochemicals like alkaloids, glycosides and anthraquinones. [43]

Observation was made by [45} in the survey of ethnobotany and conservation in Northern Nigeria that some plant species have multiple uses and treated and cured different ailments which included asthma, typhoid, stomach ache, headache, diarrheoa, whitlow, dysentery, anaemia, gonorrhoea, cough, among others. This also applies to the plants in Jere LGA in which part of the plants apart from being used to treat typhoid fever could also treat malaria,, cancer, high blood pressure, clustered headache and migraine. According to [46], since oral information can never be as accurate as was told to the recipient, a whole library of herbal information were being buried gradually with every person that dies. This resulted in slow pace of development of alternative medicine in Nigeria and in Africa in general.

TMPs used different additives and solvents in preparing their formulations. Some additives for example red potash (Jari kanwa) and potash (Kanwa) are mostly added to make some of the preparations that are taken orally more acceptable [29,33]. These can also be, milk, which can be added to decoctions and infusions to reduce the bitterness of the remedies in order to make them easier to drink. Lack of data on the biological roles of these materials like red potash and potash has been noted in the literature [29]. The plants mentioned in the preparations are evaluated generally by biological methods, but the materials added by the TMPs are generally not screened [29].

The potential of a plant to cure a disease can be estimated by its fidelity level (FL), [28,29] There was a high level of agreement among the TMPs in Gomari Airport Ward, Jere LGA on the plants used in treating typhoid fever. 6 of the plants had high citations and FL of 6 of the plants were high as well. This means that the medicinal properties of these plants can seriously be considered for more ethnopharmacological screening [41], since they are species widely applied by many people and for a long time have been so.

The pattern of traditional prescriptions revealed that majority of the medications involved a mixture of plants with only a few (1 preparation) treated with a high level of documentation. Traditional healers claimed that using multiple plants may provide a synergistic effect in therapeutic efficacy. [42,48]Although traditional medicines are still in common use by the TMPs in Borno State, Nigeria and other people in Nigeria, accurate information of the plant and their medicinal properties are held by only a few individuals in the community. These TMPs are almost without exception, community elders of 50 years of age or older, hence there is high probability that these invaluable knowledge and art of healing which have been religiously preserved for generations may not be passed on to the younger generation. To ensure that this information on plants is not lost with the current elderly generation of healers, documentation and preservation of this indigenous knowledge must be accorded utmost priority in this culture and other cultures, so that future generations can benefit from it in overcoming emerging problems of public health, agricultural and pharmaceutical sectors. [42]

The result of this study does not agree with that of Ampitan [39,46,49] where the age group of TMPs were (41-50) years respectively. In the area of study, age bracket ≤50 years were few (10.00 %) whilst age bracket & above 50 years were mainly the TMPs. Thus, the age of TMPs may be said to vary from place to place depending on where the survey is carried out. Many of the TMPs.

Majority of the TMPs in the LGA were men (90 %). This observation agrees with the one made by [39} who carried out a study of medicinal plants in Biu LGA, Borno State, where the traditional medicine practitioners were males.. The result however disagreed with that made by 50 in Abeokuta, Ogun State where women were the predominant traditional medicine practitioners. These results might be due to the people’s religion which forbid women from meeting or mingling with men either in the community or private. [39] However, of note, is that even in the South West of Nigeria, a study carried out in Abeokuta as well, by (38) on treatment of diabetes with plants had 96% male TMPs.

Majority of the TMPs agreed that knowledge of herbal treatment was mainly acquired by training (from their ancestors and parents) and is usually passed down from one generation to another. This ensures that the practice stays within the family. This is in agreement with the working of [38] who carried out a survey of the management of diabetes with plants in South Western regionof Nigeria that source of information on alternative medicine is mainly from the family (83%).

The plant part used was “traditionally” estimated, so the variations in the doses would either increase or decrease toxicity or affect the amount of the plant that would probably elicit pharmacological action. [51] Furthermore, lack of exact doses were reported by the TMPs in Jere LGA and the duration were not precisely given. This lack of exact doses in traditional practice has also been documented by many researchers [2,29,38,39,42,51,52]. The reason being that the healers failed to reveal all their knowledge.

Medicinal plants’ use is probably of a lower cost than allopathic pharmaceutical remedies [53] and most TMPs do not charge, they only received whatever the patients could offer except for the few who charged some money. In many of the plants studied pharmacologically, compounds were isolated from organic extracts of the plants while TMPs use water extract to cure their patients. The question how these nonvolatile substances could be the active constituent in phytomedicines normally administered as water extracts is interesting. One probable explanation might be that the minimum inhibitory concentration (μg range) of these compounds are low, as such they are effective.

Another reason is that in the plant material there could be co-extraction as plants often contain phytochemicals like saponins [51,5,4], that could lead to the solubility of and other non-soluble compound if it is in the same mixture. Plants are indispensable source of medicines for humans since creation [29,55] and constitute major economic resource of most countries on the planet including Nigeria. Most of the herbal medicines came from the trees followed by shrubs, many of which also have other uses such as providing timber and protection of the environment [29] They have taxonomic classes which enable their classification with respect to their role in economic development [29,56]

The unprecedented interest and demand for plants with medicinal properties and potency for treatment of various ailments is causing overexploitation of such plant genetic resources in the area of study. According to [29,57], the depletion rate of plants generally is high, yet little is known about a large portion of the world’s plant species especially tropical floras. When viewed against the present rate of extinction and decimation of the forests in this area, there is the need to conserve what is left as forest for posterity.

The most frequent liquid used in preparation is water, powders are sometimes suspended in milk to probably mask their bitter taste. [61]

The major method of administration is oral [29] followed by baths. Other ways of administration include direct application such as inhalation or bathing. Today, baths are still an important way to treat some illnesses and pains. [41,58,59]

The reported adverse effects effects when these antityphoid plants are used are dizziness and urine colouration according to the healers headaches, may be due to overdose of the medications or the additives. When the side effect is violent, stopping of the treatment is recommended [59,62]

The reported typhoid fever as diagnosed by the TMPs in fact may be symptoms only, which indicate that the traditional practice in Gomari Airport Ward of Jere LGA is symptom-directed as 100 % of the TMPs treated high fever and headache which are symptoms of diseases. This agreed with what was obtained in various regions of Mali [51], since there are a few other means of diagnosis apart from the symptoms observed by the patients [51,60]

CONCLUSION

The study provides information that could assist in the quest for locally sourced drug development in the treatment of typhoid fever in Nigeria. Screening and evaluation of the identified plants may be a next step in developing local therapeutic agents for typhoid fever.

ACKNOWLEDGEMENTS

The authors gratefully acknowledge the assistance of Mallam Adamu Bello (for Hausa interpretation to English), Mallam Idi-Sarki Baka (a TMP who linked the authors with other TMPs), the Director of Pharmaceutical Services, Pharmacist Steven Jasini and Director of Medical Services, Dr Ibrahim Kida, Borno State Ministry of Health, Maiduguri. The West African Postgraduate College of Pharmacists, (WAPCP) with the Secretariat in Yaba, Lagos, is also appreciated for the opportunity to carry out this research work.

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