HERBAL MEDICINES USED BY BAPEDI TRADITIONAL HEALERS TO TREAT REPRODUCTIVE AILMENTS IN THE LIMPOPO PROVINCE , SOUTH AFRICA

The current study focussed on documenting the ethnobotanical knowledge of herbal medicines used by the Bapedi traditional healers to treat reproductive ailments in the Limpopo Province, South Africa. Fifty one healers from 17 municipalities covering Capricorn, Sekhukhune and Waterberg districts of the Limpopo Province were interviewed between January and July 2011. Semi-structured interviews, observations and guided field surveys with the healers were employed. Thirty-six medicinal plant species belonging to 35 genera and 20 families were documented. The most used species were Zanthoxylum humile (25.5%), Catha edulis (21.6%), Ozoroa sphaerocarpa (15.7%), Hypoxis hemerocallidea (13.7%), Hypoxis obtusa (11.7%), Gomphocarpus fruticosus subsp. fruticosus and Gymnosporia senegalensis (9.8% each). The dominant growth forms among the reported medicinal plants were herbs (39%), followed by shrubs and trees with 33% and 28%, respectively. The preferred plant parts were roots (63.9%), followed by bark (13.9%), whole plant (11.1%), tubers (8.3%), bulbs (5.6%), fruits, leaves, stems and twigs (2.8% each). The majority of the species were used to treat gender specific reproductive ailments; while a minority were used for treating reproductive ailments of both genders. Twenty-two species (61.1%) are supported by reports of similar uses in other countries or have proven biological activity. This study illustrates that Bapedi traditional healers possess remarkable knowledge on medicinal plants used for treating and managing reproductive ailments.


Introduction
Traditional healers can be found in most societies (Cheikhyoussef et al., 2011).In sub-Saharan Africa, the ratio of traditional healers to the population is approximately 1:500, whilst western-trained medical doctors present a 1:40 000 ratio to the rest of the population (Richter, 2004).Kale (1995) and Setswe (1999) estimated that there were approximately 200 000 traditional healers practising in South Africa in 1995, compared to 25 000 medical doctors.Traditional healers play an important role in their local community's tradition and primary health care system.Approximately 70 -80% of the South African population still rely on traditional healers for day-to-day health care (UNAIDS, 2006), who prepare traditional remedies from as many as 700 indigenous plant species (Meyer and Afoloyan, 1995).
A large percentage of the population in developing countries uses traditional medicines.The reasons being their close proximity (Muthu et al., 2006), the high cost of western pharmaceuticals and health care, and because traditional medicines are more acceptable from a cultural and spiritual perspective (Cunningham, 1988).According to King and Homsy (1997), traditional healers provide client-centred, personalized health care that is culturally appropriate and tailored to meet the needs and expectations of the client by paying special attention to the social and spiritual concerns of the client.Msiska et al. (1997) noted that rural patients are more dependent on medicinal remedies from traditional healers for the treatment of reproductive ailments for a number of reasons, such as the lack of access to modern medical facilities and hesitancy to relate their illnesses to unfamiliar doctors.Research shows that a wide range of reproductive ailments from across the world are being treated by medicinal plants.These include for example, menstrual disorders, fertility problems, spermaturia and impotency in India (Hegde et al., 2007), cloudy urination in women, leucorrhoea in Bangladesh (Hossan et al, 2010), and womb problems, menstrual pain, and female complaints in Trinidad and Tobago (Lans, 2007).In South Africa, substantial numbers of women seek treatment from traditional health practitioners for a variety of complications and disorders associated with reproductive health (Bereda 2002).These include amongst others, menstrual disorders, abortion, antiabortifacient, contraception and breast problems (Steenkamp, 2003).In contrast, South African males consult traditional healers mostly for impotence (Rakuambo et al., 2006).For most ethnic groups in South Africa, this rich indigenous knowledge on medicinal species used to manage reproductive ailments is either poorly known or misunderstood.Thus a study was undertaken to document medicinal species used by the Bapedi traditional healers to treat reproductive ailments in the Limpopo Province of South Africa.

The study area
This study was conducted in 17 local municipalities of the Limpopo Province, covering three districts (Capricorn, Sekhukhune and Waterberg) (Figure 1, Table 1).The majority of people in the study area belong to the Bapedi ethnic group.

Data collection
A total of 51 Bapedi traditional healers were selected with the assistance of local administrators and elders.Data on medicinal plants used by them to treat reproductive ailments were collected from January 2011 to July 2011.Interviews and open-ended discussions with healers were conducted in Sepedi, the local language.Prior to interviews and any discussions on medicinal plants used to treat reproductive ailments, verbal informed consent was obtained from participating healers.The researchers also adhered to the ethical guidelines of the International Society of Ethnobiology.Information on plant names, plant part(s) used, methods of herbal preparation, administration, dosage and duration of treatments were documented.Based on ethnobotanical information provided by traditional healers, voucher specimens were collected and deposited at the Larry Leach Herbarium (UNIN), University of Limpopo.

Medicinal plant diversity
Bapedi traditional healers use 36 plant species to manage reproductive health problems (Table 2).These medicinal species are distributed among 35 genera and 20 families.The largest proportion of medicinal species collected belongs to the family Asteraceae (6 species), followed by Fabaceae (4 species); Celastraceae and Euphorbiaceae (3 species each); Anacardiaceae, Apocynaceae, Hyacinthaceae and Hypoxidaceae (2 species each).Other families were represented by a single species each.The dominance of the Asteraceae and Fabaceae, and to a lesser extent the Euphorbiaceae, probably relate to their large numbers of species.Thus it is not surprising that these families have also been recorded in ethnomedicinal inventories of different countries throughout Africa and Asia.For example, Kamatenesi-Mugisha and Oryem-Origa (2005) reported on the dominance of the Euphorbiaceae in the treatment of impotency in western Uganda.The Asteraceae and Euphorbiaceae were documented as dominant families in the treatment of reproductive ailments in Cameroon (Focho et al., 2009) and Ghana (Diame, 2010).Hossan et al. (2010) noted the dominance of the Fabaceae in the treatment of urinary tract infections and sexually transmitted diseases in Bangladesh.
Fifteen species (41.7%) are used by Bapedi traditional healers to treat female reproductive problems.These include: Bidens pilosa, Brachylaena discolor, Capsicum chinese, Chamaesyce prostrata, Cyperus papyrus, Elaeodendron transvaalense, Euphorbia ingens, Geigeria aspera var.aspera, Heteropyxis transvaalensis, Kleinia longiflora, Mundulea sericea, Pelargonium spp., Phytolacca dodecandra, Sesbania punicea and Sclerocarya birrea.The utilized species were mainly to treat female infertility.Female fertility is a dominant theme in the culture of black South Africans as it ensures preservation and propagation of the tribe (Veale et al., 1992), while the inability to conceive is regarded as a disgrace, as procreation is expected to follow marriage (Katsoulis, 2000).The above mentioned species were also used to a lesser extent in initiating abortion, and to manage breast cancer, menstrual disorders, period pains, vaginal candidiasis and womb problems.Only 6 medicinal species (16.6%) were used to treat and manage both male and female reproductive problems; Carica papaya (impotence and abortion), Jatropha curcas (impotence and vaginal candidiasis), Osyris lanceolata (impotence and menstrual disorder), Peltophorum africanum (impotence and female infertility), as well as Drimia elata and Hypoxis obtusa (impotence and female infertility).
Phytochemical and pharmaceutical studies have been done on some of the medicinal plant species documented in this study, examples include testing the efficacy of Securidaca longepedunculata as a potential remedy for sexual dysfunction (Rakuamboa et al., 2006;Sumalatha et al., 2010).Anti-fertility activities of Phytolacca dodecandra has been reported by Taniguchi et al. (1978) and Katende et al. (1995).Extract of Catha edulis at the dose of 100 mg/kg reduced mounting and intromission latencies, thereby enhancing sexual motivation or arousal in male rats after 15 days of treatment (Abdulwaheb et al., 2007).Adebivi et al. (2002) noted that unripe or semi-ripe Carica papaya fruit is unsafe in pregnancy and its consumption usually resulted in abortion.Furthermore, preliminary clinical research in a primate model demonstrated the potential contraceptive and abortifacient capability of Carica papaya (Lohiya et al., 2002).This study found that Carica papaya seeds have contraceptive effects in adult female langur monkeys, and possibly in adult female humans.

Growth forms, plant parts used and method of herbal application
An analysis of the medicinal species used by the Bapedi traditional healers to treat reproductive ailments, revealed that 28 species (77.8%) are indigenous to the Limpopo Province, while 8 species (22.2%) are exotics.Herbs constituted the largest proportion of growth forms (39%), followed by shrubs and trees with 33% and 28%, respectively.The plant parts mostly used to prepare herbal medicines were roots (63.9%), followed by bark (13.9%), whole plants (11.1%), tubers (8.3%), bulbs (5.6%), fruits, leaves, stems and twigs (2.8% each) (Figure 2).Results obtained in this study compares favourably with findings by Steenkamp (2003) who reported the widespread use of root and bark remedies by South African women for gynaecological complaints.Similar findings were reported by Hedge et al. ( 2007) who noted the extensive use of root and bark remedies for treating reproductive ailments in India.
Mono therapies based on preparations made from a single species were the most prevalent (91.7%), and only 8.3% of reproductive health remedies were prepared from a combination of two or more species.This is in line with findings of Hegde et al. (2007) and Hossan et al. (2010) who found that traditional healers in India also prefer using a single species for herbal preparations to treat reproductive ailments.The preference for a single-based species extract is unknown at this stage and warrants further investigations.However, we postulate that it could be that the various species for multi therapies (2 or more species) might not always be available or that more effort and finances need to be expended to collect species for multi therapies, making it unattractive.In our study, plant remedies were often utilized in the form of extracts (72.5%) and powder (20%).Plant remedies were also made by maceration or squeezing (5%).This involved the use of Euphorbia ingens stem sap or immature fruit of Carica papaya and root maceration of Kleinia longiflora.The majority (97.3%) of the herbal remedies were administered orally three times a day until reproductive health ailments subsided.Stem sap of Euphorbia ingens was applied topically on an incision on breasts made by the traditional healer.

Conclusion
This study shows that Bapedi traditional healers utilised a significant number of medicinal species to treat reproductive ailments.It is thus of paramount importance to verify the phytochemical safety and pharmaceutical efficacy of these herbal remedies.Since roots, bark and even whole plants are used, the risk of plant and species loss is high in the Limpopo Province of South Africa.This loss may inter alia lead to the disappearance of many traditional healers and ultimately cultural identity.

Figure 1 .
Figure 1.Study area: Capricorn, Sekhukhune and Waterberg districts, Limpopo Province, South Africa.A to Q designates the involved municipalities.

Figure 2 .
Figure 2. Plant parts used by Bapedi traditional healers to treat reproductive health ailments.

Table 1 .
Districts and local municipalities included in this study

Table 2 :
Plant species used for the treatment of reproductive ailments in the Limpopo Province.An asterisk (*) indicates that the taxon is known or believed to be exotic to the Limpopo Province