The present study evaluated ethno medicinal knowledge of people in the rural community of São Sebastião, Vitória da Conquista, Bahia, Brazil. Using semi-structured interviews, 84 randomly chosen individuals informed about the use of traditional medicinal plants in their community, thereby identifying their therapeutic potential, which were categorized according to the ICD-10 (International Statistical Classification of Diseases and Related Health Problems). The collected data were analyzed with using the Informant consensus factor (ICF), the Relative importance (RI) and the scores were calculated by using Fidelity level (FL). Forty-six species traditionally used in treatment of ailments were categorized as diseases: digestive system, respiratory problems, general symptoms/signs, nervous system and circulatory system. Lippia alba, Cymbopogon citratus and Foeniculum vulgare had a RI >1, indicating important value to the community. Highest values of FL were: Spondias purpurea, Bauhinia forficata, Punica granatum, Matricaria chamomilla, Stryphnodendron adstringens, Foeniculum vulgare, Mentha piperita, Amburana cearensis and Dysphania ambrosioides. S. purpurea, to treat hypertension, and Amburana cearensis (indigestion) deserve in depth pharmacological and toxicological studies so that they might be included in the National Program of Medicinal Plants and Phytotherapics of the Brazilian Sistema Único de Saúde and safely prescribed by regional health teams, lowering costs for local health system.

Keywords: ethnobotanical study, northeast brazil, traditional medicine, medicinal plants, spondias purpurea

ICF, informant consensus factor; RI, relative importance; FL, fidelity level; UESB, universidade estadual do sudoeste da bahia, HUESBVC, herbarium at uesb, vitoria da conquista

Brazil is a continental country with six different biomes, Amazon, Atlantic Forest, Cerrado, Caatinga, Pantanal and Pampa,¹ of which 3 are represented in the State of Bahia (Atlantic Forest, Caatinga, Cerrado).^2,3 Traditional knowledge of medicinal plants used by indigenous populations of rural areas of Bahia has not received enough attention so far, although in northeastern Brazil there are ethnobotanical studies recently published.^4‒8 Vitoria da Conquista, Bahia was formerly (18th Century) inhabited by the Indian tribes Mongoiós (subgroup Camacãs), Ymborés (or Aimorés) and to a lesser extent by the Pataxós. Their villages were scattered over a wide range, known as the Sertão da Ressaca. Today, the original vegetation cover in Vitória da Conquista does not exceed 10%, consisting of Caatinga and Atlantic Forest biomes.⁹ This vegetation type is of fundamental importance for maintaining the quality of regional watersheds, such as Rio Mole, Rio Pardo and Rio Caculé (rivers) that benefit a large population of southwestern Bahia.¹⁰ The rural communities, mainly extinguished Brazilian natives (indigenous communities) own diverse knowledge about plants and caring for the environment. Thus, the need of research on communities and how they deal with plants so that their descendants acquire their traditional knowledge.¹¹

Use of medicinal plants has grown considerably in the second half of the 20th century, from many parts of the world. In the developing countries 65-80% of the population depends exclusively on the medicinal plants for the basic healthcare,¹² including Northeastern Brazil.⁵ Brazil was considered the seventh largest market, and from 2006 to 2010 grew by 14% and it is also estimated that by 2015 Brazil will be the sixth largest market in this sector.¹³ Important policies were implemented in the last decade to encourage research and development related to the use of medicinal plants and herbal remedies which may be provided with quality, safety and efficacy to the population, prioritizing the country's biodiversity.¹⁴ Considering the actual worldwide popular use of medicinal plants, the Sistema Único de Saúde (SUS, Brazilian Health System), via the Brazilian Ministry of Health, has introduced the National Policy on Integrative and Complementary Practices and the National Policy on Medicinal Plants in 2006^13,15 which lists some indications for the use of medicinal plants, such as Aloe vera L. (against psoriasis and burns), Salix alba L. (against backache) and Rhamnus purshiana DC. (to treat constipation). The increased prescription of medicinal plants via physicians of SUS has not only raised their consume in health care but has also helped to educate about possible dangers of their indiscriminate use. As prescription of local herbal medicines by qualified professionals and accurate information have increased and this will help to prevent medical application of unsafe and ineffective plants.^16,17

Different tools to quantify ethno botanical data are applied in complementing studies of plant usage in folk medicine. Thus, collection of quantitative data could support the conservation of certain plant species and knowledge of their popular medical use, mainly by informing about species with several therapeutic indications.^18,19 Some of these tools have been successful in identifying the pharmacological potential of medicinal plants, thus enabling their effective application in herbal medicine.^20–22 The present study evaluated the ethno medicinal knowledge of the people in the community of São Sebastião, Vitória da Conquista, Bahia, using ethno botanical tools in order to provide baseline information for future ethno pharmacological and phytochemical studies.

Study area

The study area is located in the state of Bahia and the survey was conducted in the village of São Sebastião, which belongs to the city of Vitória da Conquista (14° 47' S and 40° 39' W). São Sebastião is a small rural community of 2,730 inhabitants (1,325 men and 1,405 women, average monthly income of U$ 280), to whom the use of medicinal plants may not only be a tradition but also an economic necessity; indeed, this area still hosts many Brazilian native plants, which are worth thorough study and protection, as elsewhere in Brazil.^23,24 Figure 1 shows the detailed location map of the study area.

Figure 1 Location of the study area, village of São Sebastião, Vitória da Conquista, Bahia, Brazil.

Ethnobotanical survey

Data were collected during 2012 to 2014. Participants signed the Term of Free and Clarified Assent (demanded by the National Health Council through the Ethics and Research Committee, Resolution 196/96 of the CNS/MS). The study was approved by the Committee of Ethics in Research with Human Beings (CEP) of the State University of Southwestern Bahia (Universidade Estadual do Sudoeste da Bahia-UESB) (N° 0134.0.454.000.11). Data of the semi-structured questionnaires informed on the respondents profile and knowledge about plants used in medicinal therapy, how the knowledge was acquired, plants frequently used by that community and their common therapeutic indications. The cited regional plant species were collected, identified and integrated into the collection of the herbarium at UESB, Vitoria da Conquista (HUESBVC).

Data analysis

The citations for therapeutic purposes were classified according to ICD-10 (International Statistical Classification of Diseases and Related Health Problems) established by World Health Organization.²⁵ The Informant Consensus Factor (ICF) was calculated for each ailment category to identify the agreements of the informants on the reported cures for the group of diseases.²⁶ The Relative Importance Value (RI), a measure of the diversity of medicinal applications, was calculated for each medicinal plant cited by informants.²⁷ The highest possible RI value (2.0) indicates the species with the highest diversity of medicinal use. Scores were calculated Fidelity Level (FL).²⁸

Socio-demographic information

Eighty-four (84) community residents were interviewed (83.3% women aged between 18 and 80years, half declaring themselves "housewives") representing 84 families of whom 96% used medicinal plants to treat different diseases. In regard to the level of schooling, 10.8% were illiterate, 63.1% of respondents did not complete elementary school, 11.8% did not complete secondary school and 14.3% completed secondary school.

Acquisition, parts used and mode of preparation of medicinal plants

Table 1 reports 46 medicinal plants belonging to 30 families. This survey showed that some 80% of the species with medicinal properties were cultivated in orchards or gardens in backyards of the houses; 15% are considered wild and extracted from the surrounding environments and 5% of the plants were bought at popular markets or drugstores, demonstrating the importance of cultivation as the main source of medicinal plants. Several authors in similar ethnopharmacological studies have also reported that the majority of respondents acquired plants grown in their own backyard cultivars.^20,24 The leaves (78.2%) were the most frequently used plant part for the treatment of diseases, followed by root (8.2%) and seed (6.4%) (Figure 2), which corroborated similar results found in other ethnobotanical studies.^29,30 In many parts of Brazil the use of teas is a common practice. The main preparation methods of the plants cited were by decoction (69.3%), boiling plant material in water, and infusion (21.2%), which is worrying since infusion is used to prepare all tender parts of medicinal plants such as leaves, buttons and flowers, rich in volatile components, delicate aromas and active principles, degraded by the action of water and heat.³¹

Figure 2 Plant parts used for treating diseases/disorders.

Ailments treated by medicinal plants

Respondents were asked to associate a medicinal plant with possible health care indications, according to WHO.^24,32 The highest number of citations (106) was for digestive system, while the highest ICF value was obtained for nervous problems (0.85) and digestive system (0.84). Values for nine common diseases categories are given in Table 2. Most cited were those categories related to the digestive system (32.8%), followed by respiratory diseases (17%), general symptoms/signs of inflammation (14.5%), nervous system (13.3%) and circulatory system diseases (12.6%). Similar results were already found in other studies^20,24,33,34 indicating that the residents of São Sebastião use medicinal plants as the first line of treatment for most common diseases.

Use and efficacy of the medicinal plants

Species with high value of RI (>1) are used to treat a variety of diseases and are therefore considered important to a community.²⁷ Lippia alba with RI = 2 was the most versatile species in relation to its use and was indicated for cures of up to 6 body systems, followed by Cymbopogon citratus and Foeniculum vulgare (Table 3). All plants with RI >1 through this methodology assume that a plant is important when it is most versatile; they are measures of folk knowledge and interpretations of their use must be carefully made.⁴ The data indicated that some plants have more diversified medicinal uses or applications than others.³⁵ Among all plants, Lippia alba with RI=2 was the most versatile species in relation to its use and has often been reported in ethnobotanical studies³⁶ and pharmacological use, for example, vasorelaxant effect,³⁷ action as a tranquilizer³⁸ and effective at preventing gastric ulceration.³⁹ However, when the objective is the search for new plant-derived drugs, the concordance of the answers as to the medicinal use of a particular plant is extremely important. Plants indicated for many different applications would have less credibility compared to those with a higher fidelity of use.³³ Plants with relatively high level of concordance, i.e., with multiple informants agreeing on their therapeutic value, suggest a real efficacy in disease treatment.²⁸

In order to find therapeutically potent plants for chemical screening, the Fidelity Level (FL) values of 16 medicinal plants (Table 4) were cited by three or more informants. Two plants were obtained: Spondias purpurea and Bauhinia forficata, with the highest (100%) FL values for hypertension and diabetes respectively. The species that gave the highest fidelity level values are considered more promising candidate plants for further pharmacological investigations and deserve priority attention.³⁵ Most plants mentioned in the study, for example, Bauhinia forficata, Punica granatum, Matricaria chamomilla and Stryphnodendron adstringens showed high FL, as expected, since literature has plenty of ethnopharmacological studies related to them. However, the plants which mentioned high FL, Spondias purpurea and Amburana cearensis, are suggested for further study. Spondias purpurea was cited for only one treatment (hypertension, 100%), it is exotic (not originally native from Brazil), though it is widely used in northeastern Brazil. Amburana cearensis (indigestion, 55.5%) is native from Brazil and has few published information for a therapeutic target, furthermore it has been reported in other studies ethnobotanical.^12,32 Therefore, these species are promising candidates for pharmacological studies.

Comparison of outstanding medicinal plants with the literature and other studies

Comparison of the pharmacological literature published in different countries with the present ethnobotanical data showed that many of the plants have earlier been reported to have activities against specific diseases. Examples include Bauhinia forficata, used to treat diabetes, and Allium sativum, used to treat hypertension problems. Such observations hinted at the fidelity of the reports by the residents of São Sebastião, confirming that this knowledge has been preserved as in other communities. Whereas other medicinal plants are used differently, when compared to other traditional practices, for example Amburana cearensis was used against indigestion, but it was mentioned in other studies for antibacterial activity, to treat rheumatism, cold, sinusitis⁴⁰ and as anti-inflammatory⁴¹ (Table 5). There is also a species used in this study, Spondias purpurea, but not mentioned in the literature for its medicine purpose.

Comparing this study to other ethnobotanical studies on traditional medicinal plants in Northeastern Brazil, although with areas of study in different proportions and methods of research, it was possible to observe that considerable similarity exists with respect to categories of cited diseases (problems of the respiratory system, digestive system, circulatory system).^4,5 According to this study, Amburana cearensis and Bauhinia sp are the most common medicinal plants in Northeastern Brazil cited in ethnobotanical surveys.^5,6,12,23,18

Ethnobotanical studies in rural areas in Bahia, Brazil, are rare and, when available published in local reports, Brazilian journals or part of Governmental technical reports available mainly in Portuguese, these may contribute to perpetuate local knowledge far from the light of scientific knowledge. Additionally, more studies like this should be done in Bahia, by the cultural and biological diversity, and because it is the biggest state of Northeastern Brazil. The results presented here indicated that medicinal plants are commonly used by São Sebastião rural population, a total of 46 species were documented, the main indications for medicinal plant use were against digestive system, circulatory system and respiratory diseases and of general symptoms/signs of inflammation. This evidences that the knowledge on the use of medicinal plants in this region has been preserved, since 80% of the species with medicinal properties were cultivated in the houses.

In regard to future studies, it is suggested that plants with high FL deserve attention for pharmacological studies, phytochemical, toxicological and clinical trials so that they might be included in the National Program of Medicinal Plants and Phytotherapics of the Brazilian Sistema Único de Saúde and safely prescribed by regional health teams, because there are still few plants in listed in this program. Thus, this work aimed to contribute in the long-run to improved health care in the regions of study, preservation of local knowledge, as well as search for pharmacologically principles from plants.

Work was supported by UESB. GMS was a doctoral student in RENORBIO post-graduation program. We thank Profesor Avaldo Soares Filho from UESB for kindly identifying the plants.

Author declares there are no conflicts of interest.

None.

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