Ethnobotanical survey of medicinal plants used for treating preschool children anemia in an urban setting , Douala-Cameroon

1 Laboratory of Biochemistry, Department of Biochemistry, University of Douala, P. O. Box 24157, Douala, Cameroon. 2 Laboratory of Pharmacology and Toxicology, Centre for Research on Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plant Studies, Ministry of Scientific Research and Innovation, P.O. Box. 13033 Yaoundé, Cameroon. 3 Laboratory of Biochemistry and Food Technology, Department of Food and Nutrition Science, National School of AgroIndustrial Sciences (ENSAI), University of Ngaoundéré, P. O. Box 455, Ngaoundéré, Cameroon.


INTRODUCTION
According to the WHO, anemia is defined as a lowering in blood hemoglobin level.A child is referred to as anemic when hemoglobin level is below the normal rate of 11 g/dl.This disease is of multifactorial nature.The *Corresponding author.E-mail: angono@yahoo.com.Tel: (00237) 677 811 635.
Author(s) agree that this article remains permanently open access under the terms of the Creative Commons Attribution License 4.0 International License most serious consequence on health, lies in an increased mortality risk which is 3 to 4 times higher among anemic children (OMS/ UNICEF, 2005).In addition, anemia also reduces physical capacity, working capacity, growth and immune status (Abdullah et al., 2011).
Child mortality is a core indicator for child health.Between 1990 and 2012, half of all deaths of children under 5 years worldwide (6.6 million) were in Africa (UNICEF, 2014).The main causes of deaths include diarrhea, infections, malaria and above 50% under nutrition (UNICEF, 2015).These diseases share anemia in their physiopathology in individuals and especially in children under five.Globally, an estimation of 273 million (43%) of preschool children are affected by anemia and Africa accounts for most of the cases (62.0%) according to the latest WHO estimates (WHO, 2015).In Cameroon, 6 out of 10 children under five suffer from anemia.Almost half suffer from moderate anemia.Children living in rural areas are more frequently affected than those living in urban areas (EDS-MICS, 2011).This deficiency is a significant risk of morbidity in resources-limited countries (English et al., 2002).
Iron deficiency which is the leading cause of anemia is the first nutritional deficiency in the world (El Hioui et al., 2009); it is the most common public health problem.Man has long used medicinal plants to manage its health problems.These traditional practices are still relevant since modern medicine is costly and thus is not affordable to populations which are resources-constrained (Bhushan, 2005).Besides, many studies have already confirmed the efficiency of some wild plants and identified the active compound for some diseases (WHO, 2009).Africa and especially Cameroon own an amazing rich and diverse flora harboring many plants used in traditional medicine.These plants could be used instead of conventional medicines by growing population.This is due to the fact that these drugs are expensive and sometimes inaccessible (Dibong et al., 2011).Besides, absent or inadequate health infrastructures require the mothers of developing countries to turn towards traditional medicine for the treatment of children.Therefore, development and search of novel and effective anti-anemic agents have become very important issues.
The present study sets out to identify potential antianemic medicinal plants used for the treatment of anemia on preschool children and to determine the therapeutic pattern habits, in order to better promote this pharmacopoeia.

Site of the study and justification
Douala is located in the southern part of western of Cameroon (04°03'N, 009°41'E).It features a tropical monsoon climate (Köppen climate classification Am), with relatively consistent temperatures throughout the course of the year, though the city Bayengue et al. 161 experiences somewhat cooler temperatures in July and August.It rains very much in Douala during the year.The town experiences an average precipitation of about 3.600 mm per year (World Meteorological Organization, 2016).The average temperature is 26.7°C.Some ecosystems such as humid dense forest, mangrove and swamps coexist there.This town is a cosmopolitan site where people from several areas and cultures stay.Other reasons are environmental degradation, development of malaria vectors and food insecurity that foster the development of anemia.The high density of the population and poverty experienced by people in this area promote the practicing of herbal medicine as a valid source of income.

Informed consent
The purpose of the study was explained to the local traditional herb sellers and mothers of children under 5 years who use plants and natural products to treat anemia.Informed consent was obtained from each of the participants.

Ethnobotanical survey
An ethnobotanical survey of medicinal plants used in the treatment of anemia was conducted in December 2015 in the city of Douala.
The targeted population was the actors of traditional medicine, sellers of medicinal plants and mothers of preschool children's.The raids were made first in the most populous markets namely "Central market", "Nkoulouloun market", "Dakar's market" for traditional healers (Figure 1) and other units in residential areas for mothers of children.Subsequent interaction with the traditional healers and mothers included interviews and field collection of some samples.
They were asked to provide information on preschool children anemia (causes and symptoms), herbs they use to treat infantile anemia, plant parts used, modes of preparation and administration, other plants or ingredients used in association, storage and reasons for use.A sample of each plant was collected, corresponding to the amount needed for the preparation of one litre of potion.This sample was then weighed.

Identification of plants
Voucher specimens of plants were collected and their identification was made by botanists of the Faculty of Sciences of the University of Douala, confirmed by the National Herbarium of Cameroon, Yaoundé.

Data analysis
Data generated from the field survey on the ethnobotanical survey of anemia was subjected to descriptive statistics using percentages and quantity.Microsoft office Excel was used for each parameter.

Distribution of informants
A total of 72 participants including 32 traditional healers and 40 mothers were included in the study (Figure 2).The Central Market of Douala is the most favourite because it is the most federating market in Douala.

Botanical characteristics of plants
Twenty-six plant species of 17 families were identified and listed in

Collection of plants
Majority (80%) of the plants were collected in markets, either from traditional healers or food sellers (Solanum lycopersicum and Beta vulgaris).Some were collected in fields and home gardens with the aid of mothers.Those that had only common name were identified with the help of botanist of University of Douala.

Reasons for use
The reasons for using these plants for the treatment of anemia are diverse.The main justifications are very effective (64%), cheered children up (55%) and lack of money (55%).The availability of plants is mention in spite of scarcity of some of them during the dry season.

Ethnopharmacology of plants
Treatment descriptions of seventeen plants are presented in Table 2.The plant part most cited is the leaves but barks, fruits, flowers and roots are also used.Water is the main solvent.The most used pharmaceutical form of recipe was decoction (76%).The preservation is either at room temperature or in a refrigerator.The conservation is recommended not to exceed 5 days.The decoction is usually administered orally (83%) or anally.The average time of treatment is 3 to 7 days.Herbal practitioners and mothers who were interviewed identified improvement of children when they become physically well and strong, regain appetite and play.

DISCUSSION
This survey shows that infantile anemia is present in the population of Douala.It also indicates the use of medicinal plants for the treatment of anemia on preschool children.Many plant species are used.Majority of these plants are available in their immediate environment as also observed by Dibong et al. (2011).The preferential use of one or another plant is a function of the availability.Some are not found in the markets and sometimes are seasonal.In this case, people will harvest in forest and fields.This could justify the frequency of use of some plants as compared to others.Fresh leaves are the most used part; this may be justified by its availability and accessibility to local people, and by its high content of anti-anemic agents.This fact may explain the short time of preservation of leaves and preparations.Herbal preparations in this study are administrated orally.The treatment by anal route is less frequent (1/week) than oral route (overall 7 days).Only fresh bark decoctions are administrated by anal route.
To elaborate some medicinal recipes, different plants or substances are blended.The mixing depends on the type of preparation for the same plant and the interviewee's origin.This problem, associated with dosage prescriptions in the use of herbal remedies in traditional medicine have been highlighted by a number of authors (Agbor and Naidoo, 2015).
Certain plants have several therapeutic activities as mentioned by respondents in addition to their anti-anemic activity (94%).It has been shown that some of these plants have anti-microbial properties: Eremomastax speciosa (Salmonella typhi and Escherichia coli) (Okokon et al., 2007), Alchornea cordiflia (Helicobacter pylori, Salmonella typhi, Salmonella enteritidis, Shigella flexneri and Escherichia coli) (Adeleye et al., 2008), Tectona grandis (Staphylococcus aureus, Bacillus subtilis, Escherichia coli and Klebsiella pneumoniae) (Nayeem and Karvekar, 2011).Bidens pilosa has anti-malarial properties (Bilanda et al., 2004).Eremomastax speciosa also has an anti-diarrheal effect (Oben et al., 2006) and anti-anemic effect (Okokon et al., 2007).These activities could justify the improvement in the condition of anemia in children because it has been shown that the origin of anemia can result from malnutrition and microbial infections (parasitic, bacterial and virological) (OMS/UNICEF, 2005; Ami et al., 2012;Kobto, 2012).Many of these plants have not yet been the subject of scientific studies.Efforts should be made to improve this situation in order to better promote our traditional medicine.

Conclusion
The ethnobotanical survey has shown 26 species of medicinal plants used for the treatment of anemia in preschool children in the city of Douala.The exploitation

Figure 2 .
Figure 2. Distribution of traditional healers and mothers.

Table 2 .
Traditional medicine plants with anti-anemic potentiality in Douala Cameroon.

Table 2 .
Contd.Days of medicinal plants by the population could be encouraged and valued.Valorization of these plants could help reduce the prevalence of severe anemia in urban and rural areas.It could also contribute to management of recurrent diseases of pre-school children among indigenous populations.