Toward a clinical research framework for collaboration among selected stakeholders in traditional herbal medical practice in seme and gem sub-locations in Nyanza province , Kenya

Both World Health Organization (WHO) and Kenya government have recognized the role of herbal traditional medicinal practice in primary health management due to the observation that 80% of the rural communities consult traditional healers before they go for the orthodox medical services. The traditional herbal practice remains familiar and artitional, thus least developed and hence the patients do not get the best values for their input in the services. The research strategies executed by researchers have never focussed on the plight of the patients but covered phytochemical, pharmacological and no clinical evaluations. Effectively, the data so far available remain less useful than should have been to the development of herbal traditional practices. The current project thus aimed at focussing on the establishment of a research strategy that used observational studies to establish the possibility for designing a rigorous clinical trials of herbal medical practice involving participation of three herbalists, patients, one orthodox medical doctor, a plant taxonomist and a phytochemist with the objectives of proofing and validating the practice, using principles of biomedical and bioscience in Gem and Seme sublocations in Siaya and Kisumu Districts, respectively in Nyanza province, Kenya. Through the ethnobotanical field survey, the taxonomist identified 95 plant species used by the herbalists. Through literature review it was found that 100% of the plants are used by other herbalists in East Africa to treat human and animal ailments while 30% of the species had received phytochemical and pharmacological evaluations, thus validating their therapeutic values. About 10% of these species had been used in clinical studies. The observation indicate that the herbalists have reasonable potentials for management of the diseases despite their ignorance on the literature data on these plants as well as modern medical practical procedures. The inclusion of modern diagnosis of diseases by a medical doctor and medical laboratory tests improved the rate of the healing outcome by 20% when the healing rate was compared with that observed for the treatment of patients before the intervention through this project. The results so far indicate that it is practicable to implement a rigorous clinical trial in which both herbalists, patients and researchers collaborate. Such strategies shall not only give critical data for validation of herbal traditional medicinal practice but be useful for prospection for phytochemicines based on indigenous knowledge and also be used for the improvement and management of the practice.


INTRODUCTION
In Africa, it is estimated that 75% of the rural population rely on herbal medicine for their healthcare.Herbal reme-dies have the advantage of being readily available, biodegradable and the process of isolation of active ingredients is cheaper than formulating and producing synthetic drugs (Ampofo and Johnson-Romauld, 1978).The benefit of this observation has not been realized in Africa because the research strategies used in the study of traditional medicinal practices have not been focused on the objectives which are meant to support the practitioners and the patients.The research have been on phytochemical and pharmacological evaluations without any on clinical trials and toxicological evaluations including those on standardization of the herbal remedies as well as on modern medical diagnostic practices.There have never been attempts at training the traditional practitioners and integration of medical skills in the practice including the good harvesting, manufacturing and administration of the remedies.The research paradigms neglected the integration of clinical and laboratory diagnostic techniques in the traditional practice.The ethnobotanical, ethnomedical, phytochemical and pharmacological evaluations done in Kenya have neglected the patients' feelings, attitudes, benefits and welfare (Sidiga 1995;Kokwaro, 1994;Jeruto, 2008;Gakunju, 1995;Ostrom, 2008) including the evaluation of the practitioners' practice.
Patient-centred study by Alamo (2002) was found more effective than the usual consultant-centred evaluation of effectiveness of treatment of musculoskeletal chronic pain using Chinese herbal remedies.It is also observed that there is no published information in Kenya that evaluates the reliability, efficacy, safety and validity of the traditional medical practices' performance using an approach recommended by Lewis and Elvin-Lewis (1994) and Steven and Jeffrey (2003) and participatory research approach developed for Canadian overseas projects (Found, 1995) in which all stakeholders are participants in all stages of the research.
In 1980, Clinicians working in cooperation with Chinese medicine practitioners using aqueous extracts of ten Chinese medical herbs in London treated children suffering from severe atopic eczema.In a double blind placebo controlled trial, using 37 young patients, the research proved that treatment was achieved only if all the ten plants were used (Williamson, 2001).Other challenges which must be considered in such research paradigms are ethical issues and positive attitudinal changes.The intellectual property rights, indigenous knowledge, benefit sharing, efficacy and safety must be factored into the research activities.The change of attitude and building trust among the research team, the herbalists and the patients must be undertaken so as to obtain maximum benefits to all the stakeholders participating in this project.
It is believed that these strategies must be integrated in the practice with the objectives of validation and value addition to the practice.Such efforts shall aid rational decisions on the formulation of policies and their implementation for the control of herbal medical practices and therefore health management and socio-economic development while exploiting the biodiversity in a sustain-Ogoche 145 able manner.The foregoing information directed the research strategies in which rural rapid appraisal and participatory research method to test the suitability of the strategy that was employed to conduct the pilot project herein described.Thus the team made up of a forester, plant taxonomist, phytochemist and a medical doctor organized a meeting with three herbalists and their patients where questionnaires and discussions were conducted to obtain information on identification of the plants, disease diagnosis and treatments.The literature on the ethnobotanical, ethnomedicinal, phytochemical and pharmacological data were collected and analysed so as to validate the use of the plants in treatment of the diseases by the herbalists.The information so far obtained are found useful for the design and future implementation of observational and clinical trials in herbal medical practice in Kenya that would lead to value addition to the traditional medicinal practice.

The recruitment of research team and patients
The herbalists and patients were recruited from Seme and Gem sub-locations of Kisumu and Siaya districts.A female herbalist was recruited from Gem sub-location while two male ones were recruited from Seme sub-location.The criteria for the selection of the herbalists was based on their education, age, experience and our contact with them in another project on the phytochemical and pharmacological evaluations for sustainable exploitation of Toddalia asiatica (Orwa et al., 2008).These herbalists recruited the patients whom they treated under the supervision of the medical doctor.The taxonomist was recruited on the basis of his experience in the identification of the plants in the fields.The recruitment of patients were done in Seme sub-location in Kombewa division in Kisumu District and South Gem sub location in Gem Division in Siaya District in Nyanza province in Kenya.Seme sub-location has no hospital but four, six and one health centres, dispensaries and clinic nursing home, respectively serving a population of about 50,000 people (GOK, 1996).This sub-location is in Siaya District where in 1990 to 1992, top ten causes of morbidity due to diseases were malaria, acute respiratory infection, skin infection, diarrhoeal diseases, intestinal worms, urinal tract infection, eye infection, rheumatism, ear infection and gonorrhoea with disease prevalence of 42, 23.8, 8.5, 6.7, 3.9, 3.2, 2.6, 1.7, 1.6 and 1.5%, respectively (GOK, 1993).
South Gem sub location is served by three and six dispensaries and health centres, respectively and has a population of 70,000 people.The disease prevalence is probably similar to the situation in Seme sub location, Siaya, Bondo and Kisumu towns have each one district hospital which is supposed to serve the two sub locations which are however in the rural areas, approximately 50 kilometres away from these towns.These rural areas have poor road networks and the health services due to poor personnel and drug availabilities as well as few all-weather roads.This indicates that the most immediate health services are accessed through traditional healers including herbalists.These factors were considered during the recruitment of the patients at random.In Seme, the herbalists were stationed at Kondik Trading centre while in Gem the recruitment was done at Ebusakami Primary School where each reporting patient was asked to sign the treatment agreement form after the objectives of the project was discussed with them.
The discussion on the nature of herbal medicinal treatment they were to get was adequately explained to them before diagnosis and treatment processes.

Workshop for the herbalists and the patients
The recruited patients and the herbalists were called for a three day workshop at Kondik Trading centre at which the three herbalists and fifty recruited patients were taught by the facilitators on the objectives, principles, implementation and benefits of the project to each of the stakeholders as well as the nature and issues on good herbal medical practices.The herbalists were trained on simple taxonomic, preservation and preparation techniques of herbal products.They were also given lectures on some simple methods of diagnosing and identification of the common diseases including clinical management of patients.Further, the herbalists were given lectures on the general values of research to the herbal medicinal practice with respect to the government health policies on their practice.
Questionnaires were administered to the herbalists to establish the value of the research activity compared to their earlier practice.The herbalists were also given a three hour discussion in the standardisation and measurements introduced in preparation of herbal remedies as well as diagnosis of the diseases.The patients were taught the knowledge of the common diseases they usually contact in the areas.There was a lecture on the practice of herbal medicinal practice which was meant to create awareness and attitudinal change towards misconceptions held on herbalists, herbal remedies and the practice in the rural societies and expert communities.There was a general discussion session in which stakeholders were given time to give their reflection on the herbal medical practice.Questionnaires were administered to the patients to assess their knowledge and attitudes towards the herbal medical practice they might have attended before and compared to the current one.

Identification of the herbal plants
The research team visited the herbalists who took the team around to observe the plants in their habitats for taxonomic identification.The plants which were not found at Got Ramogi, Seme and Gem sub-locations and within the vicinity of the area were collected and given to the taxonomist for identification.The herbalists were taught how to preserve the specimen in a box supplied by the project.The plant specimen was kept in paper by the herbalists for future identification of the plants for collection and processing.

Literature study of the ethnobotanical, pharmacological and phytochemical infromation
The databases such as NAPRALERT, AFLORA (AFLORA (2008)), MEDFLO, PHARMEL 2 and PRELUDE (Fernsworth, 1994), textbooks, journals, conference proceedings and the internet were sourced for botanical ethnobotanical, pharmacological, toxicological and phytochemical information available in the literature about the identified plant species.The information were analysed to validate the medicinal uses of the plants by the herbalists and also to aid preparation of the remedies.The data was tabulated and analysed to guide the standardization of the preparation of the herbal products for use by the herbalists and for formulation of future research agenda.

Preparation of the herbal remedies
The remedies were standardized by weighing and measurement of the volumes of water used in the preparation of decoctions from wet plant parts.The wet plant parts were shredded by chaff-cutter before grinding them by a plate mill.The tincture of the wet plants parts were made in a mixture of 2:1 ratio of water: whisky over a period of three days.The dry plant parts were dried under shade and burned to ash.The other plant parts were similarly dried and ground using a hammer mill to fine powders which were then mixed in ratios by weights as directed by the herbalists.The weighed amounts of dry plants were put in definite ratios to be decocted in water as directed by the herbalists.The decoctions were measured by graduated cups when dispensing to the patients.Some plants were placed into a saucepan and burned to ash to be used for treatment of wounds whereas some were dried and rolled into paper to be smoked for the treatment of asthmatic cases.Both powders and ashes were standardized by passing them through a sieve.The water extracts were filtered to obtain the suspended particles and dissolved compounds as well as pH.The density of the filtrate was obtained for standardization.The water extracts were then administered to the patients in doses advised by the herbalists.The decoctions powders and ashes were labelled by the coded names and the diseases for which they are indicated.

Standardization of the prepared remedies
The decoctions of both wet and dry plant materials were done by weighing of the wet and dry plants before putting them into measured water whose final volume was measured after boiling.The mass of both suspended particles and the dissolved compounds were measured so as to know how much substance was given to the patients in a measured volume.The pH of the decoction was also taken.
The particle sizes of the ground materials were standardized by the size of the sieve of the grinder as well as sieves for 5 to 10 micron particles.The ash which was standardized by a sieve was suspended in distilled water so as to take its pH.The rolled powdered plant material was weighed and put into a paper of known size.The decoctions were filtered and density measured then freeze dried and dissolved in a mixture of 1:1 ratio of methanol and chloroform and analysed by thin layer chromatographic technique.The number of spots identified by ultra-violet lamp and 50% sulphuric acid were used for standardisation.

Diagnosis of diseases
The patients were recruited by the herbalists and taken to Kondik trading centre of Ebusakami Primary School where they were diagnosed by both the herbalists and the medical doctor at the beginning of the project to obtain pre-treatment diagnosis.The herbalists listened to and observed the medical doctors' clinical observation of patients.The same activity was done by the medical doctor as the herbalists interviewed the patients.At the end of the clinical interviews both the herbalists and the doctor harmonised the diagnosis for each patient before and after each treatment.The patients whose diagnosis required laboratory tests were taken either to Kombewa Health Centre or Maseno Hospital of Anglican Church or Kisumu District Hospital.The project paid for the costs of the tests.After the diagnosis the herbalists administered the herbal preparations.The patients were given appointments to see the herbalists every day in the evening to review their cases.Once the patients indicated that they were feeling well then they were reviewed by the medical doctor and the patients whose cases required post-treatment laboratory tests were sent to the laboratories for confirmation of successful treatment.

The species of plants used by the three herbalists
In total, 95 plant species found in 41 families were identified with frequency of occurrence of 57, 54 and 51 in Got ramogi, Seme and Gem, respectively (Table 1).Only three species were obtained from Eldoret and Kisumu towns through vendors.The plants collected from Got ramogi were purchased by the project for the herbalists at half dollar per bundle of 2 kg of wet plants.
The plants collected at Gem and Seme were not purchased since they were from the herbalist's home gardens or live fences in Seme and Gem or conservation sites in Seme.The percent of the plant species collected from home gardens and conservation sites were 80 and 20%, respectively.The conservation site is owned by Miguye conservation group.
The frequencies of the plant parts used were given in brackets as seeds (1), flowers (6), fruits (30), root bark (39), whole (44), leaves (52) and stem bark (53) (Table 1).Literature review using databases such a NAPRALERT, AFLORA, PROTA, MEDFLORA, PHARML 2 and PRELUDE including textbooks and journals (Farnsworth, 1994;Kokwaro, 1994;Hans, 1996) revealed a lot of corroboration on the types of diseases treated by other herbalists in several societies in East Africa as indicated in Table 1.The herbalists treated 16 diseases using a multiple of plants prepared from fresh or dried materials in the form of decoctions or tinctures or burnt materials and administered orally, smoked or applied on affected skins of the patients.The literature survey indicated that the plants were ethnomedically indicated for a wider range of diseases (Table 1).The 60 and 32% of the species of the plants included in the study had received pharmacological and phytochemical evaluations which were used to validate some of the treatment claims given by three herbalists and those from other ethnic backgrounds (Tables 1 and 2).The plants in Table 2  The clinical trial studies have been conducted using P. guajava (Xavier et al., 2006), E. hirta, M. indica and L. trifolia for treatment of patients suffering from diarrhoea, amoebic dysentery, liver ailment and pulmonary tuberculosis, respectively with reasonable results.Clinical trials with the aqueous extracts of leaves of A. conyzoides (Kamboj et al., 2008) on patients suffering from arthrosis indicated that 66% of them experienced the analgesic effects while 24% of them had improved articulation and mobility without side effects.Clinical trials on human volunteers were conducted with 4% endod (Phytolacca dodecandra) ointment against dermotomyces and found to be effective (Jassim, 2003).Artex Mendar, a standardized multiplant Ayurvedic drug compost of W. somnifera, B. serrata, Zinger officinale and Curcuma linga was used in controlled clinical trials on 358 patients suffering from symptomatic osteoarthritis of the knees.The results indicated reasonable efficacy and safety over a period of 32 weeks (Chopra et al., 2004;Srivanasan et al., 2007).The clinical trials give evidence that the traditional herbal medical practice can be an avenue for discovery of herbal remedies which can be used to treat the people who may not be able to access government health facilities.

The physico-chemical parameters
The sizes of the fresh materials were cut with a chuff cutter to about 2 to 4 cm and 5 to 6 cm in length and width, respectively before grinding them in a plate mill.Both juice and the solid residues were transferred to the saucepan for boiling.The sample was then strained by tea strainer and the residues thrown away.The decoction was the set for treatment.A portion was then taken for measurement of physico-chemical parameters.The dry plant materials were milled by a hammer mill to obtain 5 to 10 micron particles whose sizes were confirmed by sieve measuring device.The powders were infused in boiling water and filtered.A portion of the decoctions from both fresh and dry plant materials were used to obtain physico-chemical parameters.The density was about 0.9 g/ml while the pH range was 6.0 to 7.9.The undissolved
Cassia spectabilis 3-O-acetylspectalin,(-)-7-hydroxy-spectalin, iso-6-spectalin Antifungal and antinoreceptive anti activities ( Viegas et al., 2008) Datura stramonium Hyoscine, atropine and hyoscyamine, Stimulant,sedative,hyprotic,antiacylcholinestrase Antispasmodic (Daniel, 2006) Table 3.The treatment of patients and administration of the prepared herbal remedies as practised by the herbalists in this project.The patient orally drunk 100 mls of the infusion three times daily for two weeks.All patients had no clinical symptoms and parasitamia Malaria 3

Diseases
Erythrina abyssinica(stem bark), Toddalia asiatica(root bark), Kigelia africana (fruit), Ficus lutea (stem bark) One kilogram in equal amounts of fresh plant materials were cut into small pieces and ground by a plate mill and boiled in one litre of water for one hour then filtered The patients were given 150 mls of the decoction three times daily for two weeks.Two patients showed no clinical symptoms and parasitamia while one patient had persistent symptoms of both Intestinal worms 3 Albizia coriaria (stem bark) Ten grammes of the powder was infused in 150 mls of warm water for ten minutes and filtered The patients were orally given 75 mls three times daily for two weeks.Two patients tested negative for cists of worms with disappearance of clinical symptoms while patient did not heal Intestinal swelling nodes with headache and dizziness 4 Viscum album (whole plant), Taraxacum officinalis (whole plant) Twenty grammes of equal amounts of the powdered plants were decocted in boiling 600 mls of water for twenty minutes and filtered The patient drunk 150 mls of decoction twice daily for three weeks.Clinical symptoms in two patients subsided while one did not heal

Allergy and fungal skin infection 4
Urtica dioica (leaf), Senna didymobotrya (leaf), Leonotis mollissima (whole plant), Ricinus communis (seed, leaf) Ten grammes of equal amounts of the leaf powders of three plants together with that whole L.mollissima were decocted in 150mls of boiling water for ten minutes and filtered.An ointment of five grammes of the leaf powder of S. didymobotrya and seeds of R. communis in equal amounts was made in 10mls of the oil of R. communis.
The patient drunk 75 mls of the decoction three times daily for two weeks.The ointment was applied on affected skin twice daily for three weeks.The clinical symptoms in three patients disappeared while one did not heal The patient smoked the cigarette and drunk the 150 mls of the decoction containing 12 drops of tincture three times daily for three weeks.The clinical symptoms subsided in three patients while one patient did not heal

Amoebic dysentery 10
Carica papaya (leaf), Euphorbia hirta (whole), Harrisonia abyssinica (stem bark), Cyphostemma nodiglandulosa (corm,leaf), Ajuga remota (leaf) Twenty grammes of equal amounts of each part of the plants were decocted in 150 mls of boiling water for 15 min and filtered The patients drunk 150 mls three times daily for three weeks.The clinical symptoms and laboratory evidence indicated that eight patients were treated from the disease while two did not Facial skin allergy due to cosmetics 3 Conyza sumatrensis (leaf), Bidens pilosa (leaf), Aloe kedogensis (leaf), Bredelia micranthus (leaf), Ageratum conyzoides (leaf), Cassia spectabilis (leaf) A decoction of three kilogrammes of equal amounts of fresh plants were made in two litres of boiling water for one hour and strained.The gel from fresh leaves of A. kedogensis was expressed manually.0ne kilogramme of leaves of A. spectabilitis was burned and ash kept for use The patients drunk 75 mls of the decoction and applied the gel on affected skin twice daily for three weeks.The clinical symptoms subsided in all patients Infected wounds on legs 3 The plants were the same as the ones for facial allergy due to cosmetics.
The preparation was the same as the one for the case for allergy due to cosmetics The patient drunk 150 mls of the decoction and washed the wounds with it and also applied the gel and the ash on the affected skin three times daily for three weeks.All patients healed as evidenced from clinical observation Fungal infection on the scalp 10 The plants were the same as those used for treatment of allergic case.
The preparations were same as the ones used in the treatment of allergic case The patients orally drunk 150 mls of the decoction, washed the surface with it and applied the gel on the surface three times daily for three weeks.All patients did not show clinical symptoms of the skin disease

Gastric hyper acidity and arthritis 4
The stem bark and leaves of the plants in Table 2 Ten kilogrammes of equal amounts of fresh parts of the plants were chopped into small pieces and ground by a plate mill then boiled in ten litres of water and filtered The patient drunk 150 mls of the concoction three times daily for three weeks.Three patients showed no clinical symptoms while one did not heal Chronic menorrhagia 5 The plants were the same as those used for treatment of gastric hyper acidity and arthritis.
The concoction was the one used for treatment of patients suffering from gastric hyper acidity and arthritis Administration was the same as that used for treating gastric hyper acidity and arthritis.four patients indicated no clinical symptoms of the disease while one did not heal Elephantiasis 2 The plants were as those used in the treatment of chronic menorrhagia The concoction was the same as that used for the treatment of chronic menorrhagia The patient drunk 150 mls of the concoction and cleaned the lesions with it three times daily for one month.There was no improvement

Herpes zoster 2
The plants were the same those used for treatment of chronic menorrhagia.
The concoction was the same as that used for treatment of chronic menorrhagia The patient drunk 150 mls of the concoction and applied the ash from A. spectabilis on the wound three times daily for three weeks.The wound and pain subsided as indicated by clinical observation and the two patient's response substances in the decoctions ranged between 0.0002 to 0.0003 g per ml whereas the dissolved substances were between 0.0002 to 0.0004 g per ml.The thin layer chromatographic analysis indicated that most of the extracts of the decoctions had 5 to 10 spots.The parameters indicated that the decoctions contained both insoluble and soluble substances or compounds which could be responsible for the therapeutic properties of the herbal drugs.These parameters can be tentatively used for standardization of the herbal drugs as well as the quantification of the doses.

The patients and the treated diseases
Three herbalists recruited 74 patients through their usual practice in Seme and Gem sub locations (  , 1993).Gastro-intestinal and chest diseases as well as malaria are the leading maladies treated by the selected herbalists in the two sub locations.

Clinical and observational evaluations
The patient and herbalist focused approach in ethnomedicinal studies led to the identification of the listed 95 plant species in Table 1 and the diseases indicated for them by the herbalists in Table 3.The literature survey on ethnobotanical uses of these plants revealed very wide spread use of these plants thus validating their use by the chosen herbalists in the project.Further phytochemical and pharmacological literature survey confirms our conviction that despite low educational capacity and poor access of information to the herbalists, the traditional practice has a lot to guide the discovery of potential drugs for treatment of the diseases.Table 3 indicates that half of the plants used by the herbalists had received reasonable pharmacological and phytochemical evaluations thus further validate the medicinal practice by these herbalists.The incooperation of the medical doctor in the project also indicated that the diagnostic capability of the herbalists did not show wide variation.There was qualitatively close agreement between the diagnosis given by the herbalist and that given by the doctor in 80% of the diseases.Such diagnoses were confirmed by both pre-treatment and post-treatment clinical laboratory tests where it was applicable.The percent healings were as indicated by bracket for each skin diseases (95%), bronchial and asthmatic pneumonia (82%), intestinal disease and headache (70%), dysentery (80%), chronic monorrhagia (80), gastric acidity and arthritis (75%), pectic ulcer (100%), intestinal worms (66%), herpes zoster (100%) and elephantiasis (0%).The medical doctors' observation and laboratory diagnosis confirmed the healing rates.The questionnaires administered to the herbalists with respect to healing rates reported for same period before this intervention indicated an improvement of 10 to 20% healing rates for most of the diseases.The details of the plants species, preparation and administration of the herbal medicines are indicated Table 3.The pharmacological, phytochemical and clinical trials attributed to the species are believed to contribute to the high healing rates between 66 to 100% except for elephantiasis for which there was no healing.It is important to note that all the herbal remedies were made of multiple plants except for treatment of intestinal worms in which only one plant was used (Table 3).These plants were indicated for treatment of multiple diseases.For example, percentages of species indicated for 5, 8, 7, 6 and 4 diseases were 50, 5, 2, 3 and 1%, respectively (Table 1).A survey of ethnomedicinal literature revealed that other herbalists elsewhere in East Africa employ polyherbal and multi-disease treatment approach.For example, 20% of the species are indicated for at least 8 diseases.Fifty percent of the plant species identified by the herbalists were indicated for nearly fifty diseases thus confirming the importance of these plants in disease management.
The pharmacological evaluations using either in vitro or in vivo methods indicated that 45% of the solvent extracts of the species had antifungal, antibacterial and antiviral activities including physiological properties which validate the therapeutic or healing values observed in this project (Tables 1 and 2).The physiological properties such as anti-inflammatory, antioxidant, analgesic, hyperglycaemic and hepatoprotective activities of the crude extracts and the isolated compounds lend credence to the therapeutic observations in this project and thus confirms the hypothesis that the plants used by the herbalists have chemical, protective and medicinal principles.
Table 2 contains 31 plant species and 80% of which are used by one of the herbalist in the preparation of the multipurpose herbal remedies orally given to patients suffering from several ailments.These plants had received phytochemical and pharmacological evaluations leading to isolation and structural elucidation of antifungal, antibacterial and antiviral as well as antiplasmodial properties.The ethnomedical, ethnopharmacological and phytochemical data not only validated the traditional medical practice but opens avenue for the next research agenda as well as clinical trials which would lead to value addition to the practice and proper health management.

AKNOWLEDGEMENTS
I sincerely thank the Regional Programme for Sustainable Use of Dryland Biodiversity for the research grant as well as Dr. Jeff Odera for his support during the research activities.My sincere thanks are due to Mr. Simon Mathenge who identified the plants.The three herbalists; Mrs Mary Muga, Mr. Okaka and Mr. Obunga must be profusely thanked for their contribution in showing us the plants, recruiting the patients and the treatment they gave to the patients.I must thank Dr. Mannase Onyimbi who kindly agreed to participate in the project as an orthodox doctor against the medical ethics as an observer but also to help us diagnose the diseases.Finally, I must thank the patients and the medical laboratory technicians who took part in the project.
Leonotis molissima (leaf), Terminalia brownii (bark), Bryonia dioica (leaf), Datura stromonium (seed) Ten grammes of equal ratios of L.molissima, T.brownii and B.dioica powders was infused in 150mls of water for 15 minutes and filtered.Twenty drops of tincture of D. stromonium in whisky steeped for seven days were put into 70mls of water The patient drunk 150 mls of infusion and 150 mls of diluted tincture daily for two weeks.Clinical symptoms of three patients subsided while one patient did not heal Bronchial pneumonia 3 Melia azadirach (leaf), Erythrina excelsa (bark) Twenty grammes of equal ratio of powders of the plants were boiled in 150 ml of water for 15 minutes and filtered.The patient was orally given 75 mls of the decoction three times daily for 8 days.All patients healed Malaria 4 Erythrina abyssinica (stem bark), Toddalia asiatica (root bark), Microglosa pyrifolia (leaf) Ten grammes of equal amounts of the powders of the plants are infused in 200 mls of boiling water for 20 min and filtered

Table 2 .
The phytochemical and pharmacological evaluations reported on the plants used by the herbalists in this project.