Medicinal plants used in gynecological procedures in Uganda

Distress and pains among other gynecological challenges mothers go through during childbirth result in mortality. This has compelled people particularly in developing countries to use traditional medicine to induce birth due to lack of more effective alternatives. In Uganda, from time immemorial most child birth and pregnancy related problems have been solved using medicinal plants as a primary alternative to conventional drugs. Although research has been done to document and validate effectiveness of these plants, it is not compil ed for communication to the wider community. This study, therefore, reviewed the medicinal plants used in Uganda for easing childbirth. The study collated and documented medicinal plants used by Traditional Birth Attendants and Traditional Health Practitioners to induce labor and ease child birth in local communities in Uganda and show the gaps that need to be investigated. The available literature on medicinal plants used in Uganda for childbirth were selected from reputable journals using citation databases including Google Scholar, Institute for Scientific Information, PubMed, Scopus, Hinari, and Scientific Information Database among others. Asteraceae, Fabaceae, and Lamiaceae, respectively were the most cited for gynecological uses by various local communities in Uganda. The commonly reported species were Laggera alata Sch. Bip., Tagetes minuta L, Clitoria ternatea Linn and Ocimum lamiifolium Hochst ex Benth among others. Authors were also determined to ascertain scientific evidence against analgesic, anti-inflammatory, oxytocic and phytochemical properties of the selected plant species.


INTRODUCTION
The painful experience women go through during pregnancy and childbirth remains a nightmare for many despite being an essential part of human existence. In sub-Saharan Africa, high maternal mortality has offset high fertility rate whereby 1 out of 20 live births results in mortality yearly (Neema, 2002). This has immensely affected population growth rates in the region. In Uganda specifically, neonatal mortality rate (NMR) remains high at 27 deaths per 1000 live births (Kananura et al., 2016). There is paucity of data on factors associated with NMR in rural communities in Uganda (Kananura et al., 2016). Some of the mortalities could be due to the misuse of herbs due to insufficient scientific evidence. A World Health Organization (WHO) report indicated that about 80% of the world's population depends on herbal medicines for treatment of various diseases (WHO, 2012) and to induce child birth. In Uganda, the Ministry of Health Statistics estimates that about 60% of Ugandans depend on Traditional Medicine for treatment of common diseases and conditions (MoH-UG, 2012). The inaccessibility and severe side effects of many allopathic pharmaceutical medicines could be major contributing factors as to why the rural people resort to the use of herbal medicine as an alternative to treatment of common diseases and conditions in Uganda (Kwesiga, 2002). Medicinal plants belonging to different families and species are used by birth attendants to induce labor, attain relatively painless delivery and hasten fetal delivery (Lipton, 1964;Ojewole and Elujoba, 1982). However, the information is scattered in different papers and repositories and cannot easily be a profitable reference. This study, therefore, collated and compiled the list of medicinal plants generally used in gynecological procedures at birth in Uganda.

METHODOLOGY
The available literatures on medicinal plants used in the management of gynecological conditions during child birth in Uganda were selected from reputable journals using citation databases including Google Scholar, Institute for Scientific Information, PubMed, Scopus, Hinari, Scientific Information Database, etc. A critical review of these medicinal plants was thereafter carried out to collate the information for scientific bases. Specific information sought included plants and parts used, method of preparation, mode of administration and ethno pharmacological use. Also recorded was the scientific evidence on the pharmacology and chemical constituents in the plants.

RESULTS
Twenty two plant families and forty two plant species were cited for review in this study. Seven plant parts were evidently used from the same plants and out of which five modes of administration were prescribed. Bathing as one of the most used modes of administration is mainly for energy boosting in pregnancy (Table 1). There are nine methods of preparation and water is used most during the preparation of the medicinal plants.

Herbal plants used to induce labor and ease childbirth in Uganda
Plant species belonging to different families used to induce labor, ease pain and solve other related gynecological problems during childbirth are presented. In addition, the distribution of the plants is presented in Table 1. The plant parts used, methods of preparation, different modes of administration and their traditional use by the local communities are provided. A summary of the plant parts and their preferred mode of administration are shown in Figure 1.
Forty two plant species belonging to twenty two different plant families were reviewed and recorded. The family Asteraceae had the highest number (21%) of plant species used to induce labor and ease childbirth, followed by Fabaceae (10%), Acanthaceae (7.4%), Basellaceae and Euphobiaceae (5%), respectively. Five different modes of administration were observed of which bathing (31.8%) was the most commonly used. Other modes include drinking (22.72%) and oral (22.72%) administration (could be by swallowing or gargling), chewing (15.9%) and topical application (6.81%), respectively.
The pharmacological and chemical compositions of the medicinal plants used by local communities during childbirth in Uganda are shown in Table 2. Most of the plants recorded have at least two chemical constituents that could be responsible for pain relief and associated gynecological activities.
A total of thirty two pharmacological activities were identified in this study. Anti-inflammatory activity was found to be the most common in the validated plants (44%) while antimicrobial (30%), antidiabetic (19%) and analgesic (13%) activities were also reported.

Plant parts used in medicinal plant preparations
There are seven recorded plant parts commonly used in traditional treatments (Figure 1). The leaves are used in more than two ways: They are used for bathing (31.8%) and for drinking (22.72%).

DISCUSSION
This review has documented a number of different plant species belonging to different families used in gynecological procedures in Uganda's local communities. The families Asteraceae, Fabaceae, and Lamiaceae were the most cited for gynecological uses by various local communities in Uganda and the commonly reported   (Karou et al., 2003). The chemical constituents recorded in this study are of significance as they could be responsible for the pharmacological activities in these plants. Different plants were recorded to have various pharmacological activities. Plants such as L. alata, C. ternatea, and O. lamifoliium were reported to have analgesic properties by 73, 29.7 were reported to have analgesic properties by 73, 29.7 and 23.8%, respectively (Wu et al., 2006;Panthong et al., 2007;Maity et al., 2012). Sida acuta was reported to have hepatoprotective and antiemetic activities (Kirtilar and Basu, 1975).
Several chemical constituents such as essential oils, flavonoids, alkaloids, and saponins were reported to have analgesic, anti-inflammatory and oxytocic activities in the various listed plants. The presence of alkaloids in plants could be responsible for the oxytocic activities observed, for example, Ergot alkaloids (Bowman and Rand,
However, most of these chemicals have not been properly profiled. The need to quantify the active compounds for proper dosages to be derived is important. More so these compounds can be used as lead templates in production of effective medicines that can be used to relieve pain and other complications hence reduce mortalities associated with hard labor.

Conclusion
The study reviewed medicinal plants used in gynecological procedures in local communities in Uganda. Plants documented in this study have been established for their acclaimed ethno botanical use while others are still under investigation. Therefore, this study was able to generate information on their current state in order to guide users on their research status.