Ethnobotany Survey of Medicinal Plants Used for Traditional Maternal Healthcare by Serawai Tribe, Seluma District, Bengkulu-Indonesia

Reviewed By: Dr. Songul Budak Diler Department: Reviewer/CMRO ABSTRACT Background and objective: Ethnomedicine plays an important role in the maternal healthcare practice of the Serawai tribe of Seluma district, Bengkulu, however, its use has never been documented. This study, therefore, conducts an ethnobotanical survey to document the medicinal plant used for traditional maternal healthcare in the Serawai tribe. Materials and Methods: The indigenous knowledge was gathered through interaction and questioners with traditional healers. Results: The study provide information on 52 species belonging to 33 different families. Most of the reported plants belong to Zingiberaceae (13.5%), Euphorbiaceae, and Poaceae (5.8%). The result of life form analyses showed that herb constituted the highest proportion of medicinal plants (42.3%), followed by the tree (25%), with leaves (50.9%) as the most utilized plant parts for preparation of traditional herbal medicines. Approximately 80% of plant material are found in the surrounding village, with herbal remedies mostly prepared in the form of decoction (57.7%) and orally administered. However, among the 16 categories of diseases a total of 8 species were affected by excessive bleeding. Conclusion: The result showed that medicinal plants had played significant roles in the management of maternal healthcare. The constraints associated with the use of this medical treatment process, is the poor interest of the younger generation in carrying out this tradition. This, has therefore, lead to a significant threat to medicinal plants. It is, therefore, necessary to preserve the indigenous knowledge on traditional medicine by proper documentation, identification of plant species used, and herbal preparation for future usage.


INTRODUCTION:
Over 60% of the world's population, still recognize traditional medicine as the preferred primary healthcare system, approximately 80% of developing countries directly depend on medicinal plants for health related-purposes [1]. In Indonesia, ethnomedicine has been practiced for a millennium, with significant contributions added over the years by indigenous healers that used medicinal plant , however, it is ⋆ Corresponding author. † Email: sriendartirahayu@gmail.com currently used by Primary Health Care (PHC) at the community level [2] 2 . Indonesia has a large biodiversity of plants with approximately 30,000-50,000 different species, however, only 7500 species are used as drug ingredient (LIPI 2015). The use of medicinal plants has been discovered to be used in the treatment of several diseases and health conditions, including maternal disorders, which is considered an important public and social health problem [2]. Subsequently, the rate of maternal mortality in Indonesia is 228 per 100,000 birth , and this is considerably higher when compared to India (62) and Netherlands (6) [3]. This unprecedented figure tends not to be disassociated from the fact that most Indonesian women employ the services of Traditional irth Attendants (TBSs) and Traditional Healers (THs). The local healers and traditional birth attendants are referred to as "dukun" and "dukun bayi" in the local Indonesian language [4]. Dukun and dukun bayi continue to play an important role in maternal healthcare, particularly in rural areas. In the Serawai tribe in Seluma district, Bengkulu, these healers are perceived as an alternative to community healthcare center [5] Generally, the knowledge of ethnomedicine is orally transmitted by individuals, families, or the community from one generation to the next [6], and most of these teachings have not been formally documented [7]. However, in recent years, there has been a continuous decline in traditional medical practices because the younger generation shows few interest. Therefore, this study aims to document plants traditionally used for the treatment of maternal disorders by the Serawai tribe of Seluma district, Bengkulu, Indonesia.

Description of the study area
This study was conducted in Seluma district, Bengkulu, which lies at a latitude of 4 o 06'23" Southwards and longitude of 102 o3 6'18" Eastwards. It is located 78,4 km from Bengkulu city and cover an area of 2.400.44 km 2 .
The average temperature is 24 o C, with a mean annual rainfall of 225 mm [8]. Furthermore, a census survey conducted in 2010 showed that the Talo district had a total population of 10.591. The inhabitant are mostly indigenous, and the majority are Muslims in possession of their script, known as "Surat Ulu" [9]. In addition, their economy is predominantly dependent on agriculture, mainly coffee and clove plantation .
Furthermore, rural areas were selected due to poor infrastructure in the urban region. They also suffer high levels of poverty due to a lack of appropriate income [10]. These factors urge people to indulge in traditional medicine for maternal healthcare and tend to preserve their indigenous knowledge.
Ethnobotanical data collection Ethnobotanical data were collected by interviewing a total of 35 respondents on the indigenous knowledge of medicinal plants used for maternal healthcare, with proper documentation on the harvested products. These respondents consisting of 15 males and 20 females, were selected using the purposive sampling method [11]. The respondents were well-known in the community due to their long practice in providing services related to traditional maternal healthcare. They consist of conventional healers between 19 to 68 years while the rest were elders who had acquired knowledge on the medicinal importance of plant from parents and relatives that used it in the past.
Furthermore, both informal and formal conversations, discussion , and semi-structured interview , as well as visits to the field , were conducted. A series of individual interviews were carried out to acquire information con- cerning name, age, sex, level of education, and occupation. Additionally, respondents were interviewed on the local names of medicinal plants, use , type of management (wild/cultivated), and maternal health conditions. They were also asked whether a combination of individual species of plants are used to treat any particular disease, the preparation method and routes of administration. Semistructured questionnaires were also used to collect data on life form from tree , shrub , herb , climbers, and traditional conservation practices of the reported medicinal plant. All the semi-structured reviews were supported by an independence visit to the field , which offered opportunities for more discussions with the respondents and practical identification of traditionally used medicinal plant in their natural environment. However, o plant samples were collected, while interview and discussion were conducted in local language .

RESULT AND DISCUSION : Diversity of medicinal plant species
The different types of plant species used by the traditional healers are shown in Table 1with the families, scientific and local name arranged in alphabetical order. In addition, the botanical and local name , families, part used method of preparation, administration route, and ailments treated are stated for each species. Table 1 The present study shows that the rural people are properly versed in nature and the natural resources in their environment. These people in a bid to get rid of various maternal A total of 52 medicinal plant species belonging to 45 genera and 33 families were used by the local communities to treat various illnesses associated with maternal health care in the Serawai tribe. Zingiberaceae (7 species), Euphorbiaceae, and Poaceae (3 species), while most of the families (32) are represented by two or one species, as shown in Figure 2. According to Ramana 2008, scientific studies conducted on the families of these plant provide insights into their rich phytoconstituents and pharmacological actions of the active compounds they possess [12]. The dominance of these families is mainly due to some special properties, such as secondary metabolites. This illustration was observed with some differences discovered in other ethnomedicinal surveys conducted in other regions of the country [13,14] or worldwide [15] The

life form of medicinal plants which treat maternal illness
The life form analysis of medicinal plants showed that herb constitute the highest proportion as shown by 22 species (42.3%), however trees were represented by 13 species (25%), while shrubs were depicted by 10 species (19.2%) and climbers were showed by 6 species (11.5%).  This study shows that the most represented life forms of medicinal plants in the study area were herbs followed by tree . The trend of using more herbaceous plants tends to be more advantageous as it is easier to cultivate it when they are in short supply. Naturally, there are more herbaceous plant species as compared to trees. Subsequently herbs were the most frequently used plant categories [16,17] Plant parts used for traditional maternal health care in Searawai tribe, Bengkulu The inhabitants of the study area harvest different plant parts for the preparation of traditional remedies e.g. leaves, rhizome , stem , root , fruits, etc. It was discovered that 26 species (50.9%) of plants were harvested for their leaves, 5 species (9,8%) for rhizomes, 4 species (7,8%) for stems and roots, 2 species (3.9%) for fruits and bulbs. However, tuber , bark , seed , flower , sap, and the entire plant constitute the remaining 1 species (1.9%) Figure 4 . The preference for leaves was because of its easy availability, harvesting, and simplicity in remedy preparation. In addition, they are the center of photochemical reactions, this causes it to be rich in metabolites. Furthermore, it accumulate alkaloids, tannins, and inulins, which are the active components of most herbal preparation [18]. Conversely, similar researches stated that it is a major dominant plant part in Indonesia [19,20] or worldwide [21][22][23] 1,22,23 for herbal medicine preparation.

Route of administration of medicinal plants used for traditional maternal health care in Serawai tribe, Bengkulu
The route of administration of these plants is also documented inFigure 5. The most common mode of administration is by drinking. However, the least mode of administration is by eating, with majority administered by drinking (57.7%) decoction and juice. These plants are often administered through the dermal (26.9%), which includes rubbing, topical application on the affected area, and traditional bath wash [24] (11.5%). This is congruent with an ethnobotanical survey conducted in East Kalimantan [25] and Edo State, Nigeria [26] The previous studies stated that the oral intake of decoction was the most common route of administration for the medicinal plant. This involves boiling plant materials for a certain amount of time to soften it and extract its active compound [14]. The predominance of oral administration tends to be explained by a high incidence of internal ailments in the region [27]. On the contrary, it is assumed that the patients mostly accept the oral route.

Sri Endarti Rahayu, Oktapianti and Matondang
Most of the plant species are exclusively used for treating diseases, while some are combined to form mixtures, such as Aloe vera, Citrus hystrix, Cymbopogon citratus, Graptophyllum pictum, Luffa acutangula, Musa paradisiaca, and Zingiber officinale because they constitute essential ingredients and they are sometimes used as substitute for others with similar medical properties Table 1. Its uses are broadly classified to enhance fertility in female and excessive bleeding.

Maternal health ailment treated by traditional medicinal plants
The traditional healers identified 16 maternal diseases in the study area Table 1. The highest number of plants were used to treat excessive bleeding (8 plants), boosting stamina after giving birth (7 plants), enhance fertility in female (5 plants), breast milk enhancement, breast cancer and reduce leucorhea (3 plants each). 2 plants each were used for the treatment of all sort of ovary problem , clearing of uterus after childbirth, promote conception while 1 plant each was used to relieve menstrual cramps, prevent abortion, irregularly in menstral cycle, ovarian cyst and dysnenorhea.
However, most of the medicinal plant species documented are used to treat bleeding. Bleeding is also one of the commonest condition treated with medicinal plants for women in other countries, such as Pakistan [28] and Namibia [29].
The plant materials are sometimes used independently or combined with other parts of the plant. Furthermore, some of the plants were used in the treatment of more than one disease, for example, Curcuma longa L.were used to treat four illnesses. Curcuma alba L. and Drymoglossum piloselloides (L.) C. Presl was each used for the treatment of three diseases. Additionally, similar studies were reported from different part of Indonesia [14,30] or Worldwide.

CONCLUSION:
In conclusion, traditional medicine remains the primary healthcare system in the Serawai tribe, Bengkulu. Many plant species are used for maternal healthcare. Unfortunately, the practice of medicinal plants by the Serawai tribe is still not adequately documented. There was severe depletion of conventional medicine knowledge among the indigenes of the study area due to the disinterest of the younger generation. However, it is important to conserve this knowledge by scientifically evaluating the biological activities of the medicinal plants. It is also essential to encourage the inhabitants of the study area to practice the cultivation of these plants because it was reported that they are collected from their surroundings.