Medicinal plants used by women from Agnalazaha littoral forest (Southeastern Madagascar).

BACKGROUND: The country of Madagascar is renowned for its high level of biodiversity and endemism, as well as the overwhelming pressures and threats placed on the natural resources by a growing population and climate change. Traditional medicine plays an important role in the daily lives of the Malagasy for various reasons including limited access to healthcare, limited markets and traditional values. The objective of this study was to assess the modern utitilization of the Agnalazaha Forest by the local population in Mahabo-Mananivo, Madagascar, for medicinal plants used by women, and to establish a list of medicinal plants used by women sourced from Agnalazaha Forest.
METHODS: Ethnobotanical studies were conducted over a period of five months in 2010 to determine the diversity of medicinal plants used by women in the commune of Mahabo-Mananivo. In all, 498 people were interviewed, both male and female ranging age from 15 to over 60 years old.
RESULTS: 152 medicinal plants used by local people were collected during the ethnobotanical studies. Among the recorded species, eight native species are widely used by women. These species are known for their therapeutic properties in treating placental apposition and complications during childbirth as well as tropical illnesses such as malaria, filariasis, and sexual diseases like gonorrhea and syphilis.
CONCLUSIONS: Littoral forests are rare ecosystems that are highly threatened on the island nation of Madagascar. Our investigation into the use of medicinal plants sourced from and around the Agnalazaha Forest by the women of Mahabo-Mananivo reinforces the need for this natural resource as a first line of health care for rural families.

Background

Traditional medicine is a term used to describe the use of natural resources, often in concert with ritual and spirituality, to prevent, treat and heal human diseases and ailments [1]. While the use of plant species for healing dates back further than the written record, with evidence the Neanderthals practiced plant medicine [2], it is still being used by many in our modern era. Eighty (80) percent of the world's population depends on traditional medicine for the treatment of pain [3]. And in developing countries such as Madagascar medicinal plants remain a primary source of medical care [4] especially in very remote areas or in case of limited health resources.

Medicinal plant use in Madagascar has the added concern of biodiversity loss, environmental degradation, and sustainability. The island nation of Madagascar separated from Africa some 170 million years and the Indian subcontinent nearly 88 million years ago and the isolated flora and fauna have evolved with a high degree of microendemism [5]. Current floristic calculations indicate Madagascar houses between 12,000 and 14,000 vascular plant species, of which 90% are endemic [6] and 96% endemism in tree species [7]. However, the increasingly intense population growth has led to rapid deforestation as land is cleared for agricultural fields and for fuel [8]. Biodiversity loss, in general, has severe implications on environmental stability which in turn affects human health [9]. When biodiversity directly adds to the wellness of a community as a resource for medicine, biodiversity loss can have even deeper consequences as medicinal plant species are lost or are no longer available [10,11].

Within Madagascar, one of the most threatened ecosystems is the littoral forest [12]. Although the littoral forests of Madagascar once stretched 1600-km along the eastern coast as one single biological corridor, there is only 10% of the original forest remaining [13]. One such littoral forest, the Agnalazaha Forest, is located in the rural commune of Mahabo-Mananivo, 750 km southeast of the capitol city of Antananarivo. Approximately 72.3% of the flora of Agnalazaha is endemic to Madagascar [14].

The villages of Mahabo-Mananivo source timber and non-timber forest products from Agnalazaha Forest littoral forest. Furthermore, the community of Mahabo-Mananivo still practice and often prefers traditional medicine, especially for common diseases and infectious diseases [15]. As is the case with most familial systems, the first line of healthcare decisions and action is often administered by female household members [16]. The purpose of this study was to assess the modern utilization of this forest by the local population with a focus on the plants known and utilized by women in their everyday care giving. We focused on the women for this study while a study on the use of medicinal plants by men was carried out simultaneously. At times men were present during the interview process and would add information about plants used by women which we allowed.

Methods

Research was coordinated by and supported in large part by the staff at the Missouri Botanical Garden Mahabo-Mananivo Conservation research site. Field research was conducted over a period of five months (January – May) in 2010 with three field trips to the community. A ten day preliminary exploration was used to become familiar with the community and introduce ourselves, make contact with local officials and present the topic of our research. A hired local guide acted as our translator, introduced us to interview prospects and coordinated interview schedules. Consent was given by the tribal leaders, local government officials and by each individual we interviewed.

Study site

Agnalazaha Forest is located within the district of Farafangana, Atsimo Atsinanana region in southeastern Madagascar, in the Commune Rural Mahabo-Mananivo (Figure 1). The National Road 12, a paved highway connecting Farafangana and Vangaindrano borders the forest to the west while the Indian Ocean borders it to the east. It is between 47° 41′and 47° 45′ E, and 23° 09′and 23° 14′ S with an altitude of less than 50 m [14]. In 2003, it was measured that this coastal forest covered an area of 1,565 ha and represents approximately 17% land coverage of the rural area of the commune Mahabo-Mananivo. Agnalazaha Forest has the status of Forest Reserve under article number 129-SF/EF/CG since May 17, 1954, but has been under the management of the Missouri Botanical Garden (MBG) since 2002.

Figure 1

Map of study area. Location of Mahabo-Mananivo community within context of Madagascar and in relation to Agnalazaha Forest.

The southeast region of Madagascar is characterized as the eastern coastal plain and has a climate of high rainfall and high average temperature [17]. The Agnalazaha Forest experiences two seasons: the hot rainy season from December to April, and the cool season from May to November. The average annual rainfall in Agnalazaha Forest is 2,706 mm. The average annual temperature varies between 21°C - 24°C (69 °F – 75 °F). According to the bioclimatic division of Madagascar, this region belongs to the humid tropics and part of the humid warm bioclimatic type [18]. Agnalazaha Forest is classifed as a littoral forest, characterized by an open canopy and sandy soils [12], seasonally flooded wooded swamps, open marshes with Nepenthes madagascariensis and Lepironia articulata, savannas, remnants of secondary forest on lateritic soils and reforestation forests of Eucalyptus robusta and Acacia mangeum. There are 275 species of plants in Agnalazaha Forest [14] distributed within 188 genera and 82 families. The site contains species belonging to three endemic families, Asteropeiaceae (2 species), Sarcolaenaceae (6 species) and Sphaerosepalaceae (1 species). Furthermore, 199 species present in Agnalazaha Forest are determined to be endemic to Madagascar (72.3%).

An inventory of primates [19] conducted in Agnalazaha Forest identified four species of lemur all of which are considered to at least be threatened, including the critically endangered Eulemur albocollaris[20]. All are known to be hunted locally. A similar study identified seven species of endemic small mammals found in Agnalazaha Forest including Pteropus rufus, Hemicentetes semispinosus, Setifer setosus and Tenrec caudatus, Hova oryzorictes, all of which are also locally hunted [21].

Surrounding community

Commune Rural Mahabo-Mananivo surrounds Agnalazaha Forest to the west, north and south. There are 6,998 residents according to the 2009 census. Mahabo-Mananivo is primarily comprised of residents identifying with the Antesaka ethnic group, while Antefasy, Merina and Betsileo members have migrated to this area as well. The municipality of Mahabo-Mananivo consists of ten fokontany surrounding the Agnalazaha Forest; Mahabo, Vohimasy, Iabotako, Nosiala, Iambomary, Baboaka, Lohagisy, Karimbelo, Rorobe, and Agnateza. A “fokontany” is the smallest political distinction recognized by the government. It may compromise several small villages with an average 1,000 people [22]. Mahabo-Manaivo is primarily an agriculture economy. Approximately 99.74% of the population is farmers. Rice fields dominate the landscape with cassava, yams, and manihot as supplementary crops. Additional income is sought through handicraft production, largely basketry weaving. The most popular species used for basketry is Lepironia articulate, Cyperus sp, and Pandanus sp. Monthly income is less than 80,000 Ariary (approximately USD$35) for a majority of the population of Mahabo-Mananivo.

There is a relatively new community health center, built in 2009, in the fokontany Mahabo, located on Road 12. It has 2 rooms and accommodates one doctor and one nurse. However, a majority of the population of Mahabo-Mananivo relies on medicinal plants to cure common diseases. To this end, local people consult traditional healers called ombiasy to be treated with medicinal plants. Ombiasy can be distinguished into four different types of healers: tromba (spiritually possesed) healers, midwives, massage healers and premonition healers.

Ethnobotanical surveys

The Agnalazaha Forest provides the local population with firewood, timber for home construction, non-timber products and medicinal plants. In order to identify medicinal plants known to be used by and for women in the rural commune of Mahabo-Mananivo, inquiries on the therapeutic use of plants were conducted primarily with women and female healers, although some men were interviewed as well. Due to time limitations, not all fokontany were included in the study. Fokontany were selected using the following criteria: (a) proximity to Agnalazaha Forest (b) Distance to the health center located in Mahabo (c) presence of female healers in the village. Fokontany closest to Agnalazaha Forest were given priority. Field visits to each fokontany selected were scheduled so that the villages furthest from the forest were visited first. The interviews were structured as semi-direct interviews with open questions [23]. The interviews were conducted with both individuals and in group settings [24]. Interview questions were written with two different approaches, inquiry of plant specific use or through disease-specific and/or symptomatic description plant use. Questionnaires or survey forms were established, first on medicinal plants used by women and healers, then the socio-economic and cultural value for each species (Additional file 1).

Surveys focused on plants used in the treatment of common female diseases in the commune. They were conducted with traditional healers (ombiasy), birth attendants, women and men who know the medicinal plants used by and for women. The interviews were interspersed with forest walks with interview participants where species were identified by their vernacular names and photos were taken. Herbarium voucher were made and the identification of these species was then conducted in the national herbarium of Tsimbazaza (TAN).

Results

Demographic variables

In the community 498 people were surveyed, 301 (60.44%) were women and 197 (39.56%) were men and 90.56% of those interviewed responded that they utilize medicinal plants. Table 1 compares the number of those who utilize medicinal plants with those who do not use medicinal plants for each age group, level of schooling, marital status and income level.

Table 1

Demographic information of the ethnobotanical interviewees

		Number of people interviewed	Percentage of total	Utilize medicinal plants (#)	Percentage of total	Do not utilize medicinal plants (#)	Percentage of total
Gender	Females	301	60.44	280	93.02	21	6.98
	Men	197	39.56	171	86.8	26	13.2
Age group	[15-19]	35	7.03	16	45.73	19	54.27
	[20–29]	84	16.87	73	86.91	11	13.09
	[30–39]	111	22.29	105	94.59	6	5.41
	[40–49]	117	23.49	115	98.29	2	1.71
	[50–59]	104	20.88	100	96.15	4	3.85
	[60 +]	47	9.44	42	89.36	5	10.64
Level of	Illiterate	328	65.9	316	96.34	12	3.66
Education	Primary	143	28.7	118	82.52	25	17.48
	Secondary	24	4.8	16	66.53	8	33.47
	University	3	0.6	1	33.33	2	66.67
Marital status	Single	105	21.1	80	76.21	25	23.79
	married	384	77.1	368	95.83	16	4.17
	widowed	9	1.8	3	33.07	6	66.93
Household	<80,000	371	74.5	349	94.07	22	5.93
Education(monthly income in Ariary)	80,000-160,000	123	24.7	99	80.49	24	19.51
	>160,000	4	0.8	3	74.9	1	25.1

Comparison of age group, level of schooling, marital status and income level of the 498 interview respondents of Mahabo-Mananivo.

People aged 40 to 49 years have the highest frequency of use of medicinal plants at 98.29%. This age group was followed by the 50 – 59 year old age bracket (96.15%), the 30 – 39 year old age bracket (94.59%), 60 years and older bracket (89.36%), the 20 – 29 years old bracket (86.91%) and finally the youngest bracket, 15 – 19 years old at 45.73%. We found that people at least 30 years old have increased knowledge in terms of medicinal plants, while lower knowledge levels occur in the younger age groups.

Furthermore, the data analysis shows that in the Commune of Mahabo-Mananavio, the majority of women (65.90%) who use were interviewed are illiterate, with 96.34% of them using medicinal plants. This high percentage is directly correlated with the fact that girls receive less education than boys. Persons with at least a primary school level of education made up 28% of our interviewees, and have a significant percentage of use of medicinal plants (82.52%), while those with secondary level of education (4.8% of our respondents) make little use of medicinal plants (66.53%). This percentage decreases again and becomes less significant for those with a university level education (33%).

Married people have a broad knowledge of medicinal plants with a percentage of 77.10%, while persons listed as single use plants at a frequency of 21.10%. Most of these respondents are single mothers who prefer to practice traditional care during childbirth and/or childhood diseases.

Diversity of medicinal plants and their application

152 medicinal plants were recorded during our ethnobotanical interviews as part of the collective women’s pharmacopeia. The diversity of medicinal plants in the botanical groups shows that dicotyledons have a very high percentage of use (87%), followed by 8% of monocotyledons and finally 5% of pteridophytes. The most important medicinal families are: Asteraceae (11 species), Poaceae and (9 species), Myrtaceae, Euphorbiaceae and Fabaceae (6 species each), Rubiaceae (5 species), Apocynaceae and Zingiberaceae (4 species each), Anacardiaceae, Moraceae, Melastomataceae and Solanaceae (3 species each). Our findings illustrate the most well known and cited species by women have a high rate of endemism or regional nativity. (Table 2).

Table 2

Species known to be medicinal by women in Mahabo-Mananivo

Family	Scientific name	Vernacular name	Part used	Disease treated	Distribution[[6],[25]]
AMARANTHACEAE	Amaranthus sp	Anampatsa	bark	intestinal parasites
AMARANTHACEAE	Chenopodium ambrosioides L.	Taimboritsiloza	Entire plant	Placental apposition - Parasites - Nosebleeds	Naturalized in Madagascar
ANACARDIACEAE	Mangifera indica L.	Manga	Bark Root	Evacuation of the placenta - Diarrhea - Hemorrhoid - Leucorrhoea - Dental Disease - Gonorrhea	Naturalized in Madagascar
ANACARDIACEAE	Rhus taratana (Baker) H. Perrier	Taranta	Leaf	Poisoning - Convulsions - Epilepsy - Stomach pain	Endemic to Madagascar
ANACARDIACEAE	Sclerocarya birrea (A. Rich.) Hochst.	Sakoa	Leaf	Venereal diseases - Sedative - Astringent - Spider Bite	Comoros, Africa
ANNONACEAE	Annona reticulata L.	Coeur de Boeuf	Leaf	Evacuation of the placenta
ANNONACEAE	Annona sp.	Sarisoky	Leaf	Stomach pain
APHLOIACEAE	Aphloia theiformis (Vahl) Benn.	Fandramana	Leaf, Bark	Evacuation of the placenta - Malaria - Tuberculosis - Sore throat - Heartburn	Comoros, Mascarenes, Seychelles, Africa
APOCYNACEAE	Catharanthus roseus (L.) G. Don	Vonenina	Entire plant, Root	Stomach pain - Pancreas pain - Cancer	Endemic to Madagascar
APOCYNACEAE	Petchia erythrocarpa (Vatke) Leeuwenb.	Hentona	Bark	Malaria	Comoros
APOCYNACEAE	Petchia madagascariensis (A. DC.) Leeuwenb.	Kabokala	Leaf	Insect bites	Endemic to Madagascar
APOCYNACEAE	Voacanga thouarsii Roem. & Schult.	Kaboky	Leaf- Latex - Roots - Bark-seeds	Evacuation of the placenta - Hypertension - Heart problems-wounds - Boils - Gonorrhea-Eczema - Scabies - Fungal Infections - Rheumatism - Stomach pain	Africa
AQUIFOLIACEAE	Ilex mitis (L.) Radlk.	Hazondrano	Leaf	Bad luck	Africa
ARACEAE	Colocasia esculenta (L.) Schott	Saonjo	Leaf	Evacuation of the placenta	Naturalized in Madagascar
ARACEAE	Typhonodorum lindleyanum Schott	Via	Leaf, heart	Evacuation of the placenta - Burn - hip problems	Comoros, Mascarenes, Africa
ARALIACEAE	Schefflera longipedicellata (Lecomte) Bernardi	Membolo - vatsila		Epilepsy - Cold - Gonorrhea	Endemic to Madagascar
ARALIACEAE	Schefflera sp.	Memboloha	Leaf	Albumin - Worms - Plague - Evacuation of placenta
ASCLEPIADACEAE	Pentopetia sp	Tandrokosy	Leaf, Stem	Eye disease - Jaundice - Gonorrhea
ASPARAGACEAE	Dracaena reflexa Lam.	Hasina	Leaf - stem	Evacuation of the placenta - Malaria - Epilepsy	Mascarenes, Africa
ASPARAGACEAE	Dracaena reflexa var. cernua (Jacq.) Baker	Fananaraha	Leaf - stem	Placental apposition - Thinning
ASPLENIACEAE	Asplenium sp.	Apanga malemy	Entire plant	gonorrhea
ASTERACEAE	Acanthospermum hispidum DC.	Bakakely	Leaf	Diarrhea	Africa
ASTERACEAE	Ageratum conyzoides L.	Ananjazavavy	flowers	Stomach pain	Naturalized in Madagascar
ASTERACEAE	Emilia sp.	Kitsitsona	Leaf	Eczema - Ulcer
ASTERACEAE	Emilia sp.	Tsiotsio	Leaf	Apposition of the placenta
ASTERACEAE	Helichrysum sp.	Aferombohitra	Leaf	Scabies
ASTERACEAE	Mimosa pudica L.	Ramoria	Leaf	Hepatitis - Albumin	Naturalized in Madagascar
ASTERACEAE	Psiadia altissima (DC.) Drake	Dinga	Leaf	Wounds	Endemic to Madagascar
ASTERACEAE	Sigesbeckia orientalis L.	Tsindaory	Leaf	Wounds	Naturalized in Madagascar
ASTERACEAE	Vernonia appendiculata Less.	Asotry	Leaf	tooth decay	Endemic to Madagascar
ASTERACEAE	Vernonia exserta Baker	Seva	Leaf	Chickenpox - Parasites	Endemic to Madagascar
ASTERACEAE	Vernoniopsis caudata (Drake) Humbert	Maranitry atoraky	Bark	Chickenpox	Endemic to Madagascar
ASTEROPEIACEAE	Asteropeia micraster Hallier f.	Manoky mena	Bark, Leaf	Evacuation of the placenta - Diarrhea - Fatigue - Mumps	Endemic to Madagascar
ASTEROPEIACEAE	Asteropeia multiflora Thouars	Manoky fotsy	Leaf Bark	Evacuation of the placenta - Malaria - Parasites - Dental Disease - Gonorrhea Fatigue	Endemic to Madagascar
BIGNONIACEAE	Phyllarthron madagascariense K. Schum.	Resiriky/ Zahana	Leaf	Malaria - Breastfeeding-Cough - disease of the hip	Endemic to Madagascar
BROMELIACEAE	Ananas comosus (L.) Merr.	Mananasy		Intestinal parasites - diarrhea	Tropics
BURSERACEAE	Protium sp	Ambihitry	Bark	Abscess - poisoning
CALOHPYLLACEAE	Calophyllum inophyllum L.	Vintanina		trigeminal neuralgia	Comoros, Africa, New World
CANELLACEAE	Cinnamosma fragrans Baill.	Kanely	Bark	Cold - intestinal parasite - Headaches - Against poison	Endemic to Madagascar
CANELLACEAE	Cinnamosma madagascariensis Danguy	Fotsinana	Bark, leaf	Evacuation of the placenta - Malaria - Hepatitis - Epilepsy - Intoxication - Dysentery - Carrie dental	Endemic to Madagascar
CANNABACEAE	Cannabis sativa L.	Rongony	Leaf	Liver disease
CARICACEAE	Carica papaya L.	Paza	Leaf, Fruit, seeds, roots	Breastfeeding - Headaches - Wounds - Menstrual Pain - Stomach: Ulcer Constipation - Indigestion - Boil - Cysticercosis - Toxoplasmosis - Cough - Yellow Fever - Tooth Decay	Tropics
COMBRETACEAE	Terminalia catappa L.	Atafa	Leaf	Ovarian cycle disruption - Albumin - Tension - Stomach pain	Madagascar, Comoros, Seychelles, Africa
CONNARACEAE	Agelaea pentagyna (Lam.) Baill.	Rangahtsara	Bark	Gonorrhea - Aphrodisiac - Stomach ache	Comoros, Mascarenes, Africa
CONVOLVULACEAE	Ipomoea batatas (L.) Lam.	Vomanga	Leaf	Pregnancy - Evacuation of the placenta - Insect stings	Naturalized in Madagascar
CRASSULACEAE	Kalanchoe prolifera (Bowie ex Hook.) Hamet	Silafafa	Leaf	Asthma - Cough - Rheumatism	Endemic to Madagascar
CUCURBITACEAE	Cucurbita maxima Duchesne	Voatavo	Leaf	Fever - colic	Naturalized in Madagascar
CYPERACEAE	Cyperus papyrus subsp. madagascariensis (Willd.) Kük.	Zozoro		Difficulty after childbirth - painful spasms
CYPERACEAE	Pycreus mundtii Cherm.	Ahibita	Entire plant	Evacuation of placenta-Malaria - Tuberculosis	Mascarenes, Africa, New World
EBENACEAE	Diospyros sp	Hazominty	Leaf	Malaria
ERICACEAE	Agauria salicifolia (Comm. ex Lam.) Hook. f. ex Oliv.	Haronga-panihy	Leaf	Scabies (Adult) - Wounds - Ulcers	Mascarenes, Africa
ERICACEAE	Erica sp.	Anjavidy	Leaf Stem leaves	Evacuation of placenta-Pneumonia - Syphilis
ERYTHROXYLACEAE	Erythroxylum ferrugineum Cav.	Menahihy	Bark Leaf	Evacuation of the placenta - Diarrhea - Anemia	Endemic to Madagascar
ERYTHROXYLACEAE	Erythroxylum gerrardii Baker	Fanjoana	Leaf Bark	Yellow fever - Epilepsy	Africa
EUPHORBIACEAE	Croton noronhae Baill.	Tsiavadika	Bark-Leaf	Placental apposition - Malaria - Cough	Endemic to Madagascar
EUPHORBIACEAE	Euphorbia hirta L.	Jean Robert	Entire plant	Gonorrhea - Dysentery - Albumin	Naturalized in Madagascar
EUPHORBIACEAE	Jatropha curcas L.	Savoa	Leaf Latex	Evacuation of placenta Asthma - Dental Disease - Pneumonia	Naturalized in Madagascar
EUPHORBIACEAE	Macaranga oblongifolia Baill.	Mokarana	Leaf	Malaria - Diarrhea	Endemic to Madagascar
EUPHORBIACEAE	Macaranga sp	Mokarana	Leaf	Diarrhea
EUPHORBIACEAE	Manihot utilissima Pohl	Kazaha	Leaf	Gonorrhea - painful spasms - Pneumonia - Boil
EUPHORBIACEAE	Suregada boiviniana Baill.	Lelangana	Leaf	Placental apposition - Dysentery - Epilepsy-Malaria	Endemic to Madagascar
FABACEAE	Albizia gummifera (J.F. Gmel.) C.A. Sm.	Volomborona	Leaf	Fatigue - Cough	Africa
FABACEAE	Cajanus cajan (L.) Huth	Ambatry	Leaf	Evacuation of the placenta - Tension	Naturalized in Madagascar
FABACEAE	Chamaecrista mimosoides (L.) Greene	Quatre épingles	Leaf	Thrush - Schistosomiasis
FABACEAE	Intsia bijuga (Colebr.) Kuntze	Hintsy	Leaf	Placental apposition - Cough	Mascarenes, Africa
FABACEAE	Mimosa pudica L.	Ramoria		Pelvic pain - Nervousness - Diuretic	Naturalized in Madagascar
FABACEAE	Senna alata (L.) Roxb.	Quatre épingles	Leaf	Hypertension	Naturalized in Madagascar
GENTIANACEAE	Tachiadenus carinatus (Desr.) Griseb.	Malanilava	Entire plant	Diarrhea	Endemic to Madagascar
GLEICHENIACEAE	Sticherus flagellaris (Bory ex Willd.) Ching	Ringotra	Leaf	Diarrhea - Measles - Vomiting - Coughing	Mascarenes, Comoros
HYPERICACEAE	Harungana madagascariensis Lam. ex Poir.	Harongana	Bud Leaf	Gonorrhea - heart disease - Albumin - Asthma - Boil-Diarrhea	Comoros, Mascarenes, Africa
ICACINACEAE	Cassinopsis madagascariensis Baill.	Valotry	Leaf - Bark	Cough - Itching - Syphilis	Endemic to Madagascar
LAMIACEAE	Ocimum gratissimum L.	Romba be	Leaf	Placental apposition - Asthma - Albumin - Headache - Dental Disease	Comoros, Mascarenes, Seychelles, Africa, Asia
LAMIACEAE	Salvia coccinea Buc’hoz ex Etl.	Romba madinika	Leaf	parasites	Naturalized in Madagascar
LAURACEAE	Persea americana Mill.	Zavoka	Leaf	Diarrhea - Apposition of placental - Cough	Naturalized in Madagascar
LECYTHIDACEAE	Barringtonia racemosa (L.) Spreng.	Fotatry	Leaf	Placental apposition - Scabies - Tetanus	Comoros, Australiasia, Africa
LILIACEAE	Asparagus simulans Baker	Ahitsifantatry	Entire plant	Epilepsy - Stomach pain	Endemic to Madagascar
LOMARIOPSIDACEAE	Nephrolepis cordifolia (L.) C. Presl	Mitsisiloha	Entire plant	Malaria	Mascarenes, Australasia, Seychelle, Afria, Asia, New World
LORANTHACEAE	Bakerella sp	Velomiato	Entire plant	Convulsion - Cough - Boil
LYCOPODIACEAE	Lycopodiella cernua (L.) Pic. Serm.	Tongotsokina	Entire plant	Asthma - Epilepsy - Pelvic Pain - Gonorrhea - Cough - Hypertension	Mascarenes, Africa, Asia, New World
LYCOPODIACEAE	Lycopodium clavatum L.	Dito	Leaf	Pregnant - Placental apposition - Gonorrhea - Filariasis - Malaria	Comoros, Mascarenes, Africa
MELASTOMACEAE	Clidemia hirta (L.) D. Don	Voatrotrokala	Leaf	Wounds	Naturalized in Madagascar
MELASTOMACEAE	Dichaetanthera sp	Felabarika	Leaf	diarrhea
MELASTOMACEAE	Medinilla	Takasina		Cough
MELIACEAE	Melia azedarach L.	Voandelaka	Leaf	Fatigue	Naturalized in Madagascar
MENIPERMACEAE	Burasaia australis Scott-Elliot	Sompatry	Leaf	Intoxication - Convulsion - Dental Disease - Malaria - Medicinal plant magic	Endemic to Madagascar
MOLLUGINACEAE	Mollugo nudicaulis Lam.	Aferotany	Entire plant	Malaria - Albumin - Convulsion - Cough - Diarrhea - Diarrhea - Blood loss - Scabies	Australasia, Africa, New World
MONIMIACEAE	Tambourissa castri-delphinii Cavaco	Amborabe	Leaf	Placental apposition - Dysentery	Endemic to Madagascar
MONIMIACEAE	Tambourissa parvifolia Baker	Ambora	Leaf	Filariasis - Loss of blood	Endemic to Madagascar
MORACEAE	Artocarpus altilis (Parkinson) Fosberg	Soanambo	Leaf	Diarrhea
MORACEAE	Ficus polita subsp. polita	Mandresy	Leaf	Placental apposition - bilious - Gonorrhea - Syphilis
MORACEAE	Ficus reflexa Thunb.	Laza	Leaf	Pelvic pain - Gonorrhea	Comoros, Mascarenes, Seychelles
MUSACEAE	Musa × paradisiaca L.	Akondro	Leaf - fruit	Placental apposition - Diabetes - Prevents tooth decay - Diarrhea - Wounds	Naturalized in Madagascar
MYRICACEAE	Morella spathulata (Mirb.) Verdc. & Polhill	Hazosiay	Leaf	Placental apposition - Malaria - Cough - Stomach Pain - Dental Disease- Injury	Africa
MYRISTICACEAE	Brochoneura acuminata (Lam.) Warb.	Raraha	Leaf	Injury - Scabies - Abscess	Endemic to Madagascar
MYRTACEAE	Melaleuca	Kininy bonaky	Leaf	Placental apposition - Cold	Naturalized in Madagascar
MYRTACEAE	Psidium cattleyanum Sabine	Angavombazaha	Leaf	Diarrhea	Naturalized in Madagascar
MYRTACEAE	Psidium guajava L.	Angavogasy	Leaf	Malaria - Colic stomach - diarrhea - dysentery	Naturalized in Madagascar
MYRTACEAE	Psidium guajava L.	Angavofotsy	Leafs Roots	Diarrhea - Vomiting Boil	Naturalized in Madagascar
MYRTACEAE	Syzygium aromaticum (L.) Merr. & L.M. Perry	Jirofo	Leaf	Placental apposition - Dental Disease - Malaria
MYRTACEAE	Syzygium bernieri (Drake) Labat & G.E. Schatz	Rotry	Bark-Leaf	Placental apposition - diarrhea - Dentistry Diseases - Scabies	Endemic to Madagascar
MYRTACEAE	Syzygium emirnense (Baker) Labat & G.E. Schatz	Rotry	Bark-Leaf	Placental apposition - Dentistry Diseases - Scabies	Mascarenes
NEPENTHACEAE	Nepenthes madagascariensis Poir.	Kapilanomba	Entire plantEau dans l’urne	Adhesion of placental-malaria-Albumin - Filariasis - Gonorrhea Syphilis-ear disease	Endemic to Madagascar
NYMPHEACEAE	Nymphaea nouchali Burm. f.	Tatamo	Tubers	Hemorrhoids - Pelvic Pain	Comoros, Mascarenes, Africa, Asia
OLACACEAE	Olax emirnensis Baker	Soazanahary	Leaf	Placental apposition - Malaria - Hepatitis - Epilepsy - Self-defense against witchcraft - Dysentery - Fatigue - Medicinal plant magic	Endemic to Madagascar
OPHIOGLOSSACEAE	Ophioglossum L.	Tsipanga	Leaf	Childbirth
ORCHIDACEAE	Angraecum sp.	Valily	Entire plant	fortifying
PANDANACEAE	Pandanus sp	Vakoana	Leaf	Fatigue - Impotence
PASSIFLORACEAE	Passiflora edulis Sims	Garana	Leaf	Tension - Parasites	naturalized in Madagascar
PHYLLANTHACEAE	Phyllanthus sp	Masombero	Leaf	Apposition of the placenta
PHYSENACEAE	Physena madagascariensis Thouars ex Tul.	Resojo	Bark	Sore throat - Anemia - Against poison	Endemic to Madagascar
PIPERACEAE	Piper nigrum L.	Poivre	Seeds	Dental disease - Poultice - Joint pain
PITTOSPORACEAE	Pittosporum verticillatum Bojer	Memboloha	Leaf- Bark	Malaria - Adhesion of placental	Endemic to Madagascar
POACEAE	Cymbopogon citratus (DC.) Stapf	Veromanitra	Entire plant	Fever	Australasia/Pacific, Africa, Asia, New World
POACEAE	Cynodon dactylon (L.) Pers.	Kindresy	Entire plant	Albumin - Malaria - Liver Disease - Menstrual Pain - Laxative	Australasia, Africa, New World
POACEAE	Eleusine indica (L.) Gaertn.	Tsipihipihina	Entire plant	Stomach pain	Africa, Asia, New World
POACEAE	Hyparrhenia rufa (Nees) Stapf	Verofehana	Entire plant	Epilepsy - Cracks skin of the feet	Africa, Asia, New World
POACEAE	Imperata cylindrica (L.) Raeusch.	Tenina	Leaf	Intoxication - Gonorrhea - Pneumonia - Tonsillitis - Measles - Tension	Naturalized in Madagascar
POACEAE	Oryza sativa L.	Vary	Bud	birth	cultivated in Madagascar
POACEAE	Panicum maximum Jacq.	Ahitry	Leafs	Wounds	Madagascar, Africa, New World
POACEAE	Sporobolus africanus (Poir.) Robyns & Tournay	Ahitry	Entire plant	Allergy	Australasia, Africa, New World
POACEAE	Zea mays L.	Katsaka	Barbe	gonorrhea	cultivated in Madagascar
POLYGONACEAE	Persicaria senegalensis (Meisn.) Soják	Fotsimbarinako	Root	Malaria	Naturalized in Madagascar
RUBIACEAE	Canthium sp.	Fotsikahitry	Leaf	Epilepsy
RUBIACEAE	Coffea sp.	Kafe	Leaf	Malaria
RUBIACEAE	Danais cernua Baker	Fangalalemy	Leaf Bark	Syphilis - Tooth Decay	Endemic to Madagascar
RUBIACEAE	Paederia foetida L.	Ahimembo	Leaf	Evacuation of the placenta - Headaches
RUBIACEAE	Psychotria sp	Sariloa	Leaf	diarrhea
RUTACEAE	Cedrelopsis grevei Baill.	Hafatraina	Leaf Bark	Stomachaches - Acne	Endemic to Madagascar
RUTACEAE	Citrus aurantium L.	Voasary makirana	Fruit	Cough - Malaria	Naturalized in Madagascar
RUTACEAE	Citrus sinensis (L.) Osbeck	Voangy gasy	Leaf	Evacuation of placenta-Malaria
SALICACEAE	Homalium axillare (Lam.) Benth.	Fotsiakara	Bark	burns	Endemic to Madagascar
SALICACEAE	Scolopia sp	Hazofotsy	Bark	Rheumatism
SAPINDACEAE	Litchi chinensis Sonn.	Letchis	Leaf	diarrhea	cultivated in Madagascar
SARCOLAENACEAE	Leptolaena pauciflora Baker	Fatra	Bark	Syphilis	Endemic to Madagascar
SARCOLAENACEAE	Sarcolaena multiflora Thouars	Hela	Leaf	Evacuation of placenta	Endemic to Madagascar
SCHIZACACEAE	Lygodium lanceolatum Desv.	Sofin’akanga	Leaf	Pancrea pain - Gonorrhea - Tension - Evacuation of placenta	Native to Madagascar
SIMARUBACEAE	Quassia sp.	Rembiky	Leaf	Aphrodisiac
SMILACEAE	Smilax anceps Willd.	Roindambo	Leaf	Convulsion - Pregnancy - Fatigue - Boil	Comoros, Mascarenes, Africa
SOLANACEAE	Capsicum annuum L.	Sakaipilo	Fruit	Rheumatism - Pain	Naturalized in Madagascar
SOLANACEAE	Datura inoxia Mill.	Ramiary	Leaf	Asthma - Calming	Naturalized in Madagascar
SOLANACEAE	Nicotiana tabacum L.	Paraky	Leaf	Nosebleed	Naturalized in Madagascar
SOLANACEAE	Solanum erythracanthum Bojer ex Dunal	Angivy	Fruit	Cough	Endemic to Madagascar
STILBACEAE	Nuxia capitata Baker	Valanirana	Leaf	Cough - Tonic - Tapeworm	Endemic to Madagascar
STRELITZIACEAE	Ravenala madagascariensis Sonn.	Ravinala	Leaf	Tension	Endemic to Madagascar
TACCACEAE	Tacca leontopetaloides (L.) Kuntze	Tavolo	Tuber	Malnutrition	Naturalized in Madagascar
THYMELACEAE	Gnidia danguyana Leandri	Avoha	Leaf	Bleeding - Parasites	Endemic to Madagascar
ULMACEAE	Trema orientalis (L.) Blume	Andrarezina / Vakoky	Leaf	Evacuation of the placenta - Dental Disease	Africa
VACCINACEAE	Vaccinium sp.	Voakaramy	Leaf	Anemia - Diabetes
ZINGIBERACEAE	Aframomum angustifolium (Sonn.) K. Schum.	Longoza	Leaf	Splinter	Africa
ZINGIBERACEAE	Curcuma longa L.	Tamotamo	Leaf	Albumin - Pregnancy - Malaria - Jaundice Viral
ZINGIBERACEAE	Hedychium coronarium J. Koenig	Longoza	Leaf	Evacuation of the placenta - Scabies
ZINGIBERACEAE	Zingiber officinale Roscoe	Sakaintany	Tuber - Leaf	Pregnancy: Nausea - Evacuation of placenta-cough-diarrhea

Complete list of the vernacular names, scientific identification, use and distribution of all the species mentioned during ethnobotanical interviews.

Medicinal plants are mainly used in the care of the digestive system (53.95%), followed by reproductive system (49.34%), then the circulatory system with 42.76%. Then, the plants used against skin diseases have a frequency of use of 28.29%, those used against diseases of the respiratory system with 20.39%. Eighteen percent (18%) of plants are taken for the care of diseases related to nervous systems, those used against diseases associated with hearing and visual are a minority (0.66% only) (Figure 2).

Figure 2

Frequency of diseases mentioned as treated by a medicinal species.

In the rural commune of Mahabo-Mananivo, leaves are most often cited as the part used for medicinal treatment, followed by bark and entire plant. Decoction is the most used method of preparation with a percentage of 51.60%. It is followed by infusions (13.07%), fumigation (12.40%), poultice (10.45%), maceration (4.58%), inhalation (3.90%), dusting (2.60%) and drops (1.40%) (Figure 3).

Figure 3

Distribution of type of plant part used (a.) and method of medicinal administration. (b.) Percentage of citations for plant parts used and method of administration for medicinal plant treatment as reported during the interviews. Some plants are noted as having multiple medicinal uses with multiple parts of plants utilized.

Among the medicinal plants collected, a majority are sourced from the littoral forest of Agnalazaha while the cultivated fields, weedy disturbed areas, marshes, savannah, savoka (fallow fields), and river follow up (Table 3).

Table 3

Frequency of localities where medicinal plants are sourced near and around Agnalazaha Forest

Sampled locations
	Forest	Marsh	Savanna	Savoka	River	Cultivated	Disturbed areas
Frequency (%)	40	11	7	4	4	20	14

Discussion

Our focus on the use of medicinal plants by women of Mahabo-Mananivo reinforced the notion that female caregivers are the first line of health care in many Malagasy homes. We found that traditionally, men collect the medicinal plants while women were mostly responsible for the drying, storage and preparation of the plant to take care of the family members. Reproductive, prenatal and postpartum health were the most frequently cited use for medicinal plants in women’s health, a trend seen worldwide [26], however, the women’s pharmacopeia was not limited to reproductive and childbirth care and many medicinal species from Agnalazaha Forest are used to treat multiple diseases. We found eight native species that were very well known, and were used to treat multiple diseases. Voacanga thouarsii is used during childbirth and for the treatment of gonorrhea, syphilis, mycosis, wounds, hypertension and is also used for the care of the digestive tract and stomach ulcers. Cinnamosma madagascariensis treats dental decay and general oral care, malaria, and for care of complications after childbirth. Olax emirnensis is used during childbirth, and to treat malaria, hepatitis, epilepsy, dysentery, fatigue, and thought to have magical properties and to provide protection against witchcraft. Syzygium emirnense is used in childbirth, diarrhea, dental disease, and scabies. Nepenthes madagascariensis is used during childbirth, and for treatment of malaria, filariasis, ear infections, syphilis, and gonorrhea. Phyllarthron madagascariense is taken to support breastfeeding, to treat malaria and combat fatigue. Suregada boiviniana helps to evacuate the placenta and treat epilepsy, dysentery, and malaria. Asteropeia micraster also helps to evacuate the placenta and treat diarrhea, fatigue and mumps. Our study found that many of the medicinal species sourced from Agnalazaha Forest were also utilized for other daily living needs. Native medicinal species may also be used as timber, construction materials, and firewood. Conservation concerns mostly lie in the overuse of these valuable daily living species. Conversations with community members highlighted the concern and interest they had for protecting the natural resource of Agnalazaha Forest while ensuring the forest could still be used. It is our goal that through careful ethnobotanical studies of the modern use of Agnalazaha Forest, we can help the community of Mahabo-Mananivo understand their forest use and establish community driven sustainable conservation plans.

Conclusions

This study highlighted the diversity of medicinal plants used by women and female healers in the Commune of Mahabo-Mananivo. From the perspective of plant diversity, 152 species of medicinal plants in 134 genera and 79 families were identified during the ethnobotanical surveys. First, there is widespread use of medicinal plants that affect the digestive, reproductive and circulatory system. The eight native species widely used are Cinnamosma madagascariensis, Voacanga thouarsii, Nepenthes madagascariensis, Syzigium emirnense, Olax emirnensis, Phyllarthron madagarascariensis, Suregada boiviana, and Asteropeia micraster. This work is only the beginning of a comprehensive study on the ethnobotany of medicinal plants utilized by the community Mahabo-Mananivo from the Agnalazaha Forest. Further studies encompassing ecophysiological, pharmacological and ecological studies are necessary to build a more complete picture on how these rare and compelling littoral forests are used. By documenting the use littoral forest species, we hope to add to the value of these rare forests but also highlight the importance of biodiversity on the health and wellbeing of a community.

Competing interests

The authors report no competing interests.

Authors’ contributions

All authors participated in the design of the study and conducted fieldwork. MR analyzed the data. MR and ARK wrote the manuscript. All authors read and approved the final manuscript.

Additional file 1

Ethnobotanical questionnaire. PDF of the questionnaire used during ethnobotanical interviews.

Click here for file