Traditional management of ear, nose and throat (ENT) diseases in Central Kenya

  • Grace N Njoroge1Email author and

    Affiliated with

    • Rainer W Bussmann2

      Affiliated with

      Journal of Ethnobiology and Ethnomedicine20062:54

      DOI: 10.1186/1746-4269-2-54

      Received: 10 October 2006

      Accepted: 27 December 2006

      Published: 27 December 2006

      Abstract

      Diseases of ear, nose and throat (ENT) often have serious consequences including hearing impairment, and emotional strain that lower the quality of life of patients. In Kenya, upper respiratory infections are among the most common infections encountered in outpatient facilities. Some of these infections are becoming difficult to control because some of the causing microorganisms have acquired antibiotic resistance and hence the need to develop new drugs with higher efficacy. Ethnobotanical studies have now been found to be instrumental in improving chances of discovering plants with antimicrobial activity in new drug development. In Kenya the majority of local people are turning to herbal remedies for primary health care needs. In most cases the sources of these remedies are undocumented and the knowledge about them passed orally form generation to generation, hence under threat of disappearing with current rates of modernisation.

      This study explored the traditional remedies used in managing various ENT diseases in seven districts of the Central Province of Kenya. The most common ENT conditions managed using traditional therapies include: common cold, cough, tonsillitis, otitis-media, chest pains and asthma. The results indicate that 67 species belonging to 36 plant families were utilized in this region. These plants were of varying habits; herbs (37.3%), shrubs (34.4%), trees (25.4%) as well as some grasses and sedges (3%). The traditional preparations were found to be made mainly from leaves (49%), roots (20.5%) and barks (12.5%). For each of the ENT conditions multiple species are utilized mainly as individual preparations but occasionally as polyherbal concoctions. In the case of common cold for example, 30 different species are used. Plants reported in this survey are important candidates for antimicrobial tests against ENT disease causing micro-organisms, especially those with antibiotic resistance.

      Background

      Diseases of the ear, nose and throat (ENT) affect the functioning of adults as well as children, often with significant impairment of the daily life of affected patients [1]. It has been envisaged that with increase in global population, infections remain the most important causes of disease, with upper respiratory infections causing hearing loss and learning disability particularly in children [2]. Ear infections such as chronic otitis-media have serious consequences in developing countries, such as retarded language development and progress in school among children [3, 4]. Otitis-media, which is now known to be the most common childhood infection, leads annually to the death of over 50,000 children under 5 years [5]. In other cases nasal conditions may be distressing, as in the case of nasal myiasis/maggots in the nose [6].

      In most countries in the developing world the number of otolaryngologists is negligible, while the problem is complicated by the fact that there is no training for public health otolaryngology and other ENT-related otolaryngology personnel [2, 4]. This lack of trained personnel is of particular concern in African countries because the prevalence rates of some of the ENT disease such as chronic otitis-media is as high as 65% [7]. This problem as well as increased costs of conventional medicine has caused local people in Kenya and in other developing countries to seek treatment from traditional therapies.

      Diseases of the ear, nose and throat can be caused by a variety of microorganisms. Rhinoviruses are the leading cause for common cold in all age groups for example, while enteroviruses are frequently associated [8]. Acute phryngitis/nosilitis is mainly associated with respiratory viruses, although bacteria, especially Streptococus spp. are found in some patients [9]. It has been shown that the nose is the main ecological niche where some of the drug resistant microorganisms like Staphylococcus aureus reside [10]. Although acute otitis-media is caused by bacteria the leading one being Streptococcus pneumoniae [11], viral infection are a predisposing factor for its development [8, 12]. In communities that use antibiotics, Streptococcus pneumoniae rapidly acquire antibiotics resistance, often complicating this disease burden [11].

      Tuberculosis is regarded as the oldest disease in man, affecting almost every organ of the body and causing about 2 million deaths annually [13]. Cases of tuberculosis are on the increase globally, with HIV/AIDS leading to re-emergence of extra pulmonary presentations [14]. While initial tuberculosis infections occur in the lungs, forms that occur for example in tonsils and the ear are now known to occur particularly in regions such as Africa where the disease is endemic [15].

      Although antibiotics have contributed to the control of ENT infections, their over-use and misuse is now seen to cause an increase in antibiotic resistance [16]. Some of the chronic sinus ENT diseases resistant to current antibiotics include chronic middle ear infections, chronic sinus diseases, chronic coughs and recurrent pharyngo-tonsillitis [17]. Air pollution has been on the increase and is now known to directly affect the nose and the larynx causing inflammation, irritations and eventually infection. Even the ear is affected when the pollutants enter the mucosa of the tuba, causing impairment of the middle ear [18]. With increasing resistance of microorganisms associated with ENT infections and increasing environmental pollution, alternative sources for new drugs are necessary. These might be obtained from plants used in traditional medicines to control or treat these diseases. People in Kenya are now turning to the use of traditional herbal medicines so as to meet their primary healthcare needs [19].

      In Kenya diseases of the respiratory tract are among the most common illnesses in outpatient clinics [20]. These diseases, combined with malaria, account for half the diseases reported in outpatient facilities [21]. Since some of the ENT disease causing microorganisms have become resistant to current antibiotics, there is need to investigate means of developing new, efficacious drugs.

      Studies have now shown that ethobotanically-derived phytochemicals have greater activity than compounds derived from random screening and therefore a greater potential for products developed [22, 23]. One study for example, has shown that 86% of plants species reported in Samoan pharmaceutical ethnopharmacopoeia showed pharmacological activity [24]. Further, many drugs in clinical use today were discovered from the way plants were used in traditional communities. Examples include quinine which, was discovered from the way traditional communities in S. America especially Peru, Columbia and Bolivia used plant species of the genus Cinchona in managing fevers [25]. Digitoxin on the other hand is a popular heart tonic obtained from Digitalis purpurea, a plant that was in use as heart tonic in traditional communities in Europe. Taxol is a modern therapy for ovarian cancer obtained from Taxus brevifolia which was a traditional medicinal plant in British Columbia [26].

      This study investigated the diversity of traditional medicines used for the management of ear, nose and throat infections among the Kikuyus in Central Kenya with the aim of documenting plants that have potential for production of improved traditional medicines from local resources, as well as plants to be targeted for antimicrobial activity against microorganisms that cause ear, nose and throat infections especially those known to have developed antibiotic resistance.

      Materials and methods

      The Central Province of Kenya covers the area around Mount Kenya, where most of the Kikuyus live. The total population is estimated at 3,724,159 inhabitants in an area of 13,191 Km2. The Kikuyus are the largest single ethnic group in Kenya and account for 21% of the country's population [27].

      This study was part of a larger ethnobotanical survey involving over one hundred respondents, carried out for three years (2001–2004) among the Kikuyus of Central Kenya, comprising seven districts: Thika, Murang'a, Kiambu, Maragwa, Nyandarua, Kirinyaga and Nyeri (Figure 1). This study focuses on results from 64 respondents who used traditional therapies in management of ENT conditions for self medication or in treating others. Initial contacts were made with research assistants in all the districts to explain the aim of the research. These assistants were local people who knew the kikuyu language well, had lived in the area long enough and were familiar with the local people. Prior informed consent was sought with the respondents who were randomly selected in each area.
      http://static-content.springer.com/image/art%3A10.1186%2F1746-4269-2-54/MediaObjects/13002_2006_Article_66_Fig1_HTML.jpg
      Figure 1

      Main provinces in Kenya and constituent districts where fieldwork was done.

      During the surveys semi-structured questionnaires were used to carry out the interviews, which targeted common ear, nose and throat infections known to the respondents, plant species used, parts used, methods of preparations as well as administration of the drugs. In some cases interviewees were accompanied in their plant collecting duties and observations made of the plants being collected. Where the respondents were uncomfortable with the questionnaires, discussions and informal interviews were employed and in the process information on traditional management of ENT infections obtained. During discussions, information on combination therapy or poly herbal management of ENT conditions were noted and recorded. Any use of none plant remedies for management of ENT infections were recorded.

      Plants said to be useful in managing various ENT ailments during the interviews were visually identified in the field by the respondents. Voucher specimens were collected in duplicates using standard taxonomic procedures particularly recording important features for identification in the herbarium. Each specimen included vital parts such as leaves, stems, flowers, and fruits where available. For small herbaceous plants, whole plants were usually collected. For every specimen collected the vernacular names were also recorded. The specimens were dried in the herbarium and then mounted on sheets.

      The collected plant material was identified at the Jomo Kenyatta University Herbarium, using the relevant local floras and other taxonomic literature [2830]. Assistance in identification was sought from an experienced botanist (Mr Simon Mathenge) of the University of Nairobi Herbarium. The collections at Nairobi University Herbarium as well as Jomo Kenyatta University Herbarium were used to make comparisons with the identified specimens. To systematically collect data on management of ENT diseases in this region, questionnaires, semi-structured interviews, informal interviews and discussions with resource people were applied. Interviews were also supplemented by participant observations and consistent field walks to identify the medicinal plants cited and collect ethnotherapeautic specimens.

      Results and discussion

      This study found 67 species in 36 plant families as useful in management of ENT conditions in Central Kenya (Table 1) Of these, 24 species were cited three or more times during the field surveys. Some of the species with high frequency of mention included Eucalyptus saligna, Lippia javanica and Ocimum gratissimum (Figure 2). The highest proportion of species used was herbs (37.3%), followed by shrubs (34.3%) and trees (25.4%). Sedges and grasses on the other hand comprised of 3% of the species used in ENT infections management in this region. Whiles one species would have different parts used; this study shows that most of the drug preparations were obtained from leaves (49%) and reasonable amounts from barks (12.5%) and roots (20.5%). Harvesting plant medicines from barks is known to be the most destructive method of harvesting particularly because debarked trees rarely survive [31]. The trees and shrubs from which ENT concoctions are obtained from barks and roots are likely to be in danger of over-exploitation and their conservation status need further investigation.
      Table 1

      Diversity of plant species and methods used in management of ENT diseases in Central Kenya

      Species name

      Family

      Kikuyu name

      Disease

      Part used

      Method of drug preparation

      Method of drug administration

      Acacia mellifera (Vahl) Benth.

      Mimosaceae

      Mûthigira

      WC

      Bark

       

      Chewing

      Acacia mellifera (Vahl) Benth.

      Mimosaceae

      Mûthigira

      Cg

      Bark

      Crushing

      Chewing

      Ajuga remota Benth

      Lamiaceae

      Wanjirû wa rûriî

      CC

      Leaves

      Boiling

      Orally

      Ajuga remota Benth.

      Lamiaceae

      Wanjirû wa rûriî

      Cg

      Leaves

      Boiling

      Orally

      Asparagus setaceus (Kunth) Jessop

      Asparagaceae

      Karûrûra

      Cg

      Leaves

      Crushing/pounding

      Chewing

      Aspilia pluriseta Schweinf.

      Asteraceae

      Muutî

      Cg

      Bark

      Crushing

      Chewing

      Aspilia pluriseta Schweinf.

      Asteraceae

      Muutî

      OM

      Sap

      Squeezed from stems

      Directly installed

      Bidens pilosa L.

      Asteraceae

      Mûcege

      NB

      Leaves

      Boiling

      Orally

      Caesalpinia volkensii Harms

      Caesalpiniaceae

      Mûbûthî

      CC

      Roots

      Crushing to release sap

      Topically by rubbing nasal region

      Carissa edulis Forssk.

      Apocynaceae

      Mûkawa

      As

      Roots Leaves

      Boil

      Orally

      Carissa edulis Forssk.

      Apocynaceae

      Mûkawa

      CP

      Roots

      Boiling Soup added

      Orally

      Carissa edulis Forssk.

      Apocynaceae

      Mûkawa

      CC

      Roots

      Boiling

      Orally

      Citrus aurantiifolia (Christm.) Swingle

      Rutaceae

      Ndimu

      As

      Fruit

      Boiling

      Orally

      Citrus aurantiifolia (Christm.) Swingle

      Rutaceae

      Ndimû

      CC

      Fruit

      Boiling

      Orally

      Clematis brachiata Thunb.

      Ranunculaceae

      Mûgaya ng'ûndu

      CC

      Leaves

      Boiling to release steam

      Inhalation of steam

      Clutia abyssinica Jaub. & Spach

      Euphorbiaceae

      Mûthimambûri

      To

      Leaves

      Boiling

      Orally

      Coffea arabica L.

      Rubiaceae

      Kahûa/Mûhûa

      Cg

      Root

      Boiling

      Orally

      Colocasia antiquorum Schutt

      Araceae

      Kîrûtû

      OM

      Sap

      Direct

      Directly installed

      Combretum collinum Fres.

      Combretaceae

      Mûranjîkî

      OM

      Leaves

      Sap extracted

      Directly installed

      Crinum macawanii Bak.

      Liliaceae

      Gûtûngûrû kîa ngoma

      As

      Tuber

      Boiling

      Topically

      Crinum macawanii Bak.

      Liliaceae

      Gîtoka

      OM

      Leaves

      Heated, sap squeeze

      Directly installed

      Crinum macawanii Bak.

      Liliaceae

      Gîtûngûrû kîa ngoma

      To

      Bulb

      Crushing

      Massage

      Crotalaria agatiflora Schweinf.

      Papilionaceae

      Mûcingiri wa ngambainî

      OM

      Leaves

      Crushing, some water added

      Directly installed

      Croton megalocarpus Hutch.

      Euphorbiaceae

      Mûkindûri

      Cg

      Bark

      Pounding

      Chewing

      Croton megalocarpus Hutch.

      Euphorbiaceae

      Mûkindûri

      To

      Roots

      Pounded

      Chewing

      Cuscuta kilimanjari Oliv.

      Convolvulaceae

      Thîna

      OM

      Sap

      Collected from stems

      Directly installed

      Cussonia holstii Engl.

      Araliaceae

      Mûruruku

      Cg

      Bark

      Pounding

      Chewing

      Dalbergia lactea Vatke

      Papilionaceae

      Mwaritha

      As

      Wet leaves

      Crushed to release sap

      Topically

      Datura stramonium L.

      Solanaceae

      Ndatura

      To

      Stems

      Crushing

      Massage

      Dombeya burgessiniae Gerrard

      Sterculiaceae

      Mûkeû

      Cg

      Bark

      Pounding

      Chewing

      Englerina woodfordioides (Schweinf.) Balle

      Loranthaceae

      Kîeha

      CC

      Whole

      Boiling

      Orally

      Erythrina abyssinica DC.

      Papilionaceae

      Mûhûtî

      Cg

      Bark

      Boiling

      Orally

      Erythrina abyssinica DC.

      Papilionaceae

      Mûhûtî

      NB

      Bark

      Boiling

      Orally

      Eucalyptus saligna Smith

      Myrtaceae

      Mûbaû

      CC

      Leaves

      Boiling

      Inhalation of steam

      Euphorbia joyae Bally & S. Carter

      Euphorbiaceae

      Kariaria

      To

      Stem

      Boiling

      Orally

      Juniperus procera Engl.

      Cupressaceae

      Mûtarakwa

      CC

      Bark

      Boiling

      Orally

      Kigelia africana (Lam.) Benth.

      Bignoniaceae

      Mûratina wa thûkûrîi

      CC

      Rhizome

      Boiling

      Orally

      Kyllinga bulbosa P. Beau.

      Cyperaceae

      Ngothe

      OM

      Bulb

      Bulb crushed to release sap

      Directly installed

      Kyllinga bulbosa P. Beau.

      Cyperaceae

      Nyeki/Kîgombe

      To

      Leaves

      Crushing

      Chewing

      Lactuca inermis Forssk.

      Asteraceae

      Mûthûnga

      To

      Leaves

      Dry leaves in shade and soak in hot water

      Orally

      Lantana camara L.

      Verbenaceae

      Rûîthiki

      CC

      Leaves

      Crushing of wet leaves

      Inhalation

      Lantana camara L.

      Verbenaceae

      Mûkenia

      OM

      Leaves

      Crushing

      Directly installed

      Lippia javanica (Burm.f.) Spreng.

      Verbenaceae

      Mûthirîti

      CC

      Leaves

      Crushing, steeped in hot water or milk

      Orally

      Mangifera indica L.

      Anacardiaceae

      Mwîembe

      As

      Leaves

      Boil

      Orally

      Maytenus senegalensis (Lam.) Exell

      Celastraceae

      Mûthuthi

      To

      Sap

      Squeezed from stems

      Topically

      Melia azadirachta L.

      Meliaceae

      Mûarubaine

      To

      Leaves

      Boiling

      Orally

      Melia azadirachta L.

      Meliaceae

      Mwarumbaine

      CC

      Leaves

      Boiling

      Orally

      Momordica foetida Schumach.

      Cucurbitaceae

      Karera

      To

      Leaves

      Crushing

      Chewing

      Ocimum basilicum L.

      Lamiaceae

      Mûtaa

      CC

      Leaves

      Crushed/Ground, steeped in hot water or milk

      Orally

      Ocimum gratissimum L.

      Lamiaceae

      Mûkandu

      OM

      Leaves

      Crushed

      Directly installed

      Ocotea usambarensis Engl.

      Lauraceae

      Mûthaitî

      CP

      Bark

      Boiling

      Orally

      Ocotea usambarensis Engl.

      Lauraceae

      Mûthaitî

      Cg

      Bark

      Boiling

      Orally

      Osyris lanceolata Hocst & Stendel.

      Santalaceae

      Mûthaithi

      N/T

      Leaves

      Boiling

      Orally

      Physalis peruviana L.

      Solanaceae

      Mûnathi

      As

      leaves

      Boiling

      Orally

      Piliostigma thonnigii (Schumach.) Milne-Redh.

      Papilionaceae

      Mûkûra-ûtukû

      Cg

      Inner bark

      Pounding

      Chewing

      Piper capense L.

      Piperaceae

      Mûrûngû

      CC

      Leaves

      Boiling

      Orally

      Pistacia aethiopica Kokwaro

      Anacardiaceae

      Mûheheti

      CC

      Leaves

      Boiling

      Orally

      Plectranthus comosus Sims

      Lamiaceae

      Maigoya

      OM

      Leaves

      Crushing

      Directly installed

      Psidium guajava L.

      Myrtaceae

      Mûbera

      As

      Leaves Dry

      Boiling

      Orally

      Psidium guajava L.

      Myrtaceae

      Mûbera

      CC

      Leaves

      Boiling

      Orally

      Pterolobium stellatum (Forssk.) Brenan

      Caesalpiniaceae

      Mûtandambogo

      CC

      Roots

      Boiling

      Orally

      Rhamnus prinoides L'Herit

      Rhamnaceae

      Mûkarakinga

      CP

      Roots

      Boiling Soup added

      Orally

      Rhamnus prinoides L'Herit

      Rhamnaceae

      Mûkarakinga

      CC

      Leaves

      Boiling

      Orally

      Rhamnus prinoides L'Herit

      Rhamnaceae

      Mûkarakinga

      To

      Roots/Stem

      Boiling

      Orally

      Ricinus communis L.

      Euphorbiaceae

      Mûbarîki

      Cg

      Seeds

      Grinding the seeds and cooking the fatty part

      Orally

      Rubus apetalus Poir

      Rosaceae

      Mûtare

      To

      Fruit and leaves

      Boiling

      Orally

      Sarcostemma viminale (L.) R. Br.

      Euphorbiaceae

      Ndarû

      OM

      Stem

      Heated, Sap squeezed

      Directly installed

      Schkuhria pinnata (Lam.) Thell.

      Asteraceae

      Gakuinini

      CC

      Leaves

      Boiling

      Orally

      Schkuhria pinnata (Lam.) Thell.

      Asteraceae

      Gakuinini

      Cg

      Roots/Leaves

      Boiling

      Orally

      Senna didymobotrya (Fresen.) Irwin & Barneby

      Caesalpiniaceae

      Mwenû

      To

      Leaves

      Boiling

      Orally

      Solanum aculeastrum Dunal

      Solanaceae

      Gîtûra

      To

      Root

      Boiling

      Orally

      Solanum anguivi Lam.

      Solanaceae

      Gatongu

      OM

      Fruits

      Juice squeezed

      Directly installed

      Sonchus oleraceus L.

      Asteraceae

      Mahiû

      CP

      Roots

      Boiling Soup added

      Orally

      Sonchus oleraceus L.

      Asteraceae

      Mahiû

      To

      Roots

      Boiling

      Orally

      Sphilanthes mauritiania (Pers.) DC.

      Asteraceae

      Gatharaita

      CC

      Flowers

      Crushing

      Chewing

      Sporobolus pyramidalis P. Beauv.

      Poaceae

      Kagutu

      Cg

      Root

      Boiling

      Orally

      Tagetes minuta L.

      Asteraceae

      Mûbangi

      As

      Leaves

      Boiling

      Orally

      Tithonia diversifolia (Hemsl.) A. Gray

      Asteraceae

      Marûrû

      CC

      Leaves

      Boiling

      Orally

      Tithonia diversifolia (Hemsl.) A. Gray

      Asteraceae

      Marûrû

      Cg

      Leaves/Roots

      Boiling

      Orally

      Toddalia asiatica (L.) Lam.

      Rutaceae

      Mûrûrûwe

      CC

      Roots

      Boiling

      Orally

      Toddalia asiatica (L.) Lam.

      Rutaceae

      Mûrûrûwe

      CC

      Roots

      Boiling

      Inhalation

      Toddalia asiatica (L.) Lam.

      Rutaceae

      Mûrûrûwe

      Cg

      Leaves

      Boiling

      Orally

      Urtica massaica Mildbr.

      Urticaceae

      Thabai

      CC

      Leaves

      Boiling

      Orally

      Vernonia lasiopus O.Hoffm.

      Asteraceae

      Mûchatha

      CC

      Leaves

      Boiling

      Orally

      Vernonia lasiopus O.Hoffm.

      Asteraceae

      Mûchatha

      OM

      Flowers

      Sap squeezed

      Directly installed

      Warburgia ugandensis Sprague

      Canellaceae

      Mûthîga

      CC

      Bark and leaves

      Boiling

      Orally

      Withania somnifera (L.) Dunal

      Solanaceae

      Mûrumbae

      As

      Roots

      Boiling

      Orally

      Withania somnifera (L.) Dunal

      Solanaceae

      Mûrumbae

      CC

      Leaves

      Boiling

      Orally

      Zanthoxyllum usambarensis (Engl.) Kokwaro

      Rutaceae

      Mwikunya

      CC

      Leaves

      Boiling

      Orally

      Zehneria scabra (L.f.) Sond.

      Cucurbitaceae

      Rwegethia

      CC

      Leaves

      Boiling

      Orally

      Kikuyu names in brackets

      As = Asthma (Githûri kinene, Acima, Gîkorora kia ngûkû)

      CC = Common cold (Homa, Kihuti)

      Cg = Cough (Ruhaya, Gîkorora)

      CP = Chest Pains (Githûri)

      NB = Nose bleeding

      N/T = Neck/throat (Ngingo)

      OM = Otitis media (Njika, bûra)

      To = Tonsil (Ngaû)

      WC = Wooping cough (Gîkoroa thakame)

      http://static-content.springer.com/image/art%3A10.1186%2F1746-4269-2-54/MediaObjects/13002_2006_Article_66_Fig2_HTML.jpg
      Figure 2

      Frequency of plant species used in managing ENT diseases in Central Kenya.

      The most cited ENT disease managed through traditional therapies was found to be the common cold (Figure 3). This condition which has several Kikuyu names (kǐhuti, homa, njoma) is managed usually by use of individual species which are mainly boiled and administered by inhalation or leaves crushed and directly inhaled. In a few cases polyherbal preparations were noted especially the mixture of leaves of Ocimum bacilicum, O. gratissimum and lippia javanica which are boiled together and inhaled while the patient is covered with a thick piece of cloth such as a blanket.
      http://static-content.springer.com/image/art%3A10.1186%2F1746-4269-2-54/MediaObjects/13002_2006_Article_66_Fig3_HTML.jpg
      Figure 3

      Frequency of ENT diseases managed by traditional herbal preparations.

      Some studies have shown that viruses are associated with about two-thirds of the cases of common cold among children, while bacteria have been associated with about 4% of the cases. Among these viruses the leading ones are Rhinoviruses which cause common cold in all age groups but enteroviruses are also associated [8]. In the study area, about 30 plant species were found to be utilized for management of common cold. Extracts from these plants need to be a priority in testing for antimicrobial activity for further development of local drugs useful in management of colds.

      The current study revealed that 13 plant species were used in managing Otitis media (Njika/bũra, in Kikuyu) in Central Kenya (Table 1). Extracts from these plants need to be tested for their activity against some of these bacteria but also against viruses because viruses are known to be a predisposing factor for the development of acute otitis-media [11]. Lubricants from the industries and fat from chicken were also found to be installed into affected ears as a means of managing this condition. Further in some cases the queen stage of the termites were also found to be crushed and the resulting mixture installed in the affected ear(s). In a few cases the tail of the chameleon (alive) is also installed briefly into the affected ear(s). It is not clear whether this has any therapeutic value, but it is worth further investigation.

      Otitis-media is known to be the most common bacterial infection especially among children. Sometimes it has severe complications, which have high economic impacts [11]. Studies in Kenya show that this disease causes sensori-neural hearing impairment among pre-school children, in addition to other complications [4]. On a global scale otitis-media is a major indication for antibiotic use with the consequence that some of the microorganisms associated with this condition have acquired antibiotic resistance as in the case of Pneumoccoci, Staphylococcus aureus, Hemophilus influenzae among others [2, 10, 11]. The traditional therapies cited in this study need to be screened to authenticate their use in managing this condition.

      Sixteen plant species were used in managing tonsillitis in Central Kenya. In some of the cases the plant extracts were applied externally as in the case of the sap from Datura stramonium stems and bulb of Crinum macawanii. These plants are known to have analgesic properties [25] but their antimicrobial activity and those of the species that are either boiled or chewed need to be established. Respiratory viruses such as Adenoviruses, Epstein-Barr viruses, influenza viruses and enteroviruses as well as bacteria are responsible for acute tonsillitis. Some of these for example, hemolytic Streptococci have already developed antibiotic resistance [8]. These microorganisms among others need to be the key targets for antimicrobial tests.

      Asthma was one of the ENT allergic conditions traditionally managed using plant extracts in Central Kenya. The plants used in this case may be important sources of anti-allergic preparations, which warrant further study.

      Conclusion

      This study revealed that the commonest ENT diseases managed through traditional therapies were common cold, Otitis media, cough, tonsillitis, asthma and chest pains. This research further revealed that 67 plant species are used in management of ENT infections in Central Kenya, while 24 of these species are mentioned three or more times during the field survey. There are also some none plant remedies such as fat, oils and animal parts cited in this study.

      These remedies form an important database for bioassay guided identification and purification of important therapeutic compounds, antimicrobial trials on their efficacy and further development of improved traditional medicines or other new drugs for management of ENT infections. In the case of polyherbal preparations, their synergistic effects need further investigation. The study also reveals plants whose medicines are obtained in destructive manner and hence these species may need their conservation status to be investigated.

      Since ethobotanically-derived phytochemicals have greater activity than compounds derived from random screening and therefore a greater potential for new drug products developed, it is expected that the results of this study will lead to pharmacological investigations with the plants showing reasonable antimicrobial activity.

      Declarations

      Acknowledgements

      The authors acknowledge financial support of BIOTA East Africa during the fieldwork. Technical support in identifying of plant specimens by Mr Simeon Mathenge of Nairobi University Herbarium is here acknowledged. We also thank all those people of Central Kenya who shared their information during the fieldwork surveys.

      Authors’ Affiliations

      (1)
      Botany Department, Jomo Kenyatta University of Agriculture and Technology
      (2)
      Botany, University of Hawaii

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      © Njoroge and Bussmann. 2006

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