Medical ethnobotany of the Albanian Alps in Kosovo

Background Ethnobotanical studies are crucial in South-Eastern Europe for fostering local development and also for investigating the dynamics of Traditional Environmental Knowledge (TEK) related to plants in one of the most crucial European hotspots for biocultural diversity. The current medico-ethnobotanical survey was conducted in rural alpine communities in Kosovo. The aims of the study were twofold: 1) to document the state of TEK of medicinal plants in these communities; 2) to compare these findings with that of similar field studies previously conducted among local populations inhabiting the Montenegrin and Albanian side of the same Alpine range. Methods Field research was conducted in 36 villages on the Kosovar side of the Albanian Alps. Snowball sampling techniques were used to recruit 91 elderly informants (≥ 50 years-old) for participation in semi-structured interviews and structured surveys regarding the use of the local flora for medicinal and food purposes. Standard ethnobotanical methods were employed and prior informed consent was obtained for all study participants. Results and Conclusion The uses of 98 plants species belonging to 39 families were recorded; the most quoted botanical families were Rosaceae, Asteraceae, and Lamiaceae. Mainly decoctions and infusions were quoted as folk medicinal preparations and the most common uses referred to gastrointestinal and respiratory disorders, as well as illnesses of the uro-genital system. Among the most uncommon medicinal taxa quoted by the informants, Carduus nutans L., Echinops bannaticus Rochel ex Schrad., and Orlaya grandiflora Hoffm. may merit phytochemical and phytopharmacological investigations. Comparison of the data with other ethnobotanical field studies recently conducted on the Albanian and Montenegrin sides of the same Alps has shown a remarkable link between the medical ethnobotany of Montenegrin and Kosovar side of the Albanian Alps. Moreover, folk uses of the most quoted wild medicinal taxa recorded in Kosovo often include those recorded both in Albania and in Montenegro, thus suggesting a hybrid character of the Kosovar local plant knowledge. This may be also explained with the fact that Montenegro and Kosovo, despite their differences in the ethnic composition, have shared a common history during the last Century.


Background
Ethnobotanical studies in South-Eastern Europe are seen as a crucial initial step for local rural development based on eco-tourism, small-scale trade of local medicinal plants, high-quality local foods, eco-museums, and community-based bio-conservation strategies [1].
However, this region is also considered very special for conducting studies having a human ecological focus, since it represents a unique hotspot of biological and cultural diversity in Europe, thus allowing cross-cultural comparisons of traditional environmental knowledge (TEK) concerning medicinal plants. In very recent years, the Western Balkans have been the focus of a remarkable number of ethnobotanical studies [2][3][4][5][6][7][8][9], mainly focused on mountainous communities [10][11][12][13][14][15].
In this study, we investigated the Kosovo side of the Albanian Alps (in Albanian known as Bjeshkët e sufficient in the provision of their healthcare. As a result, their primary pharmacopoeia consisted of local medicinal plants.
While recent studies on the Albanian and Montenegrin sides of the Albanian Alps have reported findings on TEK of wild medicinal and food plants [10,12,13,15], no ethnobotanical surveys have been conducted thus far in Kosovo, with the exception of a very recent work carried out by our research group in the Gollak area [9], and a review on folk botanical names in diverse Albanian-speaking areas in South-Eastern and Southern Europe [25].
The aims of this study were twofold: 1) to document the ethnobotanical knowledge related to the use of local medicinal plants in the Albanian Alps region of Kosovo; and 2) to compare the recorded data with the ethnobotanical studies recently conducted in the Albanian and Montenegrin sides of the same Albanian Alps. This was done with the overarching goal in mind of elucidating the role played by cultural/ethnic components in shaping use patterns of wild medicinal plants.

Field study
Ethnobotanical field research was conducted in 36 villages belonging to the municipalities of Pejë and Deçan, located close to the Koprivnik and Strellc mountains, and which represent the central group of the Albanian Alps located in the western part of Kosovo ( Figure 1).
The settlements and villages investigated are relatively small in terms of inhabitants (≤ 500 inhabitants per village). The native residents are ethnic Albanians, who speak Gheg varieties of the Albanian language. The exact population is currently unknown, as no population census has been conducted in Kosovo since 1981. Most recently, the area populations have been negatively affected by migration due to displacement and harsh economic conditions caused by the last Kosovo War (1998)(1999).
Field studies were conducted from May to October 2010. TEK was recorded using semi-structured interviews and a questionnaire [26]. In particular, we sought the following information: respondent name and community of residence; local botanical names of useful plants; plant part(s) used; preparation/administration; local folk medicinal uses of plants.
Data were collected from 91 informants (67 male and 24 female) older than 50 years (50 to 79 years old). The respondents were mainly engaged in agricultural activities and typically inherited their ethnobotanical knowledge from their direct ancestors (parents, grandparents) via oral traditions. Study participants were selected using the snowball sampling method [2], and we particularly focused on local people who regularly use plants for medicinal purposes.
Prior informed consent was obtained conducting interviews and researchers adhered to the ethical guidelines of the International Society of Ethnobiology [27]. During the interviews, fresh plants were collected to create voucher specimens for the herbarium and the informants were followed into the field to show us the quoted species. Most plant species were collected while flowering.
Taxonomic identification was done using relevant standard botanical literature of the area [28][29][30][31]. Plant nomenclature largely follows the Flora Europaea [32], while plant family assignments follow the current Angiosperm Phylogeny Group guidelines [33]. Voucher specimens of the wild taxa were deposited at the Department of Biology (Herbarium code DE/10), University of Prishtina.

Data analysis
Despite the fact that it is always problematic to compare ethnobotanical data recorded from studies conducted using different field methods and at different times, we have attempted to compare the wild medicinal plant uses recorded in Albanian Alps in Kosovo with those recorded in previously conducted ethnobotanical studies on the Albanian and Montenegrin sides of the same alpine range [11][12][13][14]. The Jaccard similarity index among the considered studies has been calculated as in the recent comparative analysis of the circum-Mediterranean medical ethnobotany [34].

Results and Discussion
The Kosovar medico-ethnobotany of the Albanian Alps The results of the field survey are presented in Table 1; plants are arranged in alphabetical order by genus. For each species, the botanical name and family, local names, English name, botanical status, preparation/administration and folk medical or food uses are reported.
We found that 98 species (belonging to 39 families) are employed in the traditional medicine of the area. These includes three fern species, three gymnosperms and 92 angiosperms (84 dicotyledonous and 8 monocotyledons); 74 taxa are wild. Of these species, Achillea millefolium L., Cornus mas L., Hypericum perforatum L., Juglans regia L., Juniperus communis L., Malus sylvestris Mill., Plantago major L., Sambucus nigra L. were cited more then 30% of the informants. From 98 species presented in Table 1, 23 species are also included in the official Pharmacopoeia of Europe [35].
The most frequently quoted manner of preparation of medicinal plants was represented by decoctions (51%) and infusions (26%). The most frequently cited medicinal uses referred to gastrointestinal (26%), respiratory (19%) troubles, and illnesses affecting the urogenital system (12%). The first two categories were also the most frequently quoted in the ethnobotanical studies conducted on the Montenegrin and Albanian sides [11][12][13][14].

Most uncommon medicinal plants
Upon analysis of the bio-pharmacological literature on the quoted medicinal species available on PubMed, we found that it could be worthwhile to further investigate the following reports: 1. The internal use of cold water macerates of the inflorescences of Carduus nutans L. in the treatment of eczema (this taxon is scarcely known in the phytochemical and pharmacological literature). In 2000 a Turkish research group pointed out the hepatoprotective effects of extracts from this plant [36]; 2. The internal use of decoction of the roots of Echinops bannaticus Rochel ex Schrad. for kidney stones (despite a few studies on other species of the genus Echinops, this Balkan species is largely under-investigated); and 3. The internal use of decoctions of aerial parts of Orlaya grandiflora Hoffm. for its laxative effects (the plant is completely unknown in the phytopharmacological literature).
Comparison with the Albanian and Montenegrin Alpine ethnobotanical literature Table 2 and Figure 2 show the sites and field studies that have been compared with the data gathered in the Kosovar Alps.        Figure 3 and Table 3 illustrate the similarity between the wild medicinal plants used and recorded in the current study and those recorded in the Montenegrin and Albanian sides of the same Albanian Alps.
The link between the medical ethnobotany of the Montenegrin and Kosovar sides of the Alps -despite the different ethnicity/language of the local populations -appears stronger than the link between the ethnobotany of these two locations and the ethnobotany Albania.
This apparent paradox could be explained in a number of ways: 1. Different sampling techniques may have been adopted during the field survey in the three locations or the socio-economic background of the interviewees could have been different. For example, on the Albanian side of the Alps, the previous ethnobotanical studies selected local informants from very remote areas, which remained quite isolated during Communist times and with very limited access to urban environments and culture. It could be especially worthwhile to further assess the influence of the popular phytotherapeutical literature on folk medicine in Montenegro and Kosovo, since during the Yugoslavian time this kind of popularised knowledge was said to be "en-vogue". For example, this is very evident in the Montenegrin data, where a Anti-diabetic + quoted by less than 5% of the participants; ++ quoted by more than 5% and less than 30% of the participants; +++ quoted by more than 30% of the participants     [2][3][4]7,8]) could be surely considered much more "herbophilic" than the Albanian ones, and this may have influenced the folk medicine of the Kosovar population to a certain degree during  Table 4 Comparison of the most quoted folk medicinal uses of wild taxa in the current study and in ethnobotanical studies previously conducted in Albania and Montenegro [11][12][13][14] (Same or similar uses are underlined)

Botanical taxon
Used part(s) Pathologies treated in the folk medicine of the Kosovar Alps Pathologies treated in the folk medicine of the Montenegrin Alps [15] Pathologies treated in the folk medicine of Albanian Alps [11][12][13][14] Centaurium erythraea Rafn. the last century, who have always lived in contacts with the Slavs. 4. The Montenegrin study included self-declaring Serbian and Bosniak communities. However, a large part of the Bosniak community living in the Gusinje area is represented also by "bosniakised" Albanians, whose Catholic tribes settled on this side of the Albanian Alps and converted to Islam a couple of centuries ago [37]. This could mean that the ethnobotanical data of Montenegro and Kosovo may actually refer to the same core of Muslim Albanians.
Despite the commonalities found on the quoted medicinal plants, Table 4 shows the different uses of the wild taxa, which have been most quoted in all three sides of the Alps.
From Table 4 it is interesting to underline that the folk uses of the wild medicinal taxa recorded in Kosovo often include both the uses recorded in Albania and those in Montenegro. It would then appear that the medico-ethnobotany of Kosovo -because of its history in the last century and the exposure to the South-Slavic ethnobotanical traditions -has possibly incorporated both Albanian and Slavic plant uses.

Conclusions
Medicinal plants still play a crucial role in the sphere of human health in the Albanian Alps, not only in the Montenegrin and Albanian territory, but also on the Kosovar side. Oftentimes, these mountainous communities have limited or non-existent access to Western biomedical modalities, and are instead self-reliant on their TEK. The local flora is thus incredibly important to provide the first health care within the households of the Albanian Alps.
Moreover, the biodiversity richness and unique biocultural heritage of the local people here is something to be highly valued. Steps towards this end are evident in the formation of protected parks for biodiversity conservation -but further efforts in conservation of the human TEK diversity and cultural heritage are necessary as well. TEK-dependent activities such as sustainable gathering of wild medicinal taxa, their small-scale trade, and production of local high quality plant-based foods and dairy products can all contribute to the growing eco-tourism initiatives. Thus, TEK is a critical component to success in the future economic development and biocultural conservation efforts of the region.