A cross-sectional ethnopharmacological survey was conducted in rural communities within Bushenyi District, located in southwestern Uganda (Figure 1 below). Data collection took place during the months of July and August 2020. Bushenyi District, located approximately 320 km southwest of the capital city Kampala, has a population of 246,100 people (UBOS, 2014), with the majority (73.8%) residing in rural areas. Geographically, the district lies at coordinates 0.4871° S and 30.2051° E, featuring low-lying plateaus intermingled with hilly terrain and receiving an annual rainfall of 1,500–2,000 mm. The area is adorned with tropical rainforests such as Kalinzu, Katsyoha-Kitomi, and Imaramagambo, that together cover 84 square kilometers (Bushenyi District Local Government, 2014), along with savannah woodlands and wetland vegetation. In addition, the district has fertile loamy soils with varying proportions of sand and clay. Most of the district’s population (87%) is engaged in subsistence agriculture, but are also involved in commercial tea, coffee and bananas cultivation. Other economic activities include fishing, stone quarrying, sand and mineral mining, tourism and lumbering. The main ethnic groups in the district are the Banyankole, who are the majority, along with the Bakiga and Baganda. The main local language spoken is Runyanore-Rukiga. We chose Bushenyi district as our study area due to the presence of an organized group of traditional healers, the Bushenyi Medical and Traditional Healers Association (BUMETHA). Founded in 1988, BUMETHA actively fosters collaboration between modern and traditional medicine, including in research, some of which has been published (Tumwesigye, 1996; Catherine et al., 2020; Primah, 2023).

The Informant Consensus Factor (ICF) is a measure used in ethnopharmacological studies to quantify the level of agreement among traditional medicine practitioners regarding the use of specific plants for a particular ailment category, which is alcohol in this study. The ICF was calculated in this study using the formula (Oryema et al., 2021): ICF = N ur   −   N t /   ( N ur   − 1 where N_ur is the number of use reports or mentions and N_t is the number of species used.

Fifty traditional medicine practitioners were enrolled into the study. The ages of the TMPs ranged from 34 to 98 years, with a mean age of 67. The 25th percentile age was 59 years, indicating that three-quarters of the traditional healers were older than 59 years. The mean experience of the TMPs was 31 years, while the 50th percentile years of experience in traditional healing was 30, indicating that half of the healers had more than 30 years of experience in traditional healing. Approximately two-thirds of the TMPs (33/50, 66%) were female. The majority of participants (42/50, 84%) had either not received formal education or had completed only primary education. Nearly all (46/50, 92%) were engaged in additional occupations alongside their traditional medicine practices, primarily in peasant farming and informal businesses. Only four of the participants exclusively practised traditional medicine without any other occupation. Details of the socio-demographic characteristics are in Table 2 below.

The total number of plant species identified were 25 belonging to 20 families (Figure 2 below). Asteraceae was the predominant family.

The four most commonly used ethnomedicinal plant species were Dracaena fragrans (L.) Ker Gawl., Coffea canephora Pierre ex A. Froehner, Saccharum officinarum L. and Melanthera scandens (Schumach. and Thonn.) Brenan (Details in Table 3 below).

The most prevalent life form of plants employed was the herbs (36%), while grasses (4%), were the least frequently utilized, as depicted in Figure 3 below.

Leaves (48%) were the most utilized plant parts, while fruits and seeds were the least used, each contributing only 4%, as depicted in Figure 4 below.

Among the 50 Traditional Medicine Practitioners interviewed, 40% exclusively utilized a single plant, 38% combined two plants, and 19% mixed three or four plants in the preparation of herbal remedies for alcohol. The traditional healers utilized four methods to prepare the medicinal plant remedies. The decoction method involved the prolonged boiling of plant parts, such as roots, bark, or seeds, in water to extract medicinal compounds. Tinctures were made by immersing plant parts in alcohol or a mixture of alcohol and water. Additionally, plant materials were dried and processed into powders for application. Finally, certain healers employed the technique of pounding or squeezing fresh plant parts to extract beneficial juices. The most prevalent techniques employed by the Traditional Medicine Practitioners for preparing medicinal plant remedies were squeezing or pounding plant parts to extract juice, utilized by 41% of the healers, and the least was tincturing used by only 8% of the healers. In terms of administering the powder or juice, all the TMPs, with the exception of one, mixed 1–2 spoonfuls of the powder or juice with alcohol, which was then given to the patient for consumption. The sole exception to this practice involved a TMP who combined the powder with a ripe banana, forming a paste that was given to the patient for ingestion. Figure 5 below shows the methods used by the healers in the preparation of the medicinal plant parts.

In this survey, the Relative Frequency of Citation (RFC) ranged between 0.02 and 0.44. Based on this RFC data, the four most commonly used ethnomedicinal plant species were D. fragrans (0.44), C. canephora (0.40), S. officinarum (0.1) and M. scandens (0.06).

We calculated the Informant Consensus Factor (ICF) using the following formula: ICF = (N_ur - N_t)/(N_ur −1) where N_ur is the number of use reports or mentions and N_t is the number of species used. In this study, N_ur was 74, and N_t was 25. Therefore ICF = 74   –   25 / 74 − 1 = 0.67

The observation in this study that the majority of TMPs were women, and predominantly older, aligns with findings in various regions of Uganda (Akwongo et al., 2022; Ssenku et al., 2022). However, it is divergent from other studies that reported a predominant male presence (Mongalo and Raletsena, 2022; Tabuti et al., 2023). The higher representation of female traditional medicine practitioners in comparison to their male counterparts can be attributed to women taking on more roles as primary healthcare providers for their families, in line with societal traditions. Consequently, the responsibility of treating individuals with alcohol-related disorders often falls upon women. Furthermore, the notable representation of older individuals among the participants in this survey corresponds with observations in other studies conducted in Uganda and the wider region (Mukazayire et al., 2011; Kamagaju et al., 2013). Older individuals in society often possess extensive knowledge of medicinal plants and their uses, attributed to their prolonged and direct interaction with plant resources.

Our observation that the most utilized plant species employed by traditional medicine practitioners belonged to the Asteraceae family aligns with other studies in Uganda and other African regions which acknowledged its significant medicinal value (Hamill et al., 2000; Tefera and Kim, 2019; Ssenku et al., 2022). These plants are widely distributed in Uganda and the chances of TMPs using them for medicinal purposes are high (Mbatudde et al., 2007). The predominant use of these families may also be due the fact that most plant species in this family are mainly herbs and shrubs, so grow quickly and available throughout the year. The four most commonly used ethnomedicinal plant species were D. fragrans, C. canephora, S. officinarum and M. scandens. In contrast, only one plant, Dracaena steudneri Engl., belonging to the Dracaenaceae family, was identified for its use in treating alcohol-related disorders in an ethnobotanical study carried out in communities surrounding Mabira Forest in Central Uganda (Tugume et al., 2016). This finding confirms the use of medicinal plants in the traditional treatment of alcohol-related disorders across different regions of Uganda.

Comparable to other studies, this survey found that herbs were the most predominant plant life form utilized by the TMPs for treating alcohol-related disorders, with shrubs and trees following in frequency. The common use of herbs, trees and shrubs has been reported in most studies in Uganda and elsewhere (Nankaya et al., 2019a; Ojelel et al., 2019; Girma et al., 2022). Their widespread utilization can be attributed to their abundance in gardens, bushes, and forests, as well as their ease of collection. The high utilization of leaves could be attributed to the ease with which they can be collected in large quantities compared to other plant parts (Nankaya et al., 2019b). Studies reporting the preference for leaves by traditional medicine practitioners suggest that it is driven by their abundance and the high concentrations of compounds with diverse medicinal properties found within leaves (Nankaya et al., 2019b). Similar findings have been described in Uganda (Hamilton, 2004; Kamatenesi-Mugisha and Oryem-Origa, 2007; Ssegawa and Kasenene, 2007; Okot et al., 2020; Mongalo and Raletsena, 2022) and other countries in Africa (Mongalo and Raletsena, 2022; Feyisa et al., 2023). The prevalent utilization of leaves, roots, flowers, and barks in herbal medicine preparations is a widespread practice across numerous communities in Uganda, as documented in central Uganda (Kamatenesi et al., 2011), southern Uganda (Ssegawa and Kasenene, 2007), western Uganda (Asiimwe et al., 2013), communities surrounding Kibale National Park (Namukobe et al., 2011), and Mpigi in central Uganda (Schultz et al., 2020). Similar practices are also reported in other countries, such as Tanzania (Amri and Kisangau, 2012), Ethiopia (Moges and Moges, 2019) and Italy (Petelka et al., 2020).

A relatively high ICF observed in this study is comparable to other studies. High ICF were noted for plants used by traditional medicine practitioners in treating breast cancer (Lutoti et al., 2023), malaria (Adia et al., 2014) and other ailments (Ssenku et al., 2022). Other studies in Uganda have reported even higher ICF levels of up to 0.9 (36). The high ICF signifies high levels in agreement among the healers on the plants used to treat alcohol related disorders. The difference in informant consensus factor in this study compared to others may stem from variations in ecological diversity and the extent of knowledge sharing within the study areas.

The methods employed by the TMPs in preparation of medicinal plant remedies in our study aligns with the findings of another study conducted in southwestern Uganda (Gumisiriza et al., 2019) which highlighted crushing/pounding then mixing in water as a common method for preparing herbal remedies. Powders are preferred primarily for their prolonged shelf life, proving especially beneficial when utilizing seasonal plant parts like flowers and fruits. In contrast, infusions are consumed within a day, while decoctions are stored in tightly sealed containers for at least 1 week at room temperature. However, this finding contrasts with other research conducted in Uganda and the broader East African and African regions, where decoction is frequently identified as the dominant method of herbal preparation (Alebie et al., 2017; Gumisiriza et al., 2023). Decoctions may be preferred when the part of the plant used is available all year round such as leaves and bark. The widespread use of water as a solvent is attributable to its ready availability and its ability to dissolve a large number of metabolites. This property allows for the swift extraction of active ingredients during the preparation of herbal remedies (Alebie et al., 2017). An interesting observation by healers of mixing the prepared powder or tincture into alcohol is contradictory. The healers may see this as the easiest method to administer the remedy.