Ethnobotanical study of medicinal plants used in the treatment of sexual dysfunctions in traditional medicine in Kampemba-Lubumbashi, DR Congo

For a long time, vegetation has provided man with remedies to deal with his health problems such as erectile dysfunction. This study was conducted to inventory plants and recipes used in traditional medicine in Kampemba (Lubumbashi) in the treatment of sexual dysfunctions. This descriptive ethnobotanical survey was carried out between October 2017 and June 2018. It was conducted by direct interview using a guide questionnaire with 34 practitioners of traditional medicine (PMT). The 34 PMT consulted were mainly men (sex ratio Man / Women = 2.09) aged 49 ± 11 years. They provided information on 51 recipes and 33 plants among which only 21 species have been scientifically identified. Albizia adianthifolia (Schum.) W. Wight (Fabaceae) and Pericopsis angolensis (Baker) Meeuwen (Fabaceae) are the most cited species. These 21 plants are mostly trees (57%) belonging to 12 families dominated by Fabaceae (21.2%) and indicated in 22 pathologies dominated by sexual impotence with a fidelity level (FL) of 0.59. From these plants derive 37 recipes from which the root is the most used organ (75.7%). The decoction (45.9%) and the drink (78.4%) are respectively the methods of preparation and administration route most requested. This study reports for the first time the aphrodisiac use of 8 plants among which, Schrebera trichoclada Welw (Oleaceae), Strychnos stuhlmannii Gilg (Loganiaceae) and Terminalia mollis MA Lawson (Combretaceae) have the highest fidelity index (FL) (FL> 0.1). Kampemba PMTs know and use aphrodisiac plants whose investigations deserve to be continued to validate their traditional knowledge.


Introduction
Sexual dysfunction is a disturbance that can alter the cycle of sexual response to one of its four phases: arousal, plateau, orgasm, and resolution. There are several types of sexual dysfunction of which anorgasmia, sexual aversion, dyspareunia, premature ejaculation, delayed ejaculation, frigidity, impotence and vaginismus are the most common [1].
The prevalence of sexual dysfunction is estimated between 10 and 50% in men [2], but it is higher in women: 25 to 63% [3,4] in the world. A review of the literature over 10 years from 1999 to 2009) has established a prevalence of 0 to 3% of male orgasmic dysfunctions, 0 to 5% of erectile dysfunctions and 0 to 3% of dysfunctions of male hypoactive sexual desire, from 7 to 10% of female orgasmic dysfunctions and 4 to 5% premature ejaculation [5].
Several types of treatment are claimed in modern medicine against these different dysfunctions. However, most of these drugs have significant side effects and limits in meeting sexual needs; moreover they are costly [6,7]. Thus, in developing countries, most of the patients who have sexual dysfunction resort first to traditional medicine which provides several plants used for this purpose [8]. This is the case of Allium sativum L, Liliaceae [9], Anacardium occidentale L., Anacardiaceae [10], Chenopodium album L., Amaranthaceae [11], or Kaempferia parviflora Wall. ex Baker, [12]. In the city of Kampemba as in several cities of the Democratic Republic of Congo (DRC), several people use plants against sexual dysfunctions.
This study deals with the inventory and the identification of plants used in traditional Congolese medicine in Kampemba against sexual dysfunctions.

Area of study
This descriptive ethnobotanical study was conducted in the city of Kampemba (Figure 1

Ethnobotanical data collection
The ethnobotanical data were collected between October 2017 and June 2018 from traditional medicine practitioners (TMP) of the Kampemba city by direct interview using a guide questionnaire comprising 16 items. These focused mainly on the characteristics of informants (TMP) and data relating to plants used in the management of sexual dysfunction. The choice of TMP was based on their popularity in their Kampemba municipality and their willingness to share their knowledge with the investigators. The investigations were carried out in all the districts of Kampemba. Inventoried plants were collected along with PMT and an herbarium was established for each plant for further identification at the Kipopo herbarium where the identity of the plant was determined.

Data analysis
Socio-cultural characteristics of informants, flora, and ethnobotany of the plants made it possible to analyze the data collected and processed by the Excel software 2016. Three ethnobotanical indices were calculated to assess the significant species: The relative frequencies of citation (Fi (%) = n x 100 / N or Fi = n / N), the usual value (UV = ∑Ui / N), the level of relative fidelity (FL = np / N) and the consensus factor of the informant (FCI = (Nur-Nt) / (Nur-1)) as previously described [13]; With n = number of times that the character is cited and N = number of informants, Ui = Number of uses indicated by the informant i, np = number of informants who indicated a species for a use p, Nur = number of times a particular category of a condition has been mentioned, Nt = Number of plants mentioned for the treatment of this condition m. UV: used to assess the medicinal importance of a plant in the study environment, FL: used to identify the level of consensus on the use of a plant for a given indication in our study environment; FCI: establishes a consensus of informants on a given medicinal use of medicinal plants used in the study environment.

Socio-demographic characteristics of the PMT consulted
The ethnobotanical survey was conducted in 8 districts of the Kampemba city in Lubumbashi (DRC) with 34 PMTs, many of them were men (sex ratio = 2.09), with an average age of 49 years (extremes: 31 and 73 years) and an average experience of practice in the traditional medicine of 18 years (extremes: 1 and 25 years). Most informants live in Bongonga (38.3%) and Kafubu (26.5%) and are identified in the category of healers (76.5%). They did not go beyond primary education (79.4%) and most of them acquired their knowledge from their ancestors (70.6%). Although the majority are Bemba (29.4%) and Luba (38.3%) and all speak Swahili (Table 1).

Morpho-biological types, Phytogeographical distribution and Harvest site of identified plants
Only 21 out of 33 species cited during the survey as aphrodisiacs, were formally identified at the Kipopo herbarium. The identified plants were collected in 5 of the 8 districts of the Kampemba city, more than half of them were found in Kafubu (52%). The collected plant species have been divided into 3 morphological types dominated by trees (57%), 4 biological types dominated by Mesophanerophytes: MePh (55%), and 4 types of phytogeographic distribution, wherefrom Tropical Africa: TA, is the major distribution type with 38% ( Figure 2).

Aphrodisiac recipes from 21 identified plants
From 21 plants derive 37 recipes where the root (75.7%) is the most used organ alongside the leaves, stems and, mixtures of these 3 organs. These recipes are prepared according to 7 modes dominated by the decoction (45.9%) and administered in most cases in the form of a drink (78.4%) alongside the bath, the dough, and the steam (Figure 4).  (Table 3).

Pathologies managed by the plants listed
The various plants identified during this study are indicated in 22 pathologies including wounds (12), fever (12), dental caries (7), headache (7) and hepatitis (7) constitute the most cited indications apart from sexual dysfunctions ( Table 5). The consensus informing factor (FCI) is higher in the management of acne, diarrhea, gastritis, delayed ejaculation, vaginismus, otitis, colds, diabetes, and sickle cell anemia with FCI 1 but the level of informant loyalty (FL) is only higher in the management of sexual impotence (FL = 0.59). In other pathologies, the highest FL is observed for wounds and fever with an FL of 0.35 for each of these pathologies, followed by hepatitis and dental caries with an FL of 0.21 each. Apart from the use-value of pathologies of the sexual dysfunction class (UV = 0.56), the mixed class with a UV of 0.37 and the digestive tract class with a UV of 0.33 respectively occupy the second and third class (Table 5).  Concerning to the data (Table 5), this study shows that, apart from sexual dysfunctions, traditional medicine practitioners in Kampemba commune, most often use 21 plants for 4 main pathologies, fever, tooth decay, headache, and hepatitis, without having a high degree of consensus in their management unlike acne, diarrhea, gastritis, otitis, colds, diabetes and sickle cell anemia. In the category of sexual dysfunctions, the informants present a greater consensus on the use of these 21 plants in the management of sexual impotence.

Characteristics of listed plants for which botanical identification was not possible
Twelve other plants were cited during this study; however, their biological identification was not possible at the Kipopo herbarium. These plants are named in 5 vernacular languages (Zela, hemba, bemba, luba and wagenia) of which Luba is the most used language (50%). From these plants come 14 recipes where the root is the most used organ (78.6%) under 5 methods of preparation (chewing, infusion, maceration, fumigation, and decoction) dominated by the decoction (57.1%) and administered in 4 forms dominated by drink ( Figure 5). The plants Kibanda banda (Wagenia), Katshi busoko (Luba) and Kafupa (Luba) are the most cited with 4 quotes each.

Figure 5
Characteristics of aphrodisiac recipes from non-scientifically identified plants.
The recipes R46 based on the roots of Akokweto (Luba) and R50 based on the bark of roots of Mushirie Mpuya (luba), with 4 quotes each, are the most cited (Table 5). Kibanda banda (Wagenia), Katshi Busoko (Luba), Kafupa (Luba) with 4 pathologies each, are the plants most used by informants in this category of plants. Ilala jeba (Hemba) R45: Disperse 1 or 2 tbsp in the porridge (the equivalent of a dessert spoonful) or in a cup of tea; take each morning on an empty stomach. 3 Impotence, diarrhea, gastritis Kafupa (Luba) R48: Chewing a few raw roots 2 hours before acting.

Discussion
Thanks to 34 PMT, this study highlights 33 plants used in traditional medicine in Kampemba, Lubumbashi-DRC in the management of erectile dysfunction, a health problem that overwhelms a large fraction of the adult Congolese population.
In several ethnobotanical studies carried out in Lubumbashi [17,19,33,34] as well as in this study (table 1), it is showed that men over 40 years are the most encountered during the survey, and their level of education is very low. On the other hand, in some surveys conducted in North Africa [35,36], women are the majority in the practice of traditional medicine. It is possible that the proportion of women who speak out on an issue in traditional medicine is influenced by the subject himself, and in this case, sexual dysfunctions is more easily discussed topic in men than in women.
The tree is the predominant morphological type of plants identified during this study (figure 2) as an ethnobotanical study previously carried out in the same region on antimalarial plants [37]. In contrast, in several studies carried out in Cameroon, the predominant morphological type is grass [38,39]. We could suggest that the tree is the predominant morphological type in traditional medicine in Lubumbashi, and this would be influenced by the type of flora encountered in our region which is mainly the miombo forest. However, more study is needed to generalize this observation. Regarding biological types, the results of this study agree with a study carried out in Chad [40]; but disagree with a study carried out in Lubumbashi [37]. It would be more interesting to carry out a large-scale study to determine the dominant biological types in plant species used in traditional medicine in Lubumbashi. Besides, having collected more plants at Kafubu is related to the fact that this area is located near the rural areas where the vegetation itself has not yet experienced advanced deforestation unlike other areas of the city where planning has promoted deforestation [41].
The preponderance of Fabaceae as the botanical family in this study ( figure 3) is also reported in many ethnobotanical surveys conducted in Haut-Katanga [19,37,42], and this in opposition with several studies carried out in other regions of the continent [43,44].
The plants under examination are named in 6 vernacular languages ( figure 3), Bemba, Hemba, Lamba, Luba, Tshiluba and, Zela, natives of the DRC unless Tshiluba is not from the city of Lubumbashi and Bemba is the most cited language ( Table 2). These results are following in accordance with previous ethnobotanical studies carried out in the region [37,42]. The predominance of Bemba is said to be linked to two factors, notably the fact that they are among the majority ethnic groups in the region and the fact that traditional medicine is culturally developed in this ethnic group.
Regarding the knowledge reported in the literature (Table 2), these 21 plants can be grouped into 4 classes ( Figure 3) among which, Classes A and B represent more than 75% of species (Figure 3d) (Table 3). These results suggest that in the commune of Kampemba, praticians of traditional medicine are more in agreement on the use of the plant species A. adianthifolia and P. angolensis as aphrodisiacs although these two species are used the least in the practice of traditional medicine in this environment. On the other hand, E. abyssinica is the most used plant in traditional medicine in this environment. The preponderance of decoction and drink respectively as a mode of preparation and administration route of aphrodisiac recipes observed in this study ( Figure 4) are also reported in several ethnobotanical surveys reviewed in Haut-Katanga [19,37,45]. These studies are in contrast with studies carried out in other regions of the continent [43,44]. In many ethnobotanical studies, the leaf is the most used organ in traditional medicine [46][47][48][49][50], but this study indicates the root as the most used organ ( Figure 4) as in surveys of aphrodisiac plants conducted in India [51], Nigeria [25] and Mali [52]. Aside from the fact that the root constitutes a storage organ where several secondary metabolites with various therapeutic properties can be encountered, it symbolizes power, according to the people surveyed. This conception would predispose informants to resort to the root in cases of sexual impotence than in other pathologies.

Highlights
 Several Congolese suffer from erectile dysfunction and resort to traditional medicine.

Conclusion
This study reports 33 plants used in Kampemba as aphrodisiacs; 12 of them could not be botanically identified. Some of these 33 plants, such as Albizia adianthifolia (Schum.) W. Wight (Fabaceae), have been reported previously in other regions as aphrodisiac plant. Other species such as Julbernadia paniculata (Benth.) Troupin (Fabaceae) are reported for the first time and have a very significant medicinal use-value in Kampemba. Among sexual dysfunctions, most of these plants treat sexual impotence. These results suggest that further work is needed to establish scientific bases for aphrodisiac use of these plants in traditional medicine and to identify the remaining 12 species botanically.