# Ethnonutritional and Medicinal Plant Knowledge and Practices for Postpartum Maternal Healthcare in Yoto Prefecture, Togo: An Ethnopharmacological Study

Mlatovi Degbe, Efui Holaly Gbekley, Yendube Kantati, Akouvi Wotsa Mawuli Akakpo, Amivi Tetebenissan, Boe Berthine Toubate, Kossi Metowogo

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Mlatovi Degbe, Efui Holaly Gbekley, Yendube Kantati, Akouvi Wotsa Mawuli Akakpo, Amivi Tetebenissan, et al.. Ethnonutritional and Medicinal Plant Knowledge and Practices for Postpartum Maternal Healthcare in Yoto Prefecture, Togo: An Ethnopharmacological Study. European Journal of Medicinal Plants, 2025, 36 (6), pp.52-69. 10.9734/ejmp/2025/v36i61306. hal-05376168

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# Ethnonutritional and Medicinal Plant Knowledge and Practices for Postpartum Maternal Healthcare in Yoto Prefecture, Togo: An Ethnopharmacological Study

Mlatovi DEGBE a,b*, Efui Holaly GBEKLEY b,c,
Yendube T. KANTATI d, Akouvi Wotsa Mawuli AKAKPO d,
Amivi TETEBENISSAN a,b, Boe Berthine TOUBATE e
and Kossi METOWOGO d

## Authors' contributions

This work was carried out in collaboration among all authors. All authors read and approved the final manuscript.

## Article Information

DOI: https://doi.org/10.9734/ejmp/2025/v36i61306

**Open Peer Review History:**

This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers, peer review comments, different versions of the manuscript, comments of the editors, etc are available here: https://pr.sdiarticle5.com/review-history/147992

**Original Research Article**

Received: 06/09/2025

Published: 18/11/2025

<footnote>a Forestry Research Laboratory (LRF), University of Lomé, 01 B.P. 1515 Lomé 01, Togo.</footnote>

<footnote>b Laboratory of Biochemistry and Nutrition, Department of Biochemistry and Nutrition, Faculty of Sciences, University of Lomé, 01 B.P. 1515 Lomé, Togo.</footnote>

<footnote>c Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso.</footnote>

<footnote>d Laboratory of Physiology and Pharmacology, Research Unit in Pathophysiology, Bioactive Substances and Safety, University of Lomé, 01 B.P. 1515, Lomé, Togo.</footnote>

<footnote>e ISP, François Rabelais University of Tours, INRAE, 37200 Tours, France.</footnote>

<footnote>*Corresponding author: E-mail: angelodegbe@gmail.com;</footnote>

<footnote>**Cite as:** Mlatovi DEGBE, Efui Holaly GBEKLEY, Yendube T. KANTATI, Akouvi Wotsa Mawuli AKAKPO, Amivi TETEBENISSAN, Boe Berthine TOUBATE, and Kossi METOWOGO. 2025. "Ethnonutritional and Medicinal Plant Knowledge and Practices for Postpartum Maternal Healthcare in Yoto Prefecture, Togo: An Ethnopharmacological Study". European Journal of Medicinal Plants 36 (6):52-69. https://doi.org/10.9734/ejmp/2025/v36i61306.</footnote>
ABSTRACT

**Introduction:** The postpartum period is a critical phase for maternal health, particularly in sub-Saharan Africa. In Togo, modern healthcare coexists with deeply rooted, yet largely undocumented, endogenous knowledge systems for postpartum care. This ethnopharmacological and ethnonutritional heritage, vital for restoring maternal vitality, faces erosion and lacks integration with biomedicine, posing potential safety risks. This study aimed to systematically document, analyze, and evaluate the traditional knowledge governing postpartum healthcare in the Yoto prefecture of Togo.

**Methods:** A cross-sectional, mixed-methods ethnopharmacological study was conducted from July to September 2024. Semi-structured interviews were administered to 305 informants (traditional healers, birth attendants, mothers, and elders) selected via purposive and snowball sampling. Data were analyzed using qualitative thematic content analysis to understand local etiologies and quantitative ethnobotanical indices (Use Value, UV; Informant Consensus Factor, ICF) to assess knowledge consensus. A literature review was performed to assess the pharmacological plausibility and toxicological risks of key species.

**Results:** The local postpartum care model is a coherent system based on the perceived vulnerability of the new mother, focusing on healing an internal wound (88.9%), "restoring blood" (83.6%), and "warming the body" (84.6%). We documented over 21 plant taxa, with leaves (76.5%) and decoctions (63.5%) being the most frequent preparations. An exceptionally high ICF (0.99) was found for all three main therapeutic categories (uterine cleansing, anti-anemic, and wound healing), indicating a highly robust, shared knowledge system. Key species identified by high Use Value included *Tetrapleura tetraptera* (UV=0.87), *Moringa oleifera* (UV=0.83), and *Alstonia boonei* (UV=0.76). A state of medical pluralism was confirmed: 89.8% of women use modern health facilities, yet only 14% discuss their traditional remedy use with providers.

**Conclusion:** The traditional postpartum knowledge in Yoto is a sophisticated system with high pharmacological plausibility for many practices. However, this study identifies significant public health risks, notably the use of potentially hepatotoxic plants (*A. boonei*) and the intensive use of antiplatelet-rich spices (e.g., *Zingiber officinale*) that may exacerbate postpartum hemorrhage. The profound communication gap between traditional and modern systems creates a dangerous blind spot. Urgent pharmacological validation and culturally competent communication strategies are required to integrate these systems safely and effectively.

Keywords: Ethnopharmacology; ethnonutrition; postpartum care; maternal health; medicinal plants; Togo; medical pluralism; tetrapleura tetraptera.

1. INTRODUCTION

The postpartum period, or puerperium, defined as the six weeks following childbirth (World Health Organization, 2022), represents a critical phase of physiological and psychological adjustment for maternal health (Benova et al., 2018). This transition, marked by uterine involution, profound hormonal shifts, and the onset of lactation, exposes mothers to significant risks of morbidity and mortality, necessitating adequate management (Benova et al., 2018). In regions such as sub-Saharan Africa, which bears a disproportionate burden of global maternal mortality (Say et al., 2014), optimizing postnatal care is a paramount public health challenge.

In Togo, as in many African societies, modern public health strategies coexist with a rich corpus of endogenous knowledge (Sofowora, 2010).

This phenomenon, termed "medical pluralism" (Gadikou et al., 2022), describes how populations navigate between biomedicine and traditional care systems to meet their health needs. These ancestral systems are not limited to phytotherapy but comprise a holistic framework of care aimed at restoring the mother's vitality, promoting healing, and supporting lactation (Lamxay et al., 2011).

This study employs an ethnonutritional approach, which we define as the interdisciplinary study of food and health practices within a specific cultural context, examining the selection, preparation, and consumption of resources based on traditional beliefs and their perceived health benefits. This approach is distinct from purely ethnobotanical surveys as it integrates dietary regimes, food taboos, and "food-as-
medicine" concepts (Noura et al., 2024), which
are central to postpartum recovery.

In the Togolese context, local perception frames
childbirth as an event creating an internal wound
and a substantial loss of "blood" or vital
substance (Atakpama et al., 2021). This
etiological model justifies the application of
precise remedies and diets. These
ethnosciences represent an invaluable source of
knowledge regarding local resources and
culturally adapted approaches to maternal
health.

However, this phytotherapeutic and dietary
heritage, being primarily of oral tradition, faces a
dual threat. The absence of systematic
documentation and scientific evaluation
accelerates its erosion in the face of rapid socio-
economic change and globalization (Vandebroek
& Balick, 2012; Reyes-García et al., 2007). This
creates a high-risk situation, particularly for
breastfeeding women, due to the un-evaluated
use of potentially potent remedies and a
significant lack of dialogue between traditional
practitioners and modern health professionals
(Bono, 2020).

Despite its prevalence and cultural importance,
the specific ethnonutritional and
ethnopharmacological knowledge for postpartum
care in the Yoto prefecture of Togo remains
scientifically undocumented. This research,
therefore, aims to systematically document,
understand, and analyze this traditional
knowledge. The objectives are threefold: (1) To
analyze medicinal plant inventory and dietary
regimens used in postpartum maternal
healthcare; (2) to analyze the cultural logic and
know-how associated with these practices; and
(3) to evaluate the pharmacological plausibility of
the most frequently cited practices against
existing scientific literature. Ultimately, this work
seeks to provide a scientific basis for future
pharmacological investigation and to inform the
development of more holistic, safe, and culturally
relevant maternal health strategies.

**2. MATERIALS AND METHODS**

**2.1 Study Area**

The study was conducted in the Yoto prefecture,
situated in the Maritime region of Togo. This
prefecture was selected based on its rich
botanical diversity and the recognized
persistence of robust endogenous healthcare
practices. The region is characterized by a

Guinean-Congolese tropical climate with two
rainy seasons, and its ecology is a mosaic of
dense forest remnants, secondary formations,
and savannas included in the "Dahomey Gap".
The prefecture is socio-culturally diverse, though
predominantly inhabited by Ewe (Wouatchi),
Adja, and Fon ethnic groups, who maintain
strong ties to traditional medicine and cultural
postpartum practices. Fig. 1 presents a map of
the study area, indicating the specific localities
surveyed.

**2.2 Ethnobotanical and Ethnonutritional**
**Data Collection**

A cross-sectional, mixed-methods approach was
employed, combining quantitative surveys and
qualitative semi-structured interviews. Fieldwork
was conducted between July and September
2024.

A total of 305 informants were selected using
purposive sampling, supplemented by the
"snowball" technique to identify key knowledge
holders. The informants comprised traditional
health practitioners (THPs) and herbalists
(N=65), traditional birth attendants (N=30),
postpartum mothers (N=85), other
mothers/elderly women (N=90), and other key
community members (e.g., notables, household
heads) (N=35).

The selection of purposive and snowball
sampling methodologies was a deliberate choice,
aligned with the fundamental principles of
ethnobotanical and ethnopharmacological
research. While acknowledging the limitation
concerning statistical generalization across a
wider population, this approach is scientifically
required to identify and engage Key Informants
(KIs) who possess deep, specialized, and
culturally validated knowledge of ethnomedical
practices. The study's primary objective was not
statistical representativeness but the systematic
documentation and evaluation of a culturally
bounded knowledge domain (as quantified by
indices like ICF and UV). Therefore, prioritizing
the density and quality of knowledge, rather than
the random distribution of participants, was
essential to capture the nuanced and complex
local system of postpartum care.

Data were collected using a semi-structured
interview guide. This guide was developed
following established ethnopharmacological
standards (Weckerle et al., 2018) and gathered
data on: Socio-demographic information of the
informants.
<figure><img src="image_3.png" /><figcaption>Fig. 1. Yoto Prefecture (Togo)</figcaption></figure>
General ethnonutritional knowledge, including specific foods, dietary regimes, and food taboos during the puerperium.

Medicinal plant knowledge, documenting for each species: local vernacular names, plant parts used, specific postpartum ailments treated, methods of preparation, and modes of administration.

## 2.3 Botanical Collection and Identification

Voucher specimens of the cited medicinal plant species were collected in situ whenever possible, particularly for wild-harvested species, with the assistance of the informants. Each available specimen was assigned a unique collection code, photographed, and prepared following standard herbarium techniques. Specimens were formally identified by taxonomists at the Herbarium of the University of Lomé, where they are deposited. For common ethnonutritional species primarily sourced from markets or home gardens (e.g., Sorghum bicolor, Corchorus olitorius), identification was confirmed by informants and cross-referenced with local botanical guides, though voucher collection was not always feasible

## 2.4 Data Analysis

Data were subjected to both quantitative and qualitative analysis.

### 2.4.1 Quantitative analysis

Ethnobotanical data were analyzed using descriptive statistics (frequencies, percentages) in GraphPad Prism 8. To assess the relative importance of cited species, the Use Value (UV) was calculated using the formula: UV = U / N, where U is the number of use reports for a species and N is the total number of informants (Tardío & Pardo-de-Santayana, 2008). To determine the consensus among informants regarding remedies for specific ailment categories, the Informant Consensus Factor (ICF) was calculated using the formula: ICF = (Nur - Nt) / (Nur - 1), where Nur is the total number of use reports for a category and Nt is the number of taxa used for that category (Heinrich et al., 1998)

### 2.4.2 Qualitative analysis

Qualitative data from the semi-structured interviews regarding cultural beliefs and practices

were transcribed verbatim and translated into English. The data were then analyzed using thematic content analysis (Braun & Clarke, 2006). This process involved data familiarization, generation of initial codes, and identification of recurrent themes to provide a rich cultural context for the quantitative frequency data.

## 2.5 Pharmacological and Toxicological Literature Review

To establish a basis for pharmacological hypotheses, an exhaustive review of scientific literature was conducted. Databases including PubMed, Google Scholar, and Scopus were searched using the scientific names of the most cited species, cross-referenced with keywords such as "postpartum," "wound healing," "pharmacological activity," "phytochemistry," "toxicology," and "antiplatelet". This synthesis aimed to compare the documented traditional uses with existing pharmacological plausibility and toxicological data (Heinrich et al., 2017), thereby evaluating the scientific relevance of the practices.

# 3. RESULTS

## 3.1 Socio-Demographic Characteristics of Informants

A total of 305 individuals from the Yoto prefecture consented to participate in the study. The sample was predominantly female, with 225 women (73.8%) and 80 men (26.2%), reflecting the central role of women in the management of postpartum maternal health.

Analysis of the community roles and age distribution (Table 1) revealed a significant demographic trend: while mothers and recent postpartum women comprised the younger age brackets, the holders of specialized knowledge, traditional health practitioners (THPs) and traditional birth attendants (TBAs), were predominantly older. Notably, 72.3% of traditional practitioners and 83.3% of traditional midwives were over 46 years old. This finding underscores the cultural reality in many West African societies, where ethnopharmacological and ethnonutritional knowledge is accumulated through experience and its transmission is often vested in elders (Anyinam, 1995). Among the 225 women surveyed, 92% had at least one child, with an average of 4.2 children per mother.
<table><caption>Table 1. Distribution of respondents by age group and community role (N=305)</caption><thead><tr><th>Community role</th><th>18-30 years</th><th>31-45 years</th><th>46-60 years</th><th>+60 years</th><th>Total per Role</th></tr></thead><tbody><tr><td>Postpartum Woman (&lt; 1 year)</td><td>70</td><td>15</td><td>0</td><td>0</td><td>85</td></tr><tr><td>Mother / Grandmother*</td><td>12</td><td>55</td><td>18</td><td>5</td><td>90</td></tr><tr><td>Matron / Traditional birth attendant</td><td>0</td><td>5</td><td>15</td><td>10</td><td>30</td></tr><tr><td>Traditional health practitioner / Herbalist</td><td>5</td><td>18</td><td>20</td><td>22</td><td>65</td></tr><tr><td>Other (notable, household head, etc.)</td><td>2</td><td>3</td><td>8</td><td>22</td><td>35</td></tr><tr><td>Total per Age Group</td><td>89</td><td>96</td><td>61</td><td>59</td><td>305</td></tr></tbody></table>

## 3.2 Local Perceptions of Postpartum Vulnerability

The qualitative thematic analysis revealed a coherent local cosmovision that frames the postpartum period as a state of profound vulnerability. This framework is built upon three central concepts that justify all subsequent therapeutic interventions.

- **The internal woundand "cleansing":** Childbirth is almost universally conceptualized as an event that creates an internal wound (88.9% of informants). Consequently, the primary concern of postpartum care is to "cleanse" the womb (94.4%) to expel "impurities" (lochia) and promote healing.

- **Restoration of strength and "blood":** The significant blood and energy loss during delivery is a major concern, with 83.6% of informants citing the need to "restore the mother's strength" and "produce blood".

- **Restoration of thermal balance:** The qualitative data revealed a pervasive belief, consistent with many traditional humoral theories (a traditional medical concept asserting that health depends on maintaining the balance between bodily 'hot' and 'cold' qualities) (Mawson, 2013), that childbirth causes a loss of "body heat." Therefore, dietary and therapeutic practices are heavily oriented towards "warming the body" (84.6%). and avoiding "cold" elements, which are believed to slow healing.

The recommended duration for this intensive care period, 63.6% of respondents stated, is between four and six weeks, a timeframe that aligns with the biomedical definition of the

puerperium but is justified locally by these cultural imperatives.

## 3.3 Ethnonutritional and Medicinal Plant Inventory

A total of 22 plant entries, representing at least 21 distinct taxa, were documented for postpartum maternal care. *Amaranthus spp.* was cited for two distinct therapeutic purposes (anti-anemic and laxative/uterine inhibitory properties), which are presented as separate entries in the analysis. The most represented families were zingiberaceae, poaceae, malvaceae, and euphorbiaceae, each contributing two species to the inventory.

The plant-based preparations were categorized according to the local therapeutic objectives identified in the qualitative analysis. The most frequently used plant part was the leaves (76.5%), followed by the bark (54.2%). Decoction was the primary method of preparation (63.5%).

Table 2 presents the most critical species identified, integrating data on their nomenclature, vernacular names, preparation, and use frequency.

### 3.3.1 Plants for uterine "cleansing" and involution

This category showed the highest informant consensus. *Tetrapleura tetraptera* (Schumach. & Thonn.) Taub. was the most cited species (86.9%), used primarily in decoctions or soups to cleanse the womb. *Alstonia boonei* De Wild. (75.7%) was also highly cited, explicitly for healing the internal woundand promoting the expulsion of lochia. Sourcing for these potent medicinal species was primarily from wild harvesting (78% of users in this category), indicating a strong reliance on the local ecosystem.

<footnote>*Mother / Grandmother (had not given birth within the last year)</footnote>
<table><caption>Table 2. List of key medicinal and ethnonutritional plants for postpartum healthcare in yoto prefecture (N=305)</caption><thead><tr><th>Botanical Name</th><th>Family</th><th>Local Vernacular Name</th><th>Plant Part Used</th><th>Method of Preparation</th><th>Reported Use</th><th>Freq.</th><th>Percent. (%)</th></tr></thead><tbody><tr><td colspan="8"><strong>Plants for uterine "cleansing" & involution</strong></td></tr><tr><td>Tetrapleura tetraptera (Schumach. & Thonn.) Taub.</td><td>Fabaceae</td><td>Ésese</td><td>Fruits</td><td>Decoction (in soup or as a drink)</td><td>Cleanse the womb; Promote uterine involution</td><td>265</td><td>86.9%</td></tr><tr><td>Alstonia boonei De Wild.</td><td>Apocynaceae</td><td>gnamidua</td><td>Barks and Roots</td><td>Decoction (sitz bath and drink)</td><td>Internal woundhealing; Expel placental residues</td><td>231</td><td>75.7%</td></tr><tr><td>Lippia multiflora (Voucher: 09207TG Clt/AK)</td><td>Verbenaceae</td><td>Avoudati / Avloti</td><td>Leaves and Buds</td><td>Infusion or maceration (to be drunk)</td><td>Cleanse the womb; Promote uterine involution</td><td>194</td><td>63.6%</td></tr><tr><td>Zingiber officinale (Voucher: 348FDS/UL)</td><td>Zingiberaceae</td><td>dotè</td><td>Roots (Rhizomes)</td><td>Decoction (mixed with porridge)</td><td>Cleanse the womb; Promote uterine involution</td><td>159</td><td>52.13%</td></tr><tr><td>Curcuma longa</td><td>Zingiberaceae</td><td>Dotèdjin</td><td>Roots (Rhizomes)</td><td>Decoction (mixed with porridge)</td><td>Cleanse the womb; Promote uterine involution</td><td>158</td><td>51.8%</td></tr><tr><td>Commelina africana</td><td>Commelinaceae</td><td>gbeniku</td><td>Whole plant</td><td>Decoction (sitz bath)</td><td>Cleanse the womb; Promote uterine involution</td><td>122</td><td>40.0%</td></tr><tr><td>Aloe barbadensis Mill</td><td>Asphodelaceae</td><td>Aloesse</td><td>Succulent leaves</td><td>The gel is drunk raw, or the leaf is used as an infusion.</td><td>Cleanse the womb; Promote uterine involution</td><td>85</td><td>27.8%</td></tr><tr><td>Allium sativum (Voucher: 10856/296FDS/UL)</td><td>Amaryllidaceae</td><td>Ayo</td><td>Garlic cloves</td><td>Added in larger quantities to sauces, as an infusion, or eaten raw</td><td>Cleanse the womb; Promote uterine involution</td><td>72</td><td>23.6%</td></tr><tr><td colspan="8"><strong>Ethnonutritional plants for "restoring strength" (anti-anemic)</strong></td></tr><tr><td>Moringa oleifera Lam. (Voucher: TOGO15317)</td><td>Moringaceae</td><td>yovoviti</td><td>Leaves</td><td>Sauce, infusion, or powder in porridge</td><td>Restore strength; Produce blood (Anti-anemic)</td><td>252</td><td>82.6%</td></tr><tr><td>Sorghum bicolor (L.) Moench</td><td>Poaceae</td><td>Adako / adadjin</td><td>Leaf sheaths</td><td>Decoction (often with milk and</td><td>Produce blood (Anti-anemic)</td><td>215</td><td>70.5%</td></tr></tbody></table>
<table><thead><tr><th>Botanical Name</th><th>Family</th><th>Local Vernacular Name</th><th>Plant Part Used</th><th>Method of Preparation</th><th>Reported Use</th><th>Freq.</th><th>Percent. (%)</th></tr></thead><tbody><tr><td>Corchorus olitorius (Voucher: 8750)</td><td>Malvaceae</td><td>Adémé</td><td>Leaves</td><td>Sauce (leafy vegetable)</td><td>Produce blood (Anti-anemic)</td><td>188</td><td>61.6%</td></tr><tr><td>Amaranthus spp.</td><td>Amaranthaceae</td><td>Fontete</td><td>Leaves</td><td>Sauce (leafy vegetable)</td><td>Produce blood (Anti-anemic)</td><td>161</td><td>52.8%</td></tr><tr><td>Hibiscus sabdariffa (Voucher: 4431)</td><td>Malvaceae</td><td>Bissap</td><td>Flowers (Calyces)</td><td>Infusion (cold or hot beverage)</td><td>Produce blood (Anti-anemic)</td><td>140</td><td>45.9%</td></tr><tr><td>Manihot esculenta</td><td>Euphorbiaceae</td><td>Atité / akouté</td><td>Young leaves</td><td>Primarily in sauce; rarely as infusion or maceration of raw leaves</td><td>Produce blood (Anti-anemic)</td><td>67</td><td>21.96%</td></tr><tr><td>Solanum macrocarpon or Solanum aethiopicum (Voucher: - / 8519)</td><td>Solanaceae</td><td>Gboma</td><td>Green leaves (vegetables)</td><td>Vegetable primarily used for sauce</td><td>Produce blood (Anti-anemic)</td><td>63</td><td>20.65%</td></tr><tr><td>Amaranthus spp.</td><td>Amaranthaceae</td><td>Fontètè</td><td>Green leaves (vegetables)</td><td>Nutritious leaves used for sauce</td><td>possessing laxative and uterine contraction inhibitory properties</td><td>58</td><td>19.01%</td></tr><tr><td colspan="8"><b>Plants for wound healing (internal & external)</b></td></tr><tr><td>Zanthoxylum zanthoxyloides (Lam.) Zepern. & Timler</td><td>Rutaceae</td><td>Héti</td><td>Barks and Roots</td><td>Decoction (drink and sitz bath)</td><td>Internal woundhealing; Pain relief; Antiseptic</td><td>225</td><td>73.8%</td></tr><tr><td>Alchornea cordifolia (Schumach. & Thonn.) Müll.Arg.</td><td>Euphorbiaceae</td><td>Djeka</td><td>Leaves</td><td>Decoction (intimate hygiene, sitz bath)</td><td>Wound healing (perineal); Antiseptic</td><td>199</td><td>65.2%</td></tr><tr><td>Chrysopogon zizanioides</td><td>Poaceae</td><td>gongoli</td><td>Roots</td><td>Maceration or infusion (drink)</td><td>Wound healing</td><td>175</td><td>57.4%</td></tr><tr><td>Spondias mombin L.</td><td>Anacardiaceae</td><td>Aklikonti</td><td>Leaves and Bark</td><td>Decoction (drink and wash)</td><td>Wound healing</td><td>148</td><td>48.5%</td></tr><tr><td>Morinda lucida Benth.</td><td>Rubiaceae</td><td>Dadaklam</td><td>Leaves</td><td>Decoction (drink)</td><td>Wound healing</td><td>115</td><td>37.7%</td></tr><tr><td>Xylopia aethiopica (Voucher: 01984TG Clt/AK)</td><td>Annonaceae</td><td>Etso</td><td>Pods</td><td>Decoction or infusion for consumption</td><td>Wound healing</td><td>114</td><td>37.3%</td></tr></tbody></table>
### 3.3.2 Ethnonutritional plants for "restoring strength" (anti-anemic)

This category illustrates the "food-as-medicine" concept central to ethnonutrition *Moringa oleifera* Lam. (82.6%) was the most recommended plant, prepared as a leafy sauce to restore strength. The red leaf sheaths of *Sorghum bicolor* (L.) Moench (70.5%) were decocted as a beverage to "make blood". Unlike the medicinal plants, these resources were predominantly sourced from home gardens (65%) and local markets (30%), suggesting a managed and cultivated local resource base.

### 3.3.3 Plants for wound healing (internal and external)

*Zanthoxylum zanthoxyloides* (Lam.) Zepern. & Timler (73.8%) was the most cited plant for healing the internal wound and for pain relief, administered as both a drink and a sitz bath (*The postpartum practices frequently incorporate the use of medicinal plant decoctions administered*

as a sitz bath, a warm, shallow bath to cleanse and soothe the perineal area.) *Alchornea cordifolia* (Schumach. & Thonn.) Müll.Arg. (65.2%) was used almost exclusively externally as a decoction for sitz baths and intimate washing to accelerate perineal healing and prevent infection.

## 3.4 Quantitative Ethnobotanical Indices (UV and ICF)

The Use Value (UV) for all documented species ranged from 0.19 to 0.87. Species with the highest UVs included *Tetrapleura tetraptera* (UV = 0.87), *Moringa oleifera* (UV = 0.83), and *Alstonia boonei* (UV = 0.76), indicating their high relative importance in the study area. The UV for all species is presented in Table 3.

The Informant Consensus Factor (ICF) was calculated for the three main local therapeutic categories identified (Table 4). All categories demonstrated an exceptionally high degree of consensus, with ICF values of 0.99 for all three

<table><caption>Table 3. Species most frequently cited by informants for their medicinal and ethnonutritional uses in the Yoto prefecture, classified in descending order of their Use Value</caption><thead><tr><th>Botanical name</th><th>Family</th><th>Citation frequency (n)</th><th>Use Value (UV)</th></tr></thead><tbody><tr><td><em>Tetrapleura tetraptera</em> (Schumach. & Thonn.) Taub.</td><td>Fabaceae</td><td>265</td><td>0.87</td></tr><tr><td><em>Moringa oleifera</em> Lam.</td><td>Moringaceae</td><td>252</td><td>0.83</td></tr><tr><td><em>Alstonia boonei</em> De Wild.</td><td>Apocynaceae</td><td>231</td><td>0.76</td></tr><tr><td><em>Zanthoxylum zanthoxyloides</em> (Lam.) Zepern. & Timler</td><td>Rutaceae</td><td>225</td><td>0.74</td></tr><tr><td><em>Sorghum bicolor</em> (L.) Moench</td><td>Poaceae</td><td>215</td><td>0.70</td></tr><tr><td><em>Alchornea cordifolia</em> (Schumach. & Thonn.) Müll.Arg.</td><td>Euphorbiaceae</td><td>199</td><td>0.65</td></tr><tr><td><em>Lippia multiflora</em></td><td>Verbenaceae</td><td>194</td><td>0.64</td></tr><tr><td><em>Corchorus olitorius</em></td><td>Malvaceae</td><td>188</td><td>0.62</td></tr><tr><td><em>Chrysopogon zizanioides</em></td><td>Poaceae</td><td>175</td><td>0.57</td></tr><tr><td><em>Amaranthus</em> spp.</td><td>Amaranthaceae</td><td>161</td><td>0.53</td></tr><tr><td><em>Zingiber officinale</em></td><td>Zingiberaceae</td><td>158</td><td>0.52</td></tr><tr><td><em>Curcuma longa</em></td><td>Zingiberaceae</td><td>158</td><td>0.52</td></tr><tr><td><em>Spondias mombin</em> L.</td><td>Anacardiaceae</td><td>148</td><td>0.49</td></tr><tr><td><em>Hibiscus sabdariffa</em></td><td>Malvaceae</td><td>140</td><td>0.46</td></tr><tr><td><em>Commelina africana</em></td><td>Commelinaceae</td><td>122</td><td>0.40</td></tr><tr><td><em>Morinda lucida</em> Benth.</td><td>Rubiaceae</td><td>115</td><td>0.38</td></tr><tr><td><em>Xylopia aethiopica</em></td><td>Annonaceae</td><td>114</td><td>0.37</td></tr><tr><td><em>Aloe barbadensis</em> Mill</td><td>Asphodelaceae</td><td>85</td><td>0.28</td></tr><tr><td><em>Allium sativum</em></td><td>Amaryllidaceae</td><td>72</td><td>0.24</td></tr><tr><td><em>Manihot esculenta</em></td><td>Euphorbiaceae</td><td>67</td><td>0.22</td></tr><tr><td><em>Solanum macrocarpon</em> or <em>Solanum aethiopicum</em></td><td>Solanaceae</td><td>63</td><td>0.21</td></tr><tr><td><em>Amaranthus</em> spp.</td><td>Amaranthaceae</td><td>58</td><td>0.19</td></tr></tbody></table>
<table><caption>Table 4. Informant Consensus Factor (ICF) for Postpartum Ailment Categories</caption><thead><tr><td>Ailment Category</td><td>Number of taxa (Nt)</td><td>Number of Use Reports (Nur)</td><td>Informant Consensus Factor (ICF)</td></tr></thead><tbody><tr><td>Cleanse the womb / Uterine involution</td><td>8</td><td>1285</td><td>0.99</td></tr><tr><td>Produce blood / Anti-anemic</td><td>8</td><td>1144</td><td>0.99</td></tr><tr><td>Internal wound/ Wound healing</td><td>6</td><td>976</td><td>0.99</td></tr></tbody></table>

categories: "uterine cleansing & involution," "anti-anemic / 'restore strength'," and "wound healing." This indicates a very high level of shared knowledge and agreement among the informants regarding the plants used for these specific postpartum conditions.

## 3.5 Specific Ethnonutritional Regimes

The qualitative belief system was directly mirrored in the community's dietary regimes.

### 3.5.1 Recommended foods

The diet is dominated by "hot," liquid, and energy-dense foods. Cereal porridges (millet, sorghum), cited by 91.1% of informants, were the staple, valued for their ability to "warm the body"

and promote lactation. These were supplemented by "fortifying" sauces (83.3%), which are rich in protein, palm oil, and "hot" spices like *Zingiber officinale* Roscoe (ginger) and *Aframomum melegueta* K. Schum. (Guinea pepper) to "produce blood".

It appears that cereal porridges form the basis of the postpartum diet for 91.1% of respondents, with their liquid consistency and warmth being considered ideal for the new mother. Sauces, rich in protein and "hot" condiments, are perceived as a means to "produce blood," directly echoing the perception of blood loss as a loss of vital substance. The preparation of these dishes is often specific, with greater use of spices deemed beneficial and prolonged cooking times.

<table><caption>Table 5. Specific recommended foods and dishes in the postpartum period (N=305)</caption><thead><tr><td>Name of Food/Dish</td><td>Main Ingredients Described</td><td>Desired Effect(s)</td><td>Frequency of Citation (n)</td><td>Percentage (%)</td></tr></thead><tbody><tr><td>Cereal Porridges (millet, sorghum, maize)</td><td>Cereal, water, sometimes enriched with sugar, peanut paste, or spices</td><td>Promote milk production; "Warm the body"</td><td>278</td><td>91.1</td></tr><tr><td>Specific "Fortifying" Sauces</td><td>Smoked/dried meat or fish, leafy vegetables (sometimes bitter), palm oil, spices (ginger, Guinea pepper)</td><td>"Produce blood"/Provide strength; Aid healing</td><td>254</td><td>83.3</td></tr><tr><td>Dishes based on peanut paste</td><td>Roasted and crushed peanuts, meat or fish, vegetables</td><td>Promote milk production; Provide strength</td><td>188</td><td>61.6</td></tr><tr><td>Hot beverages (infusions, decoctions)</td><td>Hot water, lemongrass, ginger, cloves</td><td>"Warm the body"; Cleanse the womb</td><td>167</td><td>54.8</td></tr><tr><td>Dishes based on baobab (Adansonia digitata) leaves, Fruits, and Seeds</td><td>Leaves, fruit pulp, and seeds of Adansonia digitata</td><td>The powdery pulp is used for juice (Alangba) or in porridge, while the leaves and seed kernels are used in sauce</td><td>150</td><td>49.9</td></tr></tbody></table>
<table><caption>Table 6. Main forbidden foods and drinks for the new mother (N=305)</caption><thead><tr><td>Prohibited food / Drink</td><td>Primary Justification for Prohibition</td><td>Frequency of Citation (n)</td><td>Percentage (%)</td></tr></thead><tbody><tr><td>"Slippery" or "mucilaginous" foods (okra sauce, Corchorus olitorius sauce)</td><td>Risk of causing bleeding or impeding proper healing of the "internal wound"</td><td>221</td><td>72.5</td></tr><tr><td>"Acidic" fruits and foods (pineapple, unripe mango)</td><td>Would cause abdominal pain ("afterpains") in the mother and colic in the infant via breast milk</td><td>184</td><td>60.3</td></tr><tr><td>Cold or iced beverages</td><td>"Cools the womb" and can cause pain or slow the expulsion of impurities</td><td>175</td><td>57.4</td></tr><tr><td>Meat from certain wild animals (e.g., agouti, snake, etc.)</td><td>Can transmit "diseases" or cause skin itching in the mother and child</td><td>93</td><td>30.5</td></tr></tbody></table>

<table><caption>Table 7. Use of modern health care in the postpartum period (N=305)</caption><thead><tr><td>Frequency of healthcare utilization at hospital or clinic post-delivery</td><td>Frequency (n)</td><td>Percentage (%)</td></tr></thead><tbody><tr><td>Yes, always</td><td>181</td><td>59.3%</td></tr><tr><td>Sometimes</td><td>93</td><td>30.5%</td></tr><tr><td>Rarely</td><td>25</td><td>8.2%</td></tr><tr><td>No</td><td>6</td><td>2.0%</td></tr><tr><td>Total</td><td>305</td><td>100.0%</td></tr></tbody></table>

**Forbidden Foods (Table 6):** Prohibitions were also rationalized by this framework.

**"Slippery" foods:** Foods with a mucilaginous texture, such as okra (*Abelmoschus esculentus* (L.) Moench), were the most cited prohibition (72.5%). The local justification was that their "slippery" nature would impede the healing and "closing" of the "internal wound."

**"Cold" foods:** Cold or iced beverages (57.4%) and certain "acidic" fruits (60.3%) were strictly forbidden as they are believed to "cool the womb," causing pain and slowing the "cleansing" process.

The analysis of dietary prohibitions reveals a logic of care consistent with the perception of a maternal body that is open and vulnerable after childbirth. Slimy foods are proscribed by a large majority (72.5%) for fear that they might impede the internal healing process. Likewise, the concept of "hot" and "cold" is central, with anything cold being perceived as a potential aggressor to the mother's thermal balance. These prohibitions, like the recommendations, profoundly structure the social and nutritional environment of the new mother during the first weeks following childbirth.

## 3.6 Knowledge Transmission and Medical Pluralism

The study confirmed that this ethnonutritional and medicinal knowledge is transmitted almost exclusively through oral tradition. A majority of informants (65.9%) learned these practices directly from their mother or grandmother.

However, this traditional system is facing challenges. A majority of respondents (51%) perceived that this knowledge is being eroded or less strictly followed by younger generations, citing the "influence of school and modern life" and "warnings from health personnel".

This erosion does not imply a simple replacement. The results confirm a state of medical pluralism, where traditional and modern systems are used concurrently. A striking 89.8% of the sample reported using modern health facilities (hospitals or clinics) for postnatal check-ups, either systematically (59.3%) or occasionally (30.5%).

Despite this dual use, a significant communication gap exists. Only 14% of all respondents (43 individuals) had ever discussed their use of traditional postpartum remedies with a modern healthcare professional. The reactions
they received were reportedly neutral or
dissuasive ("advised me to stop"), highlighting a
lack of integration between the two systems.

4. DISCUSSION

This ethnobotanical and ethnonutritional study conducted in the Yoto prefecture of Togo aimed to document and analyze the endogenous knowledge associated with postpartum maternal healthcare. The results confirm the existence of a coherent and complex traditional care system, structured around a specific local etiological model of postpartum vulnerability. This discussion contextualizes these findings within the broader African and global framework, evaluates their pharmacological plausibility and potential risks, and examines the dynamics of medical pluralism observed.

Our findings show that local practices are
underpinned by a clear cosmovision: childbirth is
perceived as a traumatic event creating an
internal wound and a significant loss of "blood" or
vital substance. Consequently, the therapeutic
objectives are explicit: cleanse the womb
(94.4%), promote healing (88.9%), and produce
blood (83.6%). This framework also includes a
humoral component, consistent with "hot-cold"
theories, where "cold" is seen as an inhibitor of
healing and must be counteracted by "hot" foods
and remedies.

This conceptual model is not unique to Yoto. It is
widely documented across West Africa, where
similar notions of "cleansing" and restoring
strength form the basis of postpartum care
(Lamxay et al., 2011; Atakpama et al., 2021).
Furthermore, this logic of a restorative period
with specific dietary prescriptions and
proscriptions resonates with practices in entirely
different cultural contexts, such as the
'cuarentena' (This restorative period aligns
conceptually with the traditional 40-day recovery
phase known in many cultures as cuarentena (a
40-day, culturally prescribed period of rest and
specific care following childbirth) in Latin
American communities or the 'dieta' (A crucial
component of this care is the adherence to a
strict, therapeutic dieta, a specialized, culturally
restricted, and nutrient-focused dietary regimen
designed to restore maternal 'heat' and vitality)
among Indigenous Amazonian groups, which
also emphasize thermal balance and specific
foods to promote healing (Roue &
Nakashima, 2018; Osorio-Parraguez & Pardo-
Torres, 2019; Cakil & Giongo, 2021; Kumar et

al, 2021). This convergence suggests a
widespread human cultural response to the
physiological realities of postpartum recovery (El
Bilali, 2024).

The quantitative analysis provided strong validation for the cultural coherence observed. The Use Values (UVs) confirmed the preeminence of *Tetrapleura tetraptera* (0.87) and *Moringa oleifera* (0.83) as the most critical postpartum resources which aligns with previous study (Ojewole & Adewunmi, 2004). Furthermore, the Informant Consensus Factor (ICF) for all three major ailment categories was 0.99. This exceptionally high value signifies near-total agreement among informants, suggesting this knowledge is a highly structured, shared, and robust system rather than a collection of individual preferences. This strong consensus reinforces the pharmacological hypotheses for the most cited remedies.

A primary goal of this work was to establish
pharmacological hypotheses for the most cited
remedies. The consensus around key species
suggests a high degree of perceived efficacy,
validated by intergenerational use.

About uterine "cleansing" and involution, the
overwhelming consensus for *Tetrapleura
tetraptera* (86.9%) is strongly supported by
recent literature. Its fruits are rich in saponins
and flavonoids, which possess significant. Anti-
inflammatory, antioxidant, and estrogenic
properties, which are crucial for postpartum
uterine recovery and the restoration of hormonal
balance (Mensah et al., 2024). Similarly, the use
of *Alstonia boonei* (75.7%) is justified by its
content of indole alkaloids, such as echitamine,
known to induce smooth muscle contractions,
which plausibly assist in uterine involution and
the expulsion of lochia (Odugbemi, 2008;
Omitola, 2021). *Lippia multiflora* (63.6%), rich in
iridoids and flavonoids, is recognized for its anti-
inflammatory and antispasmodic properties, likely
providing relief from postpartum abdominal
pains. (Pascual et al., 2001).

The "food-as-medicine" concept was most
evident in the anti-anemic category. The acclaim
for *Moringa oleifera* (82.6%) as a strength-
restorer is scientifically well-supported; its leaves
are an exceptional source of iron, protein, and,
critically, vitamin C, which is a powerful enhancer
of non-heme iron absorption (Anwar et al., 2007;
Atanassova & Tzatchev, 2008). The use of other
leafy vegetables like *Corchorus olitorius* (61.6%)
and *Amaranthus* spp. (52.8%), both rich in iron and folates, represent a robust, empirically derived nutritional strategy that directly aligns with modern biomedical recommendations for preventing postpartum anemia (Uusiku et al., 2010).

A notable complexity emerges with *Corchorus olitorius*, which is listed both as a recommended anti-anemic remedy (Table 2) and as a primary food prohibition (Table 6). This apparent contradiction is resolved by examining the local justification: the prohibition specifically targets the mucilaginous sauce preparation, which is believed to impede the "internal wound" from closing. This highlights that the perceived therapeutic or prohibitive quality is not only inherent to the plant itself but is critically dependent on its method of preparation and the resulting physical properties (e.g., texture).

Beyond plants, specific dietary regimes, with their recommendations and prohibitions, confirm this therapeutic logic. The prescription of "hot" and rich foods like porridges and spicy sauces aims to compensate for energy and blood loss, while the prohibition of "slippery" (okra) or "acidic" (pineapple) foods is based on a theory of humors and textures intended not to impede the process of internal coagulation and healing. These dietary practices, far from being mere superstitions, constitute a preventive and curative care system in their own right, the logic of which deserves thorough nutritional investigation (Lamxay et al., 2011).

The observed traditional uses are significantly underpinned by plausible phytochemical mechanisms, strengthening the scientific rigor of the reported ethnomedical knowledge. For instance, species used for 'uterine cleansing and involution,' such as those in the *Entada* and *Xylopia* genera, are often rich in tannins and saponins. Tannins are well-documented for their astringent properties, which facilitate tissue contraction (supporting uterine involution) and possess antimicrobial activity, thereby aiding in the prevention of puerperal infections (Cowan, 1999; Gyawali & Ibrahim, 2014. Furthermore, several plant materials incorporated into the *dieta* (diet) are high in micronutrients and bioactive compounds. The prominent inclusion of *Moringa oleifera* leaves, for example, provides a significant supply of protein, essential minerals, and vitamins, directly addressing the maternal nutritional depletion that occurs post-partum.

This convergence between traditional application and verifiable phytochemistry provides strong evidence supporting the rationale behind the local healthcare system. (Li et al., 2011)

The remedies for wound healing highlight the nuance required in pharmacological interpretation. *Alchornea cordifolia* (65.2%) is used almost exclusively as an external sitz bath for perineal healing. This use is highly plausible: its leaves are rich in tannins and flavonoids (Cowan, 1999; Gyawali & Ibrahim, 2014). Tannins are known astringents that tighten tissues and create a protective antimicrobial layer over wounds, perfectly aligning with the traditional use (Li et al., 2011; Kumar & Pandey, 2013; Su et al., 2017).

In contrast, *Zanthoxylum zanthoxyloides* (73.8%) is used orally to heal the "internal wound". While alkaloids such as berberine and chelerythrine are present, their systemic uterine effects via oral administration are questionable, as quaternary alkaloids typically exhibit poor oral bioavailability. Therefore, the mechanism of action for the ingested decoction is likely attributable to other, more absorbable compounds. In a sitz bath, these alkaloids provide potent topical antimicrobial and anti-inflammatory effects (Sofowora et al., 2013). When taken orally, the systemic effects (analgesic and anti-inflammatory) are more likely attributable to other, absorbable compounds in the bark extract, such as lignans and other alkaloids, which have been validated in *in vivo* studies (Wouatsa et al., 2013).

While the ethnopharmacological data points to plausible efficacy, the findings also raise significant safety concerns. This study documents the heavy use of remedies that are pharmacologically potent.

The cultural framework prizes "hot" remedies to "warm the body" and "cleanse the womb." This leads to the widespread use of *Zingiber officinale* (ginger), *Allium sativum* (garlic), and *Curcuma longa* (turmeric). These three species are well-documented for their antiplatelet (antithrombotic) properties (McEwen, 2015). While potentially beneficial in other contexts, their intensive use in the immediate postpartum period, a time of high vulnerability to bleeding, could pose a significant risk of delaying coagulation and exacerbating or causing postpartum hemorrhage, a leading cause of maternal mortality in the region.
The high consensus for *Alstonia boonei* must be balanced with its known toxicological profile. While it has low acute toxicity, studies on chronic or high-dose consumption of its stem bark extracts have demonstrated the potential for significant hepatotoxic (liver) and nephrotoxic (kidney) effects in animal models (Afolabi et al., 2016; Oze et al., 2007). This highlights a critical danger: as traditional knowledge on precise dosage erodes, new mothers may be vulnerable to acute or chronic poisoning. These toxicological considerations are paramount and underscore the risk of uncritically promoting traditional remedies without rigorous safety evaluation (Fokunang et al., 2011).

The study confirms a state of established
medical pluralism, a hallmark of many post-
colonial African health landscapes (Bono, 2020).
The population navigates two systems : 89.8% of
women use modern health facilities for postnatal
checks, while simultaneously adhering to
traditional ethnonutritional and phytotherapeutic
regimens.

However, this is a juxtaposition, not an
integration. The most alarming finding is the
profound communication gap: only 14% of
respondents had ever discussed their traditional
remedy use with a modern health professional,
often meeting with dissuasive or neutral
responses (Patwardhan & Patwardhan, 2005).
This communication gap, creating a "don't ask,
don't tell" dynamic, constitutes a significant public
health risk. A patient taking antiplatelet-rich
herbal teas alongside prescribed anticoagulants,
or a woman consuming potentially nephrotoxic
herbs, represents a clear and present danger
that is invisible to the conventional health
system.

This communication failure is compounded by
the vulnerability of the traditional knowledge
system itself. The data shows knowledge is
concentrated among elders (72.3% of
practitioners > 46 years old) and transmitted
orally. A majority (51%) perceive this knowledge
is eroding among younger generations (Soldati &
Paulino de Albuquerque, 2012; Constant &
Tshisikhawe, 2018). This erosion is a dual loss :
it signifies the disappearance of a rich biocultural
heritage (Vandebroek & Balick, 2012) and
increases safety risks as practices become
detached from their original context and dosage
rules.

5. CONCLUSION

This ethnopharmacological and ethnonutritional
study conducted in the Yoto prefecture of Togo
has systematically documented a
comprehensive, coherent, and deeply rooted
endogenous knowledge system dedicated to
postpartum maternal healthcare. The findings
demonstrate that local practices are not arbitrary
but are underpinned by a specific etiological
model that frames the puerperium as a state of
profound vulnerability, characterized by an
"internal wound", a loss of vital substance
("blood"), and a critical thermal imbalance. The
exceptionally high Informant Consensus Factor
(ICF) of 0.99 observed across all three major
therapeutic categories, uterine cleansing, anti-
anemic/strength restoration, and wound healing,
confirms that this knowledge is a highly
structured, robust, and widely shared cultural
framework rather than a collection of disparate
practices.

The research identified several key species of
high ethnobotanical importance, validated by
their high Use Values (UV), including *Tetrapleura
tetraptera* (UV = 0.87) for uterine involution,
*Moringa oleifera* (UV = 0.83) as a critical "food-
as-medicine" to restore strength, and *Alstonia
boonei* (UV = 0.76) for internal healing. An
extensive literature review confirms the
pharmacological plausibility of many of these
traditional uses. The ethnonutritional strategies
for combating anemia, such as the use of M.
oleifera and other iron-rich leafy vegetables, align
directly with modern biomedical
recommendations, while the external application
of Alchornea cordifolia for perineal healing is
supported by its known astringent and
antimicrobial properties.

However, this study also illuminates significant,
previously undocumented public health risks.
The high consensus for potent remedies like
Alstonia boonei is alarming, given its
documented potential for hepatotoxicity and
nephrotoxicity in high doses. Furthermore, the
cultural imperative to "warm the body" promotes
the intensive use of spices which possess well-
established antiplatelet properties. This practice
could inadvertently increase the risk of
postpartum hemorrhage.

This research confirms a state of established
medical pluralism, wherein 89.8% of women
utilize modern health facilities while concurrently
adhering to traditional regimens. The most critical
finding is the profound communication gap: only 14% of respondents had ever discussed their use of traditional remedies with a modern healthcare professional. This "don't ask, don't tell" dynamic creates a dangerous blind spot for the formal health system, masking potential toxicities and drug-herb interactions.

This traditional knowledge, concentrated among elders and facing perceived erosion, presents a dual imperative. It is an invaluable biocultural heritage holding potential for culturally acceptable health solutions, yet it also harbors immediate safety risks. This study, therefore, serves as a crucial baseline, calling for urgent pharmacological and toxicological investigations to validate the safety and efficacy of the most-cited species. Concurrently, it highlights an urgent need to develop culturally competent communication strategies to bridge the hazardous gap between traditional practitioners and modern healthcare providers, thereby fostering a more integrated, safe, and effective model of maternal healthcare in Togo.

## 6. LIMITATION OF THE STUDY

It is important to acknowledge the limitations of this research. First, the study is fundamentally descriptive and geographically confined to the Yoto prefecture. The findings, while deep, cannot be generalized to all of Togo. Second, while our thematic analysis successfully identified the core cultural framework, a more in-depth qualitative analysis, such as a remedy-by-remedy case study, could yield further nuances regarding preparation, dosage, and perceived efficacy, which were beyond the scope of this initial inventory. Finally, this study did not involve direct phytochemical, toxicological, or clinical analysis. The pharmacological and toxicological discussions are, therefore, hypotheses based on an extensive literature review, following established ethnopharmacological standards (Heinrich et al., 2017), rather than direct proof of efficacy or harm.

## CONSENT AND ETHICAL APPROVAL

This study strictly adhered to the ethical guidelines for research involving human subjects, as outlined in the Declaration of Helsinki. The complete study protocol, semi-structured interview guides, and informed consent procedures were reviewed and approved by the Institutional Review Board (IRB) of the University of Lomé. This research has been formally

approved by the Doctoral School of Developmental Biology, which serves as its legal and institutional framework. The study's objectives, procedures, the confidentiality of their data, and their right to withdraw at any time were explained verbally in French and in the local languages (Ewe (wouatchi), Adja and Fon). Written informed consent was obtained from literate participants ; verbal informed consent were obtained from non-literate participants in the presence of an impartial witness, as approved by the IRB.

## DISCLAIMER (ARTIFICIAL INTELLIGENCE)

Authors hereby declare that NO generative AI technologies such as Large Language Models (ChatGPT, COPILOT, etc.) and text-to-image generators have been used during the writing or editing of this manuscript.

## ACKNOWLEDGEMENT

The authors wish to express their profound gratitude to all the individuals who graciously welcomed us and participated in this study by completing our questionnaires. Special thanks are extended to the local notables and family heads for their invaluable cooperation in facilitating the data collection process by encouraging the participation of their community members. We are also indebted to all those who contributed their expertise to the accurate identification of the plant species

## COMPETING INTERESTS

Authors have declared that no competing interests exist.

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