# Medicinal Plants Used for Treatment of Diarrhoeal Related Diseases in Ethiopia

Authors: Bizuneh Woldeab; Reta Regassa; Tibebu Alemu; Moa Megersa
Journal: Evidence-Based Complementary and Alternative Medicine
 (2018)

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## Abstract

This paper presents a review of relevant antidiarrhoeal medicinal plants based on the fundamental knowledge accumulated by indigenous people of Ethiopia. The review includes an inventory carried out on the phytochemical and pharmacological analysis of plant species used in the treatments of diarrhoeal diseases. This study is based on a review of the literature published in scientific journals, books, theses, proceedings, and reports. A total of 132 medicinal plants used by local people of Ethiopia are reported in the reviewed literature. Herbs (43.6%) were the primary source of medicinal plants, followed by trees (27%). Some findings include the predominance of leaf material used (78%), as well as the frequent use of crushing of the plant parts (38%) as a mode of preparation. This study demonstrates the importance of traditional medicines in the treatment of basic human ailments such as diarrhoeal diseases in Ethiopia. Baseline information gaps were observed in different regions of Ethiopia. Thus, documentation of the knowledge held by other regions of Ethiopia that have so far received less attention and urban ethnobotany is recommended for future ethnobotanical studies. In addition, phytochemical studies are recommended mainly on frequently utilized medicinal plants for treatment of diarrhoeal diseases which can serve as a basis for future investigation of modern drug development. Although societies in Ethiopia have long used medicinal plants for diarrhoeal diseases treatment, it is also a good practice to perform toxicological tests.


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## Body

## 1. Introduction

Diarrhoea is a leading killer of children, accounting for nine percent of all deaths among children under age of five worldwide in 2015 [1]. Sub-Saharan Africa and southern Asia were the regions with the highest child death rates due to diarrhoea in 2015 [2]. In these regions, children under five experience 3.2 to 12 episodes of diarrhoea every year [2]. It is also reported that millions of people were at risk of diarrhoea in Ethiopia, where acute watery diarrhoea broke out in crowded and unsanitary conditions of urban and rural areas in 2009 [3]. To fight this problem, the World Health Organization (WHO) has initiated a diarrhoea disease control program to study traditional medicine practices and prevention approaches [4]. This may have valuable advantages in reducing mortality rate in developing countries due to diarrhoea.In Ethiopia, plants have been used as a source of medicine from time immemorial to treat different ailments and traditional medicine is an integral part of Ethiopian culture [5]. Traditional remedies are the most important and sometimes the only source of therapeutics for nearly 80% of the Ethiopian population and 95% of the preparations are of plant origin [6]. The widespread use of traditional medicine in communities of Ethiopia could be attributed to cultural acceptability, efficacy, physical accessibility, and economic affordability as compared to modern diarrhoeal medicine [6]. Study on traditional remedies in Ethiopia demonstrates that diarrhoea is one of the most prominent diseases treated by traditional medicines [7–9].Although there are a range of medicinal plants with antidiarrhoeal properties that have been widely used by local communities of Ethiopia, the effectiveness of many of these antidiarrhoeal traditional medicines has not been scientifically evaluated [10]. Recently, a few of these medicinal plants have attracted considerable attention and studies being conducted to scientifically evaluate their antidiarrhoeal activities. For instance, the antidiarrhoeal activities ofCalpurnia aurea[11],Cordia africana[12],Indigofera spicata [13],Lepidium sativum[14],Stereospermum kunthianum[15],Vernonia amygdalina[16], andZehneria scabra[17] have been investigated on experimental animals.It has been reported in various studies [9, 18, 19] that the knowledge on medicinal plants is getting lost due to the lack of interest by the younger generation. Since the knowledge of traditional medicine is transferred orally from generation to generation, the basic information about part of the plants used, drug preparation methods, the diseases treated, and others may be lost and discarded amidst the knowledge transfer process. Therefore, documentation of these medicinal plants is important in order to identify candidate species for the invention of therapeutic drugs. Thus, this review is initiated to document traditional uses of medicinal plants to treat diarrhoeal diseases in Ethiopia, to provide comprehensive documentation, to identify research gaps, and to suggest perspectives for future research.


## 2. Methods

The traditional uses of medicinal plants used to treat diarrhoeal diseases in Ethiopia were collected from available literature published in scientific journals, books, theses, proceedings, and reports. Literature was searched in different electronic databases (Web of Science, MEDLINE, Science Direct, and Google Scholar) and accessed between April 2016 and September 2017 using specific search terms such as “medicinal plants”, “traditional medicines”, and “Ethiopia or Indigenous people”. After identifying potential literatures, we searched if there is a report of medicinal plants used for treatment of diarrhoea in the region where the study was carried out. Data collected from the literature includes mode of preparation and administration of the species, plant parts used, additives, condition, and dosages used. Moreover, literature search was also done to document the biological and pharmacological activities of the mostly used plant species for treatment of diarrhoea.We reviewed a total of 58 publications that provided information about the use of medicinal plant species to treat diarrhoeal diseases in Ethiopia (Figure1). There are papers reported about the use of medicinal plant species from all regions of Ethiopia published between 1965 and 2017.Figure 1
Location of study sites in Ethiopia.


## 3. Medicinal Plants Diversity

This study recorded one hundred thirty-two plant species as useful in traditionally managing diarrhoeal diseases in Ethiopia (Table1). These medicinal plants were distributed among 52 families and 113 genera. Most of medicinal plants, 74 (56%), used in Ethiopia for diarrhoeal treatment are from 29 families (Table 2). Plant families with the highest number of medicinal plants in Ethiopia used for diarrhoeal diseases treatment were Fabaceae and Lamiaceae (12 species each), followed by Asteraceae (10 species), Euphorbiaceae (7 species), Verbenaceae, Solanaceae Malvaceae, Ranunculaceae, Poaceae, and Cucurbitaceae (4 species each). Fabaceae, Lamiaceae, and Asteraceae families have the highest number of species used as herbal medicines. The rest of the families were represented by one, two, or three species each (Table 2). The genus with the highest number of species was Ajuga with three species.Table 1
Ethiopian medicinal plants used for treatment of diarrhoeal diseases. Description of data. Vernacular name (Or: Afaan Oromo; S: Somali; Ku: Kunama; T: Tigre, Am: Amharic; M: Maale; Me: Meinth; Sh: Shinasha; G: Gumuz; Si: Sidama) and parts used (L: leaf; B: bark; F: fruit; R: root; Bu: bulb; Fl: flower; S: seed; St: stem; Wp: whole plant). Cultivation (Cu: cultivated; Nc: not cultivated). An asterisk (∗) indicates data collected from traditional healers.
Scientific name Vernacular name Family Parts used, preparation, and application References Abutilon longicuspe Hochst. Polo (M) Malvaceae L [20]Nc  Acacia albida Del. Gerbi (Or, S) Fabaceae B, F, and L drunk orally (concoction)B crushed, homogenized in water, and drunk [21]Nc​[22]  Acacia tortilis(Forssk.) Hayne Tadacha, Dhadhacha (Or) Fabaceae Infusion L drunk orally [21]Nc  Acalypha villicaulis A. Rich. Zibute-kemun (Me) Euphorbiaceae R [23]Nc  Achyranthes asperaL. Maxxannee (Or) Amaranthaceae The L is crushed and mixed with water [24]Nc  Agave sisalanaPerrine Angolaga (Ku) Eka (T) Agavaceae Chewing the internal (white) part of the R and swallowing the solution [25]Nc,∗  Ajuga albaRobyns Shai Shar (Aari) Lamiaceae LCrushed fresh L homogenized [18, 20]Nc  Ajuga integrifoliaBuch. Ham. Zibute-kurijun (Me)Amaro (Am) Lamiaceae RDecoction of the fresh L is drunk [23, 26]Nc  Ajuga leucanthaLukhoba Shai sher (Aari) Lamiaceae L [20]Nc  Allium sativumL. Nech-shinkurt (Am) Alliaceae The bu are chewed and swallowed [26]Cu  Amaranthus caudatusL. Bahr tef (Am) Iyasu (Or) Amaranthaceae Squeeze the L and make a juice [27–29]Nc  Anogeissus leiocarpa (DC.) Guill. & Perr. Hanse (T)Sigaa (Am) Combretaceae B and LFr are crushed in water and one cup is taken [30]Nc​[31]  Aristolochia bracteolata RETZ. Digel (Berta) Aristolochiaceae S grounded, dispersed in water, and drunk [32]Nc  Artemisia rehanL. Arity (Am) Asteraceae Boil L with water and drink the hot decoction [27]Cu  Asystasia guttata Brummitt  Acanthaceae R [33]Nc  Barleria argenteaBalf. fil.  Acanthaceae R or L [33]Nc  Bersama abyssinica Fresen.  Melianthaceae Boil and drink the decoction (L) [33]Nc  Bidens pilosa L. Hachenti (M) Asteraceae R [20]Nc  Boscia angustifoliaA. Rich. Vinna (Ku), Kermed (T) Capparidaceae Chewing [25]Nc,∗  Boswellia papyrifera (Del.) Hochst. Meker (Am) Burseraceae B [30]Nc  Brucea antidysentericaJ. F. Mill. Wagnos (Am)Qomanyo (Or) Simaroubaceae Juice of crushed bark takenR powdered and mixed in water and drunkF powder mixed with honey [34]Cu​[9]​[35, 36]  Cadaba rotundifoliaForssk.  Capparaceae Fresh L crushed and mixed with water to drink the concoction [37]Nc  Calpurnia aurea (Ait.) Benth. Ceekataa (Or)Digita (Sh, Am)Hitsawts (T)Kayneka/Digita (Aari)Zikita (Am) Fabaceae Fresh L crushed, boiled, and drunkYoung shoot homogenized in water, decanted, and then drunk with honeyThe L of the young shoots from seven plants of Digita rubbed in the handsFresh L soaked in water and taken orally S grinded, mixed with milk product locally called mancheba, and drinkRF crushed, pounded, and drunkL is crushed, and the fluid is drunkGrind the S and eat after pounding with honey [22, 23]​[28]Nc​[38][39][40] [20] [41] [42] [43] [35]  Capparis tomentosa Lam. Gaho (Sidama) Capparaceae L [44]Nc  Carica papaya L. Paapaayee (Or) Caricaceae S crushed and swallowed [22]Cu  Carissa spinarumL. Mitmita (Am) Apocynaceae Crush and squeeze the R [31, 33]Cu  Cissampelos mucronata A. Rich. Balari (M)Siyapewa (G) Menispermaceae R, crushed and squeezed [20, 31]Nc  Cissampelos pareira L. Abujelajil (G) Menispermaceae R, grounded and drunk with water [32]Nc  Citrus aurantifoliaSwingle  Rutaceae  [45]Cu,∗  Citrus limon (L.) Burm. fil. Loomii (Or) ​Lendenan (S) Rutaceae Juice is drunk with pounded young L ofCordia africana​The fruit is squeezed and the juice drunk [28], [46]∗​[47]Cu  Clematis hirsuta Guill. & Perr.  Ranunculaceae Crush the R, homogenize with cold water and drink [33]Nc  Clematis simensisFresen. Hida Fiitii (Or) Ranunculaceae L are mixed in water and the solution is taken [28]Nc  Cleome gynandraL.  Capparidaceae Roasted S of the plant eaten [18]Nc  Clerodendrum myricoides (Hochst) Vatke Maraasisaa (Or)Misirich (Am) Lamiaceae R powder solution taken orallyL [48]Nc​[23]  Clutia lanceolataForssk. Fiyelefej (Am) Euphorbiaceae Crush the R and give with water [23, 43]Nc  Coffea arabica L. Buna (Or)Bunna (Am) Rubiaceae Roast the S, pounded and mixed with honeyThe roasted S is eaten or drunk in toempty stomach for 2-3 daysRoasted powder taken with honey in empty stomachThe dried coffee bean powdered and mixed with honey [29]Cu​[49][50][24][9, 26, 43, 51]  Colocasia esculenta(L.) Schott. Goodarree (Or, G) Araceae Crush dry/fresh concocted withZingiber officinale Rhizome is taken with coffee [7]Cu, [52]Cu,∗   Conyza bonariensis(L.) Cronq. Qilqilia (M) Asteraceae L [23]Nc  Conyza pyrrhopappa A. Rich. Donya (Dawaro) Asteraceae Crushed decocted L taken orally [53]Nc  Cordia africana Lam. Wanza (Am, Sh)Waddeessa (Or)Awhi (T)Banja (G) Boraginaceae Pound and squeeze the L by adding drop of water and drink the concoction by a cup of coffee.F (5–7) are eaten daily in the morning.B is crushed, homogenized in water, and drunk.Crush the L and drink it alone or by mixing it with boiled coffeeR bark is crushed, squeezed with water, and given to drink [37]Cu​[54]​[55]∗​[28, 31]​[40]  Craterostigma plantagineum Hochst. Roba Enjire (Or) Scrophulariaceae R or L concoction taken orally [56]Nc  Croton macrostachyus Hochst. ex Delile Bakkanniisa (Or)Bissana (Am) Euphorbiaceae Dried L are powdered and mixed with hot water, and the mixture is taken orallyL are eaten with wat [55]Cu,∗​[35]Nc  Cucumis dipsaceus Ehrenb. Hafaflo (T) Cucurbitaceae R [30]  Delphinium dasycaulon Fresen. Merbba (Ku) Fabaceae The R and L are pounded and drink a bottle cup of the juice in the morning [25]Nc,∗  Dodonaea angustifolia L. f.  Sapindaceae Boil the R and drink the decoction [33]Nc  Dorstenia barnimiana Schwienf. Work Bemeda (Am) Moraceae R powder mixed with honey and fermented for seven days. Then, taken orally in the morning until cured [35]Nc  Echinops cacrocheatus L. Keberich (Am) Asteraceae Pieces of St pounded, and the powder is taken [57]Cu  Eleusine coracana (L.) Gaertn. Dagusa (Am) Poaceae S [58]Cu  Embelia schimperiVatke  Myrsinaceae Crush the F, homogenize with cold water and drink [33]Nc  Entada abyssinicaA. Rich. Sesenaffa (ku) Fabaceae Pounding the R and drink a bottle cup of the juice in the morning [25]Nc,∗  Ensete ventricosum(Welw.) Wassa (Kocho) Musaceae Rhizome fermented, cooked and eaten [59]Cu  Erythrina bruceiLam. Ex DC.  Fabaceae Fresh inner B crushed and homogenized in water [18]Nc  Euphorbia candelabrum Tremaut ex Kotschy Karicho (Si) Euphorbiaceae L [44]Nc  Fagaropsis angolensis (Engl.) Dale Godicho (Si) Rutaceae L and Fl [44]Nc  Ficus sycomorus Forssk. Shola (Am)Fuka (G) Moraceae B juice is given orallyR is crushed, soaked in water, and taken [60]Nc​[31]  Ficus thonningii Blume. Chibha (Am) Moraceae Chewing the R [35]Nc  Fuelugge virosa(Willd.) Voigt. Weela (G) Euphorbiaceae R is crushed and squeezed and one cup is taken [31]Nc  Gossypium barbadenseL. Tite (Am) Malvaceae L powdered and mixed with water [41]Cu  Grewia villosa Willd. Bururi (K) Malvaceae Juice of L is taken orally. [55]Nc,∗  Guizotia abyssinica(L.f.) Cass. Nuugii (Or) Asteraceae Fried S, finely pounded and added as an ingredient to any concoction from medicinal plants [28]Cu  Heracleum abyssinicumC. Norman Ululee (Or) Apiaceae R is pounded together with R ofThalictrum rhyncocarpum [28]Nc  Hibiscus luduwigii Eckl. and. Zeyh.  Malvaceae R [36]Nc  Hoslundia opposita Vahl Dumdumach (Me) Lamiaceae R [19]Nc  Hypericum quartinianum A. Rich.  Hypericaceae L extracted with cold water [61]Nc  Hypoestes forsskaolii (Vahl) R. Br. Busino (M) Acanthaceae R [20]Nc  Indigofera spicata Forssk. Wesfat deshe (Aari) Fabaceae WPCrushed fresh R homogenized in water [22]Nc​[18, 23, 36]  Ipomoea obscura (L.) Ker-Gawl. Lago (M) Convolvulaceae L [20]Nc  Ipomoea purpurea(L.) Roth  Convolvulaceae Crushed fresh L homogenized in water [18]Cu  Kosteletzkya adoensis (Hochst. ex A. Rich.) Mast. Wari Beshe (M) Malvaceae L [20]Nc  Lagenaria siceraria​(Molina)​Standl. Busino (M) Cucurbitaceae L chopped and ground and drink the filtrate [62]Nc,∗  Lantana camara L. Yewef kollo (Am) Verbenaceae Dry St powder mixed with water and taken orally [7]Nc,∗, [52]Nc  Lantana ukambensisVerdc.  Verbenaceae Crushed fresh L homogenized in water [18]Nc  Leonotis ocymifolia (Burm. F.) Iwarsson Yeferes zeng (Am) Lamiaceae Dried L and Fr powder mixed with honey is given orally [39]Nc  Lepidium sativumL. Feecoo (Or)Shinfae (T)Fetto (Am) Brassicaceae S and Bu ofAllium sativumare pounded Grind the S, mix with honey, and eat Mix the S powder in water and drinkGrind the S and mix with honey and swallow [63]Cu​[25]∗​[41][30][26]  Leucas abyssinicaBriq. Kirikisa (Dawaro) Lamiaceae Crushed and mixed with water and taken [53]Nc  Leucas deflexa Hook. f. Qechemen (B)Qilqilich (Me) Mezi (Sheko) Lamiaceae L [23]Nc​[19][64]  Linum usitatissimum L. Telba (Am) Linaceae The water solution of roasted and powdered S is drunk in an empty stomach [26]Cu  Lippia javanicaSpreng.  Verbenaceae R [36]Nc  Maesa lanceolata Forssk. Gowacho (Si) Meliaceae L and B [33, 44]Nc  Maytenus senegalensis(Lam.) Kbkib (T) Celastraceae Crush the L, mix it with milk, and drink [40]Nc  Melia azedarach L. Kiniinii (Or) Meliaceae B crushed, homogenized in water and drunk [22]Cu  Momordica charantia L.  Cucurbitaceae L and R ground well and mixed with milk and taken orally [62]Nc,∗  Momordica foetida Schumach. Yekurahareg (Am) Cucurbitaceae Pound the L, squeeze, and then drink [36]Nc  Musa paradisiaca L. Musi (Aari) Musaceae F [20]Cu  Myrtus communis L. Ades (Am) Myrtaceae Juice of L is taken orally in the morning [35]Nc  Nigella sativa L. Tikur azmud (Am) Ranunculaceae Leaves are pounded, and juice is preparedConcoct dry pounded seed [57]Cu​[18]  Nicotiana tabacum L. Tombowae (K) Solanaceae Crushed, decocted, and concocted freshleaves are taken, and powdered roots aremixed with water or milk and drunk [55]Cu,∗  Ocimum forskolei Benth. Gurdarindo (M) Lamiaceae WP [20]Cu  Ocimum lamiifoliumHochst. ex. Benth. Damakese (Am) Lamiaceae Fresh L are pounded in water and the juice is drunkCrushed fresh L homogenized in water [26]Cu​[25]∗  Olinia rochetianaA. Juss.  Oliniaceae Boil the R and drink the decoction [33]Nc  Oryza sativa L. Ruz (Am) Poaceae One-half of a cup of coffee of squeezed L is drunk [26]Cu  Otostegia fruticosaSebald  Lamiaceae  [65]Nc  Otostegia integrifolia (Forssk.)  Lamiaceae The L is crushed and squeezed then the concoction is drunk [65]Nc  Otostegia tomentosa A. Rich.  Lamiaceae The L is pounded and squeezed and drunk [65]Nc  Oxalis radicosa A. Rich. Solcarindo (M),Kinsa kins (Aaari) Oxalidaceae L [20]Nc  Pavonia urens Cav. Maxxannee (Or) Malvaceae R is chewed with salt and swallowed [63]Cu  Pentas lanceolata (Forssk.) Deflers Gaina deshe (Aari) Rubiaceae RL [20]Nc​[23]  Persea americana Mill. Abukato (Si) Lauraceae Dried F crushed, powdered, mixed with coffee and Drink [59]Cu  Phragmanlhera Macrosolen(A. Rich) ined. Diigaluu ceekaa (Or) Loranthaceae L is pounded and mixed with water [63]Nc  Plantago lanceolataL. Qorxobbii (Or) Plantaginaceae R is pounded with l ofCalpurnia aurea and drunk with honey [28]Nc  Plectranthus cylindraceusBenth.   Crushed and squeezed L is mixed in boiled cup of coffee and then the decoction is drunk [65]Nc  Plectranthus longipes Baker Solelo (M) Lamiaceae Wp [20]Nc  Plumbago zeylanicaL. Aftuh (Am) Plumbaginaceae R [30]Nc  Podocarpus falcatusC.N. Page Birbirsa Podocarpaceae Chop the L, and drinking one coffee cup 2 times a day for three days [66]Nc  Pouzolzia parasitica (Forssk.)Schweinf. Dirba Urticaceae L and R crushed together and infusion is taken oral [56]Nc  Pseudocedrela kotschyi (Schweinf.) Harms Aduruba Meliaceae B eaten as it is [32]Nc  Pterolobium stellatum (Forssk) Brenan Qudu Fabaceae R boiled in water and drunk [32]Cu  Punica granatumL. Roomaan (Or) Lythraceae L boiled and drunk [22]Cu  Pycnostachys abyssinica Fresen. Anchip (M) Lamiaceae L [20]Nc  Rhus natalensisKrauss Kubri (M) Anacardiaceae L [20]Nc  Rubia cordifolia L. Anqis (Or) Rubiaceae Powder the R and drink the decoction [61]Nc  Rubus steudneriSchweinf. Gormach (Me) Rosaceae RBoil the R and drink the decoction [19]Nc​[33]  Rumex nepalensisSpreng. Germach (B)Tult (Am)Girshu (Sheko) Polygonaceae Crush R, mix with water, and drinkCrush the R, mix with water, and then drink juiceR and L [23, 34]Nc​[27, 64][43]  Rumex nervosus Vahl. Dhangaggoo (Or)Embuacho (Am) Polygonaceae L crushed, homogenized in water, and drunkR powdered and mixed with melted butter [23]Nc​[67]  Salvia acuminataRuiz & Pav. Anchino (M) Lamiaceae Chewing the L [61]Nc  Salvia nilotica Juss. ex Jacq. Shokoksaa (Or) Lamiaceae The f juice is taken orally [55]Nc,∗  Sapium ellipticum(Hochst)  Euphorbiaceae Decocted fresh L mixed with butter to drink [18]Nc  Schinus molleL. Tikur berbere (Am) Anacardiaceae Crush, the L filter and drink the fluid [39, 68]Cu  Senna didymobotry (Freser) Irowin & Barinely Sanamakii (Or) Fabaceae L are pounded, and juice is prepared [57]Nc  Senna obtusifolia (L.) Irwin and Barneby  Fabaceae S crushed, homogenized in water, and drunk [22]Nc  Senna singueana (Delile) Lock Karhaleko (M) Fabaceae R [20]Nc  Solanacio gigas(Vatke) Jeffrey Dilluu araba (Or) Asteraceae L and Fl are pounded together and taken [28]Nc  Solanum giganteumJacq.  Solanaceae R [36]Nc  Solanum nigumL. Awut (Am) Solanaceae Crush the L, chew, and then swallow the juice [43]Nc  Sorghum bicolor (L.) moench Bisingaa (Or)Zengada (Am) Poaceae The S is powdered and made into a porridgeS [69]Cu​[58]  Sporobolus pyramidalisBeauv. Gic’igiliya (Dawro) Poaceae L powdered and mixed with the L ofConyza pyrrhopappaand taken [53]Nc  Stereospermum kunthianum Cham. Zana (Ag), Wahsinte (Am)Estegne eyo (Berta) Bignoniaceae R grounded, dispersed in water, and drunkR is crushed, diluted in water, and one cup is taken [54]Nc​[31]  Stylosanthes fruticosa (Retz.) Alston Dino desho (M) Fabaceae L [20]Nc  Syzygium guineenses(Willd.) DC. Dokima (Am)Diwa (G) Myrtaceae Decoction of B powderSt bark is crushed, squeezed and taken orally [69]Nc​[31, 43]  Tagetes minutaL. Kawato (M)Hada Gola (Am) Asteraceae L decocted [62]Nc,∗​[70]  Tamarindus indicaL. Koriya (Dawro) Fabaceae F crushed and mixed with water and taken orally [53]Cu  Terminalia brownii Fresen. Weyba (T)Rukessa (Si) Combretaceae B and LL [30] [44]Nc  Termnalia schimperiana Hochst Biguha (G) Combretaceae B is crushed, diluted in water, and taken orally [31]Nc  Thalictrum rhynchocarponQuart.  Ranunculaceae Boil the R and drink the decoctionCrushed fresh L homogenized in water [33]Nc​[18]  Tragia mitisex A. Rich.  Euphorbiaceae Crushed R, mixed with water and sugar [70]Nc  Trigonella foenum-graecumL. Abeake (T) Boraginaceae Add the s into boiled water which containZingiber officinale, allow it to boil for a while, and then drink a cup of the decoction [25]Nc,∗  Verbascum sinaiticum Benth. Gurraharree (Or)Kutitina (Am)Daba Keded (Am) Scrophulariaceae L crushed, homogenized in water, and drunkCrush the R and drink with waterJuice of R is taken orally [22]Nc​[43] [35] [36]  Verbena officinalis L. Atuch (Am)Q/albaatii (Or) Verbenaceae R powder mix with waterDecant from pounded root is drunkThe crushed R is left in water for some time and then the extract is drunk [54]Nc​[67] [28] [26] [24]  Vernonia amygdalinaDel. Eebicha (Or, G) Asteraceae Crush the L and mix with little water and then drink for five daysCrush the L, pound and mix with little water and then drink for five days [52]Cu,∗​[69] [7]∗​[33]  Vernonia auriculiferaHiem Aegidim (G) Asteraceae R is crushed and squeezed and one cup is taken [31]Nc  Viscum tuberculatumA. Rich Dhigri (S) Viscaceae R grounded, boiled with water, and drunk [47]Nc  Withania somnifera (L.) Dunal. Gizawa (Am) Solanaceae Infusion powder of 3 L mixed with water [71]Nc  Ximenia americana L. Feya (Gumuz) Olacaceae Crushing and squeezing the R [31]Nc  Zehneria scabra(Linn. f.) Sond. Hidda bofaa (Or)Hidda reffaa (Or)Hareg resa (Am)Areg resa (Am) Cucurbitaceae L are pounded, and juice is preparedThe juice of fresh squeezed L is drunkCrush the L and drink The juice of fresh squeezed leaves is drunk [57]Nc​[69] [43] [26] [33]  Zingiber officinaleRoscoe. Zingibil (T, Am) Zingiberaceae Chew and swallow the fluid [40]Cu​[33]  Zinnia peruviana L  Asteraceae R [36]Nc  Ziziphus mauritianaLam. Amurusam (Berta) Rhamnaceae S is ground, dispersed in water, and drunk [32]Nc  Ziziphus spinachristi (L.) Desf. Kurkura (Or); Gob, Geb (S)Sirra Rhamnaceae The concoction of L drunk orallySt bark is crushed, soaked in water, and filtered [21]Nc​[31]Table 2
Taxonomic diversity of medicinal plants in the study area.
Family Number of genera Percentage Number of species Percentage of species Fabaceae 10 9.0 12 9.1 Lamiaceae 7 6.2 12 9.1 Asteraceae 8 7.1 10 7.5 Euphorbiaceae 7 6.2 7 5.3 Cucurbitaceae 3 2.6 4 3.0 Malvaceae 4 3.5 4 3.0 Poaceae 4 3.5 4 3.0 Ranunculaceae 3 2.6 4 3.0 Solanaceae 3 2.6 4 3.0 Verbenaceae 3 2.6 4 3.0 Rubiaceae 3 2.6 3 2.3 Rutaceae 2 1.7 3 2.3 Moraceae 2 1.7 3 2.3 Other 39 families 54 47.7 58 44.0 Total 113 100.0 132 100.0


### 3.1. Growth Forms and Parts Used

The result of growth form analysis of medicinal plants shows that herbs constitute the highest proportion being represented by 56 (43.6%) species, while there were 34 (27%) tree species, 31 (20.6%) shrubs, and 6 (2%) climbers (Figure2). Almost all plant parts, the roots, rhizomes, stem, bark, leaves, flowers, fruits, young shoots, and whole plants, were used to prepare different remedies (Table 1). The most frequently used plant parts were leaves (78%), followed by roots (60%), and seeds (29%), and others constitute 20% (Figure 3).Figure 2
Growth forms (habits) of medicinal plants.Figure 3
Plant parts used for the treatment of diarrhoeal diseases in Ethiopia.


### 3.2. Methods of Preparation of Traditional Medicine

Most of the medicinal plant preparation involved the use of single plant species or a single plant part (76%), whereas the preparation via mixing different plants or plant parts (24%) is rarely encountered in Ethiopia. In Ethiopia, the most common methods of preparation of traditional medicine from plant materials are crushing (38%), followed by decoction (21%) and others (Table3).Table 3
Method of preparation of traditional medicine in Ethiopia.
Method of preparation Number of preparations Percentage Crushing 53 38.2 Decoction 30 21.5 Powdered 14 10.1 Chewing 7 5.0 Concoction 5 3.6 Others 30 21.5


### 3.3. Condition, Additives, and Dosages of Medicinal Plants

Most of the remedies (58%) used in Ethiopia for treatment of diarrhoeal diseases are prepared from fresh parts of medicinal plants followed by drying form 27% and 15% prepared either from dry or fresh plant parts. Various additives are used during administration of traditional medicine. Additives like honey (48%), salt (13%), sugar (13%), local beer (3%), milk (16%), and butter (6.5%) are used with traditional medicine to increase the flavor, taste, and general suitability of orally administered remedies.People living in rural areas of Ethiopia use various ways of measuring dosage which are generally categorized under three major classes. One is dosage used for those medicinal plants which are expected to be highly toxic. For such medicines, the measurement can be undertaken by little finger index and very little amount of the prepared medicine taken by half a coffee cup. For example, medicines prepared fromCordia africana,Calpurnia aurea,Verbena officinalis,andBrucea antidysentericaare toxic if overdosed. The second is the dosage used for medicinal plants which can have little effect on human health if overdosed. The dosage is measured by hand palm and taken by bottle or locally made material fromLagenaria siceraria. Examples of species includeDelphinium dasycaulon andEntada abyssinica. In the third case, there are medicinal plants that do not have any observable side effect. Medicines prepared fromZingiber officinale,Coffea arabica,Syzygium guineense, Guizotia abyssinica,andCitrus limon can be taken according to the existing traditional practice of communities and/or personal preference.


### 3.4. Frequently Reported Medicinal Plants

Among the most commonly used plants wereCalpurnia aurea,Coffea arabica,Cordia africana,Rumex nepalensis,Zehneria scabra,Verbena officinalis,Verbascum sinaiticum,Amaranthus caudatus,Vernonia amygdalina,Stereospermum kunthianum,Lepidium sativum,Indigofera spicata,Syzygium guineense,Leucas deflexa,Citrus limon, andBrucea antidysenterica are some to mention.


### 3.5. Phytochemical and Pharmacological Studies of Mostly Reported Medicinal Plants

The most frequent approach to species selection for phytochemical, pharmacological, or antimicrobial analysis is by reviewing the ethnobotanical literature [72]. In this approach, various modern drugs were extracted from traditional medicinal plants using plant materials [73]. Plant-based traditional medicine is still playing a vital role in the development and advancement of modern studies by serving as a starting point for the development of novelties in drug discovery [74]. The presence of active ingredients such as flavonoids, terpenoids, steroids, phenolic compounds, and alkaloids in herbal medicines has been reported to have antimicrobial activity and directly linked to their ability to prevent or treat ailments such as diarrhoeal diseases [75, 76]. Phytochemical analysis of plant preparations and the identification of active components therein is also helpful to explain the mechanism of antidiarrhoeal activity [10]. For instance, polyphenols and tannins provide strength to intestinal mucosa, decrease intestinal secretion, and promote balance in water transportation across the mucosal cells [77]. Flavonoids and saponins inhibit the release of prostaglandins, autacoids, and contractions caused by spasmogens as well as motility and hydroelectrolytic secretions [78]. The phytochemical analysis of mostly cited medicinal plants used for treatment of diarrhoeal diseases in Ethiopia will be discussed below. Few of these plants have been validated as treatments for diarrhoea based on their ability to prevent diarrhoeal symptoms induced in experimental animals.


#### 3.5.1.Calpurnia aurea (Ait.) Benth.

It is shrub or small tree commonly growing up to 5 m in bushlands and occasionally up to 10 m in forests of Ethiopia. The plant grows in different habitats, such as grazing lands, roadsides, and homegardens [9, 18].C. aurea is widespread throughout the highlands from 1400 to 2500 m where rainfall is from 1000 to 2000 mm per year [79]. Trees are found in flower throughout the year but most abundantly after the small rains in May [79]. The leaves ofC. aurea (Figure 4) are used traditionally in many parts of Ethiopia to treat diarrhoeal diseases. The use ofC. aurea for diarrhoeal diseases by local people of Ethiopia was reported 14 times by researchers. Methanol extracts of leaf revealed the presence of alkaloids, tannins, flavonoids, and saponins [11]. Plants species possessing alkaloids, tannins, flavonoids, steroids, and terpenoids exhibit antidiarrhoeal activity [80]. Alkaloids demonstrated inhibitory effect on Nitric oxide synthesis [81]. Tannins and flavonoids have been reported to have antidiarrhoeal activity through inhibition of intestinal motility [82] and hydroelectrolyte secretion [83]. The leaf extracts ofC. aurea have exhibited dose (100–400 mg/kg) dependent inhibition of castor oil induced diarrhoea on experimental mice like loperamide [11]. More interestingly, studies also confirmed that extracts from the species have broad spectrum antibacterial activity [84]. Being broad spectrum is advantageous in reducing diarrhoea as there are various causative agents of the disease.Figure 4
C. aurea(Courtesy: [Regassa, Hawassa, Ethiopia, 2016]).


#### 3.5.2.Zehneria scabra (Linn. f.) Sond.

Z. scabra is one of the commonly used medicinal plants in Ethiopian traditional medicine practices (Figure 5). Local people in Ethiopia use the leaves of the plant to get relief from diarrhoea [43]. The plant is also used for the treatment of wound, alopecia, and eczema in folk medicines [85]. The phytochemical study conducted by [17] showed the presence of tannins, saponins, anthraquinones, O-anthraquinones, and phenols in the crude extract of leaves ofZ. scabra. The phytochemical study of root extracts ofZ. scabra by [86] also revealed the presence of Gypenoside. China pharmaceutical company manufactures Gypenoside tablets; it is used as a supplemental medicine for treating various diseases. The methanolic extracts ofZ. scabra showed antidiarrhoeal activity in mice [17]. Studies also report that ethanol, methanol, ethyl acetate, and aqueous extracts ofZ. scabra show maximum zone of inhibition for standard strains ofStaphylococcus aureus[86].Figure 5
Z. scabra(Courtesy: [Woldeab, Jimma, Ethiopia, 2017]).


#### 3.5.3.Stereospermum kunthianum Cham.

It is a small tree occurring at medium to low altitudes, frequently on rocky outcrops and hillsides. It also occurs in open woodlands and at margins of evergreen forests [87] and is found from 700 to 2000 m in areas with an annual rainfall range between 700 and 1800 mm per year [79]. Flowering most abundantly after the small rains in April and May, some trees can be found with flowers any time from September up to May [79].S. kunthianumis only found in the wild and increasingly becoming difficult to harvest due to high scarcity [54]. The root and bark of the plantS. kunthianum are used in diarrhoea treatment in Ethiopia [31, 35]. Preliminary phytochemical screening of the leaves extract ofS. kunthianum reveals the presence of sterols/triterpenes, saponins, tannins, coumarins, and free carboxylic group [88]. The methanolic extracts from this plant species exhibited antidiarrhoeal activity on mice. The effect is comparable to loperamide, which is presently one of the most widely used antidiarrhoeal drugs [88]. The antidiarrhoeal effect of a flavonoid isolated from the stem bark aqueous extract ofS. kunthianumis investigated using rodent models of castor oil-induced gastrointestinal motility and castor oil-induced diarrhoea [15]. The result indicates that pretreatment with dimethoxyflavone causes a delay in the onset of diarrhoea, reduction in the frequency, and weight of wet stools [15]. The result from this study suggests that the antidiarrhoeal activity of dimethoxyflavone fromS. kunthianumcastor oil-induced diarrhoea in mice is probably due to antielectrolyte permeability action [15]. Toxicity studies of the aqueous extract ofS. kunthianum stem bark show that the extract has a wide safety margin [89].


#### 3.5.4.Lepidium sativum L.

It occurs in all regions of Ethiopia at altitudes between 750 and 2900 m [90].L. sativumis not widely cultivated; instead it grows with other crops, particularlyEragrostis tef (Zucc.) Trotter and is available in all local markets [79]. In different regions of Ethiopia,L. sativum seeds (Figure 6) are used commonly to treat abdominal discomfort, such as dysentery and diarrhoea [9, 42]. A study conducted by [91] indicated antidiarrhoeal effect of alcoholic and aqueous extract ofL. sativumseeds in three animal models (castor oil induced diarrhoea in rats, prostaglandin induced enteropooling in rats, and charcoal meal test in mice) of diarrhoea. Furthermore, the study found aqueous extract to be more potent than alcoholic extract.L. sativum has been used widely in different parts of the world for its wide therapeutic application [14]. The plant is well studied phytochemically with various active components, such as alkaloids, riboflavin, and ascorbic, linoleic, oleic, palmitic, and stearic acids [92]. Moreover, cucurbitacin has also been identified as plant constituent [93]. The plant has been shown to exhibit antidiarrhoeal and antispasmodic effects in rats, mediated through dual blockade of muscarinic receptors and Ca++ channels [14]. The findings of [94] suggest that the aqueous methanol extracts of seeds ofL. sativum exhibit antidiarrhoeal activity through activation of K+ channels and inhibition of PDE enzyme in rabbit intestine.Figure 6
L. sativumseeds (Courtesy: [Regassa, Hawassa, Ethiopia, 2016]).


#### 3.5.5.Vernonia amygdalina Del.

It is found in a wide range of bushlands, woodlands, and forest habitats between 500 and 2800 m; it is also often found around home. Its rainfall range is from 750 to 2000 mm per year [95]. Flowering trees can be found from December to May, but the main flowering period is from January to February [79]. Some observations showed that the plant is widely available and frequently growing in homegardens [7, 9, 17, 33, 69]. The leaves ofV. amygdalina(Figure 7) are used in Ethiopian folk medicine to treat malaria [7, 9] and gastrointestinal disorders [28, 42, 58]. The leaf extract is reported to reduce the symptoms of castor oil-induced diarrhoea in rats and reduce gastrointestinal transit of a charcoal meal in mice [10]. Methanolic extract ofV. amygdalinashows that the 400 mg/kg body weight administered orally to the experimental rats was effective in the reduction of the faecal spots [16]. A qualitative phytochemical analysis revealed the presence of some important active components such as saponins and alkaloids [16, 96], tannins [16], flavonoids [97], and glycosides [16]. Some of these components might be responsible for the antidiarrhoeal properties [96]. Therefore, this might indicate that the antidiarrhoeal activities are the most likely combined effect or a single effect [16]. Moreover, the other biomolecules may be neither synergistic nor antagonistic.Figure 7
V. amygdalina(Courtesy: [Megersa, Gute, Ethiopia, 2013]).


#### 3.5.6.Cordia africana Lam.

It is found in moist evergreen highlands and riverine forests of the northwest and southwest highlands and very common in western Ethiopia between 550 and 2600 m where the rainfall range is 700 to 2000 mm per year [79]. Some trees can be found in flower at any time of the year, but the main flowering period is from October to March [87].C. africana is the most preferred plant by local people of Ethiopia for various uses, such as construction, timber production, charcoal, and medicine [9, 54, 55]. Due to its multipurpose uses,C. africana is becoming threatened, which is evidently shown by its scarce distribution in different areas of Ethiopia [9, 54, 98].C. africana is one of indigenous tree species that have currently been given conservation priority by using in situ and ex situ conservation in the country [99].In an ethnobotanical study,C. africana(Figure 8) is reported to be used in the management of diarrhoea in Shinasha, by Agew-Awi, Oromo, Tigray, and Amhara people in Ethiopia [28, 31, 37, 55]. The phytochemical analysis of methanolic root bark extracts ofC. africanarevealed that the plant material contains phenols, saponins, tannins, terpenoids, and flavonoids [100]. The mechanism of action of saponin for antidiarrhoeal effect is through the inhibition of histamine; terpenoids inhibit release of autacoids and prostaglandins; phenol makes intestinal mucosa more resistant [12]. There are considerable reports onC. africana studies showing the antidiarrhoeal effects on experimental animals [12, 101] For instance, the study conducted by [101] indicated the significant reduction of castor oil induced diarrhoea compared to loperamide. The study also revealed that the extract significantly reduced intestinal transit like that of atropine.Figure 8
C. africana(Courtesy: [Megersa, Gute, Ethiopia, 2013]).


#### 3.5.7.Indigofera spicata Forssk.

I. spicata is traditionally used for the treatment of meningitis [18], diarrhoea [20, 23], stomach-ache [35], diabetes [9], and other health problems in Ethiopia. Phytochemical studies conducted on this plant species indicated the presence of alkaloids, flavonoids tannins, and steroids in this plant [13, 102]. Steroids reported to enhance the absorption of hydroelectrolytes across the intestinal lumen [75]. In the castor oil induced diarrhoea in mice, the root extract ofI. spicata inhibits frequency of defecation and fluid content of stool more likely in a dose dependent manner [13]. Moreover, the study found 53.51% inhibition of frequency of defecation which was equivalent to 51.02% of the positive control (atropine). The demonstrated biological antidiarrhoeal activity of crude root extracts ofI. spicata could be due to the presence of these constituents [13]. Besides its use as antidiarrhoeal, usage of this plant raises the safety concern because the plant has showed effect on liver and cause abortion [103] and teratogenic effects in animals [104].


### 3.6. Prospects and Viewpoints

This review showed that local people in Ethiopia rely on traditional medicines to treat diarrhoeal diseases and are knowledgeable about the applications of medicinal plants. Many people in Ethiopia are still dependent on medicinal plants, at least for the treatment of basic human ailments. Diarrhoea is a major concern in Ethiopia and it is one of the basic human ailments frequently treated by medicinal plants in many regions of Ethiopia [8, 9, 46]. The finding correlates strongly with observations made by [105] that diarrhoea is a major concern in Mozambique [106], in South Africa, and [76] in south-central Zimbabwe. Reports of similar medicinal applications of the documented plants in Ethiopia and the rest of the world indicate that these species are valuable sources of ethnomedicines.The current review addresses the existence of traditional indigenous knowledge. This considerable indigenous knowledge, from the earliest times, is linked with the use of traditional medicine in many countries including Ethiopia [107]. Indigenous knowledge refers to the knowledge, innovations, and practices of indigenous and local communities around the world [108]. Thus, there is a growing appreciation of the value of traditional knowledge and its potential benefits to modern industry [108]. Many widely used products, such as plant-based medicines for human and livestock health, have been developed using indigenous traditional knowledge. It is, therefore, necessary to preserve this indigenous knowledge on traditional medicines by proper documentation, identification of plant species used, herbal preparation, and dosage. This review will assist future studies on the selection of herbal plants to evaluate for phytochemical safety and pharmaceutical efficacy.Almost all ethnobotanical studies in Ethiopia have so far focused on medicinal plants used by rural communities. Urban ethnobotany is minimal or lacking as almost all studies gave with consideration to ethnobotanical studies in rural areas. Applied to the context of immigration, urban ethnobotany will offer the opportunity to evaluate ethnobotanical data within a larger, transnational framework by comparing plant knowledge and use by the same cultural group in its original and new environment [109]. The paradigm shift is also needed from ethnobotanical studies to phytochemical and pharmacological studies. For instance,C. arabica was reported by eight authors,R. nepalensisby six authors,V. officinalisby five authors,andV. sinaiticum by four authors used to treat diarrhoeal diseases in Ethiopia, but no study validated their antidiarrhoeal property by investigating the biological activity of the extracts. Along with phytochemical and pharmacological studies, ethnobotanical studies should also continue, particularly in areas that have received less attention so far. For example, studies should be conducted in the Afar, Benishangul Gumuz, Gambela, Somali, and Tigray regions, like that of Amhara, Oromia, and SNNPR regions (Figure 1).Almost all ethnobotanical studies conducted in Ethiopia have an objective of documentation of medicinal plants used to treat various diseases including diarrhoea. Early ethnobotanical studies conducted in Ethiopia simply focused on listing the name of medicinal plant species with diseases treated [45, 58, 68] without providing any detailed information on the medicinal plants in the region. Another concern of ethnobotanical studies conducted in Ethiopia is the number of informants selected to participate in the study. In this regard, many of the studies collected data from 17 to 38 informants [45, 54, 58, 65, 68] and concluded the knowledge is accumulated by the respected societies. Surprisingly, one study [45] collected ethnobotanical data from three traditional healers and concluded that the knowledge is acquired by local communities of the study area. These numbers could not be a representative sample size to elucidate the entire knowledge of indigenous people found in a district. Therefore, future ethnobotanical studies in Ethiopia should increase the number of informants to have a representative sample size. This will help to gather sufficient information about medicinal plant species. Many studies also did not compute ranking indices [23, 52, 56] though they have invaluable advantages in identifying the most preferred (important) medicinal plants in the study area which could aid phytochemical and pharmacological studies in searching of new drugs. Threats and conservation status of medicinal plants [21, 35, 54] were also overlooked by researchers, though they have advantages to using them sustainably. Ethnobotanical studies should also focus on identifying gender-based and age-based knowledge differences related to medicinal plant uses. In addition, future ethnobotanical studies in Ethiopia should focus on identifying most serious threats to medicinal plants and how local communities manage medicinal plants. Such studies will help in understanding the best conservation strategies and how local communities relate to the plant resources that they use as medicines.The existing literature shows that there are several plant species having antidiarrhoeal activities. These plants have a lot of potential to be developed as alternatives to the existing drugs. Studies are needed to determine if, for the same active principle and at the same dosage, the efficiency is different for traditional and western remedies [72]. Despite the encouragement of promises shown by these materials, the applications have not been able to transfer from experimental animals’ trials to humans and real-life applications; they all remained on papers. One of the drawbacks of the use of traditional medicinal plants for diarrhoeal diseases is the lack of precise dosage which may enhance toxicity [110]. In the assessment of the performance efficiencies of the different plant species as antidiarrhoeal properties, little efforts have been made to evaluate the toxicological effects of the extracts from these plant species. To ameliorate this challenge, attempts should be made to standardize (the drug preparation, dosage, and route of administration) and authenticate plant species which have antidiarrhoeal properties so that they could be used as natural drugs [111]. These efforts will help to produce effective drugs in treating various diarrhoeal diseases. Moreover, establishment of a medicinal plants database with important medicinal uses will have valuable advantages in searching of new drugs.In searching of new drugs from medicinal plants overexploitation and the Nagoya protocol (2010) should not be overlooked. Overexploitation of medicinal plants especially those found in a restricted geographic location might lead to extinction. For example,C. africana, Cucumis dipsaceus, S. kunthianum, andWithania somnifera which were readily available in Ethiopia are now at the verge of extinction because of overexploitation [9, 54, 71]. Therefore, pharmaceutical companies and research institutions along with local communities should be encouraged to cultivate these medicinal plants to ensure the continuous supply of plant materials [112]. From a governance point of view, Ethiopia requires an enforceable policy that protects wild medicinal plants and policy incentives for the cultivation of medicinal plants to reduce overexploitation. Regarding the Nagoya protocol, fair and equitable sharing benefits arising from the utilization of genetic resources and community knowledge must be shared between the people using community knowledge and the people providing them as it is clearly stated in the agreement. If any product is used from the plant species for drug development obtained from indigenous knowledge, the local communities who acquired the knowledge should get benefit.In order to obtain necessary information for optimum and practical conditions for antidiarrhoeal medicinal plants, there is also a need to investigate the physiological and biochemical functions demonstrated by these plant species. Additionally, identifying the individual bioactive natural products and elucidating the underlying mechanism of the process will have invaluable advantages to use the specific plant species for specific diarrhoeal diseases. Although different active components from various plant species are reported to have antidiarrhoeal activities, availability of similar amounts of those components among different plant species may not result in a similar antidiarrhoeal capabilities. The antidiarrhoeal activities within a single species may also vary depending on the type of climate, soil contents, crop year, and geographical features. Therefore, future phytochemical studies should consider the abovementioned conditions to produce the best out of plant species with antidiarrhoeal properties.Phytochemical and pharmacological studies should have continued until the end users that experience the problem of diarrhoea. To do this, the dissemination of research findings to the appropriate governmental and nongovernmental agencies, who served as a boundary between the end users and the researchers, is necessary, but lacking. Thus, improvement on this channel of information dissemination shall be of great assistance in the promotion of the plant based antidiarrhoeal drugs to real life applications.


## 3.1. Growth Forms and Parts Used

The result of growth form analysis of medicinal plants shows that herbs constitute the highest proportion being represented by 56 (43.6%) species, while there were 34 (27%) tree species, 31 (20.6%) shrubs, and 6 (2%) climbers (Figure2). Almost all plant parts, the roots, rhizomes, stem, bark, leaves, flowers, fruits, young shoots, and whole plants, were used to prepare different remedies (Table 1). The most frequently used plant parts were leaves (78%), followed by roots (60%), and seeds (29%), and others constitute 20% (Figure 3).Figure 2
Growth forms (habits) of medicinal plants.Figure 3
Plant parts used for the treatment of diarrhoeal diseases in Ethiopia.


## 3.2. Methods of Preparation of Traditional Medicine

Most of the medicinal plant preparation involved the use of single plant species or a single plant part (76%), whereas the preparation via mixing different plants or plant parts (24%) is rarely encountered in Ethiopia. In Ethiopia, the most common methods of preparation of traditional medicine from plant materials are crushing (38%), followed by decoction (21%) and others (Table3).Table 3
Method of preparation of traditional medicine in Ethiopia.
Method of preparation Number of preparations Percentage Crushing 53 38.2 Decoction 30 21.5 Powdered 14 10.1 Chewing 7 5.0 Concoction 5 3.6 Others 30 21.5


## 3.3. Condition, Additives, and Dosages of Medicinal Plants

Most of the remedies (58%) used in Ethiopia for treatment of diarrhoeal diseases are prepared from fresh parts of medicinal plants followed by drying form 27% and 15% prepared either from dry or fresh plant parts. Various additives are used during administration of traditional medicine. Additives like honey (48%), salt (13%), sugar (13%), local beer (3%), milk (16%), and butter (6.5%) are used with traditional medicine to increase the flavor, taste, and general suitability of orally administered remedies.People living in rural areas of Ethiopia use various ways of measuring dosage which are generally categorized under three major classes. One is dosage used for those medicinal plants which are expected to be highly toxic. For such medicines, the measurement can be undertaken by little finger index and very little amount of the prepared medicine taken by half a coffee cup. For example, medicines prepared fromCordia africana,Calpurnia aurea,Verbena officinalis,andBrucea antidysentericaare toxic if overdosed. The second is the dosage used for medicinal plants which can have little effect on human health if overdosed. The dosage is measured by hand palm and taken by bottle or locally made material fromLagenaria siceraria. Examples of species includeDelphinium dasycaulon andEntada abyssinica. In the third case, there are medicinal plants that do not have any observable side effect. Medicines prepared fromZingiber officinale,Coffea arabica,Syzygium guineense, Guizotia abyssinica,andCitrus limon can be taken according to the existing traditional practice of communities and/or personal preference.


## 3.4. Frequently Reported Medicinal Plants

Among the most commonly used plants wereCalpurnia aurea,Coffea arabica,Cordia africana,Rumex nepalensis,Zehneria scabra,Verbena officinalis,Verbascum sinaiticum,Amaranthus caudatus,Vernonia amygdalina,Stereospermum kunthianum,Lepidium sativum,Indigofera spicata,Syzygium guineense,Leucas deflexa,Citrus limon, andBrucea antidysenterica are some to mention.


## 3.5. Phytochemical and Pharmacological Studies of Mostly Reported Medicinal Plants

The most frequent approach to species selection for phytochemical, pharmacological, or antimicrobial analysis is by reviewing the ethnobotanical literature [72]. In this approach, various modern drugs were extracted from traditional medicinal plants using plant materials [73]. Plant-based traditional medicine is still playing a vital role in the development and advancement of modern studies by serving as a starting point for the development of novelties in drug discovery [74]. The presence of active ingredients such as flavonoids, terpenoids, steroids, phenolic compounds, and alkaloids in herbal medicines has been reported to have antimicrobial activity and directly linked to their ability to prevent or treat ailments such as diarrhoeal diseases [75, 76]. Phytochemical analysis of plant preparations and the identification of active components therein is also helpful to explain the mechanism of antidiarrhoeal activity [10]. For instance, polyphenols and tannins provide strength to intestinal mucosa, decrease intestinal secretion, and promote balance in water transportation across the mucosal cells [77]. Flavonoids and saponins inhibit the release of prostaglandins, autacoids, and contractions caused by spasmogens as well as motility and hydroelectrolytic secretions [78]. The phytochemical analysis of mostly cited medicinal plants used for treatment of diarrhoeal diseases in Ethiopia will be discussed below. Few of these plants have been validated as treatments for diarrhoea based on their ability to prevent diarrhoeal symptoms induced in experimental animals.


### 3.5.1.Calpurnia aurea (Ait.) Benth.

It is shrub or small tree commonly growing up to 5 m in bushlands and occasionally up to 10 m in forests of Ethiopia. The plant grows in different habitats, such as grazing lands, roadsides, and homegardens [9, 18].C. aurea is widespread throughout the highlands from 1400 to 2500 m where rainfall is from 1000 to 2000 mm per year [79]. Trees are found in flower throughout the year but most abundantly after the small rains in May [79]. The leaves ofC. aurea (Figure 4) are used traditionally in many parts of Ethiopia to treat diarrhoeal diseases. The use ofC. aurea for diarrhoeal diseases by local people of Ethiopia was reported 14 times by researchers. Methanol extracts of leaf revealed the presence of alkaloids, tannins, flavonoids, and saponins [11]. Plants species possessing alkaloids, tannins, flavonoids, steroids, and terpenoids exhibit antidiarrhoeal activity [80]. Alkaloids demonstrated inhibitory effect on Nitric oxide synthesis [81]. Tannins and flavonoids have been reported to have antidiarrhoeal activity through inhibition of intestinal motility [82] and hydroelectrolyte secretion [83]. The leaf extracts ofC. aurea have exhibited dose (100–400 mg/kg) dependent inhibition of castor oil induced diarrhoea on experimental mice like loperamide [11]. More interestingly, studies also confirmed that extracts from the species have broad spectrum antibacterial activity [84]. Being broad spectrum is advantageous in reducing diarrhoea as there are various causative agents of the disease.Figure 4
C. aurea(Courtesy: [Regassa, Hawassa, Ethiopia, 2016]).


### 3.5.2.Zehneria scabra (Linn. f.) Sond.

Z. scabra is one of the commonly used medicinal plants in Ethiopian traditional medicine practices (Figure 5). Local people in Ethiopia use the leaves of the plant to get relief from diarrhoea [43]. The plant is also used for the treatment of wound, alopecia, and eczema in folk medicines [85]. The phytochemical study conducted by [17] showed the presence of tannins, saponins, anthraquinones, O-anthraquinones, and phenols in the crude extract of leaves ofZ. scabra. The phytochemical study of root extracts ofZ. scabra by [86] also revealed the presence of Gypenoside. China pharmaceutical company manufactures Gypenoside tablets; it is used as a supplemental medicine for treating various diseases. The methanolic extracts ofZ. scabra showed antidiarrhoeal activity in mice [17]. Studies also report that ethanol, methanol, ethyl acetate, and aqueous extracts ofZ. scabra show maximum zone of inhibition for standard strains ofStaphylococcus aureus[86].Figure 5
Z. scabra(Courtesy: [Woldeab, Jimma, Ethiopia, 2017]).


### 3.5.3.Stereospermum kunthianum Cham.

It is a small tree occurring at medium to low altitudes, frequently on rocky outcrops and hillsides. It also occurs in open woodlands and at margins of evergreen forests [87] and is found from 700 to 2000 m in areas with an annual rainfall range between 700 and 1800 mm per year [79]. Flowering most abundantly after the small rains in April and May, some trees can be found with flowers any time from September up to May [79].S. kunthianumis only found in the wild and increasingly becoming difficult to harvest due to high scarcity [54]. The root and bark of the plantS. kunthianum are used in diarrhoea treatment in Ethiopia [31, 35]. Preliminary phytochemical screening of the leaves extract ofS. kunthianum reveals the presence of sterols/triterpenes, saponins, tannins, coumarins, and free carboxylic group [88]. The methanolic extracts from this plant species exhibited antidiarrhoeal activity on mice. The effect is comparable to loperamide, which is presently one of the most widely used antidiarrhoeal drugs [88]. The antidiarrhoeal effect of a flavonoid isolated from the stem bark aqueous extract ofS. kunthianumis investigated using rodent models of castor oil-induced gastrointestinal motility and castor oil-induced diarrhoea [15]. The result indicates that pretreatment with dimethoxyflavone causes a delay in the onset of diarrhoea, reduction in the frequency, and weight of wet stools [15]. The result from this study suggests that the antidiarrhoeal activity of dimethoxyflavone fromS. kunthianumcastor oil-induced diarrhoea in mice is probably due to antielectrolyte permeability action [15]. Toxicity studies of the aqueous extract ofS. kunthianum stem bark show that the extract has a wide safety margin [89].


### 3.5.4.Lepidium sativum L.

It occurs in all regions of Ethiopia at altitudes between 750 and 2900 m [90].L. sativumis not widely cultivated; instead it grows with other crops, particularlyEragrostis tef (Zucc.) Trotter and is available in all local markets [79]. In different regions of Ethiopia,L. sativum seeds (Figure 6) are used commonly to treat abdominal discomfort, such as dysentery and diarrhoea [9, 42]. A study conducted by [91] indicated antidiarrhoeal effect of alcoholic and aqueous extract ofL. sativumseeds in three animal models (castor oil induced diarrhoea in rats, prostaglandin induced enteropooling in rats, and charcoal meal test in mice) of diarrhoea. Furthermore, the study found aqueous extract to be more potent than alcoholic extract.L. sativum has been used widely in different parts of the world for its wide therapeutic application [14]. The plant is well studied phytochemically with various active components, such as alkaloids, riboflavin, and ascorbic, linoleic, oleic, palmitic, and stearic acids [92]. Moreover, cucurbitacin has also been identified as plant constituent [93]. The plant has been shown to exhibit antidiarrhoeal and antispasmodic effects in rats, mediated through dual blockade of muscarinic receptors and Ca++ channels [14]. The findings of [94] suggest that the aqueous methanol extracts of seeds ofL. sativum exhibit antidiarrhoeal activity through activation of K+ channels and inhibition of PDE enzyme in rabbit intestine.Figure 6
L. sativumseeds (Courtesy: [Regassa, Hawassa, Ethiopia, 2016]).


### 3.5.5.Vernonia amygdalina Del.

It is found in a wide range of bushlands, woodlands, and forest habitats between 500 and 2800 m; it is also often found around home. Its rainfall range is from 750 to 2000 mm per year [95]. Flowering trees can be found from December to May, but the main flowering period is from January to February [79]. Some observations showed that the plant is widely available and frequently growing in homegardens [7, 9, 17, 33, 69]. The leaves ofV. amygdalina(Figure 7) are used in Ethiopian folk medicine to treat malaria [7, 9] and gastrointestinal disorders [28, 42, 58]. The leaf extract is reported to reduce the symptoms of castor oil-induced diarrhoea in rats and reduce gastrointestinal transit of a charcoal meal in mice [10]. Methanolic extract ofV. amygdalinashows that the 400 mg/kg body weight administered orally to the experimental rats was effective in the reduction of the faecal spots [16]. A qualitative phytochemical analysis revealed the presence of some important active components such as saponins and alkaloids [16, 96], tannins [16], flavonoids [97], and glycosides [16]. Some of these components might be responsible for the antidiarrhoeal properties [96]. Therefore, this might indicate that the antidiarrhoeal activities are the most likely combined effect or a single effect [16]. Moreover, the other biomolecules may be neither synergistic nor antagonistic.Figure 7
V. amygdalina(Courtesy: [Megersa, Gute, Ethiopia, 2013]).


### 3.5.6.Cordia africana Lam.

It is found in moist evergreen highlands and riverine forests of the northwest and southwest highlands and very common in western Ethiopia between 550 and 2600 m where the rainfall range is 700 to 2000 mm per year [79]. Some trees can be found in flower at any time of the year, but the main flowering period is from October to March [87].C. africana is the most preferred plant by local people of Ethiopia for various uses, such as construction, timber production, charcoal, and medicine [9, 54, 55]. Due to its multipurpose uses,C. africana is becoming threatened, which is evidently shown by its scarce distribution in different areas of Ethiopia [9, 54, 98].C. africana is one of indigenous tree species that have currently been given conservation priority by using in situ and ex situ conservation in the country [99].In an ethnobotanical study,C. africana(Figure 8) is reported to be used in the management of diarrhoea in Shinasha, by Agew-Awi, Oromo, Tigray, and Amhara people in Ethiopia [28, 31, 37, 55]. The phytochemical analysis of methanolic root bark extracts ofC. africanarevealed that the plant material contains phenols, saponins, tannins, terpenoids, and flavonoids [100]. The mechanism of action of saponin for antidiarrhoeal effect is through the inhibition of histamine; terpenoids inhibit release of autacoids and prostaglandins; phenol makes intestinal mucosa more resistant [12]. There are considerable reports onC. africana studies showing the antidiarrhoeal effects on experimental animals [12, 101] For instance, the study conducted by [101] indicated the significant reduction of castor oil induced diarrhoea compared to loperamide. The study also revealed that the extract significantly reduced intestinal transit like that of atropine.Figure 8
C. africana(Courtesy: [Megersa, Gute, Ethiopia, 2013]).


### 3.5.7.Indigofera spicata Forssk.

I. spicata is traditionally used for the treatment of meningitis [18], diarrhoea [20, 23], stomach-ache [35], diabetes [9], and other health problems in Ethiopia. Phytochemical studies conducted on this plant species indicated the presence of alkaloids, flavonoids tannins, and steroids in this plant [13, 102]. Steroids reported to enhance the absorption of hydroelectrolytes across the intestinal lumen [75]. In the castor oil induced diarrhoea in mice, the root extract ofI. spicata inhibits frequency of defecation and fluid content of stool more likely in a dose dependent manner [13]. Moreover, the study found 53.51% inhibition of frequency of defecation which was equivalent to 51.02% of the positive control (atropine). The demonstrated biological antidiarrhoeal activity of crude root extracts ofI. spicata could be due to the presence of these constituents [13]. Besides its use as antidiarrhoeal, usage of this plant raises the safety concern because the plant has showed effect on liver and cause abortion [103] and teratogenic effects in animals [104].


## 3.5.1.Calpurnia aurea (Ait.) Benth.

It is shrub or small tree commonly growing up to 5 m in bushlands and occasionally up to 10 m in forests of Ethiopia. The plant grows in different habitats, such as grazing lands, roadsides, and homegardens [9, 18].C. aurea is widespread throughout the highlands from 1400 to 2500 m where rainfall is from 1000 to 2000 mm per year [79]. Trees are found in flower throughout the year but most abundantly after the small rains in May [79]. The leaves ofC. aurea (Figure 4) are used traditionally in many parts of Ethiopia to treat diarrhoeal diseases. The use ofC. aurea for diarrhoeal diseases by local people of Ethiopia was reported 14 times by researchers. Methanol extracts of leaf revealed the presence of alkaloids, tannins, flavonoids, and saponins [11]. Plants species possessing alkaloids, tannins, flavonoids, steroids, and terpenoids exhibit antidiarrhoeal activity [80]. Alkaloids demonstrated inhibitory effect on Nitric oxide synthesis [81]. Tannins and flavonoids have been reported to have antidiarrhoeal activity through inhibition of intestinal motility [82] and hydroelectrolyte secretion [83]. The leaf extracts ofC. aurea have exhibited dose (100–400 mg/kg) dependent inhibition of castor oil induced diarrhoea on experimental mice like loperamide [11]. More interestingly, studies also confirmed that extracts from the species have broad spectrum antibacterial activity [84]. Being broad spectrum is advantageous in reducing diarrhoea as there are various causative agents of the disease.Figure 4
C. aurea(Courtesy: [Regassa, Hawassa, Ethiopia, 2016]).


## 3.5.2.Zehneria scabra (Linn. f.) Sond.

Z. scabra is one of the commonly used medicinal plants in Ethiopian traditional medicine practices (Figure 5). Local people in Ethiopia use the leaves of the plant to get relief from diarrhoea [43]. The plant is also used for the treatment of wound, alopecia, and eczema in folk medicines [85]. The phytochemical study conducted by [17] showed the presence of tannins, saponins, anthraquinones, O-anthraquinones, and phenols in the crude extract of leaves ofZ. scabra. The phytochemical study of root extracts ofZ. scabra by [86] also revealed the presence of Gypenoside. China pharmaceutical company manufactures Gypenoside tablets; it is used as a supplemental medicine for treating various diseases. The methanolic extracts ofZ. scabra showed antidiarrhoeal activity in mice [17]. Studies also report that ethanol, methanol, ethyl acetate, and aqueous extracts ofZ. scabra show maximum zone of inhibition for standard strains ofStaphylococcus aureus[86].Figure 5
Z. scabra(Courtesy: [Woldeab, Jimma, Ethiopia, 2017]).


## 3.5.3.Stereospermum kunthianum Cham.

It is a small tree occurring at medium to low altitudes, frequently on rocky outcrops and hillsides. It also occurs in open woodlands and at margins of evergreen forests [87] and is found from 700 to 2000 m in areas with an annual rainfall range between 700 and 1800 mm per year [79]. Flowering most abundantly after the small rains in April and May, some trees can be found with flowers any time from September up to May [79].S. kunthianumis only found in the wild and increasingly becoming difficult to harvest due to high scarcity [54]. The root and bark of the plantS. kunthianum are used in diarrhoea treatment in Ethiopia [31, 35]. Preliminary phytochemical screening of the leaves extract ofS. kunthianum reveals the presence of sterols/triterpenes, saponins, tannins, coumarins, and free carboxylic group [88]. The methanolic extracts from this plant species exhibited antidiarrhoeal activity on mice. The effect is comparable to loperamide, which is presently one of the most widely used antidiarrhoeal drugs [88]. The antidiarrhoeal effect of a flavonoid isolated from the stem bark aqueous extract ofS. kunthianumis investigated using rodent models of castor oil-induced gastrointestinal motility and castor oil-induced diarrhoea [15]. The result indicates that pretreatment with dimethoxyflavone causes a delay in the onset of diarrhoea, reduction in the frequency, and weight of wet stools [15]. The result from this study suggests that the antidiarrhoeal activity of dimethoxyflavone fromS. kunthianumcastor oil-induced diarrhoea in mice is probably due to antielectrolyte permeability action [15]. Toxicity studies of the aqueous extract ofS. kunthianum stem bark show that the extract has a wide safety margin [89].


## 3.5.4.Lepidium sativum L.

It occurs in all regions of Ethiopia at altitudes between 750 and 2900 m [90].L. sativumis not widely cultivated; instead it grows with other crops, particularlyEragrostis tef (Zucc.) Trotter and is available in all local markets [79]. In different regions of Ethiopia,L. sativum seeds (Figure 6) are used commonly to treat abdominal discomfort, such as dysentery and diarrhoea [9, 42]. A study conducted by [91] indicated antidiarrhoeal effect of alcoholic and aqueous extract ofL. sativumseeds in three animal models (castor oil induced diarrhoea in rats, prostaglandin induced enteropooling in rats, and charcoal meal test in mice) of diarrhoea. Furthermore, the study found aqueous extract to be more potent than alcoholic extract.L. sativum has been used widely in different parts of the world for its wide therapeutic application [14]. The plant is well studied phytochemically with various active components, such as alkaloids, riboflavin, and ascorbic, linoleic, oleic, palmitic, and stearic acids [92]. Moreover, cucurbitacin has also been identified as plant constituent [93]. The plant has been shown to exhibit antidiarrhoeal and antispasmodic effects in rats, mediated through dual blockade of muscarinic receptors and Ca++ channels [14]. The findings of [94] suggest that the aqueous methanol extracts of seeds ofL. sativum exhibit antidiarrhoeal activity through activation of K+ channels and inhibition of PDE enzyme in rabbit intestine.Figure 6
L. sativumseeds (Courtesy: [Regassa, Hawassa, Ethiopia, 2016]).


## 3.5.5.Vernonia amygdalina Del.

It is found in a wide range of bushlands, woodlands, and forest habitats between 500 and 2800 m; it is also often found around home. Its rainfall range is from 750 to 2000 mm per year [95]. Flowering trees can be found from December to May, but the main flowering period is from January to February [79]. Some observations showed that the plant is widely available and frequently growing in homegardens [7, 9, 17, 33, 69]. The leaves ofV. amygdalina(Figure 7) are used in Ethiopian folk medicine to treat malaria [7, 9] and gastrointestinal disorders [28, 42, 58]. The leaf extract is reported to reduce the symptoms of castor oil-induced diarrhoea in rats and reduce gastrointestinal transit of a charcoal meal in mice [10]. Methanolic extract ofV. amygdalinashows that the 400 mg/kg body weight administered orally to the experimental rats was effective in the reduction of the faecal spots [16]. A qualitative phytochemical analysis revealed the presence of some important active components such as saponins and alkaloids [16, 96], tannins [16], flavonoids [97], and glycosides [16]. Some of these components might be responsible for the antidiarrhoeal properties [96]. Therefore, this might indicate that the antidiarrhoeal activities are the most likely combined effect or a single effect [16]. Moreover, the other biomolecules may be neither synergistic nor antagonistic.Figure 7
V. amygdalina(Courtesy: [Megersa, Gute, Ethiopia, 2013]).


## 3.5.6.Cordia africana Lam.

It is found in moist evergreen highlands and riverine forests of the northwest and southwest highlands and very common in western Ethiopia between 550 and 2600 m where the rainfall range is 700 to 2000 mm per year [79]. Some trees can be found in flower at any time of the year, but the main flowering period is from October to March [87].C. africana is the most preferred plant by local people of Ethiopia for various uses, such as construction, timber production, charcoal, and medicine [9, 54, 55]. Due to its multipurpose uses,C. africana is becoming threatened, which is evidently shown by its scarce distribution in different areas of Ethiopia [9, 54, 98].C. africana is one of indigenous tree species that have currently been given conservation priority by using in situ and ex situ conservation in the country [99].In an ethnobotanical study,C. africana(Figure 8) is reported to be used in the management of diarrhoea in Shinasha, by Agew-Awi, Oromo, Tigray, and Amhara people in Ethiopia [28, 31, 37, 55]. The phytochemical analysis of methanolic root bark extracts ofC. africanarevealed that the plant material contains phenols, saponins, tannins, terpenoids, and flavonoids [100]. The mechanism of action of saponin for antidiarrhoeal effect is through the inhibition of histamine; terpenoids inhibit release of autacoids and prostaglandins; phenol makes intestinal mucosa more resistant [12]. There are considerable reports onC. africana studies showing the antidiarrhoeal effects on experimental animals [12, 101] For instance, the study conducted by [101] indicated the significant reduction of castor oil induced diarrhoea compared to loperamide. The study also revealed that the extract significantly reduced intestinal transit like that of atropine.Figure 8
C. africana(Courtesy: [Megersa, Gute, Ethiopia, 2013]).


## 3.5.7.Indigofera spicata Forssk.

I. spicata is traditionally used for the treatment of meningitis [18], diarrhoea [20, 23], stomach-ache [35], diabetes [9], and other health problems in Ethiopia. Phytochemical studies conducted on this plant species indicated the presence of alkaloids, flavonoids tannins, and steroids in this plant [13, 102]. Steroids reported to enhance the absorption of hydroelectrolytes across the intestinal lumen [75]. In the castor oil induced diarrhoea in mice, the root extract ofI. spicata inhibits frequency of defecation and fluid content of stool more likely in a dose dependent manner [13]. Moreover, the study found 53.51% inhibition of frequency of defecation which was equivalent to 51.02% of the positive control (atropine). The demonstrated biological antidiarrhoeal activity of crude root extracts ofI. spicata could be due to the presence of these constituents [13]. Besides its use as antidiarrhoeal, usage of this plant raises the safety concern because the plant has showed effect on liver and cause abortion [103] and teratogenic effects in animals [104].


## 3.6. Prospects and Viewpoints

This review showed that local people in Ethiopia rely on traditional medicines to treat diarrhoeal diseases and are knowledgeable about the applications of medicinal plants. Many people in Ethiopia are still dependent on medicinal plants, at least for the treatment of basic human ailments. Diarrhoea is a major concern in Ethiopia and it is one of the basic human ailments frequently treated by medicinal plants in many regions of Ethiopia [8, 9, 46]. The finding correlates strongly with observations made by [105] that diarrhoea is a major concern in Mozambique [106], in South Africa, and [76] in south-central Zimbabwe. Reports of similar medicinal applications of the documented plants in Ethiopia and the rest of the world indicate that these species are valuable sources of ethnomedicines.The current review addresses the existence of traditional indigenous knowledge. This considerable indigenous knowledge, from the earliest times, is linked with the use of traditional medicine in many countries including Ethiopia [107]. Indigenous knowledge refers to the knowledge, innovations, and practices of indigenous and local communities around the world [108]. Thus, there is a growing appreciation of the value of traditional knowledge and its potential benefits to modern industry [108]. Many widely used products, such as plant-based medicines for human and livestock health, have been developed using indigenous traditional knowledge. It is, therefore, necessary to preserve this indigenous knowledge on traditional medicines by proper documentation, identification of plant species used, herbal preparation, and dosage. This review will assist future studies on the selection of herbal plants to evaluate for phytochemical safety and pharmaceutical efficacy.Almost all ethnobotanical studies in Ethiopia have so far focused on medicinal plants used by rural communities. Urban ethnobotany is minimal or lacking as almost all studies gave with consideration to ethnobotanical studies in rural areas. Applied to the context of immigration, urban ethnobotany will offer the opportunity to evaluate ethnobotanical data within a larger, transnational framework by comparing plant knowledge and use by the same cultural group in its original and new environment [109]. The paradigm shift is also needed from ethnobotanical studies to phytochemical and pharmacological studies. For instance,C. arabica was reported by eight authors,R. nepalensisby six authors,V. officinalisby five authors,andV. sinaiticum by four authors used to treat diarrhoeal diseases in Ethiopia, but no study validated their antidiarrhoeal property by investigating the biological activity of the extracts. Along with phytochemical and pharmacological studies, ethnobotanical studies should also continue, particularly in areas that have received less attention so far. For example, studies should be conducted in the Afar, Benishangul Gumuz, Gambela, Somali, and Tigray regions, like that of Amhara, Oromia, and SNNPR regions (Figure 1).Almost all ethnobotanical studies conducted in Ethiopia have an objective of documentation of medicinal plants used to treat various diseases including diarrhoea. Early ethnobotanical studies conducted in Ethiopia simply focused on listing the name of medicinal plant species with diseases treated [45, 58, 68] without providing any detailed information on the medicinal plants in the region. Another concern of ethnobotanical studies conducted in Ethiopia is the number of informants selected to participate in the study. In this regard, many of the studies collected data from 17 to 38 informants [45, 54, 58, 65, 68] and concluded the knowledge is accumulated by the respected societies. Surprisingly, one study [45] collected ethnobotanical data from three traditional healers and concluded that the knowledge is acquired by local communities of the study area. These numbers could not be a representative sample size to elucidate the entire knowledge of indigenous people found in a district. Therefore, future ethnobotanical studies in Ethiopia should increase the number of informants to have a representative sample size. This will help to gather sufficient information about medicinal plant species. Many studies also did not compute ranking indices [23, 52, 56] though they have invaluable advantages in identifying the most preferred (important) medicinal plants in the study area which could aid phytochemical and pharmacological studies in searching of new drugs. Threats and conservation status of medicinal plants [21, 35, 54] were also overlooked by researchers, though they have advantages to using them sustainably. Ethnobotanical studies should also focus on identifying gender-based and age-based knowledge differences related to medicinal plant uses. In addition, future ethnobotanical studies in Ethiopia should focus on identifying most serious threats to medicinal plants and how local communities manage medicinal plants. Such studies will help in understanding the best conservation strategies and how local communities relate to the plant resources that they use as medicines.The existing literature shows that there are several plant species having antidiarrhoeal activities. These plants have a lot of potential to be developed as alternatives to the existing drugs. Studies are needed to determine if, for the same active principle and at the same dosage, the efficiency is different for traditional and western remedies [72]. Despite the encouragement of promises shown by these materials, the applications have not been able to transfer from experimental animals’ trials to humans and real-life applications; they all remained on papers. One of the drawbacks of the use of traditional medicinal plants for diarrhoeal diseases is the lack of precise dosage which may enhance toxicity [110]. In the assessment of the performance efficiencies of the different plant species as antidiarrhoeal properties, little efforts have been made to evaluate the toxicological effects of the extracts from these plant species. To ameliorate this challenge, attempts should be made to standardize (the drug preparation, dosage, and route of administration) and authenticate plant species which have antidiarrhoeal properties so that they could be used as natural drugs [111]. These efforts will help to produce effective drugs in treating various diarrhoeal diseases. Moreover, establishment of a medicinal plants database with important medicinal uses will have valuable advantages in searching of new drugs.In searching of new drugs from medicinal plants overexploitation and the Nagoya protocol (2010) should not be overlooked. Overexploitation of medicinal plants especially those found in a restricted geographic location might lead to extinction. For example,C. africana, Cucumis dipsaceus, S. kunthianum, andWithania somnifera which were readily available in Ethiopia are now at the verge of extinction because of overexploitation [9, 54, 71]. Therefore, pharmaceutical companies and research institutions along with local communities should be encouraged to cultivate these medicinal plants to ensure the continuous supply of plant materials [112]. From a governance point of view, Ethiopia requires an enforceable policy that protects wild medicinal plants and policy incentives for the cultivation of medicinal plants to reduce overexploitation. Regarding the Nagoya protocol, fair and equitable sharing benefits arising from the utilization of genetic resources and community knowledge must be shared between the people using community knowledge and the people providing them as it is clearly stated in the agreement. If any product is used from the plant species for drug development obtained from indigenous knowledge, the local communities who acquired the knowledge should get benefit.In order to obtain necessary information for optimum and practical conditions for antidiarrhoeal medicinal plants, there is also a need to investigate the physiological and biochemical functions demonstrated by these plant species. Additionally, identifying the individual bioactive natural products and elucidating the underlying mechanism of the process will have invaluable advantages to use the specific plant species for specific diarrhoeal diseases. Although different active components from various plant species are reported to have antidiarrhoeal activities, availability of similar amounts of those components among different plant species may not result in a similar antidiarrhoeal capabilities. The antidiarrhoeal activities within a single species may also vary depending on the type of climate, soil contents, crop year, and geographical features. Therefore, future phytochemical studies should consider the abovementioned conditions to produce the best out of plant species with antidiarrhoeal properties.Phytochemical and pharmacological studies should have continued until the end users that experience the problem of diarrhoea. To do this, the dissemination of research findings to the appropriate governmental and nongovernmental agencies, who served as a boundary between the end users and the researchers, is necessary, but lacking. Thus, improvement on this channel of information dissemination shall be of great assistance in the promotion of the plant based antidiarrhoeal drugs to real life applications.


## 4. Conclusions

The study showed a rich diversity of indigenous medicinal plants commonly used for treatment of diarrhoeal diseases in Ethiopia. In this review paper, 132 medicinal plant species are reported that are used in the traditional diarrhoeal treatment by Ethiopian people. Ethnomedicinal research on distribution and usage pattern of antidiarrhoeal plants show variability across geographic and different regions in the country. For instance, sufficient studies were not conducted in the Afar, Benishangul Gumuz, Gambella, and Somali regions. Thus, researches should continue working in these areas that have received less attention. Use pattern of antidiarrhoeal herbal remedies and associated toxicity risks also need to be studied for future application without any doubt of observable side effects. Other challenges that need to be addressed are validation and efficacy of antidiarrhoeal plants. This could be addressed through in vivo and in vitro experiments with consideration to frequently used medicinal plants as to compete with existing conventional drugs. Any drug development needs clinical trials. This is the ultimate procedure to drug development for human or animal use.



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