Development of a tool to predict high risk users and monograph for common herbal medicine use among women in Perak, Malaysia

Abstract

Preference for herbal use is increasing worldwide, especially among Malaysian women. Malay women in Malaysia, through traditional and cultural values, commonly used herbal remedies in traditional post-partum care, closely guided by women traditional practitioners or healers. The knowledge on the uses of medicinal plants and the practices among traditional healers are reported to be varied according to geographical location and local traditions. With the current lack of proper documentation, there is a risk of losing information on the practice and common plants used by women traditional practitioners in post-partum care. As such the overall aim of the study is to preserve traditional medicine use for post-partum care among Malay traditional healers. The objectives of the study were to develop a tool to predict high risk users of herbal medicine among all Malaysian adult women, identify preferred herbs among Malay women, investigate common plants used in post-partum care among female Malay traditional practitioners, and perform pharmacognostical studies on few selected plant species, in attempt to develop monographs for the plants. To develop the predictor score, 1435 respondents were included into the study. Two-thirds of the data used to develop the score using multiple logistic regression (n=957, 66.7%) demonstrated that Malays, married women, employed and a monthly income of less than RM 3000 was associated with herbal use (χ²=235.9, df=6, p<0.001). Scores were then assigned based on significant factors in the model. The performance and accuracy of the constructed scores in predicting herbal use was 0.759 (ROC) (95% CI=0.729-0.789). The constructed scores were then validated with the remaining one-third of the data (n=478, 33.3%) and showed good accuracy 0.765 (ROC) (95% CI=0.722-0.807). Following this, among 1067 Malays female respondents, 592 (55.5%) admitted to using herbs for health. In general, raw herbs were the most preferred herbal remedies used (n=407, 69.5%), with general health (n=271, 43.9%) and post-partum use (n=212, 34.4%) being most common. An interview of 36 female traditional practitioners, revealed that there were 139 different plant species used for post-partum management. The mostly used plant species were serai wangi (Cymbopogon nardus L. Rendle (Poaceae)) (n=18, 50%), mengkudu (Morinda citrifolia L. (Rubiaceae)) (n=15, 41.7%) and pandan (Pandanus amaryllifolius Roxb. (Pandanaceae)) (n=14, 38.9%), of which leaves were frequently used (n=94, 67.6%). Macromorphological and microscopic investigation of the vegetative parts of the plant of interest in this study i.e., Flemingia strobilifera, L. inermis and P. amaryllifolius plants revealed their diagnostic anatomical features. The extractive values analysis demonstrated the quality and the purity of the crude herbal medicine. The water-soluble extractive values for Flemingia strobilifera, L. inermis and P. amaryllifolius were not less than 12%, 25% and 12% respectively for hot method, and not less than 3%, 18% and 11% respectively for cold method. Whereas the ethanol-soluble extractive values were not less than 8%, 24% and 6%, respectively for hot method, and not less than 4%, 18% and 3%, respectively for cold method. Chromatographic characterization (TLC and HPLC) was carried out and chromatographic fingerprints for these plants were established. This work provides insight into specific groups, information and health initiatives that can be targeted to strengthen herbal use monitoring among Malay women based on a simple tool to address nondisclosure of herbal medicine use. Chromatographic profile and other pharmacognostical information were successfully documented and can be utilised as identification tools in the monographs of the selected plants. These findings can be used for monitoring, regulatory, quality control and assurance of safety for L. inermis (inai), P. amaryllifolius (pandan), and F. strobilifera (seringan)