Phytochemical-constituents, safety and efficacy of commonly used medicinal plants for the treatment of malaria in Ethiopia-a review

According to 2017 WHO malaria report, 394.7 million people was at risk with Plasmodium falciparum (98%) and Plasmodium vivax (2%). Even though death with malaria decreased from 70,700 in 2010 to 20,800 in 2016,41.5 million malaria confirmed cases was reported in the East African region.1 P. falciparum resistance to artemisinin has been detected in five countries in the Greater Mekong sub-region. In Cambodia, high failure rates after treatment with an ACT have been detected for four different ACTs.2 Malaria remains a major public health problem in Ethiopia where only 25% of the population live in areas that are free from malaria and still among the ten top leading causes of morbidity and mortality in children under-5.3 Malaria transmission in Ethiopia is seasonal, depending mostly on altitude and rainfall, with a lag time varying from a few weeks before the beginning of the rainy season to more than a month after the end of the rainy season and transmission peaks bi-annually from September to December and April to May, coinciding with the major harvesting seasons.4 The prevention of malaria in Ethiopia has relied mainly on early diagnosis and treatment of infection and reduction of humanvector contact by indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs).5 The Action and Investment to defeat Malaria (AIM) 2016–2030 strategy underscored that, malaria is not only a health issue, but also a broader developmental, socio-political, economic, environmental, agricultural, educational, biological, social issue and this strategy laid strong emphasis on the importance of keeping target community at the center of the fight against malaria and highlights the need for inclusive and collaborative efforts to create a malaria-free world by 2030.6 The rise of drug-resistant parasites especially P. falciparum multidrug resistance hamper malaria containment strategies.7 In Ethiopia, artemether-lumefantrine replaced sulfadoxine-pyrimethamine (SP) in 2004 due to the increasing resistance of malaria to SP.8,9 The emergence of artemisinin resistance has raised concerns that threaten the potency of existing anti malaria’s and their therapeutic effectiveness of artemisinin which have been the drugs of choice is limited by a number of factors such as short half-life, neurotoxicity, and low solubility which affects their bioavailability. Traditional medicines are often more available, affordable and sometimes are perceived as more effective than conventional antimalarial drugs. Moreover, 80% of the Ethiopian population uses traditional medicine due to the cultural acceptably of healers and the relatively lower cost than modern drugs.10,11