Indigenous medicinal knowledge and therapeutic practices of the endangered Ongota/Birale of Southwest Ethiopia

Abstract

Background

This study documents the indigenous medicinal knowledge of the Ongota/Birale people in Hinchete Kebele (county) of Benna Tsemay Woreda (district), South Omo Zone, Ethiopia whose language is endangered, with only six speakers remaining. With their language endangered, documenting their heritage of ethnomedicine is necessary. The study was conducted from January 2023 to February 2024.

Methods

Data were collected using in-depth interviews and focus group discussions with the remaining speakers, field observations, and medicinal plants specimen collection across 14 locations. The data were translated, transcribed, coded, and thematized. Thematic analysis was applied for identifying recurring themes and patterns in the data and interpreting. Frequency analysis was used for some quantifiable data.

Results

Ninety-eight sources were cataloged in this study including 31 plant taxa, 8 animal derivatives, 4 minerals, and 3 other materials. Thirty-seven distinct human health problems/Roosaa/ were treated by these. Solanaceae is the most frequently used plant family closely followed by Burseraceae and Tiliaceae. Herbs comprised the largest proportion (38.7%) of the identified medicinal plant species, followed by shrubs (25.8%), trees (22.58%), and climbers (12.9%). 83.87% were harvested from wild areas (natural forest) and 16.13% from home gardens. Grinding and crushing constituted (70%) as the dominant preparation method. The most common routes of administration are dermal (51.35%) and oral (35.13%). Animal-based products (milk, butter, honey, spleen, fat, blood), traditional drinks (‘areke’ and ‘boordee’), and minerals (red soil, the salt mineral ‘megaaddoo,’ common salt, and copper) were also used. The most frequent therapies reported are cauterization (33.3%), bloodletting (33.3%), massage (22.2%), and acupressure (11.1%). From the 26 medicinal plants that grow in the study area, 7 i.e., Ocimum americanum, Acalypha fruticosa, Corchorus tridens, Adenium obesum, Terminalia brownii, Boswellia neglecta, and Sansevieria ehrenbergii were not reported for similar uses previously. Pharmacological studies have not yet been reported for 12 of the 26 medicinal plants against the causative agents of the diseases they reported.

Conclusion

The Birale/Ongota have rich indigenous medicinal knowledge and therapeutic practices that have been maintaining their health. However, due to threats by environmental challenges and the endangerment of their language and culture, further research on ways of conserving their biodiversity and indigenous livelihoods, preserving their medicinal plants, finding the active ingredients in them, and integrating their indigenous healthcare system with the modern are required.

Background

According to the World Health Organization (WHO), traditional/indigenous medicine is "the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness" [1]. Fokunag et al. [2]emphasize medicines and physical therapies when they define it as health procedures, methods, knowledge, and convictions that include physical exercises, spiritual therapy, and medications derived from plants, animals, and minerals[p. 284].Sever [3]further provides a definition that covers the process from diagnosis to healing defining it as the whole set of procedures and methods that the general public uses to independently diagnose and cure different illnesses[p.1]. It can generally be defined as the traditional system of knowledge of medicinal and healing practices that uses plants, animals, minerals, physical therapies, rituals, and spiritual beliefs to promote health and well-being.

African indigenous medicine is a kind of all-inclusive health care system with three levels of specialization, i.e., divination, spiritualism, and herbalism [4: p.191]. Illness is viewed in African indigenous medicinal knowledge “as having both natural and supernatural causes and thus must be treated by both physical and spiritual means” [4: p.191]. Several studies on indigenous medicinal knowledge and healing practices in Africa have been conducted [5–7]. Nevertheless, there is a need to evaluate the current narrow perspective in the health sector and promote respect for diverse cultural practices that provide healthcare services [2, 4, 7, 8].

Ethiopians are more dependent on indigenous medicine because modern health services are concentrated in urban areas and are less accessible to the rural population. It is estimated that approximately 80% of Ethiopians, principally in rural areas, use indigenous medicine owing to its availability and affordability [9–12]. The long history of medicinal plants usage recorded in different medico-religious manuscripts are believed to have originated several centuries ago [13]. Medicinal textbooks were written in Geez and Arabic in Ethiopia since the mid-seventeenth century suggesting medicinal plants have been used for traditional medicine in Ethiopia [14, 15]. In Ethiopia, medicinal plants are employed to treat “abscess, arthritis, ascariasis, burns, colds, colic, constipation, diabetes, dysentery, eclampsia, gastritis, gonorrhea, heartburn, headache, hemorrhoids, hepatitis, herpes simplex, kwashiorkor, leprosy, malaria, measles, rabbis, rheumatism, scabies, syphilis, schistosomiasis, and toothache”[16]. These and many other studies have documented indigenous medicinal knowledge in different parts of Ethiopia. However, the knowledge of traditional healers is not well recognized and integrated into the national health care system [7, 17].

The plants of Ethiopia are estimated to encompass between 6500 and 7000 species, 10–12% of which are considered endemic [18]. Approximately “1000 plant species, more than 15% of the total flora, are reported to have medicinal value” [19]. Admasu and Yohannes documented the parts, use, ecology, and quality control of 80 Ethiopian medicinal plants used in indigenous medicine [20]. It is also thought that there are still scores for unidentified medicinal plant species in Ethiopia [12]. However, recently, the knowledge and practice of ethnomedicine in Ethiopia have faced challenges, including threats to resources and associated knowledge, lack of awareness and documentation, and limited collaboration with modern healthcare [21].

To this end, identification and documentation of unidentified indigenous medicinal knowledge and therapeutic practices in undocumented cultures are critical. This study focused on the medicinal knowledge and therapeutic practices of the six remaining speakers of the culturally and linguistically endangered people of Ongota/Birale in the Hinchete Kebele (county) of Benna-Tsemayi district of South Omo Zone, southern Ethiopia. A study conducted by Assegid and Tesfaye to document the traditional utilization and management practices of wild medicinal trees and shrubs in the Benna Tsemay district failed to include the Birale people with no kebeles in which Birales reside sampled [22]. It also focused on the management and utilization of medicinal plants, excluding medicinal animal products, minerals, and therapies. The current study aims to fill this gap by providing a comprehensive documentation of the indigenous medicinal knowledge and therapeutic practices of the Birale people. With Ongota/Birale people’s language endangered and cultural assimilation into Tsemay ongoing by denouncing their identity and accepting Tsemay identity through the Gore ritual, it is high time to document and preserve their indigenous ethnomedicinal knowledge and therapeutic practices before the passing away of the six remaining speakers.

This study is therefore done with the following objectives: -

1.To find out the common human health problems in the study area.

2.To document the medicinal plants' composition, parts used, mode of preparation, and administration in the study area.

3.To find out the non-herbal remedies from animal products, traditional drinks, and minerals as well as the physical therapies used in the study area.

Study area description

The most well-versed speaker of the language remaining, Geda Qawla, underlined in an interview in January 2024 that ‘Iifa Ongota’ is used to refer to the language and ‘Birale’is used to refer to the people, contrary to Sava’s claim that Birale is a name despised by the people that their neighbors use [23]. We therefore use the term “Birale” to refer to the people and “Iifa Ongota” to their language. Birales are an ethnic group in southwest Ethiopia whose livelihood mainly depends on traditional agriculture, fishing, hunting, and beekeeping [24, 25]. They live in Hinchete kebele of the Bena-Tsemay district of the South Omo Zone on the western shores of the Weyto River around Weyto town between Konso and Keyafer on the road from Arba Minch to Jinka.

The literature and statistical data of the central statistical agency (CSA) of Ethiopia provide controversial figures on the population size of Birale people, which ranges from 89 to 469 [26–31]. This discrepancy may be due to confusion of ethnic and linguistic identity as well as the ongoing cultural and linguistic shift to Tsemayi. Currently, we have made a count in January 2024 and registered 417 ethnically Birale/Ongota members in the majority of their small settlements in Hinchete kebele, with only few in the Kilala, Gonba, Dhugaburko, and Bula scattered households unrecorded. We have also met and ascertained that there are six remaining speakers of their language Iifa Ongota, three of whom are very fluent and well versed. The rest, 411, can only speak the neighboring Tsemay and Ale languages. A number of linguists have established that their language is endangered mainly due to intermarriage with the more populous and dominant Tsemay, conversion to Tsemay identity through the Gore ritual, shift to Tsemay language, and the break of language transfer from parent to child [26–31]. UNESCO has listed their language as an endangered languages with the Nomination File No. 00493 [28]. The endangerment of their language also meant the endangerment of their culture. The classification of their endangered language has also been controversial and is not yet clear [32]. Birale oral lore on their origin claims their language is the result of a mixture of different languages that their ancestors used to speak before they mixed together and created the Birale community.

The Birale believe in one creator whom they refer to as Waga and their ancestor’s spirits. They comprise seven clans: Uzbekko, Izmakko, Baritto, Amadho, Algakko, Regakko, and Ellako. Ritualists from each clan have their own specializations. For example, those from Uzbekko preside over crop diseases and animal pests, Izmakko over crop blessings, Baritto over Tampo (social control and protection) and Amadho over rain-related rituals. The powers of their clan chiefs, Bahas, are mostly spiritual. The Baha of the Uzbekko clan is considered the leader of the Birale people.

Materials and methods

This study is qualitative ethnographic research aimed at describing and documenting the indigenous medicinal knowledge and therapeutic practices in the memory of the six remaining speakers of Iifa Ongota. As qualitative research, it uses open ended questions and collects interview and observation data which are transcribed into text and from which themes and patterns are interpreted [33].

Data collection

First, purposive and snowball sampling techniques were used to trace and identify the informants with the defined quality of speaking the dying language Iifa Ongota using Tongco’s approach [34]. The remaining speakers of the language were chosen as informants because indigenous medicinal knowledge is stored in their memory in their language and because the transfer of the language and the knowledge it carries has been effectively broken due to the shift to Tsemay language and culture. After the remaining speakers, which are six (4 men aged 85, 90, 95, and 105, and 2 women aged 46 and 57), were identified, in-depth interviews were done with each of them after gaining their full consent. Then, two focus group discussions were done with five of the six speakers (3 men and 2 women). Finaly, two field observations in which five remaining speakers (3 men and 2 women) participated in showing and demonstrating the medicinal plants, minerals, animal products, and therapeutic practices were conducted.

The two field observations through the places where the five remaining speakers lived, worked, and where the reported medicinal plants were found (from Tele to Aydolle) were done with the five remaining speakers. The places visited have an altitude ranging from 500 – 1000 m a.s.l. with mean annual rainfall of 400 mm to 920 mm and mean annual temperature 17.6⁰C to 27⁰C. The vegetation types are mostly dry commiphora woodlands and scrubs that change to thick riverine vegetation along the banks of the Weyto River. These visited locations where the medicinal plant samples were collected from are described in the map in Fig. 1 and in Table 1 as follows:

Fig.1.

Map of the visited locations

Table 1.

Description of the visited locations

^*These areas are places where seasonal settlements, Weyto river bank farming, cattle and goat rearing, beekeeping, and hunting and gathering take place. They change their settlements many times due to flooding of their farmland on the river bank. Informants, therefore, did not report these as areas of their current residence

The medicinal plants were reported by the informants in Iifa Ongota and Tsemay languages. Preliminary identification was done with the assistance of the botanist1 in our team. Medicinal plant specimens were then collected with the help of the botanist and were sent to The National Herbarium of Ethiopia for preservation and scientific name identification.2 Twenty-four medicinal specimens (SE 1 – SE24) were identified at the herbarium as shown in Appendix 4. The remaining 10 popular medicinal plants domesticated as food, spice, beverages, etc. like garlic, ginger, tobacco, coffee, pumpkin, etc. (SE 25 – SE34) were identified by the botanist at the department of biology referring to Flora of Ethiopia and Eritrea, Vol. 1 -8.

The data collection was conducted in different rounds from January 2023 to February 2024 until the data reached saturation point. The data were assumed to have reached saturation point when no more new information could be provided by the six remaining speakers.

Data analysis

These collected data were then transcribed and organized. The transcribed data were coded, categorized, and thematized. Thematic analysis was done in line with the specific objectives of the study by identifying recurring themes and patterns in the data, grouping related information together to understand broader concepts, and identifying common themes in the use of specific plants, animal products, minerals, and therapies for various ailments.

Though this study is primarily qualitative, some quantifiable data were analyzed through frequency analysis in which the frequency of occurrence of certain terms or concepts such as growth forms, plant parts used, route of administration, method of preparation, plant families, and the most frequently used medicinal plants are counted and presented in numbers and/or percentages. Jaccard Similarity Index was employed to compare list of medicinal plant species collected in this study with those from previous studies conducted in different regions of Ethiopia. The Jaccard Index formula used is:

$$\text{J}\left(\text{A},\text{B}\right)=\left|\text{A}\cap \text{B}\right|/\left(\left|\text{A}\right|+\left|\text{B}\right|-|\text{A}\cap \text{B}|\right)$$

where: A is the present study; B the previous study |A ∩ B| is the number of shared species.

The results of these analysis are presented in separate subsections under the ‘Results’ section below. The findings were then compared to previous research data and findings in Ethiopia and elsewhere, interpreted, and their overall implications discussed in the ‘Discussions’ section.

Results

Common human Roosaa /health problems/ in the study area

This survey cataloged ninety-eight sources, encompassing 31 plant taxa, 8 animal derivatives, 4 minerals, and 3 other materials of varied origins. These were linked to a total of 37 distinct human health conditions, identified through consultations with the six remaining elders who are also traditional medicine practitioners in the study area. The frequency of reported ailments and the corresponding number of medicinal plants, animals, and minerals used for their treatment are summarized in Table 2. The most frequently mentioned condition was treated using 7 different medicinal plant species, while the next six conditions were each addressed with 3 plant species. Nine additional ailments, each reported with a frequency of 6, were treated with 2 distinct plant species. The remaining 10 conditions, also reported with a frequency of 6, were each treated using a single medicinal plant species.

Table 2.

Common human ailments and number of medicinal plant species used to treat ailments

Ongota/Birale terms	Clinical terms	Frequency of reported	No. of plant species used
Gulfa	Common cold (CA00)	6	7
Baahaa Ba’atunne	Constipation (ME05.0)	6	3
Bohaakko	Boils (1B75.0) and Pimples	6	3
Erezaa	Diarrhea (ME05.1)	6	3
Itimaaroos	Tooth infection (DA09.62)	6	3
Tsaanaa	Skin allergy (EK5Y)	6	3
Wowwa Kroos	Ear infection (AA0Z)	6	3
Aaaraa	Yellow fever (1D47)	6	2
Busug’aa	Sexual dysfunction	6	2
Gomara	Tonsilitis (CA03.0)	6	2
Guni Kid’a	Snake-bite poisoning	6	2
Hanaago Kid'a	Scorpion bite and poisoning	6	2
Khiibo roos	Impetigo (1B72)	6	2
Matsaa	Urinary tract infection (GC08)	6	2
Sunpa Kroos	Lung disease (CB40.Y)	6	2
Welaalko	Typhoid (1A07) and typhus (1C30)	6	2

The composition of medicinal plants species

A total of 31 plant species belonging to 30 genera and 27 families were identified to have medicinal value in the study area. These species were used primarily to treat major human health problems. An enumeration of all recorded species including voucher codes, botanical name, local name, family, parts used, and ailment treated are provided in Appendix 1.

Species diversity analysis by family revealed that Solanaceae was the most dominant family, comprising 3 species. Two families (Burseraceae and Tiliaceae) were represented by two species each, whereas the rest of the 24 families were represented by one species each (Table 3).

Table 3.

Composition of Medicinal Plants Species

Family	No. of species	Percent (%)	Family	No. of species	Percent (%)
Solanaceae	3	9.68	Fabaceae	1	3.23
Burseraceae	2	6.45	Lamiaceae	1	3.23
Tiliaceae	2	6.45	Menispermaceae	1	3.23
Acanthaceae	1	3.23	Molvaceae	1	3.23
Amaranthaceae	1	3.23	Moringaceae	1	3.23
Amaryllindaceae	1	3.23	Olacaceae	1	3.23
Apocynaceae	1	3.23	Plumbaginaceae	1	3.23
Asclepiadaceae	1	3.23	Poaceae	1	3.23
Asparagaceae	1	3.23	Portulacaceae	1	3.23
Combretaceae	1	3.23	Rubiaceae	1	3.23
Cucurbitaceae	1	3.23	Rutaceae	1	3.23
Cyperaceae	1	3.23	Salvadoraceae	1	3.23
Dracanaceae	1	3.23	Zingiberaceae	1	3.23
Euphorbiaceae	1	3.23

Among the medicinal plant species identified, Withania somnifera (L.), Portulaca quadrifida L., Ximenia americana L., Corchorus olitorius L., Ruellia patula Jacq., Cissampelos pareira L., Moringa stenopetala (Baker f.) Cufod., Zingiber officinale Roscoe, Allium sativum L., Coffea arabica L., and Nicotiana tabacum L. were the most frequently utilized, each being employed in the treatment of 2 to 4 distinct diseases.

The life form analysis revealed that herbs comprised the largest proportion (38.7%) of the identified medicinal plant species, followed by shrubs (25.8%), trees (22.58%), and climbers (12.9%). Regarding the sources of these plants, 83.87% were harvested from wild areas (natural forest) and 16.13% from home gardens.

Mode of preparation and administration

The most commonly employed method of preparation was grinding and crushing with a mortar and pestle, followed by boiling in water, mixing with water, and chewing and swallowing the juice (Table 4).

Table 4.

Mode of preparation to plant parts used of identified species for treatments

Types of preparation	Frequency	Percentage
Grinding and crushing	14	31.82
Boiling in water	5	11.36
Mixing with water	4	9.09
Chewing and swallowing the juice	4	9.09
Rinsing in water	3	6.82
Smoking	3	6.82
Roasting	2	4.55
Mixing with honey and water	1	2.27
Warming on fire and squeezing the liquid out	1	2.27
Extracting oil	1	2.27
Mixing with red soil and butter	1	2.27
Warming on fire	1	2.27
Licking	1	2.27
Mixing with honey	1	2.27
Chewing and holding between the teeth	1	2.27

Among the identified plant species, 70% were used in single prescriptions, while the remaining species were combined in poly prescriptions (blended with multiple plant species to enhance therapeutic efficacy) for the treatment of various human ailments (see Appendix 1).

The findings also indicated that the majority of these prescriptions were administered via dermal route (51.35%), followed by the oral route (35.13%). Inhalation accounted for 10.81%, while warm compresses were the least utilized method at 2.7% (Table 5).

Table 5.

Mode of administration of the plant remedies of the identified species in the study area

Route of administration	Frequency	Percentage (%)
Dermal	19	51.35
Oral	13	35.13
Inhalation	4	10.81
Warm compress	1	2.7

Jaccard similarity index

The Jaccard Similarity Index was used in this study to check the similarity of medicinal plant species of the present study with those recorded by previous researchers from communities in different regions of Ethiopia. The medicinal plant species in the current study were compared with 18 published ethnomedicinal sources as shown in Table 6 below. The neighboring Hamar area which has similar weather condition and vegetation type with the study area showed relatively higher percentage of similarity and shared more common species. Gubalafto and Mana Angetu areas also shared relatively higher number of common species because they encompassed some dry lowland vegetation. The rest mostly shared few common household remedies consumed as foods, beverages, and spices. The fact that there are medicinal plant species not previously reported in this area can be attributed to the fact that the area where the Birale live is remote, understudied, and has a relatively better conserved biodiversity.

Table 6.

Jaccard similarity index comparing the current study with earlier research conducted in different regions of Ethiopia

Study area	Species number (a or b)	Common species©	Jaccard index	Similarity (%)	References
Ongota/Birale	31	-	-	-	Present Study
Hamar	143	15	0.09434	9.434	[114]
Benna Tsemay	23	4	0.08	8	[22]
Debre Tabor	37	5	0.079365	7.9365	[15]
Amaro	56	6	0.074074	7.4074	[35]
Tigray	27	4	0.074074	7.4074	[39]
Horo Guduru	56	6	0.074074	7.4074	[46]
Gubalafto	133	11	0.071895	7.1895	[48]
Bale	53	5	0.063291	6.3291	[116]
Yem	158	9	0.05	5	[112]
Mana Angetu	210	11	0.047826	4.7826	[49]
Libo-Kemkem	163	8	0.043011	4.3011	[52]
Dawro	176	8	0.040201	4.0201	[53]
Ada'a	86	4	0.035398	3.5398	[50]
South Omo	87	4	0.035088	3.5088	[106]
Hadiya	31	2	0.033333	3.3333	[36]
Dalle	70	3	0.030612	3.0612	[115]
Minjar	39	2	0.029412	2.9412	[51]
Gurage	23	0	0	0	[113]

Medicinal animal products, traditional drinks, and minerals

Some of the medical solutions /Chagaagaa/ utilized by local practitioners are derived from non-herbal remedies. The non-herbal remedies (Appendix 2) include substances such as animal-based products, traditional drinks like ‘areke’ and ‘boordee’, and minerals. Among the minerals with medicinal applications are red soil, the salt mineral known as ‘megaaddoo,’ common salt, and copper. According to the informants, most locally significant non-plant-based remedies are used for treating thirteen distinct diseases in humans like pityriasis versicolor, anthrax, atopic dermatitis (eczema), tinea capitis, alopecia, tonsilitis, diarrhea, diptera larvae myiasis, malaria, urinary tract infection, wart, scorpion bite and poisoning, and candidiasis.

For example, animal-based products such as blood, spleen, sheep tail fat, and butter were used to treat conditions including pityriasis versicolor, atopic dermatitis (eczema), alopecia, anthrax, and dipteran larvae myiasis. Minerals were reported to be utilized for ailments in the categories of tinea capitis and tonsillitis. Traditional beverages like ‘areke’ and ‘boordee’ were employed in the treatment of malaria and urinary tract infections.

Human health problems treated by physical therapies

According to the six remaining speakers, they practice various therapeutic physical treatments in addition to ingestion or application of medicinal solutions. These include minor surgical operations, cauterization, bloodletting, dry cupping, acupressure techniques, and massage. Minor surgical operations are performed to remove objects that accidentally pierce into and enter the body and remove cancerous development. In particular, there are experts in Gawada (Ale) who perform traditional operations to remove objects that penetrate deeper into the body. Some of the common Roosaa and the physical therapies used to treat them in Appendix 3 show that the most frequent therapies reported are cauterization (33.3%), bloodletting (33.3%), massage (22.2%), and acupressure (11.1%) (see Appendix 3).

Additional massage, acupressure techniques, cauterization (‘Aste’) nerve treatment, bloodletting, dry cupping, and some minor surgical operations practiced that are reported are:- massaging and correcting displaced intestine, heart, and spleen; massage to relieve muscle soreness or tension; back pain-relieving massage; dry cupping and acupressure; bloodletting and cauterization; hand, leg and other body part damage-adjusting massage; and bone fracture maintenance: returning the bone to its right place, tying it with bamboo plates, and feeding the sick meat, honey and milk so that the bones can heal quickly. Massaging is generally performed with raw butter. An acupressure and dry cupping technique in which a thread dipped in gasoline is lit over the painful area and covered by a glass cup to create sucking pressure is practiced. Cauterization (‘aste’) nerve point touch-burn with ‘Itimaa’/the protruding tooth of the warthog/ or bow arrow, which is heated on fire, is practiced. Cauterization or bloodletting is applied to the nerve point where the sick individual feels piercing pain.

Discussion

The composition of medicinal plants species

The large number of medicinal plant species documented in this study underscores the significant botanical diversity of the region, with a broad spectrum of plants utilized for the treatment of various ailments. Furthermore, the findings highlight the extensive indigenous knowledge of medicinal plants within the community. The diversity of plant species recorded in this study exceeds the figures reported in previous research across Ethiopia [35–39]. The high species diversity observed in this study is primarily attributed to the effective conservation of natural forests within the study site, which functions as a sanctuary for a wide array of medicinal plants, including those of historical significance. This site plays a crucial role in safeguarding these remnant forests, which remain an essential reservoir of medicinal plant species. Additionally, the continued reliance on herbal medicine, in conjunction with limited access to modern healthcare services, has likely facilitated the persistence of traditional healing practices as a fundamental aspect of the community.

The plant remedies most frequently utilized in this study were derived from herbs, shrubs, and trees, a trend that likely reflects the floristic composition of the region, which is predominantly characterized by these growth forms. The high prevalence of perennial plants in this survey can also be attributed to the resilience of herbs, shrubs, and trees during extended dry seasons, which enables their continued availability and abundance in semi-arid regions. While herbs were the most commonly used growth forms for medicinal purposes, shrubs followed closely in frequency. Similar findings were also reported previously in Ethiopia which indicated that most of medicinal plant were constituted of herbs and shrubs [35, 40–42]. This pattern may be explained by the relatively limited number of tree species in the study area, which likely led traditional healers to rely more heavily on herbs and shrubs than on trees.

Our findings also indicated that the majority of medicinal plants were primarily sourced from natural forests. While some plants were found in home gardens, they were generally not cultivated with medicinal purposes in mind but rather for other functions, such as providing shade, serving as live fences, or for food, cash income, and spices. The dominance of wild plant collections observed in this study is consistent with findings from other research in Ethiopia [43–46] as well as international studies [47], indicating that wild plant harvesting is a prevalent practice in regions with comparable ethnobotanical traditions. Consequently, the protection of natural habitats is essential to ensure the continued availability of medicinal plants, as those growing in the wild may accumulate active compounds over extended periods, potentially enhancing their medicinal efficacy.

Mode of preparation, and administration

The predominant method of preparation was grinding and crushing, a finding consistent with studies by [22, 39, 51, 52], all of whom identified crushing as the most common technique for remedy preparation. Additionally, the study found that many remedies were prepared from a single plant species, which aligns with the observations of [41, 52], who similarly reported a high prevalence of single-plant remedies.

In terms of administration, remedies for internal ailments were predominantly administered orally, while treatments for skin diseases and injuries were generally applied externally. However, some skin conditions and certain traumas also involved the oral administration of remedies. Oral application is favored due to its ease of administration for humans. Additionally, solvents such as water and food are commonly used as carriers to facilitate the delivery of the remedies. This pattern of remedy application aligns with findings from other studies conducted in Ethiopia and other tropical regions [53, 54].

Traditional uses and pharmacological activities of the species identified

Among the medicinal plants reported in this study (Appendix 1), the medicinal uses of ginger, garlic, coffee, tobacco, and lemon are widely reported and popular throughout the world. Ximenia americana is used by them against yellow fever, typhoid and typhus, boils, pimples, and skin allergy. Similar findings have been reported by [55] who pharmacologically proved its effectiveness against typhoid fever, and [56–58] have reported its widespread use to treat all the same diseases and many more. Withania somnifera is used by them to treat fever, yellow fever, itchy eye allergic conjunctivitis and snake poisoning. [59] have similarly reported Withania somnifera’s uses to treat conjunctivitis, while [60] proved its effectiveness against snake poisoning. Ocimum americanum which they use to treat anthrax has been dissimilarly reported to be used for fever and wound healing [61]. Acalypha fruticosa Forssk which the Birale use to treat heartburn has been dissimilarly reported as effective in treating peptic ulcers in human patients [62]. Pupalia lappacea which the Birale use for healing allergy rushes and wounds has been reported to have antimicrobial and anti-inflammatory activities by [63].

Moringa stenopetala, which they use to treat ear infection, common cold, and lung disease, has been reported by scholars to have similar usages [64, 65]. Their use of Gossypium herbaceum’s seed oil against ear infection is also widely known in folk medicine and modern pharmacology [68]. Salvadora persica which they use to treat impetigo has been reported as effective against multiple skin diseases caused by bacteria, fungi, and inflammation [67]. Acacia mellifera which the Birale use to treat boils and pimples has been reported as antimicrobial and antifungal and as active against the most common cause of boils Staphylococcus aureus by [68]. Cyperus rotundus which they use to relieve stomachache has been similarly reported as having medicinal uses against inflammation, pain, diarrhea, and as gastroprotective [69]. The extracts of Cucurbita pepo L. seed, which they take as a solution against tapeworms, have been reported as effective against Gastrointestinal (G.I.) nematode infections [70].

Corchorus olitorius which they use both as a vegetable and as medicinal plant to treat constipation and male sexual dysfunction is widely known both as an edible vegetable and medicinal plant. Although pharmacological studies are inconclusive as to the direction of its effect on sexual performance [71, 72], a study done on human subjects in Japan has proved its effectiveness against constipation [73]. Corchorus tridens which the Birale use both as a vegetable and to treat female sexual dysfunction has been dissimilarly reported as utilized in numerous countries for treating fever, pain, inflammation, and sexually transmitted diseases [74]. Solanum incanum which the Birale use to treat tooth infection and wounds has been similarly reported as antimicrobial and anti-inflammatory [75]. Adenium obesum which they use as an antidote for scorpion poisoning has been dissimilarly reported for abdominal colic and evil eye [76]. Terminalia brownii which they use to treat skin allergy has been dissimilarly reported as used against abdominal pain and jaundice [77]. The use of Commiphora sp. gum raisin to control epilepsy and convulsions, which the Birale practice, has been similarly reported [78]. Though frankincense and myrrh produced in Ethiopia including those from Boswellia neglecta have been generally reported as used against the common cold and coughs [79], there are no reports specifically focusing on Boswellia neglecta gum’s uses for the common cold which the Birale practice.

Sansevieria ehrenbergii which the Birale use aginst ear infection and for cleaning turbid water has been dissimilarly reported as used for treating snakebite wounds in Kenya [80]. Ruellia patula used by the Birale to treat candidiasis, impetigo, urinary tract infection, and typhoid and typhus has been widely reported as having anti-bacterial, anti-inflammatory, wound healing and hepatoprotective activity [81]. It has also been reported as used to treat “gonorrhea, sore eyes, renal infection, kidney stones, dental problems, stomach ache, syphilis, tumors, rheumatic complaints, itches, insect bites, cough, scalds, paranchia and act as cardiotonic and anti-ulcer agent” [81: p.1]. Dregea schimperi which the Birale use to treat diarrhea have been similarly reported for anti-bacterial activity against bacterium that cause diarrhea and other ailments by [82]. Plumbago zeylanica L. which the Birale use against tooth infection has been reported as having anticancer, antibacterial, and antioxidant pharmacological activities [83].

Cissampelos pareira L. which the Birale use to treat ascaris, diarrhea and constipation has been similarly reported as used traditionally to treat diarrhea, gastrointestinal issues, and many other diseases as well as exhibiting antimicrobial pharmacological activity by [84]. [85] also corroborated Birale people’s use of this medicinal plant against ascaris reporting its anthelmintic pharmacological activities. Asparagus falcatus L. which is used to treat tooth infection by the Birale has been reported as having antimicrobial and anti-inflammatory activities and as commonly used against a number of diseases by [86]. Portulaca quadrifida L. which is used by the Birale to treat Atopic dermatitis (eczema), Tinea capitis, and constipation has been reported as used against diseases like “gastric ulcer, ophthalmia, as an anti-microbial, anti-hyperglycemic” in Ethiopia and as having antioxidant and antibacterial activities by [87].

From the 26 medicinal plants that grow in their area 19 have been reported for similar traditional uses by previous studies while 7 i.e., Ocimum americanum, Acalypha fruticosa, Corchorus tridens, Adenium obesum, Terminalia brownii, Boswellia neglecta, and Sansevieria ehrenbergii were not reported for similar uses previously. Pharmacological studies have reported pharmacological activities of 14 of the 26 medicinal plants species that grow in their area against the causative agents of the diseases they reported while 12 of them have not yet been studied. This shows that further pharmacological studies are required.

Use of animal body parts and/or animal products

In this study, informants reported the use of various animal-derived products in different forms for medicinal purposes. Commonly utilized remedies included animal products such as honey and butter, visceral organs like fat and spleen, blood, and external body parts such as hair and excrement.

Animal products such as honey and butter were primarily used to treat a range of conditions, including pityriasis versicolor, anthrax, tinea capitis, diarrhea, dipteran larvae myiasis, and warts. Similar therapeutic uses of animal products have been documented in Ethiopia [88]. Honey, in particular, has been reported as an effective remedy for ailments such as warts, asthma, diarrhea, throat pain, stomachaches, cough, tuberculosis, mumps, and heart failure [89]. Honey's therapeutic properties are attributed to its complex composition, which includes sugars, water, proteins, amino acids, vitamins, minerals, organic acids, phenolic compounds, and volatile compounds, all of which contribute to its healing properties [90]. The Birale use of honey to treat gastrointestinal issues is corroborated by many studies. [91] reported that honey is used to treat gastrointestinal issues. According to [92], the red honey in Ethiopia has superior antibacterial activity. Many studies have similarly shown that honey has significant antibacterial effects against multi-dung resistant bacteria and is effective in the healing of wounds [92–94]. Honey is also reported to contain phytochemicals that have anti-inflammatory, anticancer, and antioxidant effects when it is monofloral [95].

Butter, on the other hand, was used to treat conditions such as pleurisy, the common cold, bone fractures, weight gain, toothaches, ear pain, and headaches [90, 96].

Visceral organs, including fat and spleen, were used for treating skin disorders such as pityriasis versicolor, atopic dermatitis (eczema), and alopecia. Similar uses have been documented in Ethiopia [97]. In Brazil, animal fat has been applied for treating scabies, skin diseases, swelling, burns, and wounds [98]. Ethnobiological studies have also highlighted the use of fats in the treatment of neurological disorders, atherosclerosis, thrombosis, and the effects of aging, likely due to the presence of omega-3 fatty acids in vertebrate fats [99–102].

Blood from animals was commonly used in the treatment of pityriasis versicolor, with similar practices observed among various tribal communities in Ethiopia [88, 90]. Animal blood was frequently applied in the management of skin infections and fungal diseases.

External body parts, particularly hair and excrement, were integral components in numerous remedy preparations for skin conditions such as anthrax and warts. This finding contrasts with reports from the Motta city administration and Hulet Eju Enessie District in East Gojjam, Northwest Ethiopia, where dried human feces were used in the treatment of the "evil eye" [97].

Use of mineral substances and traditional drinks

In our study, we observed the use of salt minerals and a red copper bracelet in the treatment of tonsillitis in humans. Similarly, in Kyrgyzstan (Central Asia), copper, white clay, and sodium chloride solutions have been employed to disinfect the oral cavity of animals affected by foot-and-mouth disease and to treat external wounds [103]. The use of copper has also been documented in Southern Italy, where it is applied as either a ground powder or dissolved in vinegar, or combined with water and salt, to treat cracked hooves or the chapped skin surrounding the hooves of livestock [104] [Confessor et al., 2009]. Additionally, in Romania, a mixture of soil and butter has been used to treat mastitis in cattle [105], and in our study, this remedy was adapted for the treatment of tinea capitis in humans.

Various substances, including honey, oil, milk, sugar, salt, colorants, and water, are frequently incorporated as additives in ethnomedicine preparations, as noted in a previous study by [89]. [106] has also similarly reported the traditional use of butter as a solvent for orally taken herbal medicines. While some remedies did incorporate these ingredients, the majority of treatments did not rely on the inclusion of water, butter, honey, salt, or coffee. These additives primarily serve to enhance solubility, improve taste, and facilitate the consumption of ethnomedicines [88]. Furthermore, these substances often have dual purposes, such as masking unpleasant flavors, reducing side effects like vomiting and diarrhea, and potentially enhancing the therapeutic efficacy and healing properties of the remedies, as reported by participants in focus group discussions.

The traditional medicinal use of salt by the Birale in various forms, mostly together with medicinal plants, to treat illnesses has been similarly reported by [106–108]. The intake of fermented alcoholic drinks such as ‘Boorde’ in Ethiopia, which the Birale use, has been similarly reported as linked to improved gut health and strengthened immunity by [109] while [106] reported their use as solvents.

Physical therapeutic practices

The physical therapies of cauterization, massage, bloodletting, and dry cupping which the Birale practice have been reported to be practiced in traditional Islamic Arab medical therapy and in ancient and medieval civilizations for similar cases [110]. In Africa and Ethiopia, cauterization and dry cupping with or without bloodletting have similarly been reported to be employed to treat different types of headaches [111].

Health and environmental implications of the findings in the study area

Generally, the Birale use over 31 medicinal plants, some animal products, minerals, traditional drinks, and physical therapies to treat over 37 diseases. This offers a wealth of potential applications and implications for modern healthcare systems and conservation efforts. The indigenous medicinal plants, animal products, and minerals documented here can lead pharmacologists to the discovery of novel compounds with medicinal properties that can be used for developing new drugs or improving existing ones. Their indigenous healing practices can be integrated into primary healthcare systems to provide culturally appropriate care. Their traditional healers can improve access to healthcare in their remote settlements and their indigenous medicine can serve as a complementary therapy to modern medicine.

As their environment is a semi-arid lowland with increasingly longer dry season, the medicinal plants in dry woodlands, scrubs, riverine vegetations, homestead gardens, and plots are increasingly under threat. The Weyto river’s seasonal overflooding and expansion of its banks takes away their farmlands and soil together with the riverine vegetation, destroying the habitat of many species. The long draughts are also affecting their livelihood and the biodiversity. These environmental challenges and the inaccessibility of their area have been making the Birale to move from their ancestral settlements by changing their livelihood to sedentary agriculture and mixing with other ethnic groups, mainly Tsemay. This change is one of the reasons for the endangerment of their language and culture and the impending loss of their indigenous medicinal knowledge. Therefore, the biodiversity of their environment in which they have conserved their medicinal plants to this day and their resource management and livelihood systems which are currently under stress need research based participatory interventions that integrate their indigenous knowledge.

Conclusions

The objectives of documenting the indigenous medicinal knowledge and therapeutic practices of the Birale/Ongota from the six remaining speakers of Iifa Ongota have been successfully accomplished in this study. Ninety-eight sources were cataloged in this study including 31 plant taxa, 8 animal derivatives, 4 minerals, and 3 other materials. 37 distinct human health problems/Roosaa/ were treated by these. Solanaceae is the most frequently used plant family closely followed by Burseraceae and Tiliaceae. Withania somnifera (L.), Portulaca quadrifida L., Ximenia americana L., Corchorus olitorius L., Ruellia patula Jacq., Cissampelos pareira L., Moringa stenopetala (Baker f.) Cufod., Zingiber officinale Roscoe, Allium sativum L., Coffea arabica L., and Nicotiana tabacum L. were the most frequently utilized, each being employed in the treatment of 2 to 4 distinct diseases. The most frequent plant parts used are leaves and roots while the most common routes of administration are dermal and oral. Most of their medicines are prepared by grinding and crushing/wet pounding/. Many of the medicinal plant species they use have been similarly reported as having medicinal values against similar diseases and/or illnesses while 7 were not. Fourteen were reported for their pharmacological activities against the causative agents of the diseases Birale reported, while 12 were not. Their medicinal uses of honey, butter, visceral organs, red soil, copper, salt, and fermented alcoholic drinks were supported by previous studies. Furthermore, physical therapeutic practices involving minor surgical operations, cauterization, bloodletting, dry cupping, acupressure techniques, and massage were also identified.

The fact that the 31 medicinal plants reported belong to 27 different families suggests that there are diverse plant families with medicinal values in the area. In addition, the 7 species that were not reported for similar indications previously and the 12 that were not pharmacologically studied point to the need for further study. Further in-depth study covering more areas and involving additional informants from adjacent communities by future researchers could result in the discovery of many more medicinal plants in the area, while pharmacological studies of the 12 species may help scientifically verify their effectiveness and find the active ingredients.

Their indigenous medicinal knowledge and therapeutic practices are serving the role of providing primary health care service to the community due to the inaccessibility of their area and distant location of the closest modern healthcare centers. Their indigenous medicinal knowledge and therapeutic practices are what have been maintaining their health as modern healthcare is inaccessible to them. But environmental challenges resulting from the increasingly longer dry seasons and the seasonal overflooding of their farmland by Weyto river is challenging the sustainability of their livelihoods and the sustainability of the biodiversity of their land. This has made many to move away from their ancestral settlements and intermarry primarily with Tsemay resulting in the endangerment of their language and culture and the indigenous knowledge stored in it.

This study has limitations due to its confinement to documenting the general ethnomedicinal knowledge in the memory of the six remaining speakers of the endangered Birale/Ongota only. Medicinal knowledge of members of the Birale that shifted to Tsemay and Ale languages were not incorporated. It also only documented indigenous uses and did not study the pharmacological activities of the medicinal plants. It did not involve several informants and did not cover a large area.

Comprehensive studies need to be done by researchers by involving more members of Birale and the neighboring Ale, Tsemay, and Maale to collect and preserve more medicinal plants, animal products, minerals, and therapeutic practices of the area. Research also needs to be done by social scientists and conservationists to help conserve their biodiversity and indigenous livelihood through community based participatory approaches. Pharmacologists could study and identify the active ingredients in the medicines reported to develop new medicines and improve old ones. Public health experts can study ways of integrating their indigenous healthcare system with the modern and create awareness on some of their practices that have health risks. Moreover, their spiritual healing practices and rituals which are not covered in this study must be studied before the passing away of the six remaining speakers to provide a complete picture of their indigenous ethnomedicine.

Appendix 1.

Medicinal plants known to the Birale, their scientific and local names, growth forms, plant parts used, the Roosaa (diseases /illnesses) they are used to treat, method of preparation and treatment, and administration.

Medicinal plant Species	Family	Voucher Code	Local Name	Growth form	Roosaa (Disease/Illness) Treated	Plant Parts used	Preparation and/or treatment	Administration
Acalypha fruticosa Forssk	Euphorbiaceae	SE1	Kentalle	Perennial Shrub	Zebe’aakko (heartburn MD95)	Stem	chewing parts of the stem and swallowing its juice	Oral
Withania somnifera (L.) Dunal	Solanaceae	SE3	Dheemote	perennial herb	Aaaraa (yellow fever 1D47)	Leaves, stems and roots	Ground in a mortar, mixed with honey and water applied to whole body before sleep for three days; or boiled and its vapor smoked as a steam twice a day for three days; or rinsed in a bucket of water and body washed every morning for three days	Dermal and inhalation
					Shoolaa (itchy eye allergic conjunctivitis 9A60.02)	Leaves	leaves warmed on fire and applied over the two eyelids	dermal and warm compress
					Guni Kid’a (snake-bite poisoning)	Roots	roots ground to create paste and applied to the bitten area;	dermal
Ocimum americanum L	Lamiaceae	SE4	Kaarkoo	annual herb	Chulaa (anthrax 1B97)	leaves, stems and roots	rinse the whole plant pulled out from the ground in water by shaking off the soil and apply the water on the affected skin; grind the leaves and apply on the affected skin	dermal and inhalation
Pupalia lappacea (L.) A. Juss	Amaranthaceae	SE5	Chabalaqqo	sprawling perennial herb	Tsaanaa (skin allergyEK5Y)	spiky seeds	spiky seeds used to scratch the Booshe /allergy rash/ until it bleeds after which it heals	dermal
Portulaca quadrifida L	Portulacaceae	SE6	Merraahe	succulent, annual, mat-forming herb	Qatsaa (Atopic dermatitis (eczema)EA80)	stem, leaves and roots;	the whole plant is ground and mixed with sheep tail fat and smeared over the affected area;	dermal
					Poortoo (Tinea capitis1F28.0)	stem, leaves and roots;	ground and mixed with a red soil called ‘Qooyitaa’ and a white fresh raw cow butter /Shu’unaa/ and applied over the attacked area of the skin	dermal
					Baahaa Ba’atunne (constipation ME05.0)	stems and leaves	stems and leaves boiled in water with Corchorus olitorius L. leaves and eaten	oral
Adenium obesum (Forssk.) Roem. & Schult	Apocynaceae	SE7	Araadoongo	Succulent perennial plant	Hanaago Kid'a (scorpion bite and poisoning)	latex	Extracting latex and applying the bitten area	dermal
Cyperus rotundus L	Cyperaceae	SE8	Gontsola	Perennial gregarious herb	Boora Jeneka (stomachache)	Roots	chewed and its juice swallowed	Oral
Ximenia americana L	Olacaceae	SE9	Tulaakko	perennial shrub or small tree	Aaaraa (yellow fever 1D47)	Leaves, stems and roots	ground in a mortar, mixed with honey and water applied to whole body before sleep for three days; or boiled and its vapor smoked as a steam twice a day for three days; or rinsed in a bucket of water and body washed every morning for three days	inhalation and dermal
					Bohaakko (boils 1B75.0 and pimples)	leaves	ground wet in a mortar applied to the eye of the boil or pimple	dermal
					Tsaanaa (skin allergyEK5Y)	fruits	fruits roasted, ground, and applied to the affected area	dermal
					Welaalko (typhoid1A07 and typhus1C30)	leaves and stems	ground to create paste and applied to the whole body	Dermal
Salvadora persica L	Salvadoraceae	SE10	E’aakko	perennial evergreen shrub	Khiibo roos (impetigo 1B72)	roots	chewing and applying on the affected area	Dermal
Commiphora sp.	Burseraceae	SE11	Silbanaa	Tree	Roonkaa (epilepsy 8A66/Convulsions 8A68.Z)	guduntee (dried gum resin incense)	smoked closer to the nose of the patient as soon as the seizure starts, patient screams and wakes from seizure	Inhalation
Senegalia mellifera (Vahl) Seigler & Ebinger)	Fabaceae	SE12	Boyitoo	shrub or small tree 1–6 (–9) m	Bohaakko (boils 1B75.0 and pimples)	leaves	ground wet in a mortar applied to the eye of the boil or pimple	dermal
Corchorus tridens L	Tiliaceae	SE13	Mulkaya Shokta	annual herb	Busug’aa (sexual dysfunction)	leaves and shoots	(for women patients) leaves shall be slightly boiled and eaten while they are still green	oral
Corchorus olitorius L	Tiliaceae	SE14	Mulkaya Ayma	annual herb	Busug’aa (sexual dysfunction)	leaves and shoots	(for men patients) leaves shall be slightly boiled and eaten while they are still green	oral
					Baahaa Ba’atunne (constipation ME05.0)	stems and leaves	stems and leaves boiled in water with Portulaca quadrifida L. leaves and eaten	oral
Boswellia neglecta S. Moore	Burseraceae	SE15	Dengeraa	Tree	Gulfa (common cold CA00)	Dengeeraa (gum resin incense)	get smoked with the gum resin incense	inhalation
Sansevieria ehrenbergii Schweinfurth ex Baker	Dracanaceae	SE17	Aalgee	succulent perennial	Wowwa Kroos (ear infection AA0Z)	Stem	stem warmed on fire and the liquid squeezed out and applied to the affected ear	dermal
Ruellia patula Jacq	Acanthaceae	SE19	Tse’aakko	herbaceous shrublet	Boronga (candidiasis 1F23) ‘Alta’	leaves and stems	ground in a mortar and mixed with water and smeared over the affected area	oral and dermal
					Khiibo roos (impetigo 1B72)	stems and roots	grinding and applying on the affected area	dermal
					Matsaa (urinary tract infection GC08)	leaves and roots	mixing leaves and roots with water and drinking	oral
					Welaalko (typhoid 1A07 and typhus 1C30	leaves and stems	ground to create paste and applied to the whole body	Dermal
Solanum incanum L	Solanaceae	SE20	Chumoo	Perennial subshrub or shrub, 0.4–1.5 m	Itimaaroos (tooth infection DA09.62	Root	chewed and held on the infected tooth	dermal and oral
Dregea schimperi (Decne.) Bullock	Asclepiadaceae	SE21	Maache Gitamatte	twining climber	Erezaa (diarrhea ME05.1)	root	grinding the roots mixing with water and drinking. Or chewing the roots and swallowing the juice	oral
Plumbago zeylanica L	Plumbaginaceae	SE22	Dha’eewwa	scrambling shrub	Itimaaroos (tooth infection DA09.62)	Root	chewed and held on the infected tooth	dermal and oral
Cissampelos pareira L	Menispermaceae	SE23	Merrahikko	herbaceous twining climber	Geebaree (Ascaris 1F62)	root	chewed by removing the outer layer and its juice swallowed	oral
					Erezaa (diarrhea ME05.1	Root	grinding the roots mixing with water and drinking. Or chewing the roots and swallowing the juice	oral
					Baahaa Ba’atunne (constipation ME05.0)	leaves	leaves ground and rinsed in water and drunk	oral
Asparagus falcatus L	Asparagaceae	SE24	Dhurra	scrambling shrub	Itimaaroos (tooth infection DA09.62)	Root	chewed and held on the infected tooth	dermal and oral
Triticum aestivum L	Poaceae	SE25	Gazgo	annual plant (bread wheat)	Bohaakko (boils 1B75.0 and pimples)	seed	Seed dough applied to the eye of the pimple	dermal
Moringa stenopetala (Baker f.) Cufod	Moringaceae	SE26	Reewwaa	Tree	Wowwa Kroos (ear infection AA0Z)	leaves	leaves ground and the paste applied to the affected ear	dermal
					Gulfa (common cold CA00)	Leaves and shoots	Boil fresh young leaves and shoots with salt and sheep tail fat and drink its soup	Oral
					Sunpa Kroos (lung disease CB40.Y)	leaves	Drinking the tea of leaves boiled with water and lemon	Oral
Gossypium herbaceum L	Molvaceae	SE27	Fudoo	perennial shrub	Wowwa Kroos (ear infection AA0Z)	seed	seed oil applied to the affected ear	dermal
Zingiber officinale Roscoe	Zingiberaceae	SE28	Zinjibil	herbaceous, perennial plant	Gomara (tonsilitisCA03.0)	rhizome	piercing the swollen tonsil and chewing and swallowing the ginger juice;	Oral
					Gulfa (common cold CA00)	rhizome	Drink ‘Shuforoo’ coffee inner husk tea boiled with chopped ginger rhizome and garlic bulb	Oral
Allium sativum L	Amaryllindaceae	SE29	Nech-Shunkurt	perennial bulbous herb grown as annual	Gomara (tonsilitis CA03.0)	bulb	piercing the swollen tonsil and chewing and swallowing bulb juice	Oral
					Gulfa (common cold CA00)	bulb	Drink ‘Shuforoo’ or coffee inner husk tea boiled with chopped ginger rhizome and garlic bulb	Oral
Coffea arabica L	Rubiaceae	SE30	Buno	perennial evergreen shrub or small tree	Gulfa (common cold CA00)	fruit	Drink ‘Shuforoo’ or coffee fruit inner husk tea boiled with chopped ginger rhizome and garlic bulb	Oral
					Matsaa (urinary tract infection GC08)	fruit	Drink ‘Shuforoo’ or coffee fruit inner husk tea	Oral
					Erezaa (diarrhea ME05.1)	Seed/bean	Roasted and ground coffee bean powder shall be mixed with honey and eaten	Oral
Cucurbita pepo L	Cucurbitaceae	SE31	Bootaa	a vine-like annual herb	Phirts (tapeworm 1F76.1)	seed	roasted and eaten with roasted maize	Oral
Nicotiana tabacum L	Solanaceae	SE32	Taanpo	annual or short-lived perennial herbaceous plant	Gulfa (common cold CA00)	leaves	Inhale the smoke of fermented leaves powder (Gaayyaa Kinnaahoo) and exhale via the nose	inhalation
					Guni Kid’a (snake-bite poisoning)	leaves	Fermented leaves powder mixed with water and drunk to induce vomiting	Oral
					Hanaago Kid'a (scorpion bite and poisoning)	Leaves	grinding the fermented leaves and applying to the bitten area	dermal
Citrus × limon (L.) Osbeck	Rutaceae	SE33	Loomi	perennial evergreen tree	Gulfa (common cold CA00)	fruit	Suck the juice	Oral
					Sunpa Kroos (lung disease CB40.Y)	fruit	Adding the lemon fruit juice to moringa leaves, boiling and drinking the tea	Oral
Terminalia brownii Fresen	Combretaceae	SE34	Aaraa	deciduous tree	Tsaanaa (skin allergyEK5Y)	leaves	leaves ground and applied to the affected area of the skin	dermal

Appendix 2.

Roosaa/disease and illness/ with medical solutions from animal products, traditional drinks, and minerals.

Roosaa (Disease)	Chagaga (Medicine)	Mineral/Animal Products/Traditional drinks Used	Preparation and/or treatment	Route of Administration
Odolaa	Blood of bird called Gaayyolaa and Spleen of goat or cattle	Blood and spleen	Extracting the bird's blood and smearing the blood over the affected area; cutting open the goat or cattle spleen and smearing it on the affected area	Dermal
Pityriasis versicolor (1F2D.0)
Chulaa	White raw butter; excrement of donkey	Butter; excrement	Smearing the butter on the ulcer on the skin; smoking the donkey excrement in the house of the sick	Dermal and inhalation
Anthrax (1B97)
Qatsaa/Qatsoo in Tsemay	Sheep tail fat; hot spring water	Sheep tail fat and the hot spring water	Mix ground Merraahee with sheep tail fat and smeared over the affected area; wash the area with hot spring water	Dermal
Atopic dermatitis (eczema) (EA80)
Poortoo	A red soil called ‘Qooyitaa’; raw cow butter /Shu’unaa/	Soil; butter	Ground Merraahee mixed with a red soil called ‘Qooyitaa’ and a white fresh raw cow butter /Shu’unaa/ and applied over the attacked area of the skin	Dermal
Tinea capitis (1F28.0)
Mudullaa’ee	Sheep tail fat	Sheep tail fat	Rubbing the affected area with the fat	Dermal
Alopecia
Gomara	Megaaddo (salt mineral); Miidoo’ (red copper bracelet)	Salt and copper	Licking the salt mineral called ‘megaaddo’ and ‘Miidoo’ (a red copper bracelet)	Oral
Tonsilitis (CA03.0)
Erezaa	Shokaayaa (honey)	Honey with coffee powder	Mix roasted and ground coffee bean powder with the honey and eaten	Oral
Diarrhea (ME05.1)
Tuugo	Raw butter and heat	Butter and heat	Rubbing it with raw butter and warming the area with heat/fire and squeezing out the larvae	Dermal
Diptera larvae myiasis (1G01)
Ginaano	Areke traditional distilled alcohol; salted water	Areke and salted water	Drinking two cups of ‘areke’ and sleeping, washing the whole body early in the morning, and drinking salted water and staying out in the sun to trigger vomiting	Oral
Malaria (1F41)
Matsaa	‘Boorde’ traditional alcoholic drink	‘Boordee’	Drink the ‘boorde’	Oral
Urinary tract infection (GC08)
Siinaa	Own excrement; cattle tail hair	Excrement and hair	Applying his/her own excrement upon the wart; tightly tying the wart with a long hair taken from cattle tail and leaving it tied	Dermal
Wart (1E80)
Hanaago Kid'a	Scorpion itself should be killed and ground	Killed and ground scorpion	Grinding the scorpion and applying to the bitten area	Dermal
Scorpion bite and poisoning
Boronga	Soup made from sorghum	Saltless and spiceless soup made from sorghum and avoiding salt, meat and honey	Drinking the soup	oral
Candidiasis (1F23) ‘Alta’

Appendix 3

Roosaa (Diseases or illnesses) and their physical therapies.

Roosaa (Disease and illnesses)	Material	Material Part Used	Treatment Practice	Therapy type
Chibbaa (backbone pain)	protruding teeth (‘Itimaa’) of common warthog and ‘aste’ (a bow arrow)	Itimaa or bow arrow tip	The tip of the Itimaa or arrow is heated on fire and placed on the point where the patient feels a piercing pain	cauterization and nerve point bloodletting
Phine Chake (HeadacheMB4D)	‘Aste’ with bow arrow	arrow tip	burning nerve points on the right and left of the forehead with a heated arrow tip; boring into some blood vessels on the side of the forehead and bloodletting; tightly holding nerve points on the right and left side of the forehead (acupressure) for kids and women	cauterization and nerve point bloodletting; acupressure
Isaa (skin cancer, basal and squamous cell cancers)	Sharp knife	Tip of sharp knife	piercing the swell with the sharp knife and bloodletting	bloodletting
Raante (gland like cancer on skin)	‘Aste’ with bow arrow	arrow tip	burning it with heated arrow tip	Cauterization
Zin (swelling of the stomach)	raw butter	raw butter	massaging experts will massage it with raw butter and it will heal	Massage
Roqenta roos (displaced heart)	raw butter	raw butter	female massagers massage the chest with raw butter and return it to its place	Massage

Appendix 4

Author contributions

EHG played the lead role in this research from the initiation of the proposal, data collection on the field, to final write up; completed the writing of the article; and read and approved the final manuscript. TML participated in reviewing and providing comments on different versions of the research from proposal to final manuscript and collected data. SSW commented on the various drafts of this research from proposal to final manuscript, helped translate and transcribe Ongota terms. GKK commented on the various drafts of this research from proposal to final manuscript, helped translate and transcribe the data. BMG helped identify scientific names of the diseases and illnesses. MKR carried out the medicinal plant specimen collection and scientific name identification with the help of experts at The National Herbarium (ETH). AGD and GMB read and commented on the drafts of this research at different stages and assisted in the collection, translation and transcription of the data.

Funding

The data collection process of this research was funded by Arba Minch University as part of the grand research project ‘Documenting and Description of Ongota’ with project code GOV/AMU/GRAND/GR01/ICLR/01/15.

Data availability

No datasets were generated or analyzed during the current study.

Declarations

Conflict of interests

The authors declare no competing interests.

Consent to participate

The study followed the ethical principles of ethnographic research and the informants involved were adults. They have been informed about the purpose of this study and the uses of the interview data collected from them. They have given their informed consent to participate in the research process. This study also has ethical clearance from Arba Minch University.

Consent for publication

We have informed representatives of the Birale ethnic group and the authorities of the district about this research and its publication process and they have given us their verbal consent for publication.

Ethics approval

Human Ethics and Consent to Participate declarations: not applicable.