2.1 Description of the study area

The research was conducted in Biharamulo district in the Kagera region, which is allocated to North Western part of Tanzania. Tropical-equatorial climatic conditions with bimodal rainfall characterize the area. Peasant agriculture is the economic backbone of society. Its dominant tribes are Subi, Ha, and Haya, who belong to Christians, Muslims, and paganism5 . Five of the 17 wards, namely Biharamulo town, Kabindi, Kalenge, Nyarubungo, and Nyakahura wards, were selected for the study. Below is a map of the Biharamulo district indicating the study areaFigure 1 .

2.2 Study designs

It employed a cross-sectional study design. The cross-sectional study design involved interviewing ethnobotanical surveys among five wards of Biharamulo district.

2.3 Sample Size and sampling techniques

Snowball sampling technique was used to recruit 400 participants in an interview by using semi-structured questionnaires during an ethnobotanical survey in Biharamulo district; it involved five wards, namely Biharamulo town, Kabindi, Kalenge, Nyarubungo, and Nyakahura. According to sample size was calculated from Yamane's formula: -

n=N/ (1+Ne2)

n=124 368/ (1+124 368*0.052)

Where n = desired sample size, e= acceptable error (5%), N =124 368 people as the known population from the census 2012 in 5 wards of Biharamulo district. Therefore, the sample size was 399 participants.

2.4 Ethnobotanical Survey and Identification of medicinal plants

In the ethnobotanical survey, villagers, traditional healers, and key informants in 5 wards of Biharamulo district were interviewed using semi-structured questionnaires with open and closed-ended questions. Information on medicinal plants vernacular names or morphology helped to identify the plants by matching their pictures with those in plant net identification software and confirmed through the literature10 .

2.5 Method of data analysis

The ethnobotanical survey data were compiled by using Microsoft Excel in Windows 2016. Version 16 of the Statistical Package for Social Sciences (SPSS) software was used to analyze the data using the Chi-square test11 . Statistically significant differences between interviews' awareness of UTIs and their medicinal plants were determined from the Chi-square test at the p-values < 0.05.

3.1 Demographic characteristics of participants inwards of Biharamulo district, Kagera

The ethnobotanical survey on medicinal plants for treating UTI was conducted in Biharamulo district, whereby 400 respondents were interviewed using semi-structured questionnaires to assess the effects of medicinal plants used for treating urinary tract infections in humans. Female respondents were more (65%) than males. In age, most respondents were youth (60.5%), followed by adulthood (28%) and elders (11.5%). Of the occupations that participated, most of them were nondominant occupations (45.2%) like teachers, medical service providers, homemakers, and motorcycle riders, followed by farmers (34.8%), businessmen (11.8%), and traditional healers (8.2%). Most participants attained secondary and primary education by 43.5% and 41.8%, respectively. In tribals, Ha participated with high frequencies (39.2%), followed by Subi (26.2%), other less dominant tribes (19.5%), Haya (11%), and finally, Hangaza (4%)Table 1

3.2 Correct responses on awareness of UTI and its medicinal pants

Awareness of UTI among 400 interviews indicated that people already diagnosed or heard patients with UTI (98.2%), those able to give causes and mode of transmission (41%), and those said UTI could be treated by using medicinal plants (53.5%). For awareness of UTI medicinal plants, those mentioned at least one medicinal plant (99.5%), those who used the herbs (92.8%), those who know herbs locations (93.5%), understanding herbs safety (85%), people sold medicinal plants (13.8%), those able to mentioned medicinal plants for treating other related microbial infections like typhoid, gonorrhea, and syphilis (15%) and participants appreciated medicinal plants for treating UTI (68.8%)Table 2

3.3 Awareness of UTI and its medicinal plants according to the sexes of participants

In assessing awareness of UTI and its medicinal plants, females had a good understanding (72.3%) compared to males (66.6%). On the other hand, females were more knowledgeable in using medicinal plants than males as most of them agreed for UTI to be treated by medicinal plants, used their surrounding medicinal plants to treat UTI in daily life, and had a positive attitude toward medicinal plants by appreciating them than male respondents at a significant difference p-value < 0.05Table 3

3.4 Awareness of UTI and its medicinal plants according to age groups of participants

In assessing awareness of UTI and its medicinal plants, old and middle-aged people had a good understanding (76%) compared to youth (68.7%). On the other hand, old and middle-aged people were more knowledgeable about treating UTIs and other related microbial infections by using medicinal plants. They sold experienced safety or nontoxic medicinal plants, including traditional healers, then youth age respondents at a significant p-value of < 0.05Table 4

3.5 Awareness of UTI and its medicinal plants according to wards of respondents

Participants from Biharamulo town were awarded in knowing UTI patients, clinical signs, medicinal plants' use, the availability of herbs, insurance of s safety to users, and understanding medicinal plants treat UTI and other microbial infections. They appreciated medicinal plants compared to other wards at a significant difference p-value of < 0.05 [Table 5]. Awareness of UTI and its medicinal plants indicated that Biharamulo town ward had a good understanding (77.71%, followed by, Nyakahura (72.19%), Nyarubungo (68.85%), Kabindi (63.13%), and finally Kalenge ward (60.10%).Table 5

3.6 Awareness of UTI and its medicinal plants according to education level

Tertiary education has good awareness of UTI etiology, transmission, and treatments compared to other levels. Based on education level, tertiary education level had more understanding (75%) than primary (71.2%), informal (70.4%), and lastly secondary educated members (62.4%). In contrast, conversational education level followed by primary levels were most aware of how to use medicinal plants, sell medicinal plants, their availability locations, and herbs for treating other microbial infections compared to different groups at a significant difference p-value of < 0.05Table 6

3.7 Awareness of UTI and its medicinal plants among Participant occupations

Among participant occupations, traditional healers had good awareness (85.7%) compared to business people (72.7%), farmers (70.9%), and lastly, other less dominant occupations (65%). On the other hand, traditional healers had an excellent awareness of UTI causes and transmission, using the medicinal plant in treatments, equipped with psychomotor skills in the preparation and selling of UTI herbs, their side effects and safety, and understanding of medicinal plants able to treat UTI and other related microbial infections like gonorrhea and syphilis, with high appreciation to medicinal plants compared to other occupations at the significant difference of p-values of < 0.05Table 7

3.8 Awareness of UTI and its medicinal plants among tribes of participant

In awareness of UTI and its herbs, Hangaza was more knowledgeable compared to other tribes as they encountered (80.2%,) followed by Subi (70.2%), Haya 69%), Ha (66.4%), and finally, a mixture of other tribes (63.3%). Based on statistical significance, Hangaza, followed by Subi, possessed good awareness of UTI and its medicinal plants in diagnosis and hearing patients, UTI transmissions, treatments of UTI by using medicinal plants, identification of UTI herbs, use of herbs to treat UTI, the safety of UTI herbs and herbs to treat related microbial infections compared to other tribes at a significant difference p-value of < 0.05Table 8

3.9 Information dissemination on UTI and its medicinal plants in Baramulo's societies

Information dissemination on UTI and its medicinal plants among Biharamulo societies was distributed by villagers among themselves (49.5%), followed by medical experts and public health extension educators (18.8%), parents (11.8%), traditional healers (5.5%), from other occupations (2.3%) and lastly, those who did not remember where they acquired UTI information (0.8%). These indicated a need for further provision of UTI information by responsible institutions, as most of the education was provided by villages that were less knowledgeable about UTI Figure 2

3.1 Medicinal plants and their information

Based on interview information in the ethnobotanical survey, among the 42 medicinal plants identified, only 29 (69%) were supported by literature to have pharmacological significance in treating UTIs. Furthermore, their vernacular and botanical names, families, parts, usable states, preparation methods, and diseases treated were documented, whereby among the active 29 herbs, pharmacologically treated UTI (96.5%), typhoid (48.3%), malaria (34.5%), anthelmintic (24.1%), STDs (20.9%), cough (17.2%), worm infections (11.9%), wounds and ulcers (17.2%), fungal infections (13.7%), anemia (10.3%), diabetes, cancer, and toothache were each represented by cancer (6.9%), measles, cardiovascular diseases, and yellow fever were each represented once by (3.4%) (Table 2.9).

The 29 medicinal plants belonged to 20 families, whereby the dominant were Lamiaceae (17.24%), Asteraceae, Rutaceae, and Myrtaceae each accounted (6.9%), while the rest appeared once as 3.45%Table 9

4.0 Discussion

This study revealed that society must be aware of UTI, their medicinal plants, and other microbiological infections like typhoid, gonorrhea, and syphilis. In sex, females were more knowledgeable about UTI and its medicinal plants compared to males, it was attributed to the fact that women have genital anatomical structures that expose them to susceptibility to UTI infections compared to males, and they also maintain the health status of their families. Support for the same argument came from and who realized that women had the primary responsibility of providing healthcare in a family. This circumstance sparked their interest in researching accessible and effective medicinal plants against nosocomial infections, including UTIs.

The age groups were associated with acquiring knowledge of UTI medicinal plants. The Old age group was more knowledgeable, followed by the middle and finally, the youth age. This was linked to older people's prolonged exposure to herbs against ailments, especially traditional healers, who acquire herbal knowledge and experiences throughout their lifetime. Gave a similar finding that the level of understanding of herbs and experiences in a community varies directly in proportion to seniority, provided that senescence had not deteriorated the mental activities. The same ideal was observed by who argued that youths' irritation with medicinal plants was associated with seniors' concealment in herbs and youth preferences for orthodox over herbal remedies.

Biharamulo town wards were more knowledgeable in UTI and its medicinal plants due to extensive connection with individuals who brought their ancestral herbal knowledge from rural to urban areas, as opposed to other rural wards with few tribes fixed to a limited number of herbs. The previous studies from Lagos and proved that about 66% of urban inhabitants recognized and used medicinal plants for contagious infectious ailments like UTIs at affordable expenses.

Participants with higher educational levels had more heightened awareness of UTI but were less knowledgeable in its medicinal plants as most used antibiotics and ignored medicinal plants. Vice versa was accurate at the informal and primary levels, where most of them were aware of medicinal plants compared to higher levels of education [Table 6]. Similar findings from indicated a negative relationship between attained education and knowledge of folk medicine, with the argument being that as education levels ri, it initiates the loss of interest in folk medicine. They supported the argument by providing evidence that the uneducated exemplified more herbs than scholars.

Compared to other professions, traditional healers had a better understanding of UTI and its medicinal plants as they treated many patients and marketed herbs as commodities, giving them much experience with antimicrobial plants.

Hangaza tribes were more aware of medicinal plants for treating UTI than other tribes due to their proximity to neighboring nations like Burundi and Rwanda, which have historically swapped information about herbs dating back to the colonial era.In addition, people could participate by disclosing the details of UTI medicinal plants. This could account for Haya, who were suspected of knowing many medicinal plants but mentioned a small number of UTI medicinal plants. According to popular belief, healers keep secret in disseminating herbal information.

As a result of their accessibility and commitment to plant protection, most participants from Biharamulo applied leaf decoctions and infusions as preparation methods for UTI treatments. This scenario was in line with a previous study conducted by who credited for the accessibility and consistency of leaves throughout the year except for a few arid climate zones. Furthermore, appreciated people from Kagera for utilizing leaves in medicinal plants.

Information dissemination on UTI and its medicinal plants within Biharamulo's societies was enhanced by less than 50% among villagers. Public health extension educators, traditional healers, and parents have educated the community on UTIs to a small extent, which is why most respondents did not understand the causes and transmission of UTIs. Comparative research from Kenya by shows that non-traditional healers, particularly older women are the best sources of herbal information for over 50%, while traditional healers hinder the herbal details. These signified a need for further provision of UTI information to the majority where villages provide UTI education. Regarding African folk medicine innovation has been hampered by the absence of reliable and secure supervision, inconsistent dosage, toxicity assessment, and recordkeeping. Herbalists are urged to adhere to these restrictions.

Biomedical justification for UTI herbal efficiencies. The literature review confirmed that all 42 medicinal plants possess tannins, phenols, and flavonoids with different extinctions of phytochemicals as described below; It has been ascertained that the Combretaceae family, which includes Terminalia mollis, contains resins and combrela tannins that kill microorganisms by precipitating their amino acids in cell walls. Myrtaceae (S. guineense, and S. cordatum) reported that anticancer have antimicrobial, hypoglycaemic, anthelmintic, and virucidal activities [46]. On the other hand, it was contended that members of the Olacaceae family, notably X. caffra, had antimicrobial, anticarcinogenic, and antiparasitic properties. Inulin found in the Asteraceae was reported by to have antimicrobial properties, including UTI. Many plants in the Lamiaceae family, but some of them, like S. hispanica, P. barbatus, and H. opposite, had poor antibacterial activity reported in the literature.

According to rutaceae family (C. limon and Z. album) contain limonoids, carbazole, benzylisoquinolines, and anthranilate, all of which have antimicrobial, antitumour, and anti-HIV. Kleinia sp had oleanolic acid, which accounts for antimicrobial activities. Family Solanaceae (P. peruviana) was reported by to comprise solanine, solasonine, and solamargine, which enhances antibacterial, anticancer, and cardiac impairments. Family Lauraceae (C. verum) contains aroma, Benzylisoquinoline, cinnamaldehyde, benzyl benzoate, and terpenoids, which elicit antimicrobial activities, antidiabetic and antiulcer potentials. Iridoids, quinones, and phenylpropanoids were reported by in Bignoniaceae (J. mimosifolia) to be accountable for the antibacterial, antiprotozoal, antidiabetic, and antitumor. Aloe vera contains anthraquinones and phenols responsible for antibacterial and antiplasmodial actions. Azadirachta indica was reported by to consist of limonoids, phenols, terpenoids, and coumarins, used as antimicrobial, antiplasmodial, and antiulcer.

Jatropha curcas produced atropine, terpenoids, and curcumin, which were associated with antibacterial, anti-HIV, relieve toothache, wound, and tumor healing properties. Lantana camara yields verbascoside and lantadene had antimicrobial activities. Moringa oleifera contains Benzyl glycosylates and gallic acid, which signifies antimicrobial, anticancer, antihyperglycemic, anti-infertility, and modulating the immune system. Clematis terniflora contains clematichinenoside, benzylisoquinolines, and triterpenoid, which are antibacterial, antiplasmodial, and antitumor and facilitate programmed cell death. Cymbopogon citratus was investigated by and found that it possesses scent citral and limonene, which are utilized as anticarcinogenic and can potentially kill bacteria and reported the family Leguminosae (E. Abyssinia, S. siamea, and S. didymobotrya possess resins, quinolizidine, anthraquinones, sennosides, naphthalene, and naphthalene with pharmacological significance in helminth and microbial infections.

According to the previous study, Harungana madagascariensis (Hypericaceae) produces the anthraquinones hypericin, hyperoside, and harungin used to treat diabetes, ulcers, and typhoid. Ipomoea America (Convolvulaceae) has phenylpropanoid, glycolysis, convolving, cyanogenic glycoside, and phytate, used as antimicrobial, antidiabetic, treats high blood pressure, and antitumor. Neocarya macrophyla, which incorporates terpenes and stigmasterol, was reported to be vital for antimicrobial and skin infections. Cucurbitacin and phytosterols from Zehneria scabra are used to fight against cancer and microbiological diseases. Finally, phytochemical analysis conducted by revealed the synthesis of gingerol isomers and zingiberene in Zingiber officinale, both of which have antibacterial and antifungal potentialities. Other species and their antimicrobial activities in different families are indicated in (Table 9). The 29 medicinal plants (69%) identified out of the total 42 were found to have related therapeutically implications, ethnobotanical assertions, pharmacological justifications in literature, or possessed potential phytochemicals enough to treat UTI or related microbial illnesses.