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\def\citeauthor{~Frenk~B~Paschal,
              ~Gaymary~G~Bakari,
              ~Elisa~D~Mwega}
\def\citetitle{\textbf{Ethnobotanical Study on Awareness of Medicinal Plants Used to Treat Urinary Tract Infection and Microbial Infections in Biharamulo District} \textbf{\space }}
\def\copyrightstmt{This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.}
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\def\RunningAuthor{Frenk B Paschal et al.}
\firstPage{169}
\articleType{Original Article}
\receivedDate{24 Mar 2023}
\acceptedDate{31 Mar 2023}
\revisedDate{29 Mar 2023}
\journalVolume{3}
\journalIssue{2}
\journalDoi{fjphs.v3i2.464}
\copyrightYear{2023}
\eISSN{2583-116X}
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\title{\textbf{Ethnobotanical Study on Awareness of Medicinal Plants Used to Treat Urinary Tract Infection and Microbial Infections in Biharamulo District} \textbf{\space }}
\author{Frenk~B~Paschal\textsuperscript{*}\textsuperscript{1},  
            Gaymary~G~Bakari\textsuperscript{2}, 
            Elisa~D~Mwega\textsuperscript{1}~\\[5pt]{\textsuperscript{1}Department of Microbiology, Parasitology, and Biotechnology, Sokoine University of Agriculture, P. O. Box 3019, Morogoro, Tanzania}~\\{\textsuperscript{2}Department of Veterinary Physiology, Biochemistry, and Pharmacology, Sokoine University of Agriculture, P. O. Box 3017, Morogoro, Tanzania}}

\begin{abstract}
Medicinal plants have been interested in many researchers for overcoming a catastrophic disaster of antimicrobial resistance. This study aimed to identify medicinal plants for treating UTI through an ethnobotanical survey conducted in the Biharamulo district in the Kagera region in Tanzania. Semi-structured questionnaires were used to assess the awareness of society on UTIs and their medicinal plants. UTI herbs were collected and identified. The ethnobotanical data were analyzed using the Chi-square test in SPSS version 16. Participants' awareness was justified by the statistically significant difference of p-values \textless\ 0.05. The study found most participants to have an understanding of UTI and its herbs because they identified clinical signs (85.2\%), mode of  transmission and etiology (41\%), UTI herbs (99.5\%), and used herbs to treat UTI (92.8\%). Out of the 42 medicinal plants identified for treating UTI, 29 (69\%) had pharmacological supports for antimicrobial activities, which were attributed to their phytochemicals and ethno medical literature support for treating UTI and other related microbial infections; they belonged to 20 families whereby the dominant were Lamiaceae 17.2 \%, and legumes are (10.3 \%). This agreed with other studies that society knew UTIs and their medicinal plants. Ethno medical literature supported this study. The study results were significantly justified and supported the uses of identified medicinal plants for treating UTIs with antimicrobial efficacies, as traditional healers and herbalists claimed. Hence this study may provide a direction and scope for further discovery of new UTI drugs.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Antimicrobial resistance,\newline awareness,\newline medicinal plants,\newline and Urinary Tract Infection
\end{keywords}
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\makeatletter{\raggedright{\Large$^\ast$}Corresponding Author\par Name:\ Frenk~B~Paschal~\\ Phone:\ ~\\  Email:\ frenkbp15@gmail.com
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\section{Introduction}
Medicinal plants possess therapeutic potentials with more  significance than orthodox medications by having a wide range of  efficiencies with sophisticated mechanisms for  curing various illnesses. At the same time, some may become sources of nutrients, all of which enhance people's health. The holy bible depicted at most minuscule 30 medicinal plants, while Hippocrates gave over 400 herbs\unskip~\cite{1886393:27799485}. An ethnobotanical survey helps gather information about herbs from residents who belong to their traditions and beliefs\unskip~\cite{1886393:27799482}. Through an ethnobotanical  survey, much-hidden information on medicinal plants can be obtained and become helpful in treating various diseases which slow down the development of the community. To effectively tackle antimicrobial illnesses, WHO associated folk and Western medicines with contemporary and alternative medications \unskip~\cite{1886393:27799476}.

Urinary tract infection happens when microbes like bacteria and fungi colonize and infect parts of the urinary system. Previous studies showed that the prevalence of UTI is 30.9\% among pregnant women at Bugando in Mwanza, Tanzania\unskip~\cite{1886393:27799475}. Bacteria and fungi cause UTIs, with \textit{E. coli} being the leading microbe, accounting for more than 80\% of the etiology\unskip~\cite{1886393:27799483}. The rest UTI causative agents are countered by \textit{P. mirabilis}, \textit{K. pneumonia}, \textit{S. aureus}, \textit{E. faecalis}, and fungi\unskip~\cite{1886393:27799478}. When UTI is accompanied by illnesses that deteriorate host immunity, it is regarded as a complicated UTI\unskip~\cite{1886393:27799476}. The disease is transmitted through genital organs to contact with infected agents like water from toilets and bathrooms, poor personal hygiene, the crossing of \textit{E. coli} from the alimental canal to the urinary system, and sexual intercourse. Urinalysis and media-based microbial culture are the diagnostic tests for UTI\unskip~\cite{1886393:27799477}. Gave clinical indications of UTI as pains during urination, high rate of urination, fever, shivering, vomiting, and aches in the lower abdomen and back. Its side effects are associated with discomfort, deterioration of the reproductive system, body impairment, and promotes miscarriage in females. UTI is treated by using antibiotics, probiotics, and medicinal plants and equipping self and public person hygiene\unskip~\cite{1886393:27799479}.

Biharamulo district has medicinal plants found in sub-equatorial climatic conditions. Within the district civilization, there are herbalists with extensive awareness gained via battling illnesses in daily life and from oral dissemination of traditional herbal knowledge and skills from nearby nations \unskip~\cite{1886393:27799480}. The majority of herb knowledge is passed down orally through informal education, which has resulted in the concealment of some necessary details about folk therapies among the communities and resulted into the prohibition of their accessibility of such information to the younger generation\unskip~\cite{1886393:27799482}. Herbal remedies were undermined and discredited throughout the colonial era in Africa, as inferior medical interventions, but later on, research into their phytochemicals had revealed that they possess pharmacological significance. Research is a crucial tool for taking what hearsays into consideration when putting theories into perspective in order to support what traditional healers have claimed and believed on herbal remedies for a long time\unskip~\cite{1886393:27799482}. 

To address the issue, an ethnobotanical survey was required to verify the information narrated by critical informants and traditional healers regarding using specific medicinal plants to treat UTIs. Finally, to document what is revealed for society's future health and prosperity. Therefore, this study identified and established medicinal plants for treating UTI and other related microbial infections.



\subsection{\textbf{2.0 Materials and Methods} \textbf{\space }}



\subsubsection{\textbf{2.1 Description of the study area} \textbf{\space }}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 paganism\unskip~\cite{1886393:27799483} . 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~\ref{f-312abcc390e7} .


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\caption{\boldmath {A map of Biharamulo district in Kagera. Source:Created by GIS program (2021)}}
\label{f-312abcc390e7}
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\egroup
\textbf{2.2 Study designs} \textbf{\space }

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



\subsubsection{\textbf{2.3 Sample Size and sampling techniques} \textbf{\space }}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.



\subsubsection{\textbf{2.4 Ethnobotanical Survey and Identification of medicinal plants} \textbf{\space }}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 literature\unskip~\cite{1886393:27799487} . 



\subsubsection{\textbf{2.5 Method of data analysis} \textbf{\space }}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 test\unskip~\cite{1886393:27799488} . Statistically significant differences between interviews' awareness of UTIs and their medicinal plants were determined from the Chi-square test at the p-values \textless\ 0.05. 



\subsection{\textbf{3.0 Results} \textbf{\space }}



\subsubsection{\textbf{3.1 Demographic characteristics of participants inwards of Biharamulo district, Kagera} \textbf{\space }}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~\ref{tw-b38cc7137e4e}


\begin{table*}[!htbp]
\caption{\boldmath {Demographic characteristics of respondents} }
\label{tw-b38cc7137e4e}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{LLL}
\tbltoprule 
 &
   &
  \\
 &
  \multicolumn{2}{p{\dimexpr(\mcWidth{2}+\mcWidth{3})}}{N = 400 interviews}\\
Characteristics &
  Frequencies &
  Percentage (\%)\\
Sex &
   &
  \\
Male &
  140 &
  35\\
Female &
  260 &
  65\\
Age &
   &
  \\
Youth age: 18 - 35 years old &
  242 &
  60.5\\
Middle age: 36 - 55 years old &
  112 &
  28\\
Old age: 56 years and above &
  46 &
  11.5\\
Occupations &
   &
  \\
Farmer &
  139 &
  34.8\\
Businessmen &
  47 &
  11.8\\
Traditional healer &
  33 &
  8.2\\
Others &
  181 &
  45.2\\
Education level &
   &
  \\
Informal education &
  20 &
  5\\
Primary education (std 1 - 7) &
  167 &
  41.8\\
Secondary education (std 9 - 12) &
  174 &
  43.5\\
Tertiary education (above std 12) &
  39 &
  9.8\\
Tribes &
   &
  \\
Subi &
  105 &
  26.2\\
Ha &
  157 &
  39.2\\
Haya &
  44 &
  11\\
Hangaza &
  16 &
  4\\
Sukuma &
  43 &
  10.8\\
Others &
  35 &
  8.8\\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Source: Field data (2022).}
\end{tablenotes}
\end{threeparttable}

\end{table*}
\textbf{3.2 Correct responses on awareness of UTI and its medicinal pants} \textbf{\space }

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~\ref{tw-522ddcde011b}


\begin{table*}[!htbp]
\caption{\boldmath {Correct responses on awareness of UTI and itsmedicinal pants} }
\label{tw-522ddcde011b}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{LLL}
\tbltoprule 
\multicolumn{1}{p{\dimexpr(\mcWidth{1})}}{\multirow{2}{\linewidth}{Characteristics }} &
  \multicolumn{2}{p{\dimexpr(\mcWidth{2}+\mcWidth{3})}}{N=400}\\
 &
  Frequencies &
  Percentage \\
People diagnosed or heard of UTI patients in the society &
  393 &
  98.2\\
Awareness of UTI clinical signs &
  341 &
  85.2\\
Understanding UTI mode of transmission &
  167 &
  41.8\\
Understanding UTI etiology &
  164 &
  41.0\\
People said UTIs could be treated by using medicinal plants &
  214 &
  53.5\\
People can mention medicinal plants for treating UTI &
  398 &
  99.5\\
People treated UTIs by using medicinal plants &
  371 &
  92.8\\
People said UTI medicinal plants to be available  &
  374 &
  93.5\\
People said UTI medicinal plants are safe for the health &
  340 &
  85\\
People selling medicinal plants &
  55 &
  13.8\\
Knowing herbs to treat related microbial infections &
  60 &
  15\\
People appreciated medicinal plants to cure UTI &
  275 &
  68.8\\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Source: Field data (2022)}
\end{tablenotes}
\end{threeparttable}

\end{table*}
\textbf{3.3 Awareness of UTI and its medicinal plants according to the sexes of participants} \textbf{\space }

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 \textless\ 0.05Table~\ref{tw-5266b9b9299b}


\begin{table*}[!htbp]
\caption{\boldmath {Awareness of UTI and its medicinal plantsaccording to the sexes of participants} }
\label{tw-5266b9b9299b}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{LLLL}
\tbltoprule 
 &
   &
   &
  \\
 &
  \multicolumn{2}{p{\dimexpr(\mcWidth{2}+\mcWidth{3})}}{Sexes' answer frequencies (\%)} &
  \multicolumn{1}{p{\dimexpr(\mcWidth{3})}}{\multirow{3}{\linewidth}{P-value}}\\
\multicolumn{1}{p{\dimexpr(\mcWidth{1})}}{\multirow{2}{\linewidth}{Awareness in:}} &
  Male &
  Female &
  \\
 &
  n = 140 (35) &
  n = 260 (65) &
  \\
People diagnosed or heard UTI patients &
  138 (34.5) &
  255 (63.8) &
  0.532\\
Mentioning UTI clinical signs &
  116 (29.0) &
  225 (56.2) &
  0.199\\
Understanding of UTI mode of transmission &
  56 (14.0) &
  111 (27.8) &
  0.34\\
Understanding of UTI etiology &
  59 (14.8) &
  105 (26.2) &
  0.407\\
Treatment of UTI by medicinal plants &
  62 (15.5) &
  152 (38.0) &
  0.001\\
Identification of UTI medicinal plants &
  139 (34.8) &
  259 (64.8) &
  0.578\\
Use of medicinal plants to treat UTI &
  121 (30.2) &
  250 (62.5) &
  0.002\\
Selling UTI medicinal plants &
  17 (4.2) &
  43 (10.8) &
  0.152\\
Availability of UTI medicinal plants &
  127 (31.8) &
  247 (61.8) &
  0.221\\
Safety of UTI medicinal plants &
  112 (28.0) &
  228 (57.0) &
  0.120\\
Knowing Herbs to treat other related microbes &
  86 (21.5) &
  162 (40.5) &
  0.473\\
Appreciation for UTI medicinal plants &
  85 (21.2) &
  190 (47.5) &
  0.053\\
Total percentages of items (\%) &
  (66.6) &
  (72.3) &
  \\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Significant p-values ({\textless}0.05) according to the Chi-square test; Source: Field data (2022).}
\end{tablenotes}
\end{threeparttable}

\end{table*}
\textbf{3.4 Awareness of UTI and its medicinal plants according to age groups of participants} \textbf{\space }

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 \textless\ 0.05Table~\ref{tw-5587f77cb54a}


\begin{table*}[!htbp]
\caption{\boldmath {Awareness of UTI and its medicinal plants accordingto age groups of participants} }
\label{tw-5587f77cb54a}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{LLLLL}
\tbltoprule 
\multicolumn{1}{p{\dimexpr(\mcWidth{1})}}{\multirow{2}{\linewidth}{Characteristics}} &
  \multicolumn{3}{p{\dimexpr(\mcWidth{2}+\mcWidth{3}+\mcWidth{4})}}{Age groups in years} &
  Chi-square\\
 &
  Youth (18-35) &
  Adulthood (36-55) &
  Old age (55 +) &
  P-value\\
 &
  n = 242 (60.5) &
  n = 112 (28) &
  n = 46 (11.5) &
  \\
People diagnosed or heard UTI patients  &
  237 (59.2) &
  110 (27.5) &
  46 (11.5) &
  0.619\\
Mentioning UTI clinical signs &
  204 (51.0) &
  99 (24.8) &
  38 (9.5) &
  0.520\\
Understand UTI transmission &
  101 (25.2) &
  49 (12.2) &
  17 (4.2) &
  0.734\\
Understanding of UTI etiology &
  101 (25.2) &
  47 (11.8) &
  16 (4.0) &
  0.660\\
Treatment of UTI by medicinal plants &
  108 (27.0) &
  74 (18.5) &
  32 (8.0) &
  0.000\\
Identification of UTI medicinal plants &
  240 (60) &
  112 (28.0) &
  46 (11.5) &
  0.519\\
Use of medicinal plants to treat UTI &
  218 (54.5) &
  107 (26.8) &
  46 (11.5) &
  0.114\\
Selling UTI medicinal plants &
  28 (7.0) &
  18 (4.5) &
  14 (3.5) &
  0.004\\
Availability of UTI medicinal plants &
  220 (55) &
  108 (27.0) &
  46 (11.5) &
  0.52\\
Safety of UTI medicinal plants &
  191 (47.8) &
  104 (26.0) &
  45 (11.2) &
  0.000\\
Knowing Herbs to treat other microbes &
  76 (19.0) &
  54 (13.5) &
  22 (5.5) &
  0.003\\
Appreciation for UTI medicinal plants &
  155 (38.8) &
  88 (22) &
  32 (8.0) &
  0.209\\
Knowing UTI expertise with evidence &
  117 (29.2) &
  60 (15.0) &
  24 (6.0) &
  0.634\\
Total percentages of items (\%) &
  68.7 &
  76.6 &
  76.8 &
  \\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Significant p-values ({\textless}0.05) according to the Chi-square test}
    
\item{Source: Field data (2022)}
\end{tablenotes}
\end{threeparttable}

\end{table*}
\textbf{3.5 Awareness of UTI and its medicinal plants according to wards of respondents} \textbf{\space }

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 \textless\ 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~\ref{tw-4e64bab6e984}


\begin{table*}[!htbp]
\caption{\boldmath {Awareness of UTI and its medicinal plantsaccording towards} }
\label{tw-4e64bab6e984}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{LLLLLLL}
\tbltoprule 
\multicolumn{1}{p{\dimexpr(\mcWidth{1})}}{\multirow{2}{\linewidth}{}} &
  \multicolumn{5}{p{\dimexpr(\mcWidth{2}+\mcWidth{3}+\mcWidth{4}+\mcWidth{5}+\mcWidth{6})}}{Wards' answer frequencies and (\%)} &
  \multicolumn{1}{p{\dimexpr(\mcWidth{3})}}{\multirow{3}{\linewidth}{P-value}}\\
 &
  Biharamulo &
  Kabindi &
  Kalenge &
  Nyakahura &
  Nyarubungo &
  \\
UTI awareness in: &
  n = 80 (20) &
  n = 80  &
  n =80  &
  n = 80  &
  n = 80  &
  \\
Diagnosed or heard UTI patients &
  80 (20.0) &
  77 (19.2) &
  79 (19.8) &
  78 (19.5) &
  79 (19.8) &
  0.437\\
UTI clinical signs &
  73 (18.2) &
  68 (17.0) &
  59 (14.8) &
  73 (18.2) &
  68 (17.0) &
  0.011\\
Understanding spread &
  43 (10.8) &
  31 (7.8) &
  27 (6.8) &
  36 (9.0) &
  30 (7.5) &
  0.089\\
Understanding etiology &
  40 (10.0) &
  29 (7.2) &
  32 (8.0) &
  34 (8.5) &
  29 (7.2) &
  0.370\\
Treatment by herbs &
  52 (13.0) &
  29 (7.2) &
  28 (7.0) &
  48 (12.0) &
  57 (14.2) &
  0.000\\
Identification of herbs &
  80 (20.0) &
  80 (20.0) &
  79 (19.8) &
  79 (19.8 &
  80 (20.0) &
  0.555\\
Use of UTI herbs &
  80 (20) &
  70 (17.5 &
  66 (16.5) &
  77 (19.2) &
  78 (19.5) &
  0.000\\
Selling UTI herbs &
  17 (4.2) &
  10 (2.5) &
  12 (3.0) &
  8 (2.0) &
  13 (3.20 &
  0.341\\
Availability of herbs &
  78 (19.5) &
  70 (17.5) &
  71 (17.8) &
  79 (19.8) &
  76 (19.0) &
  0.029\\
Safety of UTI herbs &
  77 (19.2) &
  62 (15.5) &
  50 (12.5) &
  74 (18.5) &
  77 (19.2) &
  0.000\\
Herbs for microbes &
  57 (14.2) &
  21 (5.2) &
  30 (7.5) &
  20 (5.0) &
  24 (6.0) &
  0.000\\
Appreciation of herbs &
  69 (17.2) &
  59 (14.8) &
  44 (11.0) &
  53 (13.2) &
  50 (12.5) &
  0.000\\
Total percentages (\%) &
  (77.7) &
  (63.1) &
  (60.1) &
  (72.2) &
  (68.8) &
  \\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Significant p-values ({\textless}0.05) according to the Chi-square test}
    
\item{Source: Field data (2022).}
\end{tablenotes}
\end{threeparttable}

\end{table*}
\textbf{3.6 Awareness of UTI and its medicinal plants according to education level} \textbf{\space }

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 \textless\ 0.05Table~\ref{tw-21dfc018bccb}


\begin{table*}[!htbp]
\caption{\boldmath {Awareness of UTI and its medicinal plants amongeducation levels of participants} }
\label{tw-21dfc018bccb}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{LLLLLL}
\tbltoprule 
\multicolumn{1}{p{\dimexpr(\mcWidth{1})}}{\multirow{2}{\linewidth}{Awareness of UTI and its medicinal plants in:}} &
  \multicolumn{4}{p{\dimexpr(\mcWidth{2}+\mcWidth{3}+\mcWidth{4}+\mcWidth{5})}}{Education level answer frequencies and (\%)} &
  \multicolumn{1}{p{\dimexpr(\mcWidth{3})}}{\multirow{3}{\linewidth}{P-value}}\\
 &
  Informal &
  Primary &
  Secondary &
  Tertiary &
  \\
 &
  n = 20  &
  n = 167  &
  n = 174 &
  n = 39 &
  \\
Diagnosed or heard UTI patients   &
  19 (4.8) &
  166 (41.5) &
  169 (42.2) &
  39 (9.8) &
  0.213\\
Mentioning UTI clinical signs &
  17 (4.2) &
  141 (35.2) &
  146 (36.5) &
  37 (9.2) &
  0.360\\
Understanding the mode of transmission &
  5 (1.2) &
  67 (16.8) &
  66 (16.5) &
  29 (7.2) &
  0.000\\
Understanding UTI etiology &
  6 (1.5) &
  61 (15.2) &
  71 (17.8) &
  26 (6.5) &
  0.005\\
Treatment of UTI by medicinal plants &
  15 (3.8) &
  113 (28.2) &
  67 (16.8) &
  19 (4.8) &
  0.000\\
Identification of UTI medicinal plants &
  20 (5.0) &
  167 (41.8) &
  173 (43.2) &
  38 (9.5) &
  0.231\\
Use of medicinal plants to treat UTI &
  20 (5.0) &
  164 (41.0 &
  151 (37.8) &
  36 (9.0) &
  0.003\\
Selling UTI medicinal plants &
  7 (1.8) &
  28 (7.0) &
  19 (4.8) &
  6 (1.5) &
  0.030\\
Availability of UTI medicinal plants &
  19 (4.8) &
  165 (41.2) &
  153 (38.2) &
  37 (9.2) &
  0.007\\
Safety of UTI medicinal plants &
  17 (4.2) &
  163 (40.8) &
  127 (31.8) &
  33 (8.2) &
  0.000\\
Knowing Herbs for related microbes &
  9 (2.2) &
  64 (16.0) &
  54 (13.5) &
  25(6.20) &
  0.002\\
Appreciation for UTI medicinal plants &
  15 (3.8) &
  128 (32.0) &
  106 (26.5) &
  26 (6.5)  &
  0.214\\
Total percentages of items (\%) &
  (70.4) &
  (71.2) &
  (62.4) &
  (75.0) &
  \\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Significant p-values ({\textless}0.05) according to the Chi-square test}
    
\item{Source: Field data (2022).}
\end{tablenotes}
\end{threeparttable}

\end{table*}
\textbf{3.7 Awareness of UTI and its medicinal plants among Participant occupations} \textbf{\space }

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 \textless\ 0.05Table~\ref{tw-d14ceca09916}


\begin{table*}[!htbp]
\caption{\boldmath {Awareness of UTI and its medicinal plants amongparticipant occupations} }
\label{tw-d14ceca09916}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{LLLLLL}
\tbltoprule 
\multicolumn{1}{p{\dimexpr(\mcWidth{1})}}{\multirow{3}{\linewidth}{Awareness of UTI and its medicinal plant in:}} &
  \multicolumn{4}{p{\dimexpr(\mcWidth{2}+\mcWidth{3}+\mcWidth{4}+\mcWidth{5})}}{Correct answer frequencies and (\%)} &
  \multicolumn{1}{p{\dimexpr(\mcWidth{3})}}{\multirow{3}{\linewidth}{P-value}}\\
 &
  Farmers &
  Business &
   Healer &
  Others &
  \\
 &
  n = 139  &
  n = 47  &
  n = 33  &
  n = 181  &
  \\
Diagnosed or heard UTI patients &
  137 (34.2) &
  47 (11.8) &
  33 (8.2) &
  176 (44) &
  0.598\\
Mentioning UTI clinical signs &
  115 (28.8) &
  43 (10.8) &
  29 (7.2) &
  154 (38.5) &
  0.547\\
Understanding the mode of transmission &
  44 (11.0) &
  24 (6.0) &
  17 (4.2) &
  82 (20.5) &
  0.044\\
Understanding UTI etiology &
  44 (11.0) &
  23 (5.8) &
  16 (4.0) &
  80 (20.3) &
  0.088\\
Treatment of UTI by medicinal plants &
  89 (22.2) &
  30 (7.5) &
  25 (6.2) &
  70 (17.5) &
  0.000\\
Identification of UTI medicinal plants &
  139 (34.8) &
  47 (11.8) &
  33 (8.2) &
  179 (44.8) &
  0.639\\
Use of medicinal plants to treat UTI &
  134 (33.5) &
  44 (11.0) &
  33 (8.2) &
  160 (40) &
  0.134\\
Selling UTI medicinal plants &
  9 (2.2) &
  3 (0.80 &
  30 (7.5) &
  18 (4.5) &
  0.000\\
Availability of UTI medicinal plants &
  136 (34.0) &
  44 (11.0) &
  33 (8.2) &
  161 (40.2) &
  0.071\\
Safety of UTI medicinal plants &
  133 (33.2) &
  45 (11.2) &
  29 (7.2) &
  113 (33.2) &
  0.000\\
Knowing Herbs for related microbes &
  46 (11.5) &
  13 (3.2) &
  19 (4.8) &
  74 (18.6) &
  0.021\\
Appreciation for UTI medicinal plants &
  102 (25.5) &
  36 (9.0) &
  30 (7.5) &
  107 (26.8) &
  0.036\\
Total percentages of items (\%) &
   (67.63) &
  (70.74) &
  (82.58) &
  (63.26) &
  \\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Significant p-values ({\textless}0.05) according to the Chi-square test}
    
\item{Source: Field data (2022).}
\end{tablenotes}
\end{threeparttable}

\end{table*}
\textbf{3.8 Awareness of UTI and its medicinal plants among tribes of participant} \textbf{\space }

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 \textless\ 0.05Table~\ref{tw-c954b4e44b98}


\begin{table*}[!htbp]
\caption{\boldmath {Awareness of UTI and its medicinal plants amongtribes of participants} }
\label{tw-c954b4e44b98}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{LLLLLLL}
\tbltoprule 
\multicolumn{1}{p{\dimexpr(\mcWidth{1})}}{\multirow{2}{\linewidth}{Demographic information }} &
  \multicolumn{5}{p{\dimexpr(\mcWidth{2}+\mcWidth{3}+\mcWidth{4}+\mcWidth{5}+\mcWidth{6})}}{Tribal answer frequencies and (\%) } &
  \multicolumn{1}{p{\dimexpr(\mcWidth{3})}}{\multirow{3}{\linewidth}{P-value}}\\
 &
  Subi &
  Ha &
  Haya &
  Hangaza &
  Others &
  \\
Awareness in: &
  n = 105  &
  n = 157  &
  n = 44 &
  n = 16 (4) &
  n = 78 &
  \\
Diagnosed or heard UTI &
  104 (26.0) &
  156 (39.0) &
  43 (10.7) &
  16 (4.0) &
  74 (18.5) &
  0.017\\
Mentioning UTI signs &
  88 (22.0) &
  128 (32.0) &
  39 (9.8) &
  15 (3.8) &
  71 (17.8) &
  0.118\\
Understand transmission &
  39 (9.8) &
  60 (15.0) &
  17 (4.3) &
  12 (3.0) &
  39 (9.8) &
  0.019\\
Understanding etiology &
  39 (9.8) &
  57 (14.2) &
  19 (4.8) &
  11 (2.8) &
  38 (9.4) &
  0.098\\
Treatments by using herbs &
  70 (17.5) &
  86 (21.5) &
  25 (6.2) &
  9 (2.2) &
  24 (6.0) &
  0.001\\
Identification of UTI herbs &
  105 (26.2) &
  157 (39.2) &
  44 (10.4) &
  16 (4.0) &
  76 (19.0) &
  0.002\\
Use of herbs to treat UTI &
  103 (25.8) &
  148 (37.0) &
  42 (10.6) &
  16 (4.0) &
  62 (15.5) &
  0.02\\
Selling UTI herbs &
  21 (5.2) &
  21 (5.2) &
  6 (1.4) &
  5 (1.2) &
  7 (1.7) &
  0.188\\
Availability of UTI herbs &
  101 (25.2) &
  148 (37.0) &
  43 (10.8) &
  16 (4.0) &
  66 (16.5) &
  0.26\\
Safety of UTI herbs &
  93 (23.2) &
  136 (34.0) &
  38 (9.5) &
  15 (3.8) &
  58 (14.5) &
  0.005\\
Herbs related microbes &
  44 (11.0) &
  54 (13.5) &
  22 (5.4) &
  11 (2.8) &
  21 (5.2) &
  0.021\\
Appreciation for herbs &
  77 (19.2) &
  100 (25.0) &
  30 (7.5) &
  12 (3.0) &
  56 (14) &
  0.833\\
Total percentages (\%) &
  (70.2) &
  (66.4) &
  (69.7) &
  (80.2) &
  (63.3) &
  0.135\\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Significant p-values ({\textless}0.05) according to the Chi-square test}
    
\item{Source: Field data (2022)}
\end{tablenotes}
\end{threeparttable}

\end{table*}
\textbf{3.9 Information dissemination on UTI and its medicinal plants in Baramulo's societies} \textbf{\space }

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~\ref{f-bcafdc4f3f30}


\bgroup
\fixFloatSize{images/8c808283-1634-41dd-92f6-c50473842bfc-uimage.png}
\begin{figure*}[!htbp]
\centering \makeatletter\IfFileExists{images/8c808283-1634-41dd-92f6-c50473842bfc-uimage.png}{\includegraphics{images/8c808283-1634-41dd-92f6-c50473842bfc-uimage.png}}{}
\makeatother 
\caption{\boldmath {A bar chart for UTI information dissemination; Source: Field data (2022)}}
\label{f-bcafdc4f3f30}
\end{figure*}
\egroup
\textbf{3.1 Medicinal plants and their information} \textbf{\space }

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~\ref{tw-a67e746d0043}


\begin{table*}[!htbp]
\caption{\boldmath {Medicinal plants of Biharamulo district used totreat diseases} }
\label{tw-a67e746d0043}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{LLLLLLLL}
\tbltoprule 
S/N  &
  Botanical names (family)   &
  Local name  &
  Parts used &
  Frequency &
  Preparation  &
  Disease Treated  &
  Supporting literature for biomedical significance \\
1 &
  Aloe vera (Asphodelaceae) &
  Shubiri (Swahili) &
  Leaves &
  101 &
  Maceration and infusion &
  UTI, typhoid, and malaria &
  Antibacterial and antifungal[12]\\
2 &
  Azadirachta indica (Meliaceae) &
  Mwarobaini (Swahili) &
  Leaves &
  108 &
  Infusion &
  UTI, typhoid, and malaria &
  Antimicrobial activity [13]\\
3 &
  Bidens pilosa (L) (Asteraceae) &
  Shanda (Subi) &
  Leaves &
  60 &
  Decoction and infusion &
  UTI and anemia, and ulcers &
  Antimicrobial activities [14,15]\\
4 &
  Cinnamomum verum (Lauraceae) &
  Mdalasini (Swahili) &
  Barks &
  1 &
  Maceration and decoction &
  UTI and ulcers &
  Antimicrobial [14] \\
6 &
  Clematis terniflora (Ranunculales) &
  Bukakara (Subi)  &
  Whole &
  17 &
  Infusion and decoction &
  UTI, gonorrhea, wounds, and yellow fever &
  Antimicrobial [16]\\
7 &
  Clerodendrum trichotomum (Lamiaceae) &
  Kiseke (Subi) &
  Leaves &
  1 &
  Decoction and infusion &
  UTI, malaria, and worms &
  Antimicrobial [17]\\
8 &
  Cymbopogan citratus (Poaceae) &
  Mchaichai (Swahili) &
  Whole &
  205 &
  Maceration and decoction &
  UTI, ant allergic, antifungal, antibacterial &
  Antimicrobial [18,19]\\
9 &
  Erythrina abyssinica (Leguminosae) &
  Omlinzi (Subi) &
  Barks &
  40 &
  Maceration and decoction &
  UTI, gonorrhea, and typhoid &
  Antimicrobial [20]\\
10 &
  Ipomoea cairica (L) (Comnvulvulaceae) &
  Kalandarugo (Haya) &
  Whole &
  93 &
  Concoction and decoction &
  UTI and typhoid &
  Antibacterial [21]\\
11 &
  Jacaranda mimosifolia (Bignoniaceae) &
  Mmea (Subi) &
  Whole &
  3 &
  Maceration and decoction &
  UTI and typhoid &
  Antimicrobial [22]\\
12 &
  Jatropha curcas L. (Euphorbiaceae) &
  Mbono (Ha) &
  Whole &
  19 &
  Maceration and decoction &
  UTI, wounds, gonorrhea, cough, and toothache &
  Antimicrobial [23]\\
13 &
  Kleinia fulgens (L.) (Asteraceae) &
  Kanyoro (Haya) &
  Roots &
  3 &
  Maceration and decoction &
  UTI, syphilis, and gonorrhea &
  Antimicrobial [24]\\
14 &
  Lantana camara (L.) (Verbenaceae) &
  Nyanunda (Subi) &
  Leaves &
  4 &
  Concoction and infusion &
  UTI &
  Antibacterial [25]\\
15 &
  Leonotis leonurus (L) (Lamiaceae) &
  Kitatelante (Subi) &
  Leaves &
  5 &
  Infusion and decoction &
  UTI, anthelmintic and  anti-malaria  &
  Antimicrobial [26,27]\\
16 &
  Moringa oleifera (Moringaceae)  &
  Mlonge (Swahili)  &
  Whole  &
  26  &
   maceration and decoction  &
  UTI, typhoid, B. P, malaria, diabetes, and cancer  &
  Antimicrobial activity [14] \\
17  &
  N. macrophylla (Chrysobalanaceae)  &
  Omnazi (Swahili)  &
  Roots  &
  7  &
  Maceration and decoction  &
  UTI and typhoid  &
  Antimicrobial [28]\\
18  &
  Ocimum sanctum (Lamiaceae)  &
  Kashwagara  &
  Leaves  &
  156  &
  Tisane and decoction  &
  UTI and typhoid, and malaria  &
  Antimicrobial activity [14,29]\\
19  &
  Physalis peruviana (L) (Solanaceae)  &
  Ntuntunya (Subi)  &
  Leaves  &
  69  &
  Infusion and decoction  &
  UTI and typhoid  &
  Antimicrobial [17]\\
20  &
  Senna didymobotrya (Leguminosae)  &
  Mbagabaga (Ha)  &
  Leaves  &
  1  &
  Maceration and infusion  &
  Cough and anthelmintic  &
  Antimicrobial [30]\\
21  &
  Senna siamea (Fabaceae)  &
  Mjoholo (Swahili)  &
  Roots  &
  16  &
  Maceration and infusion  &
  UTI, malaria, typhoid, and gonorrhea  &
  Antimicrobial [31]\\
22 &
  Syzygium cordatum (Myrtaceae) &
  Mgege (Ha) &
  Barks &
  1 &
  Maceration and decoction &
  UTI and fungus &
  Antimicrobial [32]\\
23 &
  Syzygium guineense (Myrtaceae) &
  Msalazi (Subi) &
  Roots &
  5 &
  Maceration and decoction &
  UTI, typhoid, skin infections, and worms. &
  Antimicrobial [33]\\
24 &
  Terminalia mollis(L). (Combrelaceae) &
  Mhongoro (Subi) &
  Whole &
  2 &
  Maceration and decoction &
  UTI, anthelmintic, and cough &
  Antimicrobial [20,34]\\
25 &
  Tetradenia ulticifolia (Lamiaceae) &
  Mchunchu (Subi) &
  Leaves &
  3 &
  Infusion and decoction &
  UTI and cough &
  Antimicrobial [17]\\
26 &
  Vernonia amygdalina (Compositae) &
  Mbirizi (Subi) &
  Whole &
  29 &
  Infusion and decoction &
  UTI, malaria, and measles  &
  Antimicrobial [18]\\
27 &
  Ximenia caffra (Olacaceae) &
  Mseka (Subi) &
  Roots &
  2 &
   Maceration and decoction &
  UTI, gonorrhea, typhoid, and malaria &
  Antimicrobial [35,36]\\
28 &
  Zanthoxylum chalbeum (Rutaceae) &
  Entareyilungu (Haya) &
  Roots &
  11 &
  Maceration and tisane &
  UTI, fibrosis, ulcers, and cough &
  Weak antimicrobial [37]\\
29 &
  Zingiber officinal (Zingiberaceae) &
  Ginger (Swahili) &
  Rhizomes &
  4 &
  Maceration and tisane &
  UTI, typhoid, and cough &
  Antimicrobial [14]\\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Source: Field data (2022}
    
\item{}
\end{tablenotes}
\end{threeparttable}

\end{table*}
\textbf{4.0 Discussion} \textbf{\space }

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 \textit{Terminalia mollis}, contains resins and combrela tannins that kill microorganisms by precipitating their amino acids in cell walls. Myrtaceae (\textit{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 \textit{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 \textit{S. hispanica}, \textit{P. barbatus}, and \textit{H. opposite}, had poor antibacterial activity reported in the literature. 

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

\textit{Jatropha curcas} produced atropine, terpenoids, and curcumin, which were associated with antibacterial, anti-HIV, relieve toothache, wound, and tumor healing properties. \textit{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. \textit{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 (\textit{E. Abyssinia}, \textit{S. siamea}, and \textit{S. didymobotrya} possess resins, quinolizidine, anthraquinones, sennosides, naphthalene, and naphthalene with pharmacological significance in helminth and microbial infections.

According to the previous study, \textit{Harungana madagascariensis} (Hypericaceae) produces the anthraquinones hypericin, hyperoside, and harungin used to treat diabetes, ulcers, and typhoid. \textit{Ipomoea America} (Convolvulaceae) has phenylpropanoid, glycolysis, convolving,  cyanogenic glycoside, and phytate, used as antimicrobial, antidiabetic, treats high blood pressure, and antitumor. \textit{Neocarya macrophyla,} which incorporates terpenes and stigmasterol, was  reported to be vital for antimicrobial and skin infections. Cucurbitacin and phytosterols from \textit{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 \textit{Zingiber } \textit{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.



\subsection{\textbf{5.0 Conclusion} \textbf{\space }}This study succeeded in documenting UTI medicinal plants used in Biharamulo district rather than oral herb information dissemination as practiced by indigenous people. Phytochemical screening and sensitivity tests in the literature revealed that medicinal plants well known and mentioned at high frequencies from the ethnobotanical survey had little active phytochemicals, which accounted for weak antimicrobial activities compared to those mentioned by few people at low frequencies; this indicated that few people know vibrant UTI medicinal plants due to secrecy of traditional healers and this study will disseminate efficacies of the selected UTI medicinal plants.

This study justified the claims of traditional healers and herbalists on the uses of identified selected medicinal plants to have efficacies against UTI microbes and other related microbial infections. Therefore, the present study provided a direction, evidence, and scope for further discovering new UTI drugs for combating antimicrobial resistance.



\subsection{\textbf{6.0 Recommendations} \textbf{\space }}Further research should be conducted to evaluate the antimicrobial effectiveness of identified medicinal plants and ensure their safety to users. Social and public health officers should educate people unaware of UTIs and their medicinal plants. Due to their pharmacological activities, society is advised to use environmentally friendly utilization of the herbs to sustain them so that they become reliable for the next generation.

\textbf{Acknowledgement }

I want to acknowledge Dr. Gaymary G Bakari and Dr. Elisa D Mwega as my supervisors in this study, laboratory technicians from microbiology and biochemistry departments at the Sokoine University of Agriculture, traditional healers and villagers from Biharamulo district in Kagera regional for their outstanding contributions to this study. 

\textbf{Conflict of Interest}

The authors declare no conflict of interest, financial or otherwise.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.
    

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