Medicinal plants utilized for fitness disorders treatment by ethnic groups in Papua and West Papua Province, Indonesia

Papua is one of Indonesia’s islands with a large biological wealth, including medicinal plants. This study aimed to identify the utilization of medicinal plants by selected traditional healers who met inclusion criteria to treat fitness disorders in ethnic groups of Papua and West Papua. Data was collected through interviews, observation, and sample collection. Data quantification was done by analyzing the use value parameters, simple preference ranking exercise, multi-health purpose species rank, and the plant parts value. This study revealed 43 concoction information details and identified the use of 24 plant species distributed in 19 families among 19 healers in 10 ethnic groups in Papua and West Papua. Cymbopogon citratus (DC.) Stapf (12.12%) and leaves (57.35%) were determined as the most prominent species and plant parts used. Morinda citrifolia was identified as the species with the biggest number of other treatable diseases, with a total score of 85. The most used plant families were Myrtaceae and Poaceae, each with a percentage of 12.12%. The study showed the critical role of medicinal plants and traditional healers in community health. However, conservation efforts must be initiated immediately since almost 40% of traditional healers still harvest the available plants and make no cultivation efforts.


INTRODUCTION
A fitness disorder is any type of physical condition that significantly impacts one or more major life activities (Saebu, 2010). The World Health Organization has published public health guidelines and recommendations on physical activity and sedentary lifestyle for children, adolescents, and adults on the amount of physical activity that includes frequency, intensity, and duration as one of the preventive, promotive efforts to improve physical fitness and reduce health risks (WHO, 2016). In addition to physical activity, efforts to overcome fitness disorders can be made by utilizing traditional medicine (Imandiri et al., 2020). The traditional healing system is a very common method and has been practiced in many countries since antiquity for treating physically and mentally ill people. Various things that encourage the use of traditional medicine include the lack of economic resources, relatively minimal side effects, accessibility of medical services, the high price of modern medicine, and the experience of failure in previous treatments (Junsongduang et al., 2020;Mahgoub, 2020).
The implementation of traditional medicine is highly dependent on the availability and richness of biodiversity in the region (Khanal et al., 2020). Papua is one of the islands in Indonesia that consist of two provinces, Papua and West Papua, with a large number of local ethnic groups with a large biodiversity, one of which is medicinal plants (Ananta et al., 2016). The existence of climate change and an increase in the earth's temperature are predicted to have an impact on the survival of various medicinal plant species and their distribution areas, especially on the island of Papua and two other large islands, namely, Java and Sulawesi (Cahyaningsih et al., 2021). In addition, there is a tendency for the knowledge and abilities of traditional medicine that healers possess to be better documented, causing the potential to lose indigenous knowledge (Junsongduang et al., 2020).
Conducting and publishing ethnobiological research has become an important way of preserving and protecting knowledge about local medicine and other information for the next generations (Anyaoku et al., 2015;Pramanik, 2019;Simbiak et al., 2019). It is, however, crucial to conduct the study to document and inventory the wealth of local ethnomedicine knowledge, especially regarding the use of medicinal plants for the treatment of fitness disorders in Papua and West Papua ethnic groups in Indonesia.

Study area
The study was conducted among 10 ethnic groups distributed in Papua and West Papua, as shown in Figure 1. Ethnic groups of Meyah, Inanwatam, Mey Brat, Waigeo, and Sough were located in Papua Province, while Yakai, Asmat, Ngalum, and Tobati ethnic groups administratively entered the province of West Papua. This study has obtained ethical approval from the Health Research Ethics Commission of the Health Research and Development Agency, Ministry of Health of the Republic of Indonesia.

Data collection
Data was collected in 2017 from 10 ethnic groups in Papua and West Papua. For each ethnic group, five traditional healers were selected that met various established inclusion criteria. They have both knowledge and treatment skills using medicinal plants; they are indigenous acculturated or people of the ethnic group and the most popular healer and recognized by the community. Direct interview based on a structured questionnaire among selected traditional healers was conducted in each ethnic group. Data on demography, sources of knowledge and healer's skill, vernacular plant names, plant origin, plant part used, plant habitat, treated disease, symptoms of the disease, herbs used, the dosage used, preparation method, and the administration route were obtained by the questionnaire as the tool. After the interview with the healer was over, species specimens were observed and collected. The collected specimens were identified and preserved by the Herbarium Tawangmanguensis of the Medicinal Plant and Traditional Medicine Research and Development Center.

Data analysis
The data from this study were reported and stored in the Data Management Laboratory of the National Institutes of Health Research and Development. The data request follows the standard procedure of the Data Management Laboratory. Data were quantified by analyzing the use value (UV) parameters, simple preference ranking exercise, multi-health purpose species rank, and the plant parts value.

Use value
To measure the value of each medicinal plant species used by traditional healers to treat physical disorders in Papua and West Papua ethnic groups.

UVs = Σ UVis / ni
where UVs is the use value, UV is the citation number for each species, and ni is the total number of respondents interviewed (Ayyanar and Ignacimuthu, 2011).

Plant part value (PPV)
To quantify the plant part (leaves, stem, root, fruit, stembark, and tubers) used percentage for physical disorders by traditional healers, the following equation was used.

PPV (%) = (ΣRU (plant part) / ΣRU) × 100
where PPV is described as the plant parts used to value and RU is the usage amount quoted for each plant part (Ayyanar and Ignacimuthu, 2011).

Species and multi-health purpose ranking exercise
Species ranking exercise was directed to grade the most picked medicinal plant for a specific illness symptom and disease. In this study, the rank exercise was based on citation numbers by informants (Alemneh, 2021). The bigger the citation number of the species, the better the rank. Other than for physical disorders, multi-health purposes were also determined to provide data on the use diversity of cited species for health purposes.

Demographic data of informants
This current study data demonstrated that from a total of 19 selected traditional healers having knowledge and skill in utilizing medicinal plants for curing illness, specifically for physical disorders in Papua and West Papua ethnic groups, the percentage of women with a main profession as traditional healers was greater than that of men, as shown in Table 1.
The selected traditional healers were dominated by generations with an age range of 40-60 years (78.95%), with the main livelihood as farmers (52.63%) and with low levels of education.

UV and medicinal plants utilized
The highest UV reported in this study was 0.21, and the lowest was 0.05. Each plant is equipped with various information, including the local name, plant family, plant part used, potion dose, disease symptoms, route of administration, and toxicity data obtained from previous studies ( Table 2). As many as 24 species of medicinal plants were identified, complete with their toxicity profiles and identified secondary metabolites (Table 3), belonging to 19 plant families that traditional healers have used to treat physical disorders.
The most frequently used species for overcoming physical disorder by traditional healers in Papua and West Papua was lemongrass (Cymbopogon citratus), with the highest UV and use the percentage of 0.21% and 12.12%, as demonstrated in Table  2 and Figure 2. One of the specific medicinal plants inventoried in this study was red fruit (Pandanus conoideus Lam.), as shown in Table 2. The traditional healers utilized this species belonging to the Pandanaceae family to overcome physical disorders with specific symptoms. The body is quickly tired by boiling the ingredients with water and drinking it once a day after being filtered and chilled. This species is an indigenous Papuan plant and has been reported to contain various medicinal compounds, showed no toxicological effect among experimental rats, and has been widely used by local communities for multiple purposes, for health purposes, nutritional sources, and other reasons (Wismandanu et al., 2016). Figure 3 illustrates that Myrtaceae and Poaceae were recognized as the most utilized plant family by traditional healers from 19 plant families determined in this current study, followed by the families of Compositae, Annonaceae, and other families.

Plant part value
Leaves were indicated to be the most widely harvested and utilized plant parts by traditional healers in Papua and West Papua ethnic groups compared to other parts such as stem, root, fruit, stembark, and tubers, as shown by PPV for more than 75% as revealed in Figure 4. The study results showed that the level of concern for traditional healers for the survival of medicinal plant species was quite high, as indicated by the cultivation efforts that have been carried out by more than 60% of healers (Fig. 5).

Species and multi-health purpose ranking exercise
Morinda citrifolia was recognized as the first rank species with the biggest number of other treatable diseases with a total score of 85, followed by Psidium guajava, Annona muricata, Citrus aurantifolia, and other species with a score of 76, 46, and 17, respectively (Table 4). While C. citratus was identified as the first rank species reported to overcome physical disorders based

DISCUSSION
The crucial role of indigenous traditional healers and medicinal plants in dealing with health problems in society, especially in Papua and West Papua, Indonesia, is evident from the results of this study. The percentage of women who primarily work as traditional healers is greater than men in this study is in line with a previous study that stated that for women, the healing profession has a positive impact on improving their status and the status of women in society (Cabré, 2008;Popper-Giveon and Al-Krenawi, 2010). The role of women in medicine and healing has been proven throughout history, from the ancient world to the present, although in different forms (Jefferson et al., 2015). Another study stated that many men lost their prestige when they became traditional healers, while many women benefited in this regard (Bakker, 1992). However, this is not the case in Thailand, where traditional Thai medicine and healers are very important in Thai society, so men always crave these positions (Junsongduang et al., 2020). Conditions in which most of the traditional healers are more than 40 years old are also reported by Shuaib et al. (2021), whereas 51% of healers were between the ages of 30 and 50 years, with an illiterate level of 36% in Tahsil, Pakistan. Most people with the knowledge and skills to perform traditional medicine are elderly (Cheikhyoussef et al., 2011). It is stated that the people get older, their knowledge of medicinal plants expands (Srithi et al., 2009).
UV is a parameter that quantitatively indicates the relative importance of a plant species to a population (Sharif et al., 2022). Cymbopogon citratus has the highest UV. Cymbopogon citratus is also recorded as the first rank species reported to treat physical disorders based on citation number by simple ranking exercise with a total score of 4. Plant species with higher UV and use total score indicate that the species is likely to grow in abundance in the area, found mostly by local communities, and known to benefit local people for health purposes (Shuaib et al., 2021). Many previous studies have reported the phytoconstituents, such as citral, nerol, geraniol, citronellal, terpinolene, geranyl acetate, and terpinol, and pharmacological activities of C. citratus, including the analgesic, diuretic, carminative, galactagogue, antidepressant, antimicrobial, antipyretic, antiseptic, astringent, bactericidal, sedative and tonic effects (Majewska et al., 2019;Narayan and Maheshwari, 2017;Oladeji et al., 2019a;Olorunnisola et al., 2014;Shah et al., 2011). As a tonic and to treat a physical disorder, C. citratus works to improve health by enhancing the work of the respiratory, digestive, nervous, and excretory systems and facilitating the absorption of nutrients into the body, thereby providing strength and boosting the immune system (Narayan and Maheshwari, 2017).
Apart from treating physical disorders, recorded species were also used to treat other diseases. Morinda citrifolia was identified as the species with the biggest number of other treatable diseases, with a total score of 85. It showed that the utilization rate of this species for health purposes was the highest compared to other species and allowed the overharvesting of materials from nature, which can trigger its extinction. Based on The International Union for Conservation of Nature's Red List of Threatened Species, no
Myrtaceae and Poaceae were recognized as the most utilized plant families by traditional healers from a total of 19 plant families determined in this current study. Poaceae was reported to have the largest number of species in the Rongkong ethnic group (Mustofa et al., 2020). Ahmad et al. (2022) reported that the Myrtaceae family, which consists of 140 genera and about 3,500-5,800 species, is the most well-known essential oilproducing plant in the community and is widely used for medical and commercial purposes (Ahmad et al., 2022). Moreover, about 1,800 plant species belonging to the genus Syzygium in this family have been widely used in traditional medicine systems in Asian countries, including Indonesia (Uddin et al., 2022). Meanwhile, the Poaceae family, which comprises 119 genera and 1,482 described species, is also reported to have been used by indigenous people and native communities in Asian countries, specifically to treat certain diseases and ailments.
Compared to other plant parts, leaves are the most harvested and utilized parts by traditional healers in Papua and West Papua. This is in accordance with several previous studies that reported leaves as the most frequently used part (Mustofa et al., 2020;Nisa et al., 2022;Radha et al., 2021;Rahmawati et al., 2020;Sharif et al., 2022;Subba et al., 2022). Compared to other plant parts, leaves are generally available in more significant quantities in a plant, so leaf harvesting is considered safer and does       (Rabgyal and Pelden, 2021). Furthermore, the leaves also contain various bioactive components, such as flavonoids, alkaloids, phenols, and saponins, which are predicted to be responsible for their pharmacological activities (Friday et al., 2011). The concern levels of traditional healers about the survival of medicinal plant species are quite high, as indicated by the cultivation efforts that have been carried out by more than 60% of healers. This is in accordance with a previous study reported by Ungirwalu et al. (2017) that examined whether local knowledge regarding sustainable use and the traditional concept of forest resources conservation have been established in Papua, but this traditional wisdom is less exposed in the scientific literature (Ungirwalu et al., 2017). However, the initiation of cultivation needs to be carried out considering that almost 40% of healers still treat their patients using medicinal plants by collecting and harvesting existing plants without cultivating them. Moreover, local communities in Papua tend to use the forest for their daily needs (Sundari et al., 2020). Thus, a close synergy between local communities and their environment is expected to contribute positively to sustainable biodiversity resource management (Ungirwalu et al., 2017).

CONCLUSION
This study demonstrated that the study area has plenty of medicinal plants to treat ailments specifically for physical disorders. As many as 43 concoction information details and 24 plant species distributed in 19 families among 19 healers in 10 ethnic groups in Papua and West Papua were documented. Cymbopogon citratus (DC.) Stapf (12.12%) and leaves (57.35%) were determined as the most prominent species and plant parts used. Morinda citrifolia was identified as the species with the biggest number of other treatable diseases, with a total score of 85. The most used plant families were Myrtaceae and Poaceae, each with a percentage of 12.12%. This showed the important role of both medicinal plants and traditional healers in community health. Since almost 40% of traditional healers still harvested the available plants and practiced no cultivation, conservation efforts need to be started immediately to prevent the extinction of these medicinal plants.

ACKNOWLEDGMENT
The authors thank all traditional healers in Papua and West Papua and the Ristoja 2017 team and B2P2TOOT for conducting Ristoja.

AUTHOR CONTRIBUTIONS
NR, DS, SH, IYMS, DSu, HW, RM, and YW were responsible for the conceptualization, preparation of the original draft, and review and editing of the manuscript; NR and RM contributed to the methodology and data curation; RM and IYMS were responsible for the software; HW, NR, and DS validated the data; NR, DSu, and IYMS conducted the formal analysis; SH conducted the investigation; NR and DS were responsible for the resources; NR was responsible for the visualization; YW, HW, and SH supervised the study. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.

FINANCIAL SUPPORT
This research was funded by the Medicinal Plant and Traditional Medicine Research and Development Center, NIHRD, MoH RI, with decree number HK.02.03/I/1825/2017.

ETHICAL APPROVALS
This study has obtained ethical approval with the number of LB.02.02/2/KE.107/2017 from the Health Research Ethics Commission of the Health Research and Development Agency, Ministry of Health of the Republic of Indonesia.

DATA AVAILABILITY
All data generated and analyzed are included in this research article.

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