*3.3.5 Human ailments treated using* C. spinarum

This section will first outline the form of classification used for this analysis on human ailments treated. The data is then analysed in relation to medicinal usage of *C. spinarum.* The WHO-ICPC system (International Classification of Primary Care) of illness classification was developed for the BM primary care setting as a patient-centred model of classification [115]. The ICPC template is promoted by some researchers to classify certain EM studies as they often lack precise BM diagnoses [32, 116]. This analysis of *C. spinarum* uses a modified ICPC classification system for cross-cultural comparison of EM usage. This is a bi-axial system of Body Systems and Ailment Categories. Modifications of the ICPC system are made to both axes to reflect salience in the *C. spinarum* data of particular body systems and ailments. A summary of the overall classification system is presented in **Table 3a and b**.

Some Body Systems listed in **Table 3a** are self-explanatory such as digestive, musculoskeletal etc. The General and Unspecified grouping is often used where the ailment relates to the whole body such as Malaria or other infectious diseases/symptoms. The *C. spinarum*-data-specific classifications of Spirit-Related and Ill-Defined are created to reflect their prevalence in the data, with the former including Evil Eye, bewitchment, sorcery and evil spirits. The classification of Ill-Defined is created to


#### **Table 3.**

*Modified bi-axial ICPC classification for* C. spinarum*: (a) body systems and (b) selected ailment categories (GU = Genito-urinary).*

reflect ambiguity or lack of descriptions of illness e.g., "Cold-sick" where it is not clear what this means from the text [117]. Genito-urinary (GU) ailments are frequently cited in EM systems as reflected in many global studies [118] and in African *C. spinarum* related studies [91, 119–124]. The ICPC Body System classifications of women's health, andrology and urology are modified in this analysis of *C. spinarum* such that the Genito-Urinary ailments are grouped under four Body System classifications: Women's Health, Genital (not gender specific), Urology (not gender specific) and Andrology. Women's Health includes the ICPC "Female Genital" and "Pregnancy, Childbearing, Family Planning and Female Reproductive System"; Genital includes ailments which are not gender specific and this mainly refers to Sexually Transmitted Infections (STIs); Urology refers mainly to urinary tract infections and Andrology refers mainly to virility. The ICPC modification is made so that the true prevalence of women's' health issues can be evaluated rather than splitting the data into smaller categories. The original ICPC Ailment Categories of Infection, Injury, Symptom/ Complaint, Neoplasm and Other are retained while some symptoms, diagnoses and injuries are added as Ailment Categories to aid the analysis. These occur frequently in the data and would otherwise be subsumed under a broad generic Category such as

Symptom/Complaint (**Table 3b**). The added Ailment Categories are Abdominal Pain, Asthma, Cough, Diarrhoea, Evil Eye, Fever, Jaundice, Pain, Seizure and Snakebite. Examples of the bi-axial classification include: amoebiasis classified as Digestion (Body System) and Infection (Ailment Category); gonorrhoea classified as Genital and Infection; post-partum haemorrhage classified as Women's Health and Symptom/ Complaint. This is a means of analytical cross-referencing of the data.

The key Ailment Categories treated with *C. spinarum* are Infection, Pain, Evil Eye, Abdominal Pain, Fever, Diarrhoea and Symptom/Complaint, with a more complete list of 15 Categories presented in **Table 4**. These Key Ailment Categories are crossreferenced with the key ailments within those Categories. It illustrates that while.


**Table 4.**

*Key ailment categories with key ailments treated using* C. spinarum *(ailment category UR > 5; ailment UR > 4) (61% of URs).*

#### Carissa spinarum *L.: A Case Study in Ethnobotany and Bioprospecting Research DOI: http://dx.doi.org/10.5772/intechopen.104665*

Infection is the most common Category treated, Evil Eye is the most common specific Ailment treated followed by Abdominal pain, Malaria, Fever and Genital Infection.

*C. spinarum* is used across multiple Body Systems with the Digestive system predominant (**Table 5**). The other key Systems treated are General/Unspecified, Spirit-Related and Genital. The breakdown of key ailments treated within the Body Systems is illustrated showing that in the Digestive System, the key ailments treated are Abdominal pain, Diarrhoea and Constipation. The main ailments of the General/ Unspecified Body System are Malaria and Fever. Spirit-related illnesses are Evil Eye for the most part. STIs are the most common ailment treated in the Genital System, joint symptoms in the Musculoskeletal System, cough in the Respiratory System, headache in the Neurological System and snakebite is the most common ailment treated affecting the Skin.


#### **Table 5.**

*Main body system with key ailments treated with* C. spinarum *(UR > 9; 54% of total URs).*

The four dominant geographical zones with EM data for the use of *C. spinarum* in humans are Eastern Africa and South Asia—having the most data—and Southern Africa and Australia. The top 4 ailments in each of these four regions are listed in **Table 6**, which illustrates a diversity in ailments treated across the regions. Spiritrelated illness is the most reported ailment, mainly from Ethiopia. Eastern and Southern Africa both list Abdominal Pain and Genital Infection among the most commonly treated ailments. Southern Africa and South Asia both register Fever, Constipation and Diarrhoea among the top 4 ailments treated. Southern Africa and Australia alone list respiratory symptoms among the top individual ailments treated. The treatment of malaria is high in Eastern Africa relative to South Asia corresponding to current and historical relative incidence of malaria [125, 126]. The relatively low level of treatment of fever with *C. spinarum* in Eastern Africa could


#### **Table 6.**

*Key ailments in each of the top 4 global regions (31% of URs).*

## Carissa spinarum *L.: A Case Study in Ethnobotany and Bioprospecting Research DOI: http://dx.doi.org/10.5772/intechopen.104665*

reflect the choice of alternative treatments such as other plant species or pharmaceuticals as suggested in Section 3.2.3 or the overdiagnosis of fever as malaria, a recognised phenomenon [127]. Jaundice and hepatic complaints are mainly reported in South Asia. Given the prevalence in Sub-Saharan Africa of malaria and other contributors to liver ailments such as hepatitis, typhoid fever, dengue and leptospirosis this is unusual [128]. Possible explanations may be that jaundice may not be common in study areas other than South Asia, it may not be treated as a symptom *per se* in those regions or *C. spinarum* may not be a chosen treatment outside of South Asia.

Examining the Body Systems classifications illustrates more inter-regional similarity in the top 5 Systems treated (**Table 7**). The Digestive and Respiratory Systems are commonly treated in each region. The Digestive System is the most commonly treated System in all regions except Australia though to varying degrees. Likewise,


**Table 7.**

*Top 5 ICPC body systems treated by CS across 4 geographical zones (68% of total URs).*

the General and Unspecified Body System is commonly treated in each region, mainly accounted for by malaria in Eastern Africa and fever in South Asia.

The Skin has a high relative importance in all zones except Eastern Africa. The Musculoskeletal System is a key System treated with *C. spinarum* in Eastern Africa whereas the Cardiovascular System is commonly treated in South Asia. In Australia, the Body Systems treated are comparable to the other regions. Study aims and objectives contribute to variability in reports of ailments treated across different regions.

The Body Systems and Ailments treated by *C. spinarum* may be a true reflection of disease prevalence in the study areas. However, in the main there is no reporting of morbidity and mortality data in the ethnobotanical research analysed which makes it difficult to interpret the research results. Some studies have a particular disease focus such as malaria, respiratory disorders, HIV/AIDS, parasitic disease and others. However, the majority of EM information included is from general studies without focusing on a particular ailment. The most common specific research focus is malariarelated from Eastern Africa [82, 83, 129–136]. This could account for the relatively high ranking of malaria in this analysis. A study with the Luo community in Kenya found that abdominal complaints are most commonly treated with traditional medicine in the study area. The authors relate this to the availability of pharmaceuticals for the treatment of other common ailments [81]. An alternative explanation is presented in early research with the Kamba people in Kenya. The author found an organ hierarchy whereby the abdominal and reproductive symptoms were the most important [137]. This hierarchy may be relevant more broadly throughout the Eastern Africa region and could contribute to the prevalence of digestive disorders and treatment of genitourinary ailments with *C. spinarum*. The prevalence of treatment of genitourinary conditions is a common finding in EM studies and may be related as much to cultural treatment norms as to disease prevalence [118]. Its absence from Australian studies may relate to "secret business" not suitable for discussion with a researcher [57].

#### *3.3.6* C. spinarum *in ethnoveterinary medicine (EVM)*

Plant species used for human EM are commonly used for animal healthcare as well, a subject explored in a study of traditional veterinary knowledge in the Algerian steppe [138]. The authors suggested that human use may stem from the observation of animal self-treatment, a behaviour known as zoopharmacognosy. In the case of *C. spinarum*, this may be an element in therapeutic choice. Animals are known to browse on the leaves of *C. spinarum* and it is used in EVM for the treatment of helminthoses and other digestive disorders in animals as in humans. In this analysis of *C. spinarum*, there are 39 documents citing its use in EVM. The geographical spread of documents includes Sub-Saharan Africa—mainly Ethiopia and Kenya and South Asia—mainly India and Pakistan.

The plant part used follows that for human use and is predominantly the root, followed by the bark, leaf, fruit and leaf in **Figure 14a**. Comparing the plant parts used in South Asia to Eastern Africa, **Figure 14b** indicates that while the root predominates in both regions, there is greater variation in Eastern Africa. Here, the root accounts for almost half of URs but the bark is also used a good deal. This contrasts with human use where in Eastern Africa, the root/rootbark far outstrips other plant parts used. This may imply that, in Eastern Africa, the root is considered to be less toxic to humans than other plant parts given the likelihood that greater care is taken with human than animal treatments. In EVM in South Asia, the root accounts for two-thirds of URs and the leaf is used in a minority of cases. This is at variance with the plant parts used for human

Carissa spinarum *L.: A Case Study in Ethnobotany and Bioprospecting Research DOI: http://dx.doi.org/10.5772/intechopen.104665*

**Figure 14.**

*EVM of CS: (a) key plant parts used globally; (b) key parts used in Eastern Africa and South Asia; (c) key routes of administration; (d) key routes in Eastern Africa and South Asia; (e) key methods of preparation; (f) key methods in Eastern Africa and South Asia.*

treatment in South Asia where there is a more even spread between root, leaf and fruit. This could be explained by a number of factors such as the narrower range of diseases treated in EVM, cultural norms, perceived toxicity or acceptability. Similar to human EM of *C. spinarum*, globally the route of administration of EVM is predominantly oral (**Figure 14c**). However, the external route is more common than oral in South Asia whereas in Eastern Africa, the oral route predominates (**Figure 14d**). This may be due

to the predominance of skin diseases in animal ailments treated in South Asian studies (see below). In Ethiopia, Tanzania and India it is applied in a similar way to treat worminfested wounds in cattle whereby the root is ground and applied directly to the wounds [139–141]. The general methods of preparation are much more varied for EVM use. The method is divided more evenly across decoction, cold water extract and raw preparation (**Figure 14e**) though in South Asia the plant is more likely to be used in a raw state relative to the variety of preparations seen in Eastern Africa (**Figure 14f**).

#### Carissa spinarum *L.: A Case Study in Ethnobotany and Bioprospecting Research DOI: http://dx.doi.org/10.5772/intechopen.104665*

In examining the presenting ailments, they can be seen to be primarily related to infection (see **Figure 15a**) with some infections affecting the skin such as ringworm (fungal), lice, ticks, scabies and maggot infested wounds (ectoparasites—all insect related), digestive system (endoparasites—helminthosis), respiratory system in pleuropneumonia (bacterial) or more systemic infections such as theileriosis (endoparasites—protozoa), heartwater, anaplasmosis and salmonellosis (all bacterial), foot and mouth disease, chicken pox, rinderpest and lumpy skin disease (all viral). In a few of the studies, the research teams included members with BM veterinary knowledge and this explains the extent of BM diagnoses provided. Several studies from Eastern Africa have BM veterinary expertise on the research teams which set them apart from the human EM studies where it is rare to have BM diagnoses available [49, 142–149].

The majority of EVM ailments treated using *C. spinarum* are infections affecting the Skin, Digestive system and whole-body System. There is a marked difference in the classifications treated in Eastern Africa relative to South Asia. In the former, Skin infections, Digestive system and Systemic Infectious diseases are the most commonly treated Body System whereas in South Asia, Skin far outweighs any other System treated (**Figure 15b**). This is quite different to the BM systems treated with *C. spinarum* in human EM in South Asia (**Table 7**) where the digestive system is the predominant system treated. Other EVM research in South Asia shows that many body systems are commonly treated [150], which may indicate that *C. spinarum* is particularly effective in treating skin infections.

#### **3.4** *C. spinarum:* **structured ethnobotanical methods and cultural importance**

The relationship between people and plants can be examined through qualitative and quantitative means. The results of qualitative research are described in Section 3.2. Structured quantitative methods provide an additional means of examining plant use in study communities [32].

The use of statistical methods in ethnopharmacological research dates back to the 1970s [151, 152]. A number of quantitative measures are employed that have been developed and modified over the years [153–155]. The most basic unit to measure is the Use Report (UR). Other measures used are Informant Consensus Factor (ICF), Fidelity level (FL) Relative Importance (RI) and Use Value (UV). The value ranges for these measures vary by study and method of calculation, making it difficult to compare studies [32].

#### *3.4.1 Relative importance of* C. spinarum*: primary use reports (URs)*

Given the number of primary studies that are reviewed here, there is relatively little statistical detail on the ethnobotanical use of *C. spinarum*. While there is commonly accurate detail on the number of participants in the studies, few studies provide accurate detail on URs for individual use categories as recommended in best practice documents [31, 32]. Of the Primary studies reviewed, three quarters stated the overall number of participants. Where the number of participants is stated, this could be given as a single number or as a combination of categories of participant: e.g., Focus Group plus Key Informant. One quarter of reviewed studies report the number of URs (number of participants reporting any use of a species) with one third of these being aggregated URs rather than UR per single use category or ailment. One fifth of studies present the primary data as the number of URs per use category. Thus, in 80% of

primary studies, including recent ones, there is no indication of relative specific usage of any species. In overviewing the importance of *C. spinarum* where possible from UR data, it is of low to medium importance in most studies when compared to the use of other more frequently used species. This finding corresponds with a common finding in EM research whereby there are only a few species that are known by a large number of participants and many species that are known by just one or two participants [156]. The studies that indicate high importance of *C. spinarum* using the measure of URs include studies from Kenya, Sudan, Ethiopia, Angola, South Africa and Pakistan [43, 49, 157–163]. There are very few Asian studies presenting information on URs and most Australian studies involve participant-authors rather than large-scale surveys. Thus, the better assessments of value measured by UR are from African studies.

#### *3.4.2 Relative importance of* C. spinarum*: statistical calculations*

Primary research that includes statistical calculations on the relative importance of *C. spinarum* comes from Africa and Asia. Overall, where such research includes *C. spinarum* in its evaluations of importance, it is found to have a low-moderate relative importance. In parts of Uganda and Ethiopia, *C. spinarum* has a high relative importance as an edible species [164, 165]. In Zimbabwe, it has low relative importance for the treatment of schistosomiasis [166]. It is used in the treatment of Non-Communicable Diseases in a study conducted in Rodrigues Island where it has a low-moderate fidelity level for the treatment of diabetes mellitus [167]. In a study of species versatility in Saudi Arabia, *C. spinarum* has a low relative importance in the study area [120]. *C. spinarum* is used to treat malaria in a study in Pakistan but has low importance relative to the well-known *Azadirachta indica* A. Juss. (Neem tree) [168]. A study from southern India found that *C. spinarum* has a low UV and is reported for the treatment of cough alone [169].

The majority of studies that include *C. spinarum* have no measure of the cultural importance, contrary to current best practice recommendations [31, 32]. Where cultural importance is measured in Ethiopian studies, it is found in the main to have a relatively high importance over a broad range of ethnobotanical uses. In other areas, where reported, *C. spinarum* is of moderate or low cultural importance. Some early documents and the Australian studies included in this analysis contain no statistical information. The ethnobotanical information is often detailed but may involve very few participants. This would not be considered adequate according to current best practice guidelines but these studies are a valuable addition to ethnobotanical literature [80, 86, 89, 117, 170].

#### *3.4.3 Relative importance of* C. spinarum *in Ethiopia: participatory ranking*

Anthropological participatory Ranking exercises have been developed as central tools in ethnobotanical research [37, 58]. They are a feature of several Ethiopian studies examined for usage of *C. spinarum* and are a semi-quantitative method of measuring the relative frequency of use of species. Ranking exercises create a more in-depth examination of species use in the study area and follow from more general earlier explorations with participants, which can select out key species to include in comparison exercises. Inclusion in a ranking exercise for specific or general utility of itself indicates a high relative importance among participants. Participatory exercises involve the selection of a small number of key participants, 5–10 people, and a selected number of key plant species, usually 5–7 species, identified during the Carissa spinarum *L.: A Case Study in Ethnobotany and Bioprospecting Research DOI: http://dx.doi.org/10.5772/intechopen.104665*

research as having importance for broad or narrow purposes. The exercises examine a range of ethnobotanical uses through one of a number of methods: direct matrix ranking (DMR), pairwise ranking, preference ranking or simply by number of uses.

A total of 25 Ethiopian ethnobotanical participatory ranking studies were identified including *C. spinarum* among the ethnobotanically known species of the area and 16 of these included *C. spinarum* in ranking exercises. There was a total of 170 species included in these exercises. It is evident that *C. spinarum* has a high relative importance in the study areas given its selection from a large pool of species.

#### *3.4.4 Participatory general ethnobotanical rankings of* C. spinarum *in Ethiopia*

Several Ethiopian studies examined the non-medical ethnobotanical importance of species using participatory ranking exercises. The range of ethnobotanical categories of importance in ranking exercises included medicine, firewood, furniture, construction, fencing, charcoal, forage, fodder and food.

There are 16 studies listed in **Table 8** that included *C. spinarum* in their ethnobotanical species list, with 7 exercises from these studies listing *C. spinarum* as having significant general ethnobotanical importance. The study areas exhibiting above the median ethnobotanical relative importance for *C. spinarum* are distributed throughout the country. This analysis indicates a high relative importance for *C. spinarum*, which is also evident in the statistical ranking analyses such as UV and RFC in the previous section.


#### **Table 8.**

*Ethiopian rankings of* C. spinarum *use through participatory ranking for general ethnobotanical use (N/R = Not ranked) (all DMR except [171] species with >2 uses).*


#### **Table 9.**

*Ethiopian EM participatory ranking exercises in study locations listing CS. Mich is described as a febrile illness with headache and sore lips [183].*

Carissa spinarum *L.: A Case Study in Ethnobotany and Bioprospecting Research DOI: http://dx.doi.org/10.5772/intechopen.104665*

#### *3.4.5 Ethnomedical participatory rankings of* C. spinarum *in Ethiopia*

Several ranking studies specifically examine EM importance both for broad utility and for particular medical purposes. An overview of these rankings is shown in **Table 9** and consists of 22 studies with a total of 37 ranking exercises. *C. spinarum* (CS) appears in 11 exercises using a variety of ranking methods: Preference Ranking, Pair-wise ranking and Direct Matrix Ranking (DMR). In most exercises that include *C. spinarum*, it is ranked above the median value. The study areas where it exhibits importance in the general EM category are distributed throughout the central regions of Ethiopia, north to south along the Rift Valley. The most common medical ranking exercises other than the general ranking are for gastrointestinal complaints and gonorrhoea. *C. spinarum* is ranked as the best for treating gonorrhoea in three studies, it is ranked in one gastrointestinal ranking exercise and in rankings for malaria and febrile illness, *C. spinarum* is not ranked [49, 173, 175, 180, 184, 185]. From these participatory exercises, *C. spinarum* appears to be highly ranked for the treatment of gonorrhoea and not for other specific ailments. It ranks high in several areas for general ethnomedical use.

### *3.4.6* C. spinarum*: a comparison of cultural value based on statistical measures vs. participatory ranking exercises in Ethiopia*

Interpretation of cultural importance by participatory ranking exercises and UR yields, sometimes, conflicting information. Ethnomedical participatory ranking exercises found that *C. spinarum* did not rank high in the treatment of gastrointestinal complaints. This is in contrast to the finding in **Table 7** whereby, in the ICPC classification, the Digestive system is the most treated Body System with *C. spinarum* in Eastern Africa. In Ethiopia specifically, it is second to Spirit-related illness in being the most commonly treated Body System. This indicates a potential discrepancy between the two forms of analysis. However, in ranking for treatment of gonorrhoea, *C. spinarum* is ranked best in three out of four exercises. This corresponds with that found in **Tables 4** and **6** which indicate its importance in treating genital infection globally and in Eastern Africa. That *C. spinarum* is not ranked in exercises for the treatment of malaria and for febrile illness is at odds with the findings in **Tables 4** and **6**, where malaria and fever are among the ailments most commonly treated with *C. spinarum* globally and in Eastern Africa. There are other sources of variability between statistical and participatory research. In participatory rankings, as in all research, there is a randomness to the choice of participant and all participants have necessarily a different knowledge base. There is also variability in the choice of species to include in the ranking exercises and it is not clarified how particular species are selected for analysis. The choice of a particular ranking subject is a function of the study design and researcher priorities and may not reflect the key ailments treated with traditional medicine in the study areas. This could lead to another layer of bias in the results.

The potential variability of outcomes, depending on research methods and study design should be borne in mind in any interpretation of the results or implementation of the research outcomes.

#### **3.5 Phases in** *C. spinarum* **research**

The framework of Hunn's phases of ethnobiology is applied to the ethnobiological documents analysed relating to *C. spinarum* research following a method employed in a study of Southeast Asian ethnobiology [11]. There were 219 primary ethnobiological research documents analysed. Of these, 85% are EM only, while the remainder relate to mainly to diet and general ethnobotany. Within these studies, in whatever phase they are classified, there is a general lack of detail on the practicalities of medicinal plant use. There is almost total silence on plant harvesting. In 9% of cases, there is no information on the plant part used. In over one third of cases, there is no method of preparation given and where a method is given, rarely is close detail provided. The route of administration is not given in 40% of cases. The lack of such basic detail on plant use devalues the research overall, whatever the research agenda, whether for cultural record, bioprospecting or other purposes. Added to these immediate aspects of medicinal plant use are the omissions on the fabric of local life. Culture is central to healing and plant use. However, cultural elements of EM are omitted in the majority of studies such as the meanings associated with plants, disease concepts, therapeutic indications, or what "healing" actually means in the local context as distinct from BM understandings of being healed [192]. Other aspects that are rarely addressed include, for instance, local healthcare provision, morbidity and mortality, environment and economy, which, among other things, contribute to healthcare choices and to the relationship of people with plants.

The majority of the studies that include *C. spinarum* fall into the Phase I classification, representing two thirds of the total and are, in the main, bioprospecting studies. They are largely descriptive in nature, containing lists of species and their uses, with sparse detail on how they are used, as described above. There is an implication built into this rudimentary data collection, that the "how" and "why" of ethnomedicine has little to do with science. In the bioscience laboratory, studies based on EM catalogues of species generally use organic solvents to extract single or multiple metabolites and test these extracts or compounds in *in-vitro* systems, none of which bears any resemblance to the use of traditional medicines in the field. In an unpublished review by these authors of 125 documents examined for phytochemistry and pharmacology of *C. spinarum*, nine (7%) test the pharmacology of aqueous plant extracts and six (5%) identify phytochemicals from aqueous or distilled extracts (data available on request1 ). This indicates the disjuncture between traditional medical practice and preclinical ethnopharmacological studies. There are some studies in the current analysis that have characteristics of each of Phases II to V even where they still contain catalogues of species and their uses. Those with some descriptions of local understandings of illness and healing are ascribed Phase II character. Descriptions such as of disease and causation of TB in a Ugandan community, liver dysfunction in a community in Togo or the meanings associated with plant names in a South African community add to the reader's understanding of EM in those communities [46, 47, 53]. Studies with some Phase II character represent a quarter of the total, with five studies having more detail. For instance, research with Luo mothers, already discussed in Section 3.2.3, situates the treatments of digestive disorders, worms and the use of pharmaceuticals in the study community. Two studies with the Marakwet of Kenya, from 1978 and 2014, give good descriptions of disease perceptions in the study communities. Studies with the Maasai and Samburu in Kenya, give good background descriptions of health in the communities and relationship to environment which allows a deeper understanding of plant usage. Each of these more detailed studies offer an emic perspective which better situates how people use plants for life [41, 81, 86, 87, 193].

<sup>1</sup> This data is part of a PhD dissertation by the first author which includes the phytochemistry and pharmacology of *Carissa spinarum* L.

#### Carissa spinarum *L.: A Case Study in Ethnobotany and Bioprospecting Research DOI: http://dx.doi.org/10.5772/intechopen.104665*

Those using participatory ranking as described in Section 3.4.5 have Phase III character and represent 11% of the total. They give a sense of how plants form an integral part of life. The participatory studies allow researchers to understand how people think about plants in their immediate environment and how particular species may have cultural value across multiple practical and symbolic domains. Studies conducted in collaboration and co-authorship with community members have elements of Phase IV character such as several Australian publications as described in Section 3.2.1 and two Africa-based studies which mentioned benefit-sharing arrangements [41, 50, 54, 56, 59, 62, 194]. These represent 0.5% of the total. The Convention on Biodiversity (CBD) and related issues such as conservation, sustainable use of resources, prior informed consent and equitable benefit sharing relate to later phases in ethnobiology from the 1970s and Phase III onwards. They are rarely discussed in any of the documents. Consent in any form is reported in 40% of studies though there is no description of the process in any instance. Ethics is referred to where ethical approval of the research has been granted in 16% of studies though the process is not discussed nor the ethical issues examined. The International Society of Ethnobiology (ISE) code of ethics is referred to in six studies (3%) which may imply a greater attention to ethical standards in the research process. Research permits are cited in 15% of studies though the process is not elaborated upon. Intellectual property rights (IPRs) or benefit sharing arrangements are mentioned in eight studies (4%) [59, 62, 132, 157, 194–197]. Half of all studies have no mention of consent, ethics, permits, IPR or other research ethics related issues.
