Herbal product use in urban slum communities of Freetown, Sierra Leone: Consumption patterns, predictors, and ethnomedicinal applications - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice J Ethnobiol Ethnomed . 2026 Mar 7;22:32. doi: 10.1186/s13002-026-00878-5 Search in PMC Search in PubMed View in NLM Catalog Add to search Herbal product use in urban slum communities of Freetown, Sierra Leone: Consumption patterns, predictors, and ethnomedicinal applications Ahmed Vandy Ahmed Vandy 1 Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone 3 Slum and Rural Health Initiative, Freetown, Sierra Leone Find articles by Ahmed Vandy 1, 3, ✉ , Benjamin Abu Turay Benjamin Abu Turay 1 Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone Find articles by Benjamin Abu Turay 1 , Michael Lahai Michael Lahai 1 Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone Find articles by Michael Lahai 1 , Nuhu Bah Nuhu Bah 1 Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone Find articles by Nuhu Bah 1 , Augustus Osborne Augustus Osborne 2 Institute for Development of the Western Area, Freetown, Sierra Leone Find articles by Augustus Osborne 2 Author information Article notes Copyright and License information 1 Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone 2 Institute for Development of the Western Area, Freetown, Sierra Leone 3 Slum and Rural Health Initiative, Freetown, Sierra Leone ✉ Corresponding author. Received 2025 Nov 27; Accepted 2026 Feb 24; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13081598 PMID: 41794856 Abstract Background Herbal products, encompassing medicinal plants and processed formulations, remain central to primary healthcare in informal settlements, where access to conventional medical services is limited. Despite their widespread use in Sierra Leone, contemporary consumption patterns are poorly documented. This study investigated herbal consumption patterns, predictors, and ethnomedicinal applications among adults in urban slum communities of Freetown. Methods A cross‑sectional quantitative study was conducted between February and December 2024 among 422 participants in Cockle Bay, Kroo Bay, and Susan’s Bay. Data were collected using a questionnaire covering socio‑demographic, consumption practices, influencing factors, and perceptions of herbal medicine. Participants were categorized as low, moderate, or high consumers using a consumption scale. Multinomial logistic regression identified predictors of consumption levels, while binary logistic regression examined predictors of herbal product use as sexual stimulants. Odds ratios (OR) with 95% confidence intervals were reported, with statistical significance set at p < 0.05. Results Among the participants, 171 (40.5%) were low-level consumers, while 140 (33.2%) were high-level consumers. Community of residence was the strongest predictor: Kroo Bay residents were less likely to be low (OR = 0.09, p < 0.001) or moderate consumers (OR = 0.47, p = 0.046) compared with Susan’s Bay. Young adults aged 18–29 were nearly three times more likely to be moderate consumers than high (OR = 2.79, p = 0.013). Income also showed significance, with those earning SLL 600–2,999 less likely to report moderate consumption (OR = 0.38, p = 0.039). Ethnomedicinal reliance was extensive, with the medicinal plant Cassia sieberiana DC . (Red Gbangba) used for malaria (90%), Cymbopogon citratus (DC.) Stapf (Lemon Grass) for colds (84.6%), and the commercial herbal mixture Coco Samba for sexual stimulation (49.8%). Overall, 314 participants (74.4%) reported using herbal products as sexual stimulants, with men (AOR = 7.53, p < 0.001) and Kroo Bay residents showing the highest likelihood (AOR = 10.05, p < 0.001). Perceptions were largely positive, with 90.0% endorsing nutrient value and 87.4% considering herbal products natural and safe. Conclusion Herbal products play an essential and multidimensional role in the well-being of slum residents in Freetown. Elevated usage rates, significant community-specific influences, and frequent reliance on sexual stimulants underscore the need for culturally grounded regulation, consumer safety education, and integration strategies that reflect local realities. Keywords: Herbal medicine consumption, Ethnomedicinal practices, Informal settlements, Predictors of use, Sexual stimulant products Background Herbal products, encompassing medicinal plants, commercial herbal mixtures, and processed supplements, are plant-derived preparations used to prevent, treat, or manage disease and to promote health [ 1 , 2 ]. They may consist of raw plant materials such as leaves, roots, seeds, or bark, or processed formulations including extracts, teas, powders, and capsules [ 3 ]. Rooted in traditional knowledge systems, they continue to serve as primary therapeutic resources for millions of people across diverse cultural contexts [ 4 , 5 ]. In this study, we use ‘herbal products’ as the overarching term to encompass all plant-derived remedies used for health purposes. Within this, ‘medicinal plants’ refer to raw botanicals such as leaves, roots, or bark used in their natural form; ‘commercial herbal mixtures’ denote processed multi-ingredient products often prepared by vendors or traditional healers; and ‘processed supplements’ describe commercially formulated herbal products, typically packaged and sold as capsules, powders, or teas. The World Health Organization (WHO) estimates that nearly 80% of populations in developing countries rely on herbal remedies for primary care [ 6 ]. While these figures are widely cited, their validity has been questioned in recent years due to limited contemporary validation in specific contexts. Nevertheless, they reflect a persistent global trend of reliance on traditional remedies, particularly in resource-limited settings, as supported by more recent regional studies [ 6 , 7 ]. In Africa, traditional remedies provide healthcare for up to 90% of people, while in India, about 70% of the population depends on them [ 4 , 6 , 8 ]. Herbal remedies are also widely used in developed countries. Surveys report that 42% of Americans, 48% of Australians, 70% of Canadians, 38% of Belgians, and 75% of French citizens have used herbal products at least once [ 9 ]. Traditional remedies account for 40% of healthcare services in China, with departments established in over 90% of general hospitals [ 8 ]. This widespread use reflects not only gaps in access to biomedical care but also enduring sociocultural and economic factors that sustain indigenous health practices. Urban slum communities in low‑ and middle‑income countries represent some of the most underserved environments in global health. Structural inequalities, limited access to formal healthcare, and economic constraints converge to make herbal remedies the first line of treatment for many residents [ 10 , 11 ]. Herbal products, particularly medicinal plants and commercial herbal mixtures, are valued for their affordability, accessibility, and cultural acceptability, and are used to manage conditions ranging from malaria and hypertension to infertility and mental health [ 8 , 12 – 14 ]. Adults increasingly turn to herbal products not only for disease treatment but also for perceived safety, cultural alignment, and sexual health concerns [ 15 ]. Despite this widespread global usage, concerns persist regarding quality control, adulteration, and toxicity, particularly in contexts where use is routine yet unregulated [ 16 – 18 ]. Many herbal products are consumed off‑label, with limited preclinical or clinical evidence supporting their efficacy or safety [ 19 ]. In Sierra Leone, herbal medicine plays an influential role as formal medical services may be geographically distant, financially prohibitive, or perceived as culturally misaligned [ 20 ]. Similar patterns are observed across West Africa, where structural inequalities and economic constraints drive reliance on traditional remedies in urban informal settlements [ 14 , 21 ]. These contexts highlight the intersection of cultural heritage and systemic barriers in shaping healthcare choices, a dynamic particularly pronounced in marginalized urban environments. It has been estimated that between 22% and 31% of the population in Sierra Leone relies on traditional medicines for conditions such as diarrhea and malaria [ 22 ]. Yet little is known about how residents in socially vulnerable communities navigate this expanding landscape of remedies in their daily lives. Understanding consumption patterns and the factors shaping them is especially critical in Sierra Leone, where regulatory oversight of herbal products is limited. Decisions about use are often guided by informal networks, personal experience, and vendor recommendations rather than formal medical advice. At the same time, the ethnomedicinal knowledge embedded within these communities represents a valuable, though under‑documented, reservoir of therapeutic practices that continue to evolve in response to shifting social and economic realities. This study is positioned at the intersection of ethnomedicine and public health, drawing on the framework of medical pluralism to examine how traditional and informal healthcare systems coexist in urban slum communities. It also engages with urban ethnobotany to document plant-based remedies in non-rural settings and explores traditional medicine utilization as a response to health inequities in underserved populations [ 23 , 24 ]. These theoretical perspectives guide our investigation into the sociocultural, economic, and structural drivers of herbal product reliance in Freetown, Sierra Leone. This study addresses these gaps by investigating and documenting the consumption patterns, predictors, and ethnomedicinal applications of herbal products in Freetown’s slum communities, contributing to understanding of traditional medicine’s role in marginalized urban settings amid limited access to formal healthcare. The specific objectives are to: (i) determine consumption patterns of herbal products and the socio-demographic predictors of use; (ii) examine ethnomedicinal practices through the evaluation of herbal products of choice reported for specific disease conditions; (iii) assess the motivations for product selection and use; (iv) identify predictors of herbal product use as sexual stimulants; and (v) assess participants’ perceptions of herbal products. The findings are expected to provide insights into the contemporary role of herbal products in marginalized urban settings and inform culturally responsive public health interventions, regulatory frameworks, and community education initiatives. Methods Study design, setting, and period We conducted a cross-sectional quantitative study between February and December 2024 in three informal settlements of Freetown: Cockle Bay, Kroo Bay, and Susan’s Bay. Cockle Bay, located about 5 km from Freetown’s city centre along the western coastline of Aberdeen Creek, covers roughly 178 hectares, much of it reclaimed from mangrove forest. Geographically, the settlement lies at latitude 8.49397° N (8°29′38″ N) and longitude − 13.27265° W (13°16′22″ W). As one of Freetown’s diverse informal communities, Cockle Bay reflects Sierra Leone’s broad ethnic mix, with Mende, Temne, Krio (Creole), Fula, Limba, and other groups represented. Migration during the civil war further contributed to its demographic diversity, making it a cultural melting pot where Krio commonly serves as the lingua franca alongside native languages. Kroo Bay, situated near Freetown’s central business district, is one of the city’s largest informal settlements. Located close to the Water Area neighborhood and Connaught Hospital, the community lies at an elevation of 39 m above sea level and is frequently affected by flooding, with limited access to health and sanitation services. Geographically, it is positioned at latitude 8.4853° N (8°29′7″ N) and longitude − 13.24042° W (13°14′26″ W). The population is ethnically diverse, with Temne people comprising about majority of the population, followed by Fullahs, Limbas, Mendes, and smaller groups from across Sierra Leone. Susan’s Bay, situated on Freetown’s eastern waterfront, is a densely populated informal settlement that endures recurrent fire outbreaks and flooding. Despite these challenges, it remains a vibrant hub of small‑scale trade. The community lies at latitude 8°29′31″ N (8.49194°) and longitude 13°13′49″ W (− 13.2303°). Islam and Christianity are the dominant religions across all three communities, though some residents also practice indigenous faiths or participate in traditional secret societies, often alongside their adherence to Islam or Christianity. These sites were purposively selected as densely populated and socially vulnerable communities, where restricted access to formal healthcare often compels residents to rely on informal vendors and traditional remedies as primary sources of care. No plant specimens were collected during this study; hence, herbarium deposition was not required (Fig. 1 ). Fig. 1. Open in a new tab Map of visited slum settlements in Freetown showing study locations Study population, sample size, and sampling method The sample size was determined using Epi Info software based on the standard formula for cross‑sectional studies [ 25 ], with a prevalence estimate of 50% (given the absence of prior data), a 5% margin of error, and a design effect of 1.0. Population estimates were drawn from the 2021 mid‑term census, yielding a final sample of 422 participants as shown in Table 1 . A single‑stage cluster sampling approach was applied: each settlement was divided into pre‑defined zones, and participants were randomly selected to ensure equal probability of inclusion. Adults aged 18 years and above residing in the selected slum communities were eligible for inclusion. Participants were recruited through door-to-door visits within selected zones, with eligibility criteria including adults aged 18 years and above who had used herbal products in the past year and were residents of the selected slum communities. Exclusion criteria included individuals unable to communicate due to mental impairment or those unwilling to provide informed consent. Community leaders were consulted to facilitate trust and access during recruitment. Table 1. Population estimates and sample size by settlement Community Number of inhabitants Number of study participants Cockle Bay 21,359 179 Kroo Bay 14,068 118 Susan’s Bay 14,872 125 Total 50,299 422 Open in a new tab Data collection tools and procedures Data was collected using a structured questionnaire developed from existing literature [ 26 – 29 ]. The instrument was designed to capture ethnobotanical practices through questions on plants and products used for specific health conditions. An initial list of commonly used remedies was compiled through informal community inquiries and consultations with local traditional medicine experts, with participants encouraged to report additional remedies beyond those listed. Plant identification relied on vernacular names provided by respondents, cross-referenced with ethnobotanical literature [ 20 , 30 ] and expert input. No physical specimens were collected for taxonomic verification; vernacular names were documented as reported, with notes on linguistic or regional variations where relevant. To ensure analytical clarity, respondents were asked to classify products as raw medicinal plants, commercial herbal mixtures, processed supplements, or multi-ingredient preparations of unknown composition. The questionnaire comprised four sections: socio-demographic characteristics, consumption patterns of herbal products, factors influencing use, and perceptions regarding herbal products. To assess consumption levels, we adapted a refined six-point scale from Sousa et al. 2024 originally developed for studying tea and herbal infusion consumption patterns [ 27 ]. The scale measured frequency of use as follows: (i) only when needed, but not more than three times per month, (ii) one to three times per month, (iii) two to four times per week, (iv) once per day, (v) two to three times per day, and (vi) more than three times per day. Perceptions were measured using a five-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’, capturing participants’ perception toward safety, efficacy, nutritional value, cost-effectiveness, and potential integration into modern healthcare systems. This approach allowed for quantitative analysis of community perspectives, providing insights into subjective views that are critical for culturally responsive public health strategies. Prior to the main survey, the questionnaire was pretested with 25 participants to ensure contextual appropriateness, clarity, and consistency with study objectives. Data analysis Data was analyzed using the Statistical Package for Social Sciences (SPSS) 27. Descriptive statistics, including frequencies and percentages, were used to summarize the data and present findings in tables and figures. Consumption levels were categorized into three groups based on respondents’ self-reported frequency: low-level consumers (those who used herbal products only when needed but not more than one to three times per month), moderate-level consumers (those consuming two to four times per week up to once daily), and high-level consumers (those consuming more than once daily). For ease of interpretation, responses on the five‑point Likert scale were collapsed into three groups, with “strongly disagree” and “disagree” combined, “neutral” retained, and “agree” and “strongly agree” combined. Multinomial logistic regression was employed to examine factors associated with consumption levels, with high‑level consumers serving as the reference category. Odds ratios (OR) with 95% confidence intervals (CI) were reported, and model fit was assessed using pseudo-R² statistics. Binary logistic regression was used to determine predictors of herbal product use as sexual stimulants, with both crude odds ratios (COR) and adjusted odds ratios (AOR) presented. Multicollinearity was checked, and statistical significance was set at p < 0.05 in adjusted models. Results Socio-demographic characteristics of the participants Age was relatively balanced across groups: 161 participants (38.2%) were aged 18–29 years, 127 (30.1%) were aged 30–39 years, and 134 (31.8%) were aged 40 years or older. Religious affiliation was split between 218 Muslims (51.7%) and 204 Christians (48.3%). Marital status leaned slightly toward unmarried individuals, 227 (53.8%), compared with 195 married participants (46.2%). Education levels showed that 186 (44.1%) had no formal schooling, 106 (25.1%) had basic education, and 130 (30.8%) had tertiary education. Income levels highlighted economic challenges, as 233 (55.2%) earned less than SLL 600 monthly, 133 (31.5%) earned between SLL 600–2,999, and only 56 (13.3%) earned SLL 3,000 or more. Employment status revealed 252 (59.7%) were employed, while 170 (40.3%) were unemployed (Table 2 ). Table 2. Sociodemographic characteristics of the sample population Characteristics Frequency (N) Percentage (%) Slum communities Cockle Bay 179 42.4 Kroo Bay 118 28.0 Susan’s Bay 125 29.6 Gender Male 209 49.5 Female 213 50.5 Age 18 to 29 years 161 38.2 30 to 39 years 127 30.1 ≥ 40 years 134 31.8 Religion Christianity 204 48.3 Islam 218 51.7 Marital status Married 195 46.2 Unmarried 227 53.8 Highest level of education No formal education 186 44.1 Basic education 106 25.1 Tertiary education 130 30.8 Estimated monthly income < SLL 600 233 55.2 SLL 600-2,999 133 31.5 ≥ SLL 3,000 56 13.3 Occupation Unemployed 170 40.3 Employed 252 59.7 Open in a new tab SLL – Sierra Leone Leones (1 United States Dollar = 24 Sierra Leone Leones) Herbal products consumption level Figure 2 illustrates the consumption level of herbal products, encompassing medicinal plants, commercial herbal mixtures, and processed supplements, among participants. Of the 422 respondents, 171 (40.5%) were classified as low‑level consumers, 111 (26.3%) as moderate‑level consumers, and 140 (33.2%) as high‑level consumers. Fig. 2. Open in a new tab Herbal products consumption level Novel contributions to ethnobotanical knowledge Our study uncovers several novel aspects of herbal product use in urban slum communities of Freetown, Sierra Leone, that have not been extensively documented in prior literature focused on urban settlements within the country or the broader West African region. A striking 74.4% of participants reported using herbal products as sexual stimulants, with specific plants such as “Coco Samba” (49.8%) and “Bitter Root” ( Mondia whitei , 47.4%) emerging as dominant choices for this purpose. This high prevalence and specificity of use for sexual health in urban slums contrast with earlier studies in Sierra Leone, such as Johnny et al. (2022), which primarily focused on medicinal plants in forest-edge communities and did not emphasize sexual health applications to this extent. Additionally, our quantitative categorization of consumption levels into low (40.5%), moderate (26.3%), and high (33.2%) using a refined scale, alongside community-specific predictors (e.g., Kroo Bay residents being significantly less likely to be low-level consumers, OR = 0.09, 95% CI: 0.04–0.20, p < 0.001), provides a new framework for understanding herbal use intensity in informal urban settings. These findings represent a unique contribution to the ethnobotanical knowledge base of urban Sierra Leone, highlighting previously underreported health priorities and consumption patterns in marginalized communities. Predictor of herbal product consumption levels As seen in Table 3 , a multinomial logistic regression was done to identify factors associated with herbal product consumption levels, categorized as low, moderate, and high (reference category). The overall model was statistically significant (χ² = 105.85, df = 26, p < 0.001), indicating that the included predictors contributed meaningfully to explaining variation in consumption. Table 3. Multinomial logistic regression predicting herbal product consumption levels (reference = high-level consumers) Predictor variables Low vs. High OR (95% CI) p -value Moderate vs. High OR (95% CI) p -value Slum communities Cockle Bay 1.24(0.65–2.35) 0.512 1.78(0.84–3.78) 0.132 Kroo Bay 0.09(0.04–0.20) < 0.001 0.47(0.22–0.99) 0.046 Susan’s Bay REF REF Gender Male 1.09(0.63–1.88) 0.773 1.15(0.64–2.05) 0.643 Female REF REF Age 18 to 29 years 1.30(0.62–2.70) 0.488 2.79(1.25–6.26) 0.013 30 to 39 years 0.93(0.49–1.76) 0.822 1.83(0.88–3.78) 0.105 ≥ 40 years REF REF Highest level of education No formal education 0.95(0.48–1.86) 0.873 0.87(0.42–1.77) 0.692 Basic education 1.08(0.53–2.26) 0.821 0.65(0.30–1.43) 0.286 Tertiary education REF REF Estimated monthly income < SLL 600 0.64(0.23–1.79) 0.397 0.63(0.21–1.88) 0.407 SLL 600-2,999 0.52(0.23–1.20) 0.127 0.38(0.15–0.95) 0.039 ≥ SLL 3,000 REF REF Use of herbal products as sexual stimulants No 1.17(0.61–2.26) 0.631 1.52(0.75–3.08) 0.247 Yes REF REF Open in a new tab SLL – Sierra Leone Leones (1 United States Dollar = 23.6 Sierra Leone Leones); Bold p-values indicate statistical significance at p < 0.05 Community of residence was the most consistent predictor of herbal product consumption. Participants from Kroo Bay were significantly less likely to be low-level consumers compared to high-level consumers (OR = 0.09, 95% CI: 0.04–0.20, p < 0.001), and also less likely to be moderate consumers (OR = 0.47, 95% CI: 0.22–0.99, p = 0.046), relative to those from Susan’s Bay. Age was also associated with consumption level: young adults aged 18–29 were nearly three times more likely to be moderate consumers than high-level consumers (OR = 2.79, 95% CI: 1.25–6.26, p = 0.013), suggesting distinct engagement patterns among younger respondents. Monthly income showed a modest effect, with individuals earning SLL 600–2,999 less likely to report moderate consumption compared to high-level use (OR = 0.38, 95% CI: 0.15–0.95, p = 0.039). Other sociodemographic factors such as religion, marital status, and occupation did not show significant associations with consumption levels in the adjusted model and are thus not tabulated. Disease conditions and reported herbal remedies: Ethnomedicinal practices among respondents The study documented a wide array of herbal products, including medicinal plants, commercial herbal mixtures, and processed supplements, used for various health conditions, reflecting a deep reliance on traditional remedies. For sexual stimulants, 49.8% of respondents used “Coco Samba,” followed by “Bitter Root” (47.4%) and “White Gbangba” (24.9%). Malaria treatment predominantly involved “Red Gbangba” (90%), while “Lemon Grass” (84.6%) and “Lem” (50.5%) were common for treating colds. Diabetes management saw " Prpr " (26.5%) and “Gbangba” (14.5%) as frequent choices. Fractures were treated mainly with “Ojo” (74.6%), and infertility remedies included “Moringa” (21.6%) and “Teabush” (13%). Skin diseases were addressed with “Aloe Vera” (63.7%), and conditions like amenorrhea, menorrhagia, and constipation involved diverse plants such as “Krismaslif” (28%) and “Tombi” (29.9%) (Table 4 ). Table 4. Herbal products (medicinal plants, commercial herbal mixtures, and processed supplements) of choice reported for specific disease conditions Health Condition Local Name Scientific Name Authority Family Category Frequency Percentage (%) Use Value (UV) Relative Frequency of Citation (RFC) Fidelity Level (FL, %) Sexual Stimulants Coco Samba Herbal Mixture Unknown - Unknown Commercial Herbal Mixture 210 49.8 - 0.50 - Good Time (Herbal Mixture) Unknown - Unknown Commercial Herbal Mixture 57 13.5 - 0.14 - Bitter Root Mondia whitei (Hook.f.) Skeels Apocynaceae Traditional Medicinal Plant 200 47.4 0.47 0.47 100 Igbanda Unknown - Unknown Unknown Composition 13 3.1 - 0.03 - Senuebo Herbal Mixture Unknown - Unknown Commercial Herbal Mixture 3 0.7 - 0.01 - Jekonmo Unknown - Unknown Unknown Composition 9 2.1 - 0.02 - Big Boss (Herbal Supplement) Unknown - Unknown Processed Supplement 56 13.3 - 0.13 - White Gbangba Cassia sieberiana DC. Fabaceae Traditional Medicinal Plant 105 24.9 0.25 0.25 100 Cushument Carpodinus dulcis Sabine Apocynaceae Traditional Medicinal Plant 22 5.2 0.05 0.05 100 Oju-olobo Morinda morindoides (Baker) Milne-Redh. Rubiaceae Traditional Medicinal Plant 27 6.4 0.06 0.06 100 Treatment of Malaria Red Gbangba Cassia sieberiana DC. Fabaceae Traditional Medicinal Plant 380 90.0 0.90 0.90 100 Brumstone Morinda geminata DC. Rubiaceae Traditional Medicinal Plant 40 9.5 0.09 0.09 100 Agerie Momordica charantia L. Cucurbitaceae Traditional Medicinal Plant 12 2.8 0.03 0.03 100 Treatment of Common Cold Lemon Grass Cymbopogon citratus (DC.) Stapf Poaceae Traditional Medicinal Plant 357 84.6 0.85 0.85 100 Aligata Pℇpℇ Aframomum melegueta K.Schum. Zingiberaceae Traditional Medicinal Plant 43 10.2 0.10 0.10 100 Krismaslif Alchornea cordifolia (Schumach. & Thonn.) Müll.Arg. Euphorbiaceae Traditional Medicinal Plant 15 3.6 0.04 0.04 100 Neva Die Bryophyllum pinnatum (Lam.) Oken Crassulaceae Traditional Medicinal Plant 30 7.1 0.07 0.07 100 Lem Citrus aurantifolia (Christm.) Swingle Rutaceae Traditional Medicinal Plant 213 50.5 0.50 0.50 100 Tea Bush Ocimum gratissimum L. Lamiaceae Traditional Medicinal Plant 136 32.2 0.32 0.32 100 Gbangba Cassia sieberiana DC. Fabaceae Traditional Medicinal Plant 19 4.5 0.05 0.05 100 Guinea Pℇpℇ Aframomum melegueta K.Schum. Zingiberaceae Traditional Medicinal Plant 11 2.6 0.03 0.03 100 Treatment of Diabetes Papaya Carica papaya L. Caricaceae Traditional Medicinal Plant 112 26.5 0.27 0.27 100 Gbangba Cassia sieberiana DC. Fabaceae Traditional Medicinal Plant 61 14.5 0.14 0.14 100 Mangro Leaves/Tree Mangifera indica L. Anacardiaceae Traditional Medicinal Plant 44 10.4 0.10 0.10 100 Treatment of Fracture Ojo Unknown - Unknown Unknown Composition 315 74.6 - 0.75 - Blaktombla Dialium guineense Willd. Fabaceae Traditional Medicinal Plant 96 22.7 0.23 0.23 100 Gbangba Cassia sieberiana DC. Fabaceae Traditional Medicinal Plant 28 6.6 0.07 0.07 100 Guinea Pℇpℇ Aframomum melegueta K.Schum. Zingiberaceae Traditional Medicinal Plant 15 3.6 0.04 0.04 100 Treatment of Infertility Galik Allium sativum L. Amaryllidaceae Traditional Medicinal Plant 45 10.7 0.11 0.11 100 Moringa Moringa oleifera Lam. Moringaceae Traditional Medicinal Plant 91 21.6 0.22 0.22 100 Tie Yulapa Mimosa pudica L. Fabaceae Traditional Medicinal Plant 35 8.3 0.08 0.08 100 Beni Sesamum indicum L. Pedaliaceae Traditional Medicinal Plant 8 1.9 0.02 0.02 100 Krismaslif Alchornea cordifolia (Schumach. & Thonn.) Müll.Arg. Euphorbiaceae Traditional Medicinal Plant 15 3.6 0.04 0.04 100 Teabush Ocimum gratissimum L. Lamiaceae Traditional Medicinal Plant 55 13.0 0.13 0.13 100 Papaya Carica papaya L. Caricaceae Traditional Medicinal Plant 9 2.1 0.02 0.02 100 Dame Unknown - Unknown Unknown Composition 1 0.2 - 0.002 - Treatment of Skin Disease Aloe Vera Aloe barbadensis Mill. Asphodelaceae Traditional Medicinal Plant 269 63.7 0.64 0.64 100 Papaya Carica papaya L. Caricaceae Traditional Medicinal Plant 123 29.1 0.29 0.29 100 Krismaslif Alchornea cordifolia (Schumach. & Thonn.) Müll.Arg. Euphorbiaceae Traditional Medicinal Plant 44 10.4 0.10 0.10 100 Mangro Bark/Tree Mangifera indica L. Anacardiaceae Traditional Medicinal Plant 31 7.3 0.07 0.07 100 Tie Yulapa Mimosa pudica L. Fabaceae Traditional Medicinal Plant 89 21.1 0.21 0.21 100 Treatment of Amenorrhoea and Menorrhagia Krismaslif Alchornea cordifolia (Schumach. & Thonn.) Müll.Arg. Euphorbiaceae Traditional Medicinal Plant 118 28.0 0.28 0.28 100 Aligata Pℇpℇ Aframomum melegueta K.Schum. Zingiberaceae Traditional Medicinal Plant 48 11.4 0.11 0.11 100 Treatment of Constipation Lokos Parkia biglobosa (Jacq.) R.Br. ex G.Don Fabaceae Traditional Medicinal Plant 119 28.2 0.28 0.28 100 Tombi Tamarindus indica L. Fabaceae Traditional Medicinal Plant 126 29.9 0.30 0.30 100 Jinja Zingiber officinale Roscoe Zingiberaceae Traditional Medicinal Plant 59 14.0 0.14 0.14 100 Moringa Moringa oleifera Lam. Moringaceae Traditional Medicinal Plant 93 22.0 0.22 0.22 100 Gbangba Cassia sieberiana DC. Fabaceae Traditional Medicinal Plant 44 10.4 0.10 0.10 100 Papaya Carica papaya L. Caricaceae Traditional Medicinal Plant 182 43.1 0.43 0.43 100 Brumstone Morinda geminata DC. Rubiaceae Traditional Medicinal Plant 39 9.2 0.09 0.09 100 Open in a new tab Categories distinguish between raw plants, mixtures, and supplements for analytical clarity. Scientific names without authority or identification reflect limitations in taxonomic verification due to absence of specimen collection To enhance ethnobotanical analysis, we calculated key quantitative indices for the most frequently reported plants. Use Value (UV) was computed as the sum of uses reported for a species divided by the number of informants, indicating its importance. Relative Frequency of Citation (RFC) was calculated as the number of informants mentioning a species divided by the total number of informants (422), reflecting its prevalence. Fidelity Level (FL) was determined as the percentage of informants citing a species for a specific use out of those mentioning the species, indicating specificity of use. For instance, Cassia sieberiana DC. (Red Gbangba) had a UV of 1.12, RFC of 0.90, and FL of 100% for malaria treatment, underscoring its critical role in the community. Similarly, Cymbopogon citratus (L.) Stapf (Lemon Grass) showed a UV of 0.85, RFC of 0.85, and FL of 99% for colds. These indices highlight the cultural significance and specificity of key remedies in Freetown’s slums. Reasons for using herbal products Figure 3 shows the reasons participants stated for using herbal products. Most of the participants (82.5%) reportedly used herbal products to enhance existing health, 74.4% used it as sexual stimulants, and 48.6% to complement conventional medical treatment. Fig. 3. Open in a new tab Reasons for using herbal products Herbal product use for dietary deficiencies/lifestyle (6.4%) and anti-aging (6.6%) were the least reported. Decision-making criteria in herbal product selection and uptake Figure 4 illustrates the key factors participants consider when making decisions on the selection and uptake of herbal products. The most commonly cited considerations were price (74.6%), perceived effectiveness of the ingredients (73.5%), quality of the products (43.4%) and advertisement (38.9%). Brand and store location were less influential, with only 4.7% of participants identifying them as important decision-making criteria. Fig. 4. Open in a new tab Key factors consider in herbal product selection and uptake Predictors of herbal products use as sexual stimulant A striking 314(74.4%) of participants reported using herbal products as sexual stimulants, with significant predictors identified through logistic regression. Community of residence again emerged as a key factor: Cockle Bay residents were over three times more likely (AOR = 3.29, 95% CI: 1.79–6.04, p < 0.001), and Kroo Bay residents over ten times more likely (AOR = 10.05, 95% CI: 4.45–22.69, p < 0.001), to use herbal products for this purpose compared to Susan’s Bay. Gender was also a strong predictor, with males over seven times more likely than females to use herbal stimulants (AOR = 7.53, 95% CI: 4.19–13.56, p < 0.001). Other variables like age, religion, marital status, education, income, and occupation did not show significant associations in the adjusted model. See Table 5 . Table 5. Predictors of herbal product use as sexual stimulant among study participants Predictor variables p -value COR (95% CI) p -value AOR (95% CI) Slum communities Cockle Bay < 0.001 2.49(1.52–4.07) < 0.001 3.29(1.79–6.04) Kroo Bay < 0.001 8.49(4.09–17.75) < 0.001 10.05(4.45–22.69) Susan’s Bay REF REF Gender Male < 0.001 5.76(3.42–9.68) < 0.001 7.53(4.19–13.56) Female REF REF Age 18 to 29 years 0.579 0.86(0.51–1.46) 0.104 0.54(0.26–1.14) 30 to 39 years 0.695 0.89(0.51–1.157) 0.441 0.77(0.39–1.50) ≥ 40 years REF REF Religion Christianity 0.167 1.37(0.88–2.12) 0.289 1.35(0.78–2.35) Islam REF REF Marital status Married 0.255 0.78(0.50–1.20) 0.138 0.64(0.35–1.16) Unmarried REF REF Highest level of education No formal education 0.773 0.93(0.55–1.56) 0.782 1.10(0.55–2.2) Basic education 0.437 0.79(0.44–1.42) 0.543 0.80(0.39–1.65) Tertiary education REF REF Estimated monthly income < SLL 600 0.296 1.41(0.74–2.69) 0.196 1.90(0.72–5.04) SLL 600-2,999 0.646 1.18(0.59–2.33) 0.621 1.23(0.54–2.77) ≥ SLL 3,000 REF REF Occupation Unemployed 0.732 1.08(0.69–1.69) 0.183 0.61(0.29–1.27) Employed REF REF Open in a new tab Participants’ perception on herbal products The results from Table 6 on participants’ perceptions of herbal products, with an overall Cronbach’s Alpha of 0.654 for a 10-item scale indicating moderate internal consistency, reveal a generally positive view among the 422 adults from Freetown’s slum communities, though with notable variations across specific beliefs. A striking 90.0% agreed that herbal products contain essential nutrients and should be standardized for integration into modern treatment, while 89.6% found them cheaper than modern medicines, and 87.4% considered them natural and safe for consumption, reflecting strong trust in their value and accessibility. Additionally, 82.0% viewed herbal products as a good energy source, further underscoring their perceived health benefits. However, opinions were more divided on safety and efficacy: only 41.0% agreed that herbal products are free from side effects (with 36.3% disagreeing), and just 42.4% believed they are a better choice than modern medicines (33.9% disagreed), while 42.7% found them more effective (22.5% disagreed). Perceptions of versatility also varied, with 55.2% agreeing they can be used at any age (30.3% disagreed) and 48.1% believing they can cure all illnesses (20.1% disagreed). Table 6. Participants’ perception on herbal products Statement Agree x Neutral Disagree y Herbal products contain a lot of nutrients necessary for the body 380 (90.0%) 37 (8.8%) 5 (1.2%) Herbal products are free from side effects 173 (41.0%) 96 (22.7%) 153 (36.3%) Herbal products should be standardised and incorporated into modern treatment 380 (90.0%) 35 (8.3%) 7 (1.7%) Herbal products are a good energy source 346 (82.0%) 57 (13.5%) 19 (4.5%) Herbal products are a better choice than modern medicines 179 (42.4%) 100 (23.7%) 143 (33.9%) Herbal products can be used at any age level 233 (55.2%) 61 (14.5%) 128 (30.3%) Price of Herbal products is cheaper compared to modern medicines 378 (89.6%) 32 (7.6%) 12 (2.8%) Herbal products can cure all types of illnesses/diseases 203 (48.1%) 134 (31.8%) 85 (20.1%) Herbal products are more effective than modern medicines 180 (42.7%) 147 (34.8%) 95 (22.5%) Herbal products are natural and safe for human consumption 369 (87.4%) 44 (10.4%) 9 (2.1%) Open in a new tab Agree x = strongly agree and agree combined; Disagree y = strongly disagree and agree combined Table 7 shows both commonalities and differences in herbal product use. Commonalities include the consistent use of “Red Gbangba” for malaria across Sierra Leonean contexts and the reliance on affordable herbal remedies in West African urban slums. Differences are evident in the pronounced use of sexual stimulants in Freetown’s slums compared to rural Sierra Leonean studies, where chronic disease management dominates, and in the urban economic motivations compared to rural communal practices. Table 7. Comparison of herbal product use in Freetown slums with previous studies in Sierra Leone and West Africa Aspect Current Study (Freetown Slums) Sierra Leone (Previous Studies) West Africa (Regional Studies) Primary Conditions Treated Malaria (90% “Red Gbangba”), Colds (84.6% “Lemon Grass”), Sexual Stimulants (74.4%) Malaria, Diarrhea [ 20 , 22 ] Malaria, Hypertension, Chronic Diseases [ 13 , 15 ] Prevalence of Use 33.2% High-Level Consumers, 74.4% for Sexual Stimulants 22–31% General Use [ 22 ] Over 70% in Urban Slums [ 31 ] Key Plants “Red Gbangba” (Cassia sieberiana), “Coco Samba,” “Bitter Root” (Mondia whitei) “Red Gbangba,” Moringa [ 20 ] Moringa, Lemon Grass [ 13 ] Motivations for Use Affordability (74.6%), Health Enhancement (82.5%) Cultural Trust, Accessibility [ 22 ] Cost-Effectiveness, Cultural Resonance [ 31 ] Setting-Specific Differences Urban Slums: High Sexual Stimulant Use, Economic Constraints Rural/Peri-Urban: Communal Healing, Subsistence [ 20 ] Urban Slums: Economic Drivers Over Ritualistic Use [ 15 ] Open in a new tab Discussion This study offers insight into the pervasive use of herbal products, including medicinal plants, commercial herbal mixtures, and processed supplements, among 422 adults in three slum communities of Freetown, Sierra Leone, uncovering critical patterns of consumption, predictors, and perceptions that illuminate the centrality of traditional medicine in resource-constrained urban settings. Our results reveal a striking reliance on herbal remedies, with consumption levels categorized as low (40.5%), moderate (26.3%), and high (33.2%), and a remarkable 74.4% of participants using these products as sexual stimulants. A diverse array of herbal treatments was documented for conditions spanning malaria to infertility, with community of residence emerging as the strongest predictor of both consumption intensity and specific usage. Kroo Bay residents were significantly less likely to be low-level consumers (OR = 0.09, 95% CI: 0.04–0.20, p < 0.001) and over ten times more likely to use herbal products for sexual enhancement (AOR = 10.05, 95% CI: 4.45–22.69, p < 0.001) compared to Susan’s Bay. Perceptions leaned strongly positive, with 90.0% endorsing the nutritional value of herbal products and advocating for their standardization in modern treatment, though concerns about safety (only 41.0% agreed they are free from side effects) and comparative efficacy (42.4% deemed them superior to modern medicines) highlight a critical ambivalence. These findings not only underscore the profound socio-cultural and economic drivers of herbal medicine use but also expose significant public health challenges and opportunities in marginalized urban communities. The extensive adoption of herbal products in our sample aligns with a well-documented trend across sub-Saharan Africa, where traditional medicine often fills critical gaps left by inaccessible or unaffordable conventional healthcare systems [ 31 , 32 ]. A parallel study in Ghana found that over 70% of urban slum residents relied on herbal remedies, driven by cost-effectiveness and cultural resonance, mirroring our observation that 89.6% of participants perceived herbal products as cheaper than modern alternatives, a vital consideration given that 55.2% earned less than SLL 600 monthly [ 21 ]. Cultural drivers of herbal use patterns The patterns of herbal product use, encompassing medicinal plants and commercial herbal mixtures, in Freetown’s slum communities reflect a complex interplay of cultural heritage and urban adaptation, shaping both commonalities and differences with other Sierra Leonean and West African contexts. The widespread use of “Red Gbangba” ( Cassia sieberiana ) for malaria (90.0%) across our study and previous Sierra Leonean research [ 22 ] underscores a shared cultural trust in indigenous remedies, rooted in historical reliance on ethnomedicine amid limited access to biomedical care a trend also observed in West African urban slums [ 33 ]. However, the elevated use of herbal products as sexual stimulants (74.4%), particularly among males (AOR = 7.53, p < 0.001) and in Kroo Bay (AOR = 10.05, p < 0.001), points to distinct cultural constructs of masculinity and sexual prowess prevalent in urban African settings [ 34 ]. Unlike rural Sierra Leonean communities where herbal practices often involve communal healing rituals [ 20 ], the urban slum context marked by social stressors, economic hardship, and limited privacy may amplify the demand for personal empowerment through sexual health remedies. Furthermore, the prioritization of affordability (89.6% of participants) over modern medicine highlights a cultural-economic adaptation to urban poverty, contrasting with rural settings where barter systems often sustain herbal access. These cultural dynamics suggest that health interventions must be tailored to urban slum-specific values and constraints, recognizing herbal medicine as both a practical necessity and a symbol of identity in marginalized communities. The regression analyses revealed significant community-level differences, with Kroo Bay residents showing a lower likelihood of being low-level consumers (OR = 0.09, 95% CI: 0.04–0.20, p < 0.001) and a higher likelihood of using herbal products as sexual stimulants (AOR = 10.05, 95% CI: 4.45–22.69, p < 0.001) compared to Susan’s Bay. This may reflect localized cultural norms, proximity to herbal markets, or greater influence of traditional healers in Kroo Bay, a pattern consistent with studies on urban micro-environments shaping health behaviors [ 33 ]. Gender differences, with males over seven times more likely to use sexual stimulants (AOR = 7.53, 95% CI: 4.19–13.56, p < 0.001), align with sociocultural constructs of masculinity and sexual prowess prevalent in African urban settings [ 35 ]. Socioeconomic factors, such as lower income (SLL 600–2,999) reducing moderate consumption (OR = 0.38, 95% CI: 0.15–0.95, p = 0.039), underscore how economic constraints drive reliance on affordable herbal remedies over modern alternatives, a dynamic rooted in urban health inequalities [ 11 ]. These findings highlight the need for targeted interventions addressing community-specific beliefs and structural barriers. A pivotal contribution of this research lies in identifying community of residence as a dominant predictor of herbal product consumption patterns, a finding that advances beyond generalized socio-demographic associations reported in prior studies. The pronounced tendency of Kroo Bay residents to be high-level consumers and to prioritize herbal sexual stimulants suggests deeply embedded local cultural norms, possibly tied to proximity to traditional healers, herbal markets, or community-specific health beliefs, an observation supported by studies on urban micro-environments shaping health behaviours [ 33 ]. Equally compelling is the gender disparity, with males over seven times more likely than females to use herbal sexual stimulants, reflecting entrenched socio-cultural constructs of masculinity and sexual prowess prevalent across African contexts [ 34 , 35 ]. Age also emerged as a nuanced factor, with younger adults (18–29 years) more inclined toward moderate consumption, potentially indicating a generational negotiation between traditional practices and emerging exposure to modern healthcare paradigms. These layered predictors underscore the necessity of hyper-localized, culturally attuned health interventions. The motivations driving herbal product use, 82.5% for health enhancement and 74.4% as sexual stimulants, coupled with selection criteria prioritizing price (74.6%) and perceived effectiveness (73.5%), reveal a pragmatic yet culturally rooted decision-making framework. This dual rationale positions herbal medicine as both a healthcare necessity and a symbol of cultural identity in slum communities, a dynamic extensively theorized in studies of traditional medicine as empowerment amid systemic marginalization [ 36 ]. However, the ambivalence in perceptions, with only 42.4% favoring herbal products over modern medicines, signals a critical juncture for health policy. The overwhelming support (90.0%) for standardizing herbal products into modern treatment frameworks aligns with global calls for integration, yet it contrasts with persistent doubts about universal efficacy (48.1% believed they can cure all illnesses) and safety. This dichotomy demands urgent attention to reconcile community trust with evidence-based practice, particularly in settings where herbal medicine is a de facto primary care system. Environmental sustainability and herbal resource management The heavy reliance on herbal products in Freetown’s slum communities, with 33.2% of participants classified as high-level consumers and widespread use of plants like “Red Gbangba” (Cassia sieberiana, 90% for malaria) and “Lemon Grass” (Cymbopogon citratus, 84.6% for colds), raises significant concerns about the sustainability of local plant resources. Many of these herbs are likely sourced from nearby mangrove and forest areas, such as those surrounding Cockle Bay, yet our study found no evidence of community cultivation initiatives. Heavy reliance on plants like Cassia sieberiana DC. and Cymbopogon citratus (L.) Stapf raises potential concerns about overharvesting and biodiversity loss, as observed in other West African urban contexts [ 4 ]. However, this study did not assess sourcing or harvesting practices, and such risks remain hypothetical. Future research should investigate the ecological impact of herbal collection in Freetown’s surrounding mangroves and forests, alongside community-led cultivation initiatives to ensure sustainable access to medicinal resources. Environmental strategies must prioritize sustainable harvesting practices, such as regulated collection quotas, and support community-led cultivation programs to preserve medicinal plant species while meeting health needs. Partnerships with local environmental organizations could facilitate reforestation efforts and the establishment of urban herbal gardens, ensuring long-term access to these critical resources. Without such interventions, the ecological foundation of traditional medicine in Freetown’s slums could be undermined, exacerbating health vulnerabilities in already marginalized communities. Urban planning for health equity in slum communities Community-specific patterns of herbal use, particularly the high consumption in Kroo Bay (OR = 0.09 for low vs. high consumption, p < 0.001), highlight the urgent need for urban planning to address healthcare access disparities in Freetown’s informal settlements. Despite Kroo Bay’s proximity to central Freetown, limited access to formal health services as described in our study setting drives reliance on herbal remedies. City planning must integrate traditional medicine hubs, such as herbal markets or healer consultation centers, into slum redevelopment plans to formalize and support this de facto healthcare system. Additionally, environmental hazards like recurrent flooding and fire outbreaks in Susan’s Bay and Kroo Bay exacerbate health vulnerabilities, likely increasing dependence on accessible herbal solutions. Urban planning initiatives should prioritize infrastructure improvements, including drainage systems and fire-resistant housing, to reduce environmental health risks and potentially moderate the need for informal care. Collaborative urban health policies that engage community leaders could ensure that redevelopment respects cultural reliance on herbal medicine while enhancing access to complementary biomedical services, fostering health equity in these underserved areas. Herbal products and food security in Urban slums Our findings reveal that 90.0% of participants perceive herbal products as nutritionally valuable, with 82.0% viewing them as an energy source, positioning these remedies as dual-purpose agents for health and nutrition in Freetown’s slums. In a context where 55.2% of participants earn less than SLL 600 monthly, herbs like “Moringa” (Moringa oleifera, used by 22% for constipation and 21.6% for infertility) serve as accessible dietary supplements, addressing potential micronutrient deficiencies amid economic hardship. However, the lack of regulatory oversight, coupled with only 41.0% of participants believing herbal products are free from side effects, raises risks of contamination or misuse, potentially undermining food security. Future interventions should focus on integrating safe, nutrient-rich herbal products into local food systems through community education on safe preparation and standardized production protocols. Partnerships with agricultural and health agencies could promote the cultivation of medicinal-food plants in urban slums, enhancing food security while preserving cultural practices. Such strategies are critical to leveraging the nutritional potential of herbal products without compromising safety in resource-limited settings. Public health strategies for safe herbal integration The pervasive reliance on herbal products in Freetown’s slum communities, with 74.4% of participants using them as sexual stimulants and 90.0% endorsing their nutritional value, underscores their role as a de facto primary healthcare system, yet it also reveals critical public health challenges. Safety concerns are evident, as only 41.0% of participants believe herbal products are free from side effects, highlighting risks of toxicity, herb-drug interactions, and inconsistent dosing issues well-documented in unregulated contexts [ 8 ]. The high usage for sexual health, particularly among males (AOR = 7.53, p < 0.001) and in Kroo Bay (AOR = 10.05, p < 0.001), necessitates targeted sexual health programs that respect cultural norms around masculinity while introducing evidence-based alternatives to mitigate potential health risks. Moreover, the overwhelming support for standardization (90.0% of participants) aligns with WHO recommendations for integrating traditional medicine into formal healthcare systems [ 35 ]. Public health strategies must prioritize robust regulatory frameworks to ensure quality control, including mandatory testing for contaminants and standardized dosing guidelines, to safeguard consumer health. Community-based education initiatives are equally critical, focusing on safe herbal preparation and usage to bridge the trust-efficacy gap, particularly in slums where formal medical advice is scarce. Integration efforts should establish hybrid clinics in informal settlements, combining traditional healers with biomedical practitioners to provide holistic care, leveraging local ethnobotanical knowledge while ensuring safety. Failure to implement these measures risks perpetuating health inequities, as vulnerable populations continue to rely on potentially unsafe remedies due to systemic access barriers. By aligning cultural practices with evidence-based oversight, public health policies can transform herbal medicine into a sustainable, equitable healthcare resource for Freetown’s slums and beyond. Comparative insights and implications for public health Our findings on high herbal reliance (33.2% high-level consumers) and sexual stimulant use (74.4%) contrast with rural Sierra Leonean studies focusing on chronic disease management [ 20 ], highlighting urban-specific health priorities. Compared to West African urban slums, where cost-effectiveness drives use [ 21 ], Freetown’s patterns also reflect unique sociocultural factors like gender norms influencing sexual health remedies. These differences underscore the need for hyper-localized public health strategies that integrate traditional medicine into informal healthcare systems, addressing safety concerns (only 41.0% believe herbal products are free from side effects) through regulatory frameworks for quality control and community education on safe usage. Moreover, the strong support for standardization (90.0%) aligns with WHO recommendations [ 32 ], suggesting readiness for hybrid healthcare models combining traditional healers and biomedical practitioners in slum settings. Strengths and limitations This study contributes to the literature throughits comprehensive scope, engaging 422 participants across diverse slum communities in Freetown, thus ensuring a robust representation of urban underserved populations. The application of advanced statistical models, including multinomial and logistic regression, enabled precise identification of consumption predictors, while the perception survey provided critical attitudinal insights. Our focus on community-specific variations and specific herbal uses adds a novel dimension to the literature on traditional medicine in urban Africa. Nevertheless, limitations exist. A critical limitation of this study is the absence of botanical specimen collection and herbarium voucher deposition, which prevents taxonomic verification and limits the reproducibility of ethnobotanical findings. This constraint arose due to logistical challenges and the study’s focus on consumption patterns rather than botanical documentation, relying instead on participant-reported vernacular names cross-referenced with literature. Consequently, the accuracy of plant identification cannot be fully confirmed, particularly for species with similar local names or commercial mixtures of unknown composition. We also acknowledge potential recall bias in self-reported consumption data, the cross-sectional design’s inability to establish causality, and the moderate internal consistency of the perception scale (Cronbach’s Alpha = 0.654), which may reflect variability in item interpretation. These limitations underscore the need for future studies involving specimen collection, longitudinal designs, and refined survey tools to enhance scientific rigor. Future research directions To build on these findings, longitudinal studies are imperative to track temporal shifts in herbal consumption and establish causal pathways. Qualitative investigations should probe the socio-cultural underpinnings of community-specific patterns, particularly in Kroo Bay, and elucidate gender-driven usage disparities. Critically, pharmacological and toxicological assessments of widely used herbs like “Coco Samba” and “Red Gbangba” are essential to substantiate their safety and efficacy, providing a scientific foundation for integration into healthcare systems. Moreover, randomized controlled trials evaluating educational interventions on safe herbal use, alongside policy experiments for standardization, could transform community practices and inform scalable models for traditional-modern healthcare synergy. Such research is not merely academic but a public health imperative to safeguard vulnerable populations while respecting their cultural heritage. Conclusion This study offers integral role of herbal products, including medicinal plants, commercial herbal mixtures, and processed supplements, in the health landscape of Freetown’s slum communities, driven by affordability, cultural significance, and perceived benefits, yet tempered by valid concerns over safety and comparative efficacy. The pronounced influence of community of residence and gender on usage patterns demands tailored, context-sensitive interventions, while the overwhelming call for standardization signals readiness for integration with conventional systems. As traditional medicine remains a lifeline for millions in resource-limited settings, our findings compel a paradigm shift toward evidence-based, culturally respectful health policies that bridge ancient wisdom with modern rigor, ensuring equitable health outcomes for marginalized urban populations. Abbreviations WHO World Health Organization COMAHS College of Medicine and Allied Health Sciences SLL Sierra Leone Leones COR Crude odds ratios AOR Adjusted odds ratios CI Confidence Intervals Author contributions Conceptualization: AV, BAT, and ML. Data curation: BAT and NB. Data analysis: AV. Preparation of manuscript: AV and AO. Writing review and editing: AV, ML, and AO. All authors have reviewed and approved the final version of the manuscript before submission for publication. Funding No external funding was received. Data availability Most of the data is included in the manuscript. Additional information can be found from the corresponding author based on a reasonable request. Declarations Ethics approval Ethical approval for this study was obtained from the College of Medicine and Allied Health Sciences (COMAHS) Institutional Review Board (COMAHS/IRB/014-2024). The study objectives and procedures were clearly explained to all participants, who were informed of their right to voluntary participation and to withdraw at any stage without consequence. Written informed consent was obtained before data collection. Confidentiality was maintained by removing personal identifiers, and anonymized data were securely stored and used only for this research. The study was conducted in accordance with the principles of the Declaration of Helsinki and adhered to international standards for research involving human participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Saggar S, Mir PA, Kumar N, Chawla A, Uppal J, Shilpa S, et al. Traditional and Herbal Medicines: Opportunities and Challenges. Pharmacognosy Res. 2022;14(2):107–14. 10.5530/pres.14.2.15. [ Google Scholar ] 2. Jamal A. International Journal of Multidisciplinary Sciences and Arts Embracing Nature’s Therapeutic Potential: Herbal Medicine [Internet]. Vol. 2. 2023;2(1). 10.47709/ijmdsa.vxix.xxxx 3. Mudondo J, Happy K, Gang R, Ban Y, Kang Y. From nature to nutrition: exploring the synergistic benefits of functional foods and herbal medicines for holistic health. Appl Biol Chem 2025. 2025;68(1):1. 10.1186/S13765-025-00985-Z. [ Google Scholar ] 4. Latif R, Nawaz T. Medicinal plants and human health: a comprehensive review of bioactive compounds, therapeutic effects, and applications. Phytochemistry Reviews 2025. 2025;1–44. 10.1007/S11101-025-10194-7. 5. Bareetseng S. The Worldwide Herbal Market: Trends and Opportunities. J Biomedical Res Environ Sci. 2022;3(5):575–84. 10.37871/JBRES1482. [ Google Scholar ] 6. Dubale S, Usure RE, Mekasha YT, Hasen G, Hafiz F, Kebebe D, et al. Traditional herbal medicine legislative and regulatory framework: a cross-sectional quantitative study and archival review perspectives. Front Pharmacol. 2025;16:1475297. 10.3389/FPHAR.2025.1475297/FULL. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 7. Poli MA, Hossain MJ, Kholil I, Yasmin S, Bhowmick B, Kundu LR. Traditional medicine use and associated factors in chronic patients in Jamalpur, Bangladesh: a cross-sectional study. Front Public Health. 2025;13. 10.3389/fpubh.2025.1548728. [ DOI ] [ PMC free article ] [ PubMed ] 8. Wachtel-Galor S, Benzie IFF. Herbal Medicine. In: Herbal Medicine: Biomolecular and Clinical Aspects: Second Edition. CRC Press/Taylor & Francis; 2011. p. 1–10. PubMed PMID: 22593939. https://www.ncbi.nlm.nih.gov/books/NBK92773/ . [ PubMed ] 9. Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol. 2014;4. 10.3389/fphar.2013.00177. [ DOI ] [ PMC free article ] [ PubMed ] 10. Cacciatore S, Mao S, Nuñez MV, Massaro C, Spadafora L, Bernardi M, et al. Urban health inequities and healthy longevity: traditional and emerging risk factors across the cities and policy implications. Aging Clin Exp Res. 2025;37(1):143. 10.1007/S40520-025-03052-1. PubMed PMID: 40332678. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 11. an De Vijver S, Oti S, Oduor C, Ezeh A, Lange J, Agyemang C, et al. Challenges of health programmes in slums. Lancet. 2015;386(10008):2114–6. 10.1016/S0140-6736(. 15)00385-2 PubMed PMID: 26452707. [ DOI ] [ PubMed ] [ Google Scholar ] 12. Bamgboye EA, Ogunwale AO, Al-Mukhtar A, Musa B, Mhlanga L, Olawuwo M, et al. Understanding malaria treatment patronage from informal healthcare providers in Nigerian urban settlements: insights from community members and providers. Malar J 2025. 2025;24(1):1. 10.1186/S12936-025-05255-3. PubMed PMID: 39849545. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Owusu G, Antwi-Adjei M, Ofori-Amoah J, Tuekpe RM, Mainoo AE, Kodua D, et al. Prevalence of herbal medicine consumption and regulatory compliance in some selected districts of the Bono region, Ghana. BMC Complement Med Ther. 2025;2025 25(1):1. 10.1186/S12906-025-04953-4. PubMed PMID: 40474213. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 14. Thomford NE, Dzobo K, Chopera D, Wonkam A, Skelton M, Blackhurst D, et al. Pharmacogenomics Implications of Using Herbal Medicinal Plants on African Populations in Health Transition. Pharmaceuticals (Basel). 2015;8(3):637–63. doi:10.3390/PH8030637 PubMed PMID: 26402689. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 15. Okoli TC, Okereke PU, Okoh OJ, Okolo AV, Okofia BO, Nnegbo CP, et al. Perception, Knowledge, Usage, and Effects of Herbal Medicine among Outpatients in a Tertiary Care Hospital in Southeast Nigeria: A Cross-Sectional Study. Int J Med Health Dev. 2025;30(3):254–63. 10.4103/IJMH.IJMH_95_24. [ Google Scholar ] 16. Wang H, Chen Y, Wang L, Liu Q, Yang S, Wang C. Advancing herbal medicine: enhancing product quality and safety through robust quality control practices. Front Pharmacol. 2023;14:1265178. 10.3389/. FPHAR.2023.1265178 PubMed PMID: 37818188. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Jeevanesh K, Manimaran V. The Bioscan [Internet]. 2025 [cited 2025 Nov 23]. pp. 889–96. Challenges in Quality Control of Herbal Pharmaceuticals: Standardization, Analytical Methodologies, and Regulatory Frameworks. Available from: https://thebioscan.com/index.php/pub/article/view/4109 18. Lahai M, Lake L, Vandy A, Sebba B, Sesay M, Abiri OT, et al. Quality improvement in medicines regulation: a retrospective analysis of the Pharmacy Board of Sierra Leone before and during quality management system implementation. BMC Health Serv Res. 2024;24(1):1–9. 10.1186/S12913-024-11452-8/TABLES/4. PubMed PMID: 39227931. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 19. Zhang AL, Xue CC, Fong HHS. Integration of Herbal Medicine into Evidence-Based Clinical Practice. Herbal Medicine: Biomolecular and Clinical Aspects: Second Edition. 2011;453–64. PubMed PMID: 22593929. 20. Johnny J, Lebbie A, Wadsworth R, Leone S. Ethnobotanical survey of medicinal plants utilized by forest edge communities in southern Sierra Leone. J Med Plants Res. 2022;16(1):11–25. 10.5897/JMPR2021.7193. [ Google Scholar ] 21. Agyei-Baffour P, Kudolo A, Quansah DY, Boateng D. Integrating herbal medicine into mainstream healthcare in Ghana: Clients’ acceptability, perceptions and disclosure of use. BMC Complement Altern Med. 2017;17(1). 10.1186/s12906-017-2025-4. [ DOI ] [ PMC free article ] [ PubMed ] 22. Bakshi SS, McMahon S, George A, Yumkella F, Bangura P, Kabano A, et al. The role of traditional treatment on health care seeking by caregivers for sick children in Sierra Leone: Results of a baseline survey. Acta Trop. 2013;127(1):46–52. .ACTATROPICA.2013.03.010 PubMed PMID: 23545128. [ DOI ] [ PubMed ] [ Google Scholar ] 23. Fokunang C, Ndikum V, Tabi O, Jiofack R, Ngameni B, Guedje N, et al. Traditional Medicine: Past, present and future research and development prospects and integration in the National Health System of Cameroon. Afr J Tradit Complement Altern Med. 2011;8(3). 10.4314/ajtcam.v8i3.65276. [ DOI ] [ PMC free article ] [ PubMed ] 24. Kamsu-Foguem B, Diallo G, Foguem C. Conceptual graph-based knowledge representation for supporting reasoning in African traditional medicine. Eng Appl Artif Intell. 2013;26(4):1348–65. 10.1016/j.engappai.2012.12.004. [ Google Scholar ] 25. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6(1):14. PubMed PMID: 24834239. [ PMC free article ] [ PubMed ] [ Google Scholar ] 26. Olufemi Adepoju A, Oyedeji Amusa M, Oluwasegun Samson A, Okechukwu Paul-Chima U. Ethnopharmacological survey on medicinal plants utilization in Freetown, Sierra Leone. RPS Pharm Pharmacol Rep. 2023;2(2):1–13. 10.1093/RPSPPR/RQAD019. [ Google Scholar ] 27. Sousa AC, Pádua I, Gonçalves VMF, Ribeiro C, Leal S. Exploring tea and herbal infusions consumption patterns and behaviours: The case of Portuguese consumers. Heliyon. 2024;10(7):e28779. 10.1016/j.heliyon.2024.e28779. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 28. Sharifuddin J, Mazlan NA, Rezai G. Consumer buying behavior towards herbal-based products in Malaysia. 2012. 29. Kamarulzaman NH, Vaiappuri SKN, Samdin Z, Imran SN. Relationship between socio-economic variables and preference towards herbal-based products: the Malay experience. J ISSAAS. 2013;19(1):95–106. [ Google Scholar ] 30. Macfoy CA. Medicinal plants and traditional medicine in Sierra Leone [Internet]. 2013 [cited 2025 Nov 24];170. Available from: https://books.google.com/books/about/Medicinal_Plants_and_Traditional_Medicin.html?id=tDGGAgAAQBAJ 31. Kasilo OM, Trapsida JM. Regulation of Traditional Medicine in the WHO African Region. the African health monitor. 2013;(14). 32. WHO, WHO Traditional Medicine. Strategy 2014–2023 [Internet]. 2013 [cited 2025 Nov 24]. Report. Available from: www.who.int. 33. Ezeome ER, Anarado AN. Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. BMC Complement Altern Med. 2007;7. 10.1186/1472-6882-7-28. [ DOI ] [ PMC free article ] [ PubMed ] 34. Van Damme L, Chatrou L, de la Peña E, Kibungu P, Bolya CS, Van Damme P, et al. Plant use and perceptions in the context of sexual health among people of Congolese descent in Belgium. J Ethnobiol Ethnomed. 2024;20(1). 10.1186/s13002-024-00662-3. [ DOI ] [ PMC free article ] [ PubMed ] 35. Mutebi S. Staying a ‘Real Man’: Sexual Performance Concerns and Alternative Masculinities Among Young Men in Urban Tanzania. Afr Stud. 2022;81(1):87–101. ;REQUESTEDJOURNAL:JOURNAL:CAST20;ISSUE:ISSUE:DOI. [ Google Scholar ] 36. Fokunang CN, Ndikum V, Tabi OY, Jiofack RB, Ngameni B, Guedje NM, integration in the National Health System of Cameroon. Traditional Medicine: Past, present and future research and development prospects and. Afr J Tradit Complement Altern Med. 2011;8(3):284–95. 10.4314/AJTCAM.V8I3. 65276 PubMed PMID: 22468007. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement Most of the data is included in the manuscript. Additional information can be found from the corresponding author based on a reasonable request. Articles from Journal of Ethnobiology and Ethnomedicine are provided here courtesy of BMC ACTIONS View on publisher site PDF (2.0 MB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top