Indigenous Knowledge of the Traditional Use of Aromatic and Medicinal Plants in Rif Mountains Ketama District

Background Medicinal plants have long played an integral role in traditional healing systems and are crucial for meeting primary healthcare needs. This study aimed to investigate the use of medicinal plants in phytotherapy in the Ketama region of Northern Morocco. Methods Ethnobotanical data and ancestral knowledge regarding plants were collected through a field survey conducted from August 2019 to July 2021. The data were gathered using a standardized questionnaire, as well as through semistructured interviews and focus groups. Various ethnobotanical indices were applied to analyse the information collected. Results A comprehensive inventory identified a total of 81 plant species, belonging to 40 families and 65 genera. These species are used primarily to treat a variety of diseases. Notably, digestive disorders ranked first among the diseases treated, with an ICF value of 0.618. Rosmarinus officinalis L., Thymus serpyllum L., and Origanum compactum Benth exhibited the highest UV values among medicinal plants. Leaves were the most used part of the plant part (50.28%), and the decoction method was the most recommended preparation, with oral administration being the preferred mode of application of the remedy. Conclusion The Ketama region boasts a rich abundance of medicinal and aromatic plants, as evident from the quantitative analysis highlighting the significant usage of Rosmarinus officinalis L., Thymus serpyllum L., and Origanum compactum Benth. by the local population. However, further research in the form of pharmacological studies is necessary to validate their therapeutic effects.


Introduction
Te use of medicinal plants has been an integral part of traditional healthcare systems since antiquity.Approximately 391,000 plant species are distributed throughout the world, each with its repertoire of medicinal properties, of which 88 percent (31,000) have been identifed as being either used or potentially therapeutic plant species are distributed throughout the world, each with its repertoire of medicinal properties, of which 88 percent (31000) have been identifed as being either used or potentially therapeutic [1].
Various modes of application are adapted by indigenous populations to the use of medicinal plants.Although many new medicines are derived from plants, approximately 60-80% of the population in developing countries still rely on herbal medicines [2,3].
Several factors contribute to the use of herbal medicines and herbal remedies in developing countries.Tese include cultural acceptance, ease of availability, and cost efciency compared to synthetic medications.
Due to its geographical location, Morocco has a very rich ecological and plant diversity, forming a real botanical [4] reserve with nearly 3913 species belonging to 981 genera and 155 families [5].
Multiple ethnobotanical surveys have been carried out in the Rif region to document and record traditional medicinal plant use practices [6][7][8][9][10][11][12].However, the Rif region is still not explored ethnobotanically enough, specifcally the Ketama area, due to geographical constraints such as high terrain and slopes, as well as cultural restrictions that limit researchers' access to documenting medicinal plant practices.Te local community in the area is bound by ancient traditions and customs.
Te aim of this study was to identify the species of medicinal plants and the traditional use of medicinal plants used in Ketama, as well as to gather information on traditional remedies for various illnesses.Te study also aimed to document the plant parts used, preparation methods, and treatments used in these remedies.

Description of the Study Area.
Tis survey was conducted in the Ketama region (northern Morocco), approximately 431 km from Rabat, the administrative capital of Morocco.Ketama is an area that is part of the province of Al-Hoceima; it is located on the Mediterranean coast and belongs to the Tangier-Tetouan-Al Hoceima region following the 2015 territorial division.Te study area is located at 34 °52′ 35″ N. 4 °37′ 10″ W, and it has a total population of 45683 people according to the 2015 census report [13].Te Ketama region consists of four localities: Ketama, Tamsaout, Abdelghaya Souahel, and Issaguen.Bounded to the south by the province of Taounate, and to the west by the province of Chefchaouen.Te study area is characterized by an abundance of fowers and a mountainous geography with an average altitude of 1115 meters (Figure 1).It has a warm Mediterranean climate with dry summers.With an average temperature of 18.6 °C and an average annual rainfall of 642.1 mm, agriculture is the principal economic activity in this area, and its products are the main source of living for the population.Tese products are mainly based on subsistence agriculture which includes livestock, arboriculture, and cereals.

Data Collection.
Tis ethnobotanical survey was conducted over a period from August 2019 to July 2021 using simple random sampling.10 feld trips were conducted to collect ethnobotanical information.A total of 352 informants are included in the study, and all are native to the study area and were interviewed using an open-ended semistructured questionnaire that included on the one-hand general data about the informant such as age, gender, family status, place of residence, education level and, on the other hand, his knowledge of herbal medicine, the local name of the plant, the parts used in treatments, the diseases treated, the methods of preparation, the route of administration, the quantity used per day, the duration of use, and whether this plant has side efects or toxicity.Te interviews were conducted in Darija (Moroccan dialect).According to our state regulations, the collection of ethnobotanical data does not require ethics approval.However, the documentation of medicinal uses obtained from the local population in the study area was acknowledged with thanks.Tis study followed and incorporated the recommendations made by Heinrich et al. [14] for feld methods to conduct ethnopharmacological research.

Plant Identifcation and Conservation.
Te plant species were carefully pressed and put on herbarium sheets following the techniques of Martin [15].Taxonomic identifcation was performed using the fora of Morocco [16] and the catalogue of vascular plants of northern Morocco [17].Te exact botanical name was obtained from Te World Flora Online (https://www.worldforaonline.org)and Te Plant List (https://www.theplantlist.org).Te samples of plants were authenticated in the herbarium of medicinal and aromatic plants of the National Agency of Medicinal and Aromatic Plants in Taounate.

Informant Consensus Factor (ICF).
One of the indices utilized to assess the consistency of the information provided by informants.Te formula presented by [18] was utilized to determine this index.
where N ur is the total number of use reports cited for each disease category, and N t is the total number of taxa used in that disease category.Te ICF value ranges from 0 (if informants do not communicate use information) to 1 (if informants are found to exchange their knowledge).

Frequency of Citation (FC).
Te frequency of citation allows us to assess the credibility of the information received and the level of knowledge of the plants of the surveyed population [19].Te frequency of citation (FC) of a species corresponds to the number of informants who cited the species.

Relative Frequency of Citation (RFC).
Te relative frequency of citation (RFC) has been calculated to assess the level of agreement among informants on the declared species.Tis index's role is to demonstrate the local importance of each species [19], which is expressed as follows: 2 Evidence-Based Complementary and Alternative Medicine where FC is the frequency of citation, and N is the total number of informants in the survey.

Fidelity Level (FL).
Friedman et al. proposed the fdelity level (FL) to analyse plant use among Bedouins [20].
As defned by FL, it is the ratio of informants who independently suggested that a species be used for the same major purpose to all informants who mentioned the plant for any reason.
To calculate the FL index, the following formula is used: where Ip is the number of informants who independently indicated the use of a species for the same major ailment, and I U is the total number of informants who mentioned a plant for any major ailment.

Use Value (UV). Is an index proposed by Philips and
Gentry in 1993 to quantify the importance of species [21], UV is calculated according to the formula reported by Albuquerque [22].
where U i is the number of uses mentioned by each informant, and N is the total number of informants.

Family Use Value (FUV).
Te family importance value is used to estimate the importance of medicinal plant families, within the informants [23].Tis index is calculated by the formula given by [24].
where UV S is the number of informants mentioning the family, and Ns is the total number of species in each family.

Jaccard Index (JI).
Ethnobotanists estimate the Jaccard index to compare data collected to previously published data obtained from bordering sites.
where a is the number of species found in area A, b is the number of species found in area B, and c is the number of species found in area A and area B [25].A large gap in educated informants was observed in the study area.Tis is due to the lack of educational facilities, especially secondary and university schools in the study area.

Results and Discussion
Most of the informants are married (86.65%) and unmarried (13.35%).All informants speak Darija, a dialectal language in Morocco, and Rifya, an Amazigh language specifc to the Rif people.
In the present study, the largest family by number of taxa is Lamiaceae (16 species).Similarly, other studies conducted in the province of Al-Hoceima, and other provinces of Morocco [6,8,26] reported the predominance of the Lamiaceae, and this is in accordance with our fndings.Herbaceous life forms may contribute to the dominance of this family and its wide distribution [5].Also, the dominance of these families can be attributed to their abundance in the fora of the study area and the fora of Morocco.

Part Used, Method of Preparation, and Administration of
Medicinal Plants Used to Cure Diseases.According to the results obtained (Figure 3), most parts of plants used in the preparation of herbal remedies are leaves (50.28%) followed by the whole plant (15.91%), fowers (10.80%), and seeds (9.09%), while the usage percentage of other plant parts is less than fve percent.In other similar studies [8,[27][28][29] conducted in diferent regions of Morocco and the world, it was found that the leaf is the most used part of the plant.Te researchers believe that the leaves are commonly used in herbal medicine because they are easy to collect and because they are photosynthetic and therefore contain more secondary metabolites than other parts of the plant [30].
Te plants mentioned by respondents were mainly used in the form of decoction (37.25% of the responses), infusion (29.51%), and cataplasm (17.19%).Other uses (raw and cooked) are less common (Figure 4).In comparison with other studies conducted in diferent parts of the world, our results are similar [31][32][33].As a method of extracting herbal remedies using water and other liquids, namely honey and olive oil, the decoction was found to be the most common form of herbal preparation in ethnobotanical studies [26].
More than half of herbal remedies are taken orally (72.73%), which is the main route of administration.256 preparations were taken by oral route, and 45 preparations (12.78%) were used to treat a variety of disorders.Te percentage of the other route for the administration group does not exceed 14.49% (Figure 5).
In agreement, the use of the oral route is widespread among ethnic groups in diferent regions of Morocco, as found in our study.Furthermore, topical application is also an important route of administration of herbal remedies used in the treatment of various external diseases, including wounds, rheumatism, skin disorders, and muscle pain, as has been reported in many previous studies [26,34,35].3) show that the ICF value ranges from 0.618 to 0.133.Digestive diseases and respiratory diseases have the highest ICF (0.618 and 0.451), respectively, followed by musculoskeletal diseases (0.486), dermatological diseases (0.423), endocrine, metabolic, and nutritional diseases (0.333), urological diseases (0.313).On the other hand, the disease categories with the lowest ICF were cardiovascular disease (0.222) and nervous system disease (0.133).
In the study area, we frequently observed that informants who used plants to treat digestive and respiratory diseases had the highest ICF compared to other disease categories; the same result is reported in other previous studies conducted in the north and south of Morocco [28-30, 36, 37].Tis can be explained by the fact that the plants used to treat ailments are well-known among informants in the study area to treat ailments of this nature.

Relative Frequency of Citation (RFC) and Frequency of Citation (FC).
Te value of the RFC varied between 0.004 and 0.139, and the species with the highest RFC value was Tymus serpyllum L. followed by Mentha pulegium L. and Origanum compactum Benth.Te species with the lowest RFC are the species that have been mentioned only once, which are Crataegus monogyna Jacq.Anacyclus pyrethrum (L.) Lag (Table 2).
It is evident that the medicinal plant species are most frequently used for the management of specifc diseases by the local population.Te FC and RFC allow us to determine the most cited and therefore the best-known medicinal plants in the study area, according to the results obtained Tymus serpyllum L. is the best-known species for the treatment of various diseases.Several studies on Rosmarinus ofcinalis L. have been conducted using biological and pharmacological approaches, revealing antispasmodic, antibacterial, and antioxidant properties [38].

Fidelity Level of Medicinal Plants.
Te value of FL varies from 2.8 to 100 percent in this study, and species with FL equal to 100% are used to treat only one category of disease.
Te fdelity level calculation allows us to know the main therapeutic use of each species, and a higher fdelity level indicates that the plants are used only for the treatment of diseases.In this study, digestive diseases are treated by 44 species but only 12 species among them are only against digestive diseases, e.g., Arbutus unedo L. while Marrubium vulgare L., Mentha × rotundifolia (L.)Huds., and Tymus vulgaris L. have a 100% FL since they are used as a remedy only against respiratory diseases.In the Middle Atlas of Morocco, Marrubium vulgare L. is used in the therapy of respiratory diseases [27] as shown in Table 4.

Use Value of Species and Families.
In the present study, the UV index of the recorded botanical species ranged from 0.004 to 0.044 (Table 2).Te highest UV index was calculated for Rosmarinus ofcinalis L., while Tymus serpyllum L. and Origanum compactum Benth.showed the same value (UV = 0.044).Tey were followed by Dittrichia viscosa (L.) Greuter with a UV index of 0.036, and Cannabis sativa L. with a UV index of 0.032.However, low-citation species and their respective values were Dysphania ambrosioides (L.) Mosyakin & Clemants, Allium cepa L. (UV = 0.004) (Table 3).
Te calculation of use value gives an idea about the use of the species.Some species have a higher UV than others because of their frequent use in the treatment of various   Evidence-Based Complementary and Alternative Medicine diseases.Due to their reputation as natural remedies with fewer side efects, they are well-known among the population [39].In this study, Rosmarinus ofcinalis L., Tymus serpyllum L. Origanum compactum Benth., the most used species in the Ketama area are generally used in all Morocco [31,32,40,41], as well as in North Africa [42].Tis explanation clarifes the use of Rosmarinus ofcinalis L. in traditional medicine.Tis plant is abundant in secondary metabolites, such as phenolic acids, favonoids, and alkaloids, which could potentially exhibit efcacy in the treatment of various diseases.Notably, two prominent diterpenes, carnosic acid and carnosol, have been identifed in Rosmarinus ofcinalis L. [43].Tese compounds possess antioxidant properties through their electron-donating capacity, thus protecting lipid membranes against oxidative damage [44].
Tymus serpyllum L., commonly known as thyme, contains essential oils with a notable composition of 36.5% thymol.Tymol is a pharmacologically active compound that imparts antioxidant, antimicrobial, and antiinfammatory efects [45].Evidence-Based Complementary and Alternative Medicine In the case of Origanum compactum L., also called compact oregano or Moroccan oregano, the principal compound is carvacrol.Carvacrol, a phenolic compound, is responsible for the characteristic aroma and favour of oregano.Extensive research has been conducted on carvacrol, revealing its antimicrobial, antioxidant, antiinfammatory, and anticancer activities.As one of the primary bioactive constituents in Origanum compactum L., carvacrol signifcantly contributes to its traditional medicinal applications [46].
3.4.5.Jaccard Index JI.Te Jaccard similarity index (Table 5) was calculated for 10 published studies, and the criterion used for the choice of the study is that the location of the region is close to the location of our study.Te results revealed that the Taounate region is the most similar to the Ketama region with JI � 36.78 followed by the eastern region (JI � 26.77) and Ksar Lakbir (JI � 22.64).However, the study with the lowest similarity is the one conducted in Talassemtane National Park (JI � 1.09), and the other studies' JI is between 18.91 and 4.04.
Te results revealed that the province of Taounate was the most comparable to Ketama.Tis can be attributed to several factors.First, the geographical aspect plays a role, as Taounate province represents the southern limit of Ketama.In addition, the socio-economic and socio-cultural contexts are infuential factors.Te Ketama area serves as the workplace for numerous farmers from Taounate, and there is also a signifcant population in both Taounate and Ketama belonging to the Jebala ethnic group.However, the lowest IJ is that of the Talassemtane area, which is isolated and diffcult to access.We know that ethnobotanical knowledge may be infuenced by isolation in the mountains [47], which decreases the sharing and transmission of ethnobotanical knowledge and practices.

Conclusion
Traditional medicine plays a vital role in the healthcare system of many developing countries, which is highly dependent on medicinal fora.Tis study aimed to document the potential medicinal plants in the Ketama area of Al-Hoceima province, representing the frst ethnobotanical survey conducted in this region.Te survey revealed a remarkable richness, with 81 diferent medicinal plants from 40 families and 65 genera identifed.Among them, Rosmarinus ofcinalis L., Tymus serpyllum L., and Origanum compactum Benth.are emerged as the most widely recognized medicinal plants by the local population, based on the UV index.However, further research, including pharmacological and phytochemical analysis such as the isolation of bioactive compounds, is necessary to confrm their traditional use.Tis study also highlights the signifcant traditional knowledge passed down through generations, providing valuable information about the Ketama area.Moving forward, prioritizing research eforts to investigate the therapeutic potential and safety of these medicinal plants is essential.

Figure 4 :
Figure 4: Modes of preparation of medicinal plants in Ketama.

Figure 5 :
Figure 5: Diferent modes of administration of plant-based therapeutic preparation.

Table 1 :
Demographic data of informants.

Table 2 :
List of plants used by the population of Ketama.

Table 3 :
Informants' consensus on the use of medicinal plants.

Table 5 :
Jaccard similarity index for Ketama and other studies in neighbouring areas.