RESEARCH ARTICLE

1

ABSTRACT

Local natural resources play an important role in securing human health in the Balkans,

particularly as a source of food and medicine. The aims of this study were to document the

ethnomedical practices of Slavic speaking groups in South Kosovo and to compare these

findings to other studies conducted in the Western Balkans. Field research was conducted over

a series of trips in 2014. Semi­structured interviews in which respondents were asked to list

local taxa used for food and/or medicine were conducted in six communities located in the

municipalities of Prizren and Dragash. Prior informed consent was obtained and 91 people

were interviewed. Voucher specimens of cited wild flora and fungi were collected and deposited

in duplicate at the herbaria of the University of Prishtina (Kosovo) and Emory University (USA).

A total of 1,050 use citations were recorded for the various uses of 119 species (4 fungi and

115 plants) for food and/or medicine. Additionally, the ethnomedical uses of 27 ingredients of

animal, mineral or industrial origin were also documented. The greatest number of citations

were for dermatological and food uses of local plants. The most common families reported

were Rosaceae (18 species cited), Lamiaceae (16) and Asteraceae (10). Informant consensus

regarding category of use was highest (Fic ≥ 0.85) for the categories of oral health,

dermatological, and otolaryngological applications. Both wild and locally cultivated plants

continue to play an important role among various ethnic groups in South Kosovo, with 389

distinct applications documented in this study alone.

Keywords: Balkans; Traditional Ecological Knowledge; Medicinal Plants

Ethnobiology and Conservation 2018, 7:6 (02 March 2018)doi:10.15451/ec2018-03-07.06-1-42

ISSN 2238­4782 ethnobioconservation.com

Ethnomedical Knowledge among Slavic SpeakingPeople in South KosovoAvni Hajdari1†, Andrea Pieroni2†, Mamta Jhaveri3, Behxhet Mustafa1, Cassandra L. Quave3,4*

1 Department of Biology, Faculty of Mathematical and Natural Science, University of Prishtina ‘Hasan Prishtina’, Mother TheresaSt. 10000 Prishtina, Kosovo

2 University of Gastronomic Sciences, Pollenzo, Italy

3 Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA

4 Center for the Study of Human Health, Emory University College of Arts and Sciences, Atlanta, GA, USA

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INTRODUCTION

Traditional ecological knowledge (TEK) oflocal resources is closely tied to communityresilience and food security in the Balkans.Over the past decade, a number of studieshave focused on the ethnobotanicaldocumentation of TEK in the BalkanPeninsula as it pertains to the use of floraand fungi for food, handicrafts and medicine.Specific to the Western Balkans, extensivefieldwork has been conducted in Albania(Pieroni, Dibra et al. 2005, Pieroni 2008,Pieroni 2010, Pieroni, Cianfaglione et al.2014, Quave and Pieroni 2014), Bosnia andHerzegovina (Redžić 2006, Redžić 2007,Šarić­Kundalić, Dobeš et al. 2010, Šarić­Kundalić, Fritz et al. 2010), Croatia (Pieroni,Elena Giusti et al. 2003, Łuczaj, Fressel etal. 2013), Kosovo (Mustafa, Hajdari et al.2011, Mustafa, Hajdari et al. 2011, Mustafa,Hajdari et al. 2012, Mustafa, Hajdari et al.2015), Macedonia (Rexhepi, Mustafa et al.2013, Pieroni, Rexhepi et al. 2013),Montenegro (Menković, Šavikin et al. 2011,Pieroni, Giusti et al. 2011), Serbia (Jarić,Popović et al. 2007, Šavikin, Zdunic et al.2013, Jarić, Mitrović et al. 2014, Stevanović,Petrović et al. 2014, Zlatković, Bogosavljevićet al. 2014, Jarić, Mačukanović­Jocić et al.2015), but until now, research comparingtraditional ethnomedical practices betweenSlavic speaking groups in Kosovo has notbeen carried out. Geographically, theWestern Balkans represent a uniquebiocultural landscape, featuring extensivebiological, cultural, and linguistic diversityacross an area of just 213,320 km2.

Despite its small geographic size (10,840km2), Kosovo offers a unique hotspot ofbiocultural diversity for ethnobotanical study.While most of the country’s landscape isdominated by two plains (the Kosovo plain inthe north­eastern and Dukagjin Plain in the

south­western), the Sharr Mountains formthe southern border, shared with Marcedoniaand Albania, and Albanian Alps form thewestern border, shared with Montenegro andAlbania. These geographic features offer arange in elevation from 265 to 2,656 m.a.s.l.,with the majority of the area lying between500 to 1,500 m.a.s.l. These geographicfeatures combined with its modifiedcontinental climate (including sub­Mediterranean and alpine climatic zones)offer a rich range of habitats for a diverseflora to flourish. Although a complete floristicsurvey has not yet been conducted, it isestimated that there are between 2,800­3,000 vascular plant species in Kosovo.

TEK concerning the medicinal use oflocal plants, fungi and animals and theirbyproducts was investigated in the territoryof Prizren, which lies in the southern part ofthe Sharr Mountains (in Albanian known asMalet e Sharrit; in Serbo­Croatian as ŠarPlanina) and represent one of the maincenters of biodiversity in Balkans. Inrecognition of the rich levels of biodiversity inthis region, a 53,469 hectares region of theSharr Mountains was declared a NationalPark.

Until the end of the World War II,healthcare in this region was almost entirelybased on traditional medicine, and thesetraditions continued after the war as well.Healthcare was commonly attended to withinthe family, and all physical and mentalillnesses were treated with traditionalmedicines and rituals. These folk­medicaltraditions continue even now, especially inthe more mountainous and isolated areas.Local people have withstood the extremeconditions of this region for centuries –including very harsh winters. Until veryrecent decades, limitations in infrastructureand communication forced local residents tobe self­sufficient in the provision of their food

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and healthcare. As a result, their primarypharmacopoeia consisted of local medicinalplants. Previous ethnobotanical andethnolinguistic studies conducted in Kosovohave demonstrated that medicinal plants stillplay a crucial role in the sphere of humanhealth, especially in isolated rural areas(Sejdiu 1984, Mustafa, Hajdari et al. 2011,Mustafa, Hajdari et al. 2011, Mustafa,Hajdari et al. 2015).

Recently, local populations have beennegatively affected by migration due todisplacement and the harsh economicconditions caused by the last Kosovo War(1998­1999). Migration patterns contribute tothe rapid decline of traditional knowledgeand the vertical transmission of oraltraditional knowledge from one generation toanother.

In addition to the highly biodiversecharacteristics of the region, it is also veryrich in terms of cultural and linguisticdiversity. This region was historicallyoccupied by three great empires –Byzantine, Roman, and Ottoman. During theperiods of between the fall and rise ofdifferent empires, it was occupied primarilyby Bulgarians and Serbs. Today, the area ispopulated by various ethno­linguistic groups:ethnic Albanians (who speak the Ghegdialect of Albanian, as opposed to ToskAlbanian typical of southern Albania), Serbs(who speak Serbian), Turks (who speakTurkish), Bosniaks (who speak Bosnian),Gorani (who speak a Slavic language or“Našinski”, a Gora dialect similar toBosnian), and Roma (who speak Romani).In 2014, the year of our field­study, theresident population of Kosovo was estimatedto be 1.78 million, with 28% being of the age0­14, 65% at 15­64, and 7% that were 65years and older, with an average lifeexpectancy of 79.4 years for women and74.1 for men . Additional information

concerning the geographic characteristics,population, cultural aspects and naturevalues of this region have been previouslydescribed.

In previous field studies, we analyzed themedical ethnobotany of Albanians anddifferent ethnic groups living in Kosovo ;here we focus on the medical and foodethnobotany of the Slavic speaking Bosniaksand Gorani (Muslims), Serbs (ChristianOrthodox) and surrounding Albanianspopulations (Muslim) living in South Kosovo.As previously found in other works, the folkheritage of the medico­botanical resourcesamong South Slavs is particularly rich whencompared with that of other ethnic groups. Itis for this reason that we pursuedethnomedical documentation in this areawith these particular ethnic groups. The mainaims of this study were to document theethnomedical remedies (plants, animal,mineral substances and other materialsfound in nature) used among Slavicspeaking groups in South Kosovo and tocompare these findings across ethnicgroups, as well as with the pre­existingethnobotanical literature of the WesternBalkans available in English.

MATERIAL AND METHODS

Field Study

Ethnobotanical field research wasconducted in 6 villages belonging to themunicipalities of Prizren (3 villages) andDragash (3), located in Sharr Mountains,which are situated in the southern part ofKosovo.

Field studies were conducted over six dayfield trips in 2014 as part of a fieldworktraining course with students from theUniversity of Prishtina. The research teamwas divided into small groups consisting of

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Biological Specimens

During the interviews, fresh plants werecollected to create voucher specimens forherbarium deposit and whenever possible,informants were followed into the field toshow us the quoted species. Most plantspecies were collected while flowering.Taxonomic identification of plants wasundertaken using relevant standardbotanical literature of the area. Plantnomenclature largely follows the FloraEuropaea, while plant family assignmentsfollow the current Angiosperm PhylogenyGroup IV guidelines. Fungal taxonomy wasconfirmed using MycoBank. Voucherspecimens of the wild taxa were deposited atthe University of Prishtina Herbarium andEmory University Herbarium (IndexHerbarium code: GEO). Specimens are inthe process of being digitized; full collectioninformation and digital images can beaccessed via the SERNEC portal.

Data Analysis

We analyzed the data collected in effort toassess TEK across ethnic groups in thishighly biodiverse pocket of the Balkans. Wehave employed a number of tools in ourquantitative analysis of the pooled data,described below.

Use­Value Citation Index

The Use­Value (UVc) citation index isuseful for evaluating the relative importanceof each species based on its cited uses .The UVc was calculated for all taxa asfollows:

one professor and 2­3 students (threegroups in total) that interacted with eitherindividual respondents or small focus groupsof no more than 3 individuals. Prior informedconsent was obtained prior to conductinginterviews and all researchers adhered tothe ethical guidelines of the InternationalSociety of Ethnobiology. In most cases,small group interviews were conducted withdifferent members of the same family unit.Snowball sampling methods were used torecruit informants and we particularlyfocused on local people who regularly usenatural resources for medicinal purposes.

TEK was recorded using semi­structuredinterviews with informants. In particular,informal conversations focused on the issueof local taxa traditionally used for food (esp.wild food sources) and medicine. We soughtin particular the following information:respondent demographics (age, gender, andcommunity of residence), local names ofuseful plants or fungi, part(s) used, means ofpreparation, means of administration, localfolk uses of taxa. Special care was taken tospecifically document individual responsesto all questions. In other words, within asmall group, each person was questionedconcerning their knowledge and use of eachmaterial discussed. Data sets collectedreflect TEK of each independent informant.

In total, data were collected from 91respondents, all from Slavic speaking groups– 48 Bosniaks (24 male, 24 female), 27Gorani (12 male, 15 female), and 12Serbians (7 male, 7 female) – with theexception of two Albanian participants (1male, 1 female). The respondents wereolder than 50 years (with a few exceptions),mainly engaged in agricultural activities, andtypically inherited their ethnobotanicalknowledge from their direct ancestors(parents, grandparents) via oral traditions.

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species are reported to be used by a largeproportion of informants for a particularcategory, whereas lower Fic values indicatethat informants disagree over which taxa touse.

RESULTS

A total of 119 species (4 fungal and 115plant species), representing 4 fungal and 43plant families (Figure 1) were cited forethnopharmacological applications, rangingfrom health food to various forms ofmedicine. Emic categories of medicinal orother applications were determined basedon analysis of informant reports on plantuses, and qualitative interpretation of localillness assignments based on body system(e.g., cardiovascular system,gastrointestinal, dermatological, etc.), aspreviously described in other work using Fic

analysis . Seventy­one taxa were collected

where Uis is the sum of the total number ofall individual use citation reports concerninga given taxa, divided by the total number ofinformants (N).

Informant Consensus Factor

The categories selected for use in theInformant Consensus Factor (Fic) analysisare provided in Table 1 and follow apreviously described system . Each taxa usewas added to the appropriate category priorto analysis using the following formula:

where Nuc is the total number of use citationsin each category and Nt is the number oftaxa used in that category. High Fic values(near 1.0) are obtained when one or a few

Table 1. Ethnomedicine use reports

Legend: Division of ethnobotanical use reports by general categories for Informant Consensus Factor (Fic) analysis.

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from the wild, 42 were cultivated, 2 weresemi­cultivated, 3 were purchased, and onewas either wild harvested or cultivated. Themost broadly represented plant families wereRosaceae (18 species cited), Lamiaceae (16spp.) and Asteraceae (10 spp.) (Figure 1).Additionally, 13 ingredients of animal origin(Appendix I) and 14 of mineral or industrialorigin (Appendix II) were spontaneouslycited for medicinal applications, withoutspecific questions to informants concerningthe use of such materials.

The most frequently quoted manner ofpreparation of medicinal plants wasrepresented by infusions (58%), tropicalapplication (15%), decoction (7%),macerations (6%), eaten fresh (4%)

squeezed liquid (3%) tincture (2%),ointments (2%) and others preparation with1% or less (Figure 2). On the other hand, themost frequent food preparations were: tea(35%), lacto­fermented products (17%), fillfor pies (14%), jams (8%), compote (6%),alcoholic fermentation 5% and with 1%vinegar and ‘ajvar’ preparations (Figure 3).

The most frequently cited medicinal usesreferred to dermatological disorders (20%)gastrointestinal diseases (20%), respiratory(15%) troubles, gastrointestinal illness(12%), illnesses, cardiovascular illness(11%), etc. (Figure 4). 72% of the plantswere internally administered while 28 of thepreparations were externally administered.

Figure 1. Number of plant families and their number of species, cited for ethnopharmacological

applications, ranging from health food to various forms of medicine.

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Figure 3. Preparation of plants for foods

Figure 2. Preparation of plants for medicinal uses

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Figure 5. Administration of the extracts for medicinal purposes

Figure 4. Medicinal uses of plant species

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species were cited for a number ofapplications. For example, while all reportsof T. serpyllum were for its preparation as aninfusion of aerial parts, the infusion was citeda variety of uses, ranging from food, generalhealth promotion, and for various medicalapplications for women’s health,neuromuscular, respiratory, and urologicalcomplaints. Likewise, U. dioica was reportedto be prepared as an infusion (of the aerialparts, seeds, or flowers) for food (as a teabeverage) and for various medicinalapplications ranging from urological, generalhealth, cardiovascular, neuromuscular or

The most frequently cited (Nuc: 327) use oftaxa was for dermatological applications,followed by food (255), gastrointestinal (88),respiratory (83), and cardiovascular (78).The highest consensus (Fic ≥ 0.75) was fortaxa used for oral health (Fic: 0.952),dermatological (0.880), otolaryngological(0.857), food (0.756) and psychiatric (0.750)applications.

Use­Value for Cited Taxa

A detailed report of UVc values for allcited taxa is provided in Appendix I. Theaverage UVc was 0.095. H. perforatum hadthe highest use­value index score of allspecies reported (UVc: 2.56). Ten specieshad a use­value index score greater than0.25, and all were collected from the wild:Achillea millefolium, Matricaria recutita,Vaccinium myrtillus, Gentiana lutea,Hypericum perforatum, Origanum vulgare,Thymus serpyllum, Plantago major, Rosacanina, and Urtica dioica. Notably, most

Informants and Consensus

There were a total of 1,050 use citations(Nuc), and taxa were cited for differentcategories 389 times (Nt). Categories of useare described with examples in Table 1. Thenumber of taxa (Nt), number of use citations(Nuc) and the informants consensus factor(Fic) for each category is reported in Table 2.

Legend: Informant consensus concerning the internal use of local plants and fungi.

Table 2. Informant consensus

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endocrine system complaints (Appendix I).

Reports of Animal, Mineral andIndustrial Products

In addition to plant and fungal ingredients,reports of animal, mineral and industrialingredients for medicinal applications werealso recorded. Thirteen animal species werecited, with 38 distinct uses reported, and atotal of 58 individual use citations (AppendixII). Of these, the top use­value index scoreswere for sheep products (Nuc: 0.132), withdifferent dermatological applications citedusing milk, gallbladder, skin, fat or feces; andhuman products (Nuc: 0.088) of urine andbreast milk used for otolaryngological anddermatological applications.

Fourteen ingredients of mineral orindustrial origin were cited for 17 distinctuses reported and 21 total citations fordermatological, veterinary andophthalmological applications (Appendix III).The top two reported ingredients had lowuse value scores (relative to plant or animalingredients); both ash and sugar had as UVc

of 0.033.

DISCUSSION

Similarities with other Reports inthe Balkan Literature

Similar to a number of previous studiesconducted in different communities spreadacross the Western Balkans (includingAlbania, Kosovo, Serbia and Montenegro),the most frequently cited plant families forfood and medicinal use were Rosaceae,Lamiaceae and Asteraceae. Theirpredominance as a source of wild food andmedicine is thus well documentedthroughout the region and not surprising tofind here as well.

Measure of use­value indices forindividual taxa can be especially useful forcross­cultural comparison studiesconcerning the use of different taxa, andmechanisms for data analysis between twoor three groups have been explored withfield data collected in this region of theBalkans. Due to limitations in the presentstudy design (uneven numbers from differentethnicities having been recruited), a rigorouscross­cultural assessment of use­valuesacross ethnic groups was not possible here.However, comparison of the present studydata with that of a previous study conductedin SW Kosovo revealed that six of the eightmost commonly cited taxa (with >30% ofrespondents citing their use) were alsoreported to have the highest UVc scores(>0.25) here: Achillea millefolium, Urticadioica, Hypericum perforatum, Thymusserpyllum, Matricaria recutita and Vacciniummyrtillus. The other two high ranking taxafrom the prior study were also documentedin the present work, but at a lowerfrequency: Sambucus nigra L. (UVc: 0.176)and Tilia platyphyllos Scop. (UVc: 0.055).Furthermore, comparison of our data withthe entire Western Balkan ethnobotanicalliterature available in English (seereferences cited in the introduction) revealedthat the folk plant remedies with the highestfidelity levels, defined as those with highreports of the same specific use, were alsorecorded as being commonly used in themost of the considered studies.

Furthermore, in addition to their role intraditional medicine of this region, a numberof these species have also beenincorporated into the broader Europeanmarket as plant food supplements, sold invarious forms ranging from capsules, rawherbs, and tinctures; this includes A.millefolium, H. perforatum, M. recutita, S.nigra, T. serpyllum, T. platyphyllos, U.

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its phytopharmacology.Vinca minor L. was another uncommonly

recorded species used as infusion toimprove the general health. In general, it isknown to be a valuable medicinal plant useto prevention and treatment thecerebrovascular insufficiencies anddisorders, it increases cerebral blood flow,oxygen consumption and glucose utilization.Further work on the bioactivity andtoxicology of the traditional leaf infusioncould be worthwhile.

Other ingredients for local healthpractices

In addition to medicinal plants, otheringredients gleaned from the environmentare commonly used in the traditional medicalpractices of this region. For example, wedocumented the use of thirteen animalspecies for pharmacological application. Thispractice of using animal and their byproductsfor medicine is known as zootherapy, andhas constituted an important component ofthe pharmacopoeia across many culturessince ancient times. Similar to othercontemporary studies on zootherapeuticpractices, we identified insects, birds,mammals (small and large), and reptiles asingredients for various medical afflictions.Unlike other studies on this topic, no aquaticanimals were reported. It should be noted,however, that as this was not a primary lineof inquiry in interviews, which were mainlyfocused on the ethnopharmacological usesof plants and fungi, the scope of animalsuses and number of actual user reports arelikely highly underreported in the presentstudy. Further research into zootherapeuticpractices, as well as other practices whichincorporate industrial materials or minerals,would be useful to improving ourunderstanding of this phenomenon in the

dioica, and V. myrtillus.

Health Foods

Most of the plant foods quoted as being“healthy” by the informants referred to a fewwild vegetables used as filling for börek andto lacto­fermented cultivated vegetables.The Ottoman culinary tradition of preparingwild plant­based savoury pies is widespreadacross the Balkans and wild sorrel and dockleaves (Rumex spp.) represent the mostused ingredients. Both plants – sour andastringent at the same time (sorrel moresour, dock more astringent) are consumed inthe spring as a panacea and a healthy foodserving as a reconstituent following the long,cold winter period. Moreover, similarly towhat we found also among Albanian Gorani ,the customs of preparing home­made lacto­fermented plant ingredients, to consumethem during the winter, and also to drink theresulting sour liquid portion as a panacea isa cultural trait of South Slavs (and especiallyGorani) and should be better investigated interms of biological evaluation of thenutraceutical potentialities of these probioticfoods.

Uncommon Plant Uses

The most uncommon use documented inthe present work concerned the use ofEuonymus europaeus L. fruiting branches inteas as a cardiotonic. This is unusualbecause across Europe, the plant isconsidered toxic and has never been quotedin our prior field studies as being internallyused. Although it was only reported by twoinformants, it was also being sold at a localmarket; this finding should be betterinvestigated by assessment of the chemicalmakeup of the water infusion as it pertains tothe plant’s toxicological relevance as well as

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activity of extracts from this species is thephloroglucinol, hyperforin. However, thiscompound is very unstable, especially in thepresence of heat and light , calling intoquestion whether or not it is present in thetraditional oil, and if not, what is responsiblefor the purported antibacterial activity of thefolk remedy.

Another major constituent commonlyfound in H. perforatum extracts is thenapthodianthrone, hypericin. It is known tobe a major cause of photosensitization andcause of hypericism, a form ofphotodermatitis. Research on the topicalapplication of hypericin gel and oilformulations demonstrated a clinicallyrelevant rise in skin erythema. However, inour extensive discussions with informants onthe use and effects (including adverseeffects) of topical use of the kantarion oil,there were no reports of photodermatitis or aneed to avoid sun exposure during use.This suggested that hypericin might belacking in the traditional formulation, and thiswas confirmed in biochemical analyses .

CONCLUSIONS

A total of 389 distinct ethnomedical andfood uses of 115 plant, 4 fungal, and 13animal species were cited. Interviews with91 informants yielded 1,050 total usecitations for plants and fungi, and anadditional 58 for animal products, with thehighest consensus rankings attributed to thecategories of oral health, dermatological,otolaryngological, food, and psychiatricapplications.

In comparison to other ethnobotanicalstudies conducted in the Western Balkans,our findings reaffirm the importance ofcertain families (Rosaceae, Lamiaceae andAsteraceae) as sources of food andmedicine in this region of South Kosovo. Of

Balkans.

Traditional formulations ofHypericum perforatum

Of all of the species encountered in ourfield study, H. perforatum (locally referred toas kantarion) dominated the discussion ofmore than half (52%) of all interviewsconducted. It had the highest use­valueindex (UVc: 2.56), much higher than theoverall average of 0.095. This is similar toresults of an ethnobotanical study in EasternSerbia, which also documented this as themost frequently cited species, with 40.5% ofinformants citing its use .

Here, the flowering aerial parts werereported to prepared by infusion to be drunkfor urological, respiratory andgastrointestinal complaints; but the mostcommon preparation involved maceratingthe flowering aerial parts in a clear bottle fullof olive or sunflower oil in the sunlight for aperiod of 40 days, at which time the oil willtake on a deep blood red color. In somecases, this recipe included modifications,such as the addition of Calendula officinalisflowers to the oil macerate, or addition ofother materials such as iodine or brickpowder to the final oil product. The H.perforatum flower oil preparation (OleumHyperici), was reported for many differenttopical applications for dermatological,cardiovascular and veterinary use. Almosthalf (44%) of all informants referencedspecific dermatological applications ofOleum Hyperici for wound healing, burninjuries, skin infections, eczema, and skinsoftening (emollient).

The antibacterial properties of H.perforatum is well known; growth inhibitoryaction of its extracts against S. aureus havebeen previously reported. A majorconstituent responsible for the antibacterial

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natural world, and provide baseline data forfuture pharmacological studies on traditionalremedies. In particular, details concerningthe parts used, mode of preparation orformulation, disease target, mode ofapplication, frequency of use, and adverseeffects can provide important clues forconsideration in future laboratory analyses ofthe cited ingredients for potential toxicity andbioactivity.

ACKNOWLEDGEMENTS

We would like to extend our heartfeltthanks to the communities and people whoagreed to participate in this study. Specialthanks to the students who participated inthe training workshop and assisted withinterviews: Bledar Pulaj, Fatbardhë Kurti,Fisnik Asllani, Pajtim Bytyqi, Ylberza Thaqi,Mirsad Mehmeti, Andonita Buçinca, LeonoraIbrahimi, Arbnora Bytyqi, Florentina Zeneli,Zuhid Rama, and Samir Toro. Fundingsupport for this study was provided by theUS State Department, US Embassy inKosovo (grant number S­KV420­14GR­096).

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