Abstract
This study investigated the concentrations and human health risks (carcinogenic and non-carcinogenic) associated with heavy metals in liquid herbal cough formulations obtained from the Western Region of Uganda. Twelve brands of registered (government authority) herbal cough formulations from reputable pharmacies were obtained and analysed. The mixtures were acid digested prior to Atomic Absorption Spectroscopy (AAS) analysis to quantify cadmium (Cd), copper (Cu), iron (Fe), lead (Pb), nickel (Ni), and zinc (Zn) in the herbal formulations, followed by human health risk assessment, using two different approaches: deterministic and probabilistic (Monte Carlo simulation). The results showed significant variations in heavy metal concentrations, with Cu, Fe, Ni, Cd, Pb, and Zn ranging from 0.020 to 1.272, not detected (ND) to 6.734, ND to 0.129, 0.002 to 0.051, ND to 0.190, and 0.043 to 0.527 mg/L, respectively, within the World Health Organization limit (WHO). Multivariate statistical analysis revealed that anthropogenic activities were the major source of heavy metal contamination. The hazard index (HI) values obtained ranged from 7.0 × 10−4 to 2.59 × 10−2 in children and 6.0 × 10−4 to 2.49 × 10−2 in adults, indicating extremely low non-carcinogenic risk (HI < 1) of exposure to heavy metals. Similarly, the incremental lifetime carcinogenic risks (ILCRs) of Ni, Pb, and Cd for both the children and adults were below the acceptable limit of 1.0 × 10−4, indicating no carcinogenic health risk. Moreover, the probabilistic risk assessment revealed that Pb and Cd had less than a 0.01% chance of exceeding the WHO limit (negligible risk). Findings from this study indicate that heavy metal concentrations in the brands of herbal cough formulations from Western Uganda are below the safety thresholds and are safe for consumption under realistic exposure conditions.
Similar content being viewed by others
Data availability
All data generated and analyzed during this study are included in this article.
References
Walusansa, A. et al. Herbal medicine used for the treatment of diarrhea and cough in Kampala city, Uganda. Trop. Med. Health. 50, 23. https://doi.org/10.1186/s41182-021-00389-x (2022).
Oryema, C., Rutaro, K., Oyet, S. W. & Malinga, G. M. Ethnobotanical plants used in the management of symptoms of tuberculosis in rural Uganda. Trop. Med. Health. 49, 92 (2021).
Alam, M. et al. Concentrations, dietary exposure, and human health risk assessment of heavy metals in market vegetables of Peshawar, Pakistan. Environ. Monit. Assess. 190, 505 (2018).
Emmanuel, U. C., Chukwudi, M. I., Monday, S. S. & Anthony, A. I. Human health risk assessment of heavy metals in drinking water sources in three senatorial districts of Anambra State, Nigeria. Toxicol. Rep. 9, 869–875. https://doi.org/10.1016/j.toxrep.2022.04.011 (2022).
Kosalec, I. & Cvek, J. Contaminants of medicinal herbs and herbal products. Sciendo (2023).
Jaishankar, M., Tseten, T., Anbalagan, N., Mathew, B. B. & Beeregowda, K. N. Toxicity, mechanism and health effects of some heavy metals. Interdiscip Toxicol. 7, 60–72. https://doi.org/10.2478/intox-2014-0009 (2014).
Sanusi, I. O., Adepoju, A. A. & Abdulrahman, B. D. Heavy metal contamination, human health impact, and remediation techniques in water bodies: A review. Discover Environ. 3, 268 (2025).
Ssempijja, F. et al. Consumption of Raw herbal medicines is associated with major public health risks amongst Ugandans. J. Environ. Public. Health. 2020 (8516105). https://doi.org/10.1155/2020/8516105 (2020).
Sanusi, I. O., Olutona, G. O., Wawata, I. G. & Onohuean, H. Heavy metals pollution, distribution and associated human health risks in groundwater and surface water: A case of Kampala and Mbarara districts, Uganda. Discover Water. 4, 87. https://doi.org/10.1007/s43832-024-00087-9 (2024).
Rai, P. K., Lee, S. S., Zhang, M., Tsang, Y. F. & Kim, K. H. Heavy metals in food crops: Health risks, fate, mechanisms, and management. Environ. Int. 125, 365–385. https://doi.org/10.1016/j.envint.2019.01.067 (2019).
Yuan, X., Chapman, R. L. & Wu, Z. Analytical methods for heavy metals in herbal medicines. Phytochem Anal. 22, 189–198. https://doi.org/10.1002/pca.1287 (2011).
Luo, L. et al. Heavy metal contaminations in herbal medicines: determination, comprehensive risk assessments, and solutions. Front. Pharmacol. 11, 595335. https://doi.org/10.3389/fphar.2020.595335 (2021).
Buchanan, C., Smith, Z. & Nagel, A. Long-term water quality trends in USEPA region 3 (Mid-Atlantic). Potomac Riverkeeper Network (2017).
Khuda, F. et al. Comparison of toxic heavy metals concentration in medicinal plants and their respective branded herbal formulations commonly available in Khyber Pakhtunkhwa. Pak J. Pharm. Sci. 29, 4 (2016).
Meseret, M., Ketema, G. & Kassahun, H. Health risk assessment and determination of some heavy metals in commonly consumed traditional herbal preparations in northeast Ethiopia. J. Chem. 8883837 (2020). (2020). https://doi.org/10.1155/2020/8883837
U.S. Environmental Protection Agency. Exposure Factors Handbook (Office of Research and Development, 2011).
Su, H., Kang, W., Xu, Y. & Wang, J. Assessing groundwater quality and health risks of nitrogen pollution in the Shenfu mining area of Shaanxi Province, Northwest China. Exposure Health. 10, 77–97 (2018).
World Health Organization. WHO Guidelines for Assessing Quality of Herbal Medicines with Reference To Contaminants and Residues (WHO, 2007).
Ullah, R., Khader, J. A., Hussain, I., Talha, N. M. A. & Khan, N. Investigation of macro and micro-nutrients in selected medicinal plants. Afr. J. Pharm. Pharmacol. 6, 1829–1832 (2012).
Nkansah, M. A., Hayford, S. T., Borquaye, L. S. & Ephraim, J. H. Heavy metal contents of some medicinal herbs from Kumasi, Ghana. Cogent Environ. Sci. 2, 1234660. https://doi.org/10.1080/23311843.2016.1234660 (2016).
Mulaudzi, R. B. et al. Antimicrobial activity, cytotoxicity evaluation and heavy metal content of five commonly used South African herbal mixtures. S Afr. J. Bot. 112, 314–318 (2017).
Zigau, Z. A. et al. Determination of heavy metal concentrations in selected herbal medicinal preparations marketed in Kano State, Nigeria. UMYU J. Microbiol. Res. 9, 207–213 (2024).
Aigberua, A. O. Composition of potential heavy metal contaminants in selected liquid and powdered herbal medicines commonly sold in Port Harcourt metropolis, Nigeria. Int. J. Med. Plants Nat. Prod. 5, 30–39 (2019).
Keshvari, M. et al. Assessment of heavy metal contamination in herbal medicinal products consumed in the Iranian market. Environ. Sci. Pollut Res. 28, 33208–33218 (2021).
Lawi, D. J., Abdulwhaab, W. S. & Abojassim, A. A. Health risk study of heavy metals from consumption of drugs derived from medicinal plants in Iraq. Biol. Trace Elem. Res. 201, 3528–3540 (2023).
Shikov, A. N. et al. The ability of acid-based natural deep eutectic solvents to co-extract elements from the roots of Glycyrrhiza glabra L. and associated health risks. Molecules 27, 7690 (2022).
Ebrahimzadeh, G., Omer, A. K., Naderi, M. & Sharafi, K. Human health risk assessment of potentially toxic and essential elements in medicinal plants consumed in Zabol, Iran, using the Monte Carlo simulation method. Sci. Rep. 14, 23756 (2024).
Esfarjani, F. et al. Health risk assessment of heavy metals in black tea infusion by Monte Carlo simulation. Food Sci. Nutr. 12, 9632–9640 (2024).
Wu, W., Xie, X., Wang, P. & Zhang, G. Deterministic and probabilistic assessment of heavy metals in herbal teas sold in Lanzhou City, China. J. Food Compos. Anal. 135, 106627 (2024).
Zuo, T. T. et al. A novel perspective of health risk assessment of heavy metals in Chinese herbal medicine: Probabilistic risk assessment using Plantago Asiatica L. (2022).
Bigabwa, D. Health risk assessment for exposure of lead and cadmium in herbal medicines sold in Kalerwe market, Kampala, Uganda. PhD thesis, Makerere University (2023).
Olusola, J. A. et al. Heavy metals and health risks associated with consumption of herbal plants sold in a major urban market in Southwest Nigeria. BMC Complement. Altern. Med. 4, 3. https://doi.org/10.1186/1472-6882-4-3 (2021).
Jurowski, K. & Krośniak, M. Human health risk assessment of heavy metal impurities (Cd and Pb) in herbal medicinal products available in pharmacies in Poland. Toxics 10, 273 (2022).
Funding
Not applicable.
Author information
Authors and Affiliations
Contributions
GOO, HO, KV, and MGT: conceptualization, data curation, methodology, supervision and writing of the original draft. HO, SA,and IOS: data curation, methodology, analysis, writing review, and editing. All authors: reviewed, edited and approved thefinal draft.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethical approval
The ethical approval was only obtained for the collection of herbal formulations from facilities.
Consent for publication
All consented to the publication of these findings.
Consent to participate
Written consents were obtained from the Herbal facilities.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
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/.
About this article
Cite this article
Ariyo, S., Sanusi, I.O., Veerabhadrappa, K. et al. Deterministic and probabilistic health risk assessment of heavy metals in liquid herbal cough formulations from Western Uganda. Sci Rep (2026). https://doi.org/10.1038/s41598-026-40622-3
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-40622-3


