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Globally, botanicals and associated by-products often provide income that is recognized as an important contributor to livelihoods particularly in rural areas. However, limited data currently exists on the impact of commercializing medicinal plants on livelihoods. Using a dataset collected from 101 indigenous knowledge holders (IKHs) with interest in childhood diseases, we assessed the factors influencing their decisions to commercialize medicinal plants, and how the commercialization impacts livelihood outcomes measured by net returns and per capita total expenditure. We used the Propensity Score Matching as the analytical technique to correct for endogeneity bias resulting from the observed characteristics. The results revealed that commercializing medicinal plants significantly increased net returns and per capital total expenditure by 3.60% and 1.42%, respectively. Furthermore, factors such as age, education, access to water and membership of association significantly influenced the decision of IKHs to commercialize medicinal plants. Policy efforts that seek to provide support for formal and vocational training, access to irrigation technology and participation in farmer groups, particularly among the experienced IKHs may encourage the commercialization of medicinal plants. [ABSTRACT FROM AUTHOR]