Herbal Medicines in Kenya: A Review of the Toxicity and Quality Control Issues

In sub-Saharan Africa, it is estimated that 80% of the population depends on indigenous medicines for primary health-care. These herbs often contain highly active pharmacological compounds whose pharmacotherapeutic and toxicity profiles have not been well characterized. Toxicity may be related to several intrinsic and extrinsic factors. Most of the available reports related to the toxic effects of herbal medicines cite hepatoxicity as the most frequently experienced toxicity. However, noxious effects involving kidneys, the nervous system, skin, blood, the cardiovascular system, mutagenicity and carcinogenicity have also been published. This article presents a systematic review on safety and toxicity of herbal medicines used in Kenya. Keywords: Herbal medicine, herbal preparations, toxicity, Kenya, regulations, complementary and alternative medicin

Use of the nested polymerase chain reaction for detection of Toxoplasma gondii in slaughterhouse workers in Thika District, Kenya

Background. The widely used methods of diagnosis of Toxoplasma gondii are serological. Current reports indicate a high seroprevalence of T. gondii in humans in Kenya. There is a need for more sensitive diagnostic tests, especially when the specific antibody titres are below detectable threshold levels. Use of the polymerase chain reaction (PCR) targeting the repetitive 529 base pair loci has been reported to be sensitive and specific.Objective. To detect T. gondii in a high-risk group of public health workers in Thika District, Kenya.Methods. In total, 87 human blood samples were collected from male slaughterhouse workers between 1 March 2013 and 25 June 2013. The DNA extracted was amplified by the nested PCR.Results. T. gondii was detected in 39.1% (34/87) of the workers. In the cow-sheep-goat slaughterhouses the prevalence ranged between 20% and 60%, while all the chicken slaughterhouse workers (6/6, 100%) tested positive. The difference in T. gondii positivity between the workers in the chicken slaughterhouse and those in the cattle-sheep-goat slaughterhouses was statistically significant (p=0.003).Conclusion. This study shows the presence of T. gondii in an asymptomatic high-risk group in Thika District, indicating the need for enhancement of public health awareness

A Fatal Outbreak of Campylobacter jejuni Enteritis in a Colony of Vervet Monkeys in Kenya

In a group of 50 wild-caught vervet monkeys trapped for experimental studies, 23 developed severe diarrhoea  during the quarantine period. While 10 of these responded well to routine treatment with metronidazole,  kaomycin and oral electrolytes, 13 initially showed slight improvement but later relapsed. Five of  these failed to respond altogether and were euthanised. Fresh faecal samples were collected from the surviving  eight monkeys and analysed for microbiology and drug sensitivity. Campylobacter jejuni, sensitive  to erythromycin, was isolated from all the faecal samples. Following treatment with erythromycin, seven  monkeys recovered fully within ten days but one died before the end of therapy. This study indicates that  wild non-human primates may play a significant role as a reservoir of C. jejuni, whereby they may act as  natural carriers of this human pathogen. Screening for Campylobacter sp in newly acquired monkeys is  advisable as part of the quarantine procedures.

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

A fatal outbreak of Campylobacter jejuni enteritis in a colony of vervet monkeys in Kenya

In a group of 50 wild-caught vervet monkeys trapped for experimental studies, 23 developed severe diarrhoea during the quarantine period. While 10 of these responded well to routine treatment with metronidazole, kaomycin and oral electrolytes, 13 initially showed slight improvement but later relapsed. Five of these failed to respond altogether and were euthanised. Fresh faecal samples were collected from the surviving eight monkeys and analysed for microbiology and drug sensitivity. Campylobacter jejuni, sensitive to erythromycin, was isolated from all the faecal samples. Following treatment with erythromycin, seven monkeys recovered fully within ten days but one died before the end of therapy. This study indicates that wild non-human primates may play a significant role as a reservoir of C. jejuni, whereby they may act as natural carriers of this human pathogen. Screening for Campylobacter sp in newly acquired monkeys is advisable as part of the quarantine procedures.</p

Neuroprotective Effects of Tea Against Cadmium Toxicity

Background: Cadmium (Cd) is a common pollutant and potential neuro-toxicant to humans. The main treatment for heavy metal toxicity is chelation therapy which is however replete with grave side effects. This study was designed to determine the neuroprotective effects of extracts of the tea beverage on experimentally induced cadmium toxicity in the brain of rats. Cadmiumas CdCl2 was administered subcutaneously while tea was given orally.Methods: Healthy Wister rats were used to study the effects of co-administration of Cd and tea extracts on the brain. Cadmium was injected subcutaneously while tea was administered orally to the rats. Brain tissue from euthanized rats was assayed for Zinc Fingers and Homeoboxes Protein 1 (ZHX1), reduced glutathione (GSH), and lipid peroxidation markers Thiobarbituric Acid Reactive Substances (TBARS). Neurohistochemical and histopathological studies were also carried out on the brain tissues of the rats.Results: Cadmium significantly induced neuronal damage exhibited by a significant (p &lt; 0.05) decrease in ZHX1 in the brain tissue, significant (p &lt;0.05) increase in TBARS, as well as significant (p &lt; 0.05) increase in GSH implying an impaired antioxidant defense system. Co-administration of Cd with black or green tea extracts resulted in a significant decrease in lipid peroxidation as well as maintenance of GSH and ZHX1. The neurohistochemical and histopathological studies in the brain of the rats indicated that the tea extracts significantly reduced CdCl2 toxicity and preserved the normal histological architecture of the brain tissues.Conclusion: This paper reports for the first time the efficacy of tea extracts in protecting rats from cadmium induced toxicity and disturbances of antioxidant defense system in the brain.Key words: Tea; flavonoids; Cadmium; neurotoxicity; Chelating agents.</jats:p