Model and experiences of initiating collaboration with traditional healers in validation of ethnomedicines for HIV/AIDS in Namibia

Many people with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in Namibia have access to antiretroviral drugs but some still use traditional medicines to treat opportunistic infections and offset side-effects from antiretroviral medication. Namibia has a rich biodiversity of indigenous plants that could contain novel anti-HIV agents. However, such medicinal plants have not been identified and properly documented. Various ethnomedicines used to treat HIV/AIDS opportunistic infections have not been scientifically validated for safety and efficacy. These limitations are mostly attributable to the lack of collaboration between biomedical scientists and traditional healers. This paper presents a five-step contextual model for initiating collaboration with Namibian traditional healers in order that candidate plants that may contain novel anti-HIV agents are identified, and traditional medicines used to treat HIV/AIDS opportunistic infections are subjected to scientific validation. The model includes key structures and processes used to initiate collaboration with traditional healers in Namibia; namely, the National Biosciences Forum, a steering committee with the University of Namibia (UNAM) as the focal point, a study tour to Zambia and South Africa where other collaborative frameworks were examined, commemorations of the African Traditional Medicine Day (ATMD), and consultations with stakeholders in north-eastern Namibia. Experiences from these structures and processes are discussed. All traditional healers in north-eastern Namibia were willing to collaborate with UNAM in order that their traditional medicines could be subjected to scientific validation. The current study provides a framework for future collaboration with traditional healers and the selection of candidate anti-HIV medicinal plants and ethnomedicines for scientific testing in Namibia

Uso de plantas com finalidade medicinal por pessoas vivendo com HIV/ AIDS em terapia antirretroviral

Este foi um estudo observacional, transversal analítico realizado em ambulatório de referência do Estado do Maranhão-Brasil, no período de maio de 2009 a fevereiro de 2010, com o objetivo de estudar o uso de plantas com finalidade medicinal entre pessoas vivendo com HIV/AIDS, em uso de antirretrovirais. Um total de 339 pessoas respondeu um questionário abordando o uso de plantas e características demográficas, socioeconômicas, comportamentais, relacionadas à soropositividade e ao uso de antirretrovirais. A prevalência de utilização de plantas foi de 34,81%. As mais utilizadas foram: Turnera ulmifolia (12,09%); Melissa officinalis (10,62%); Plectranthus barbatus (7,67%); Cymbopogan citratus (capim limão) (4,72%) e Mentha spp. (hortelã) (2,36%). A maioria das pessoas (96,61%) referiu melhora após a utilização. Um percentual de 75,42% dos usuários de plantas não informou essa prática ao médico. Entre os que informaram o uso, 55,17% afirmaram que o médico estava de acordo e somente uma pessoa foi orientada a interromper o uso (3,45%). Apenas um médico (3,45%) indicou o uso de plantas. A análise ajustada evidenciou diferença para uso de plantas em relação ao sexo feminino (RP=1,58, 95% IC 1,15-2,15 p 0,004) e à orientação sexual do tipo homossexual (RP=0,63 IC 0,44-0,90 p 0,012). Este estudo aponta para a necessidade de melhor diálogo entre médico e pacientes sobre o uso de plantas com finalidade medicinal, alertando sobre possíveis perigos quando associados aos antirretrovirais, especialmente entre usuários do sexo feminino ou com prática do tipo homossexual.It is an observational, analytic study, developed at a hospital in Maranhao-Brazil, from May-2009 to February-2010. The objective was to study the use of plants with medicinal purpose in people living with HIV/AIDS and using retroviral therapy. A total of 339 (three hundred and thirty-nine) people answered a questionnaire about the use of plants and demographic, socioeconomic, behavioral characteristics, including those related to HIV status and use of antiretroviral therapy The prevalence of the use of plants with medicinal purpose was 34,81%. The most often used were: Turnera ulmifolia (chanana) (12,09%), Melissa officinalis (erva cidreira,) (10,62%), Plectranthus barbatus (boldo) (7,67%), Cymbopogan citratus (capim limão) (4,72%) and Mentha spp. (hortelã) (2,36%). Most people interviewed (96,61%) reported improvement after use. A rate of 75,42% of the plant users had not reported their practice to a medical doctor. Among respondents who reported use, 55.17% said their doctor agreed to it, and only one person was advised to discontinue the use (3,45%); only one doctor (3,45%) indicated the use of plants. Multivariate analysis showed differences for the use of plants in relation to gender (female PR= 1,58, 95% CI 1,15 - 2,15 p 0,004) and homosexual practices (PR= 0,63, CI 0,44 - 0,90 p 0,012). This study highlights the need for a better dialogue between doctors and patients about the use of plants with medicinal purposes, and warns about possible dangers when they are combined with antirretroviral therapy, particularly between female and homossexual users

Anthelmintic activity of medicinal plants used in Côte d'Ivoire for treating parasitic diseases

Natural products play an important role in the discovery and development of new pharmaceuticals. In the present study, we assessed the anthelmintic properties of medicinal plants used in Cote d'Ivoire. Ethanolic extracts from 50 medicinal plants were tested in vitro against trematodes (Echinostoma caproni, Schistosoma mansoni) and nematodes (Ancylostoma ceylanicum, Heligmosomoides bakeri, Trichuris muris). Active extracts were evaluated for their cytotoxicity and followed up in vivo in mice harbouring adult S. mansoni, E. caproni and T. muris at single oral doses of 400 or 800 mg/kg. All extracts tested were active against at least one helminths species. Ten of the 65 extracts tested (15.4%) in vitro revealed activity against all helminths tested. Of 65 extracts tested in vitro at a concentration of 2 mg/ml, all caused death of schistosomula and 34.4% and 39.1% were lethal against adult S. mansoni and E. caproni 72 h post-incubation, respectively. The highest activity against A. ceylanicum in vitro was observed with Sclerocarya birrea at 2 mg/ml, which resulted in death of adult worms and inhibition of activity of third-stage larvae (L3). Of the extracts, 41.5% completely inhibited movement of H. bakeri L3 at minimal lethal concentration (MLC) values of 20-200 mug/ml 48 h post-incubation, and 15.4% paralysed adult H. bakeri at 200 mug/ml 72 h after incubation. Of the extracts, 19% resulted in death of adult T. muris at MLC values of 10-100 mug/ml. In vivo, none of the extracts tested revealed activity against E. caproni. Olax subscorpioidea achieved total and female worm burden reductions of 60% and 84%, respectively in S. mansoni-infected mice. Combretum mucronatum was the most active extracts in vivo against T. muris with a worm burden reduction of 85.3%. In conclusion, several of the medicinal plants used in Cote d'Ivoire are active against different helminths, hence might play a role in the treatment of helminthiases. Further studies are necessary to isol the active components from these extract