Traditional Medicine: Past, present and future research and development prospects and integration in the National Health System of Cameroon

Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being. In the last decade traditional medicine has become very popular in Cameroon, partly due to the long unsustainable economic situation in the country. The high cost of drugs and increase in drug resistance to common diseases like malaria, bacteria infections and other sexually transmitted diseases has caused the therapeutic approach to alternative traditional medicine as an option for concerted search for new chemical entities (NCE). The World Health Organisation (WHO) in collaboration with the Cameroon Government has put in place a strategic platform for the practice and development of TM in Cameroon. This platform aims at harmonizing the traditional medicine practice in the country, create a synergy between TM and modern medicine and to institutionalize a more harmonized integrated TM practices by the year 2012 in Cameroon. An overview of the practice of TM past, present and future perspectives that underpins the role in sustainable poverty alleviation has been discussed. This study gives an insight into the  strategic plan and road map set up by the Government of Cameroon for the organisational framework and research platform for the practice and development of TM, and the global partnership involving the management of TM in the country.Key words: Tradttional medicine, Cameroon

Development of antimalaria, antibacterial, anticancer and antitumour drugs from new chemical entities from plant sources

Higher plants are capable of synthesizing complex and advanced chemical substances. Many of the unique gene sources may be lost through extinction, but as plants have great potential for producing new drugs, some remed-ial actions are required to preserve medicinal potential of plants. In cancer treatment, the percentage of non-synthetic small molecules of new chemical entities has averaged about 62 %. In other therapeutic areas, such as cardiovascular, antimicrobials, sexual dysfunction, and metabolic diseases, there has been extensive developme-nt of new chemical entities. In anti-hypertensive treatment, out of 74 synthetic drugs, about 48 have been traced to natural products. Active pharmaceutical ingredients, as lead compounds from plant sources have been devel-oped for many cancer antibiotics and anti-parasitic drugs. Other challenges of medicinal plant research are link-ed to the loss of biodiversity and conservation within the framework of sustainable management. The advances in sourcing plant products for new chemical entities as lead compounds in pharmaceuticals are reviewed in this paper. Major aspects of therapeutics, such as anticancer, antibacterial, antitumour, antimicrobials, and the use of NAPRALERT Natural Product Database are also presented. Bulk packaging and labelling of pharmaceutical plant products, and loss of biodiversity are highlighted as key factors in sustainable drug development from plants

Opportunités d'une exploitation soutenue des plantes médicinales dans l'aménagement forestier

Les plantes médicinales constituent des ressources précieuses pour les populations rurales africaines. Plus de 80% de cette population s’en sert pour assurer leurs soins de santé. Ces plantes constituent également des ressources inestimables pour l’industrie pharmaceutique. Malgré ces énormes potentialités et perspectives, l’approvisionnement en plantes médicinales accuse un grave déclin dû à la déforestation et à la dégradation des écosystèmes. Le présent papier se propose d’examiner les opportunités d’une exploitation soutenue des plantes médicinales et autres produits forestiers non-ligneux afin de concilier les défis d'un accroissement des revenus et d'une conservation de la biodiversité. Une telle gestion pourrait aisément être intégrée dans les schémas généraux d'aménagement forestier, si elle prend en compte les différentes phases de cet aménagement, à savoir le choix des essences ; le mode d’accès, les droits d’usage et l’inventaire des ressources, l’analyse et le choix des paramètres d’exploitation, le suivi et le contrôle de l’exploitation. Cette intégration comporte plusieurs opportunités, notamment la récolte d'un plus grand nombre de ressources, la réduction des coûts d'inventaire d'exploitation et d'aménagement, la conservation de la biodiversité et de l'environnement et la possibilité d'une orientation vers l'éco-certification des ressources. Une telle approche de gestion pourrait être mise en application dans le cadre des concessions forestières, de l'agroforesterie et de la foresterie communautaire.© 2010 International Formulae Group. All rights reserved.Mots clés : plantes médicinales, produits forestiers non-ligneux, gestion durable, conservation de la biodiversité

Traditional Medicine: Past, Present And Future Research And Development Prospects And Integration In The National Health System Of Cameroon

Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being. In the last decade traditional medicine has become very popular in Cameroon, partly due to the long unsustainable economic situation in the country. The high cost of drugs and increase in drug resistance to common diseases like malaria, bacteria infections and other sexually transmitted diseases has caused the therapeutic approach to alternative traditional medicine as an option for concerted search for new chemical entities (NCE). The World Health Organisation (WHO) in collaboration with the Cameroon Government has put in place a strategic platform for the practice and development of TM in Cameroon. This platform aims at harmonizing the traditional medicine practice in the country, create a synergy between TM and modern medicine and to institutionalize a more harmonized integrated TM practices by the year 2012 in Cameroon. An overview of the practice of TM past, present and future perspectives that underpins the role in sustainable poverty alleviation has been discussed. This study gives an insight into the strategic plan and road map set up by the Government of Cameroon for the organisational framework and research platform for the practice and development of TM, and the global partnership involving the management of TM in the country

HIV-1 drug resistance testing is essential for heavily-treated patients switching from first- to second-line regimens in resource-limited settings: Evidence from routine clinical practice in Cameroon

BackgroundWith the phase-out of stavudine (d4T), change to first-line regimens with zidovudine (AZT) or tenofovir (TDF) in resource-limited settings (RLS) might increase risks of cross-resistance to nucleos(t) ide reverse transcriptase inhibitors (NRTI). This would restrict the scope of switching to the World Health Organisation (WHO)-recommended standard second-line combinations (SLC) without HIV drug resistance (HIVDR)-testing in routine clinical practice.MethodsAn observational study was conducted among 101 Cameroonian patients (55.4% male, median [IQR] age 34 [10-41] years) failing first-line antiretroviral therapy (ART) in 2016, and stratified into three groups according to NRTIs exposure: exposure to both thymidine analogues AZT and D4T (group-A, n=55); exposure to both TDF and AZT or D4T (group-B, n=22); exposure solely to D4T (group-C, n=24). Protease-reverse transcriptase HIVDR was interpreted using the HIVdb penalty scores (60: high-resistance; 20-59: intermediate-resistance; <20: susceptible). The acceptable threshold for potential-efficacy was set at 80%.ResultsThe median [IQR] CD4, viral RNA, and time on ART, were respectively 129 [29-466] cells/l, 71,630 [19,041-368,000] copies/ml, and 4 [2-5] years. Overall HIVDR-level was 89.11% (90/101), with 83.2% harbouring M184V (high-level 3TC/FTC-resistance) and only 1.98% (2/101) major HIVDR-mutations to ritonavir-boosted protease-inhibitors (PI/r). Thymidine-analogue mutations (TAMs)-1 [T215FY (46.53%), M41L (22.77%), L210W (8.91%)], with cross-resistance to AZT and TDF, were higher compared to TAMs-2 [D67N (21.78%), K70R (19.80%), K219QE (18.81%)]. As expected, K65R was related with TDF-exposure: 0% (0/55) in group-A, 22.72% (5/22) group-B, 4.17% (1/24) group-C (p=0.0013). The potential-efficacy of AZT vs. TDF was respectively 43.64% (24/55) vs. 70.91% (39/55) in group-A (p=0.0038); 63.64% (14/22) vs. 68.28% (15/22) in group-B (p=1.0000); and 37.50% (9/24) vs. 83.33% (20/24) in group-C (p=0.0032). CRF02_AG was the prevailing subtype (63.40%), followed by CRF11.cpx (8.91%), A(1) (7.92%), G (5.94%); without any significant effect of the subtype-distribution on HIVDR (92.2% in CRF02_AG vs. 83.8% in non-AG; p=0.204).ConclusionFirst-line ART-failure exhibits high-level NRTI-resistance, with potential lower-efficacy of AZT compared to TDF. Significantly, using our 80% efficacy-threshold, only patients without NRTI-substitution on first-line could effectively switch to SLC following the WHO-approach. Patients with multiple NRTI-substitutions (exposed to both thymidine-analogues and TDF) on first-line ART would require HIVDR-testing to select active NRTIs for SLC