PREFACE

Preface With an estimated 5.6 million people living with HIV in 2009, South Africa’s epidemic remains the largest in the world (UNAIDS, 2010). It is approximated that 40million South Africans depend on traditional medicine for their primary health care needs and regularly visit Traditional Health Practitioners (THPs). Patients often move freely between traditional and allopathic systems of medicine. In fact, up to 90% of people living with HIV and AIDS first consult THPs before visiting practitioners of allopathic medicine. Thus THPs bear the brunt of the HIV and AIDS epidemic. With this in mind it became necessary to convene a conference where the potential contribution of traditional medicine in the fight against HIV and AIDS could be objectively assessed. It also facilitated learning and sharing experienses from practitioners, researchers, governments and NGOs/or funders that have advanced in integrating traditional medicine in HIV and AIDS. The conference covered four key priority areas in accordance with the National Strategic Plan for HIV and AIDS and STI: prevention; treatment, care and support; research, monitoring and surveillance; and financing. The Conference was titled “Traditional medicine in the era and HIV/AIDS in South Africa” and held at the International Convention Centre, Durban between 28th to 30th July 2010. This historic conference, funded by PEPFAR/CDC South Africa, was attended by more than 1500 delegates from South Africa, Belgium, Botswana, Cameroon, China, Lesotho, Nigeria, Tanzania, Uganda, United States of America, and Zambia. On each day there were 200 high school learners and 200 community members in attendance. In addition there were researchers, CAM practitioners, donors, doctors, nurses, THPs, policy makers, and members of the media. It was organised in partnership with the Department of Science and Technology, the KwaZulu-Natal Provincial Government and the University of KwaZulu-Natal and had the support of the Department of Health, the South African National AIDS Council (SANAC) and the South African Broadcasting Corporation (SABC) among others. National Parliament was represented by members of the Health and, Science and Technology Portfolio Committees, respectively. National government departments in attendance included Health, Science and Technology, and Trade and Industry. All provinces of South Africa were represented with the exception of Northern and Western Cape provinces. The House of Traditional Leaders and Local Government were represented by Her Majesty, Queen of LinduZulu, local chiefs, Mayors and Councilors. The US Government (PEPFAR) was represented by the Health Attaché in the US Embassy, US Consul General in Durban, PEPFAR Liaison Officer (KZN) and CDC (South Africa). A call for abstracts was published in 3 major national newspapers and on the internet on a number of websites. Abstract themes had to fit within the strategic areas of the National Strategic Plan for HIV/AIDS/TB. The conference received more than 70 abstracts, reviewed by a panel of national and international experts. About 50 abstracts were accepted for oral presentation and 12 as posters. Additional speakers from the 7 provincial departments of health and 7 Provincial AIDS Council THP sector representatives informed the conference on their programmes. The Department of Science and Technology and the Technology Innovation Agency shared their plans and strategies for research and development of traditional medicines in South Africa. The conference was primarily abstract-driven. Abstract contents were either research-based data using established scientific methods or demonstrated experience and information from individuals or institutions working in the field in the form of case studies or case presentations. The non-abstract-driven components of the conference addressed a variety of current viewpoints and issues including government programmes, interactive case-based sessions, and satellite symposia. The television and print media broadcasted the proceedings of the conference. Selected speakers and delegates were interviewed live. Highlights The highlights of the conference included the following: 1. South Africa could demonstrate its capacity to carry out world class clinical trials on traditional medicine. 2. Provincial Governments and Provincial AIDS Councils shared their plans and strategies to include traditional medicine in their implementations plans. 3. Traditional Health Practitioners were in full support of integrating HIV Counseling and Testing, Traditional or Medical Male Circumcision, and other national strategies in their practices but required support and capacitation for HIV testing. 4. It is necessary to intensify research on traditional medicines since a number of HIV positive patients who do not qualify for antiretroviral therapy choose them. 5. There were best practice projects promoting collaboration between traditional health practitioners and public health care workers in the fight against HIV/AIDS. 6. The media will continue to report positive and negative aspects of traditional medicine 7. The Department of Science and Technology funds the most research on indigenous knowledge systems including traditional medicines in South Africa. 8. The USA remains the largest foreign funder of HIV research and programmes on traditional medicine. This special edition carries some of the scientific papers presented at the conference. Professor Nceba Gqaleni, Chair of the Traditional Medicine in the Era of HIV and AIDS Conference Dr Vusi Shongwe, Director: Heritage, Office of the Premier, KwaZulu-Natal Government and Professor Yonah Seleti, Chief Director: National Indigenous Knowledge Systems Office, Department of Science and Technology Co-Chairpersons of the Traditional Medicine in the Era of HIV and AIDS Conference

Traditional Complementary and Alternative Medicine: Knowledge, Attitudes and Practices of Health Care Workers in HIV and Aids Clinics in Durban Hospitals

Traditional complementary and alternative medicine (TCAM) has been reported to be commonly used among individuals with HIV and AIDS disease. However a lack of communication between health care workers (HCWs) and patients as well as between HCWs and TCAM practitioners has been identified as one of the challenges that may adversely affect treatment of HIV and AIDS patients. With improved and sustained communication HCWs, patients and TCAM practitioners would be able to make informed decisions with regards to best treatment practices based on the knowledge of what is safe, effective and what is not. In order to establish a baseline understanding of the current status of interaction and communication between HCWs and TCAM profession in Durban, South Africa, the purpose of the study was to investigate the knowledge, attitudes and practices of HCWs in the HIV and AIDS clinics towards TCAM professions. Data was collected by means of anonymous self-administered questionnaire which was distributed to HCWs in the HIV and AIDS clinics. Out of 161 HCWs in the HIV and AIDS clinics 81 HCWs returned the questionnaires resulting in 50% response rate. The results showed that participants did not possess a basic knowledge of TCAM. Out of 81 participants 23 (28%) scored zero in a true or false knowledge assessment question.Keywords: Traditional Complementary and Alternative medicine, Health care workers, knowledge attitude and practices, HIV and AIDS

Best practice programme in the standardisation of traditional medicines: Evaluation of an immune booster formulated by traditional healers of the Vaal Triangle, South Africa

Background: Regulation and standardization of African traditional medicines (ATM) prescribed by traditional healers in South Africa is still far from being implemented. This is despite the fact that more people are using ATM products than ever. In an effort to demonstrate that collaboration with traditional health practitioners (THPs) can yield standardized TM products, this study aimed to evaluate the immunomodulatory effects of an herbal immune booster formulated by traditional healers from the Vaal Region, South Africa.Materials and Methods: Using normal and lipopolysaccharide (LPS) stimulated human peripheral blood mononuclear cells (PBMCs) models, doses of the immune booster ranging from 1000 to 10 μg/mL were evaluated for their cytotoxicity, inflammatory cytokines and chemokines secretion, nitric oxide (NO) secretion, malondialdehyde (MDA) assay, and 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay.Results: The immune booster induced a dose dependent cytotoxic effect on both normal and LPS stimulated PBMCs with higher doses showing cytotoxicity while lower dose from 100μg/mL did not show any cytotoxicity. When re-dissolved in aqueous PBS immune booster doses up to 100 μg/mL showed better DPPH radical inhibition (41%) than ascorbic acid at 40μg/mL (33%). The immune booster also decreased lipid peroxides significantly (p< 0.05) and this was comparable to ascorbic acid. There was also a significant (p< 0.05) increase in nitrite (NO) after treatment of LPS stimulated PBMCs with immune booster doses when compared to untreated samples. The immune booster stimulated inflammatory cytokines secretion in normal PBMCs (IL 1α, IL 1β, IL 6, IL 10 and TNFα while showing a decrease in IFNγ at the higher dose) while in LPS stimulated PBMCs some cytokines were decreased (IL 1α, IL 17α and at lower doses IL 10 and TNFα) and others were increased (IFNγ, TNFα and GM-CSF) depending on the dose used. In both normal and LPS stimulated PBMCs the immune booster significantly (p< 0.05) increased (MIP 1α) while causing significant (p< 0.05) decreases in IP 10 (high dose), I-TAC and MIG secretion.Conclusions: This immune booster showed potential immunostimulatory effects by increasing nitric oxide, inflammatory cytokines and chemokines secretion in both normal and LPS stimulated PBMCs. This TM also showed promising antioxidant potential in the MDA and DPPH assays. Further in vitro and animal studies are warranted.Keywords: Traditional healers, traditional medicines, regulation, standardization, immune stimulatio

Nutritional value of bambara groundnut (Vigna subterranea (L.) Verdc.) : a human and animal perspective.

M. Sc. Agric. University of KwaZulu-Natal, Pietermaritzburg d2014.Bambara groundnut (Vigna subterranea (L) Verdc.) is an indigenous African legume that is reported to have wide adaptation to a range of environments. It is popular among subsistence farmers in sub-Saharan African. However, research on the crop still lags behind that of other established legumes and in most places the crop is still cultivated from landraces, with no locally improved varieties available. The objective of the study was to evaluate the nutritional and agronomic potential of bambara groundnut. Three separate experiments were undertaken, (i) seed quality determination during germination, (ii) controlled environment study to determine yield and nutritional quality under water stress and (iii) field trials to determine the effect of seasons and location on nutrient composition. The results showed that the darker coloured seeds had a faster germination rate. Black speckled seeds had the highest (crude protein) CP after 8 (20.67%), 16 (22.11%), 24 (20.68 %), and 48 hours (20.77%), on the other hand cream seeds had the lowest CP after 16 (19.30%), 24 (18.71%), and 72 hours (19.16 %). The results showed that nutrient composition varied during early imbibition and the variations could be associated with seed colour and duration of imbibition. Under controlled environments, statistically significant differences were observed for plants under 100% ETc when compared with plants under 30% ETc with regards to stomatal conductance. Bambara groundnut landrace selections were able to adapt to the limited water under 30% ETc by closing their stomata. The lower stomatal conductance at 30% ETc relative to 100% ETc demonstrated a regulation of transpirational losses, through effective stomatal control. Under field conditions, the interactions between seasons, location, irrigation systems, sequential harvesting and crop varieties is one that needs sufficient planning so as to maximise nutrient quality and overall crop production. The nutritive value and mineral contents of bambara groundnut landrace selections varied considerably in response to water regimes, sequential harvesting, locations and seasons. These findings suggested that bambara groundnut is a drought resistant crop and can aid as an affordable all year round forage supplement for ruminants during the dry seasons

Effects of Sutherlandia frutescens Extracts on Normal T-Lymphocytes In Vitro

Sutherlandia frutescens (SF), a popular traditional medicinal plant found in various parts of southern Africa, is used for treatment or management of HIV/AIDS and other diseases including cancer. However, its toxicity profile has not been fully established. The aims of this study were to examine the effects of 70% ethanol (SFE) and deionised water (SFW) extracts on normal isolated human T cells. An experimental study on normal human lymphocytes treated with doses SF extract doses ranging from 0.25 to 2.5 mg/ml. Untreated, vehicle-treated (Ethanol) and camptothecin (CPT) treated normal T cells were used as controls. Induction of cell death, changes in intracellular ATP, caspase-3/-7 activity and nuclear changes were analysed using flow cytometry, luminometry and nuclear staining (Hoechst) respectively. The highest concentration (2.5 mg/ml) of SFE extract induced significant necrosis (95%), depletion of ATP (76%), and inhibition of caspase-3/-7 activity (11%) following a 24 hour incubation period (p< 0.001). The 2.5 mg/ml concentration of SFW showed the same trend but were less effective (necrosis- 26%, ATP- 91%, & caspase-3/-7- 15%). These effects showed a time-dependence over 48 hours of incubation, with high doses of SFE extracts eliminating viable cells by necrosis, depleting ATP levels and decreasing caspase-3/-7 activity (p< 0.001). The activity of SFE extract was independent of ethanol. The SFW extract dilutions were less toxic than the SFE extracts. Significant DNA fragmentation as demonstrated by Hoechst staining was also seen over 48-hour incubation for high doses of both types of SF extracts. These results showed that although high concentrations of SF extracts can be toxic to normal T cells in vitro, SFW fractions were relatively safe for use.Keywords: Sutherlandia frutescens, T lymphocytes, flow cytometry, luminometry, necrosis, apoptosi

The Immunomodulatory Effects of Sutherlandia frutescens Extracts in Human Normal Peripheral Blood Mononuclear Cells

Sutherlandia frutescens (SF) is one of the medicinal plants used as an immune booster in the treatment of chronic ailments such as HIV/AIDS and cancer. Limited data suggest that its efficacy is based on its regulatory effect on cytokines, the critical components of the immune response. In this study, we investigated the in vitro immunomodulatory effects of SF extracts on normal human peripheral blood mononuclear cells (PBMCs). An ELISA-based assay was used to assess the levels of expression of 12 cytokines in treated cells. An adenosine triphosphate (ATP) assay was used to assess cell viability in relation to cytokine secretion. SF ethanol extracts induced changes in cytokine secretion relative to the dose of the extract. Generally cytokine expression and secretion was low in concentration because were not stimulated with any endotoxin. The high SFE dose (2.5 mg/ml) significantly (p<0.001) decreased some cytokines including TNF-α and IL 1β. Low doses of this extract (0.5 mg/ml) did not change TNF-α and IL 1β secretion from the baseline (untreated cells). Changes in cytokine secretion of SFE treated cells tracked changes in ATP levels (cell viability). The SFW extract-induced changes in cytokine secretion were independent of cell viability. TNF-α was decreased (p<0.001) by the high dose of SFW extract while IL 1β and IFNγ were increased (p<0.01) by the same dose. High doses decreased cell viability which was reflected in cytokine secretion. It is evident, from these results, that SF extracts can modulate cytokine secretion in unstimulated normal PBMCs in vitro. Further studies in animal models are recommended to advance understanding of this immunomodulatory activity.Keywords: immune response, Sutherlandia frutescens, cytokines, ELISA, cell viabilit

Healthcare professionals’ perception of knowledge and implementation of Patient Safety Incident Reporting and Learning guidelines in specialised care units, KwaZulu-Natal

Background. Despite the implementation of intervention strategies, incidents in specialised care units remain high and are of serious concern, worldwide. Objective. To assess the healthcare professionals’ perception of knowledge and implementation of patient safety incident (PSI) reporting and learning guidelines in specialised care units of three selected public hospitals in KwaZulu-Natal, South Africa. Methods. The study used a descriptive, cross-sectional survey design. A purposive sample targeted 237 healthcare professionals. An online structured questionnaire collected the data. Descriptive and inferential statistics were used to analyse data. Results. A total of 181 questionnaires were returned, yielding a response rate of 76%. Notably, 83% of respondents had high-perceived knowledge of the PSI reporting and learning guidelines, while 98% had low perceptions of their implementation. The current unit (p=0.002) and shift of the day (p=0.008) were factors associated with the perception of good knowledge of PSI reporting and learning guidelines, as indicated by a p-value ≤0.05. The respondents’ age (p=0.05), current unit (p=0.015), and shift of the day (p=0.000) were significantly associated with the perception of poor implementation of the PSI reporting and learning guidelines. Conclusion. The respondents demonstrated a good perception of knowledge of PSI reporting and learning guidelines; however, the perception of the implementation was poor. Therefore, a revised implementation strategy coupled with periodical in-service training for healthcare profe

RECOMMENDATIONS FOR THE DEVELOPMENT OF REGULATORY GUIDELINES FOR REGISTRATION OF TRADITIONAL MEDICINES IN SOUTH AFRICA

The regulation and registration of traditional medicines (TM) continues to present challenges to many countries regardless of the fact that an increased number of the population utilises TM for their health care needs. There have been improvements in the legal and policy framework of South Africa based on the WHO guidelines. However, there are currently no guidelines or framework for the registration of TM in South Africa. This article reviews literature and existing guidelines of specific countries and regions and makes recommendations for South African guidelines