Evaluation of medicinal potential of Boophone disticha (L.f.) Herb. used by the indigenous people in the Raymond Mhlaba Municipality Eastern Cape

Boophone disticha (L.f.) Herb. is a bulbous plant native to southern African areas of the continent and spreads to tropical Africa. The plant has been noted in literature for its high toxicity and has a long lineage of its use in traditional medicine for the treatment of various diseases. Due to high demand in the conventional trade market, the plant's conservation status has been shown to be declining. The plant has been reported to cause human poisoning, which can lead to death, but the plant is still administered by an indigenous community to treat various diseases. This study investigated the therapeutic potential of B. disticha used by the people of Raymond Mhlaba municipality to show and verify its use in traditional medicine and how it can be used as a possible drug ingredient. This study was also set out to investigate the anti-mycobacterial activity of the plant for the first time for the B. disticha growing in the Eastern Cape region of South Africa. The phytochemical analysis of B. disticha was carried out on four different plant parts (i.e., roots, leaves, bulb inner and outer scales) and the plant was extracted using methanol and distilled water. The qualitative phytochemical analysis displayed the presence of tannins, flavonoids, phenols and alkaloids in all plant parts for both extraction solvents. Anthraquinones were absent in all the plant extracts. The detected phytochemicals (tannins, flavonoids, phenols and alkaloids) were quantified. The roots had the highest phytochemical content for methanol extract for each phytochemical tested [439.67±1.53 mg/g (QE) flavonoids, 2414.67±1.53 mg/g (GAE) phenols and 527.33±2.08 mg/g (GAE) alkaloids] compared to all the plant parts. Methanol extracts from B. disticha revealed highest phenolic contents (2414.67±1.53 mg/g GAE) for the roots, 1395.33±2.52 mg/g (GAE) for the bulb inner scales, 1560±1 mg/g (GAE) for the leaves and 1550.7±18.9 mg/g (GAE) for the bulb outer scales). The total flavonoid content of the bulb outer scales aqueous extract was not detected. The presence of significant amounts of phytochemical compounds indicates that B. disticha has a higher medicinal value and can be extensively investigated to extract bioactive ingredients that are useful to the society, and that could be sold for higher production than using synthetic drugs with side effects. The antimicrobial activity of B. disticha extracts (methanol and distilled water) was evaluated using micro-dilution bioassay in 96-well micro-plates against nine disease-causing bacterial strains (5 Gram-negative and 4 Gram-positive) and three fungal isolates. The results revealed that methanol and aqueous extract of B. disticha demonstrated very good activity, with Gram-positive strains being more sensitive than Gram-negative ones. Boophone disticha aqueous extracts displayed the best activity against Staphylococcus aureus with MIC and MBC values ranging from 0.39 to 0.78 mg/ml. The methanolic extract of B. disticha leaves and outer scales of bulb displayed good activity against Klebsiella pneumoniae at MIC 0.78 mg/ml. The methanolic extract of B. disticha bulb outer scales also displayed good inhibition against Proteus vulgaris at MIC 0.78 mg/ml, with the root extract exhibiting activity against Shigella flexineri (MIC value of 0.078 mg/ml). Concerning antifungal activity, B. disticha extracts showed very poor inhibition properties against the fungal isolates. Anti-mycobacterium potential of B. disticha extracts (methanol and distilled water) was evaluated using micro-dilution bioassay in 96-well microtiter plates. The plant parts tested were the roots, bulb inner scales, leaves and the bulb outer scales. The highest activity against Mycobacterium tuberculosis was observed with the root methanol extract at MIC 0.78 mg/ml. The anti-inflammatory properties of B. disticha were investigated using the 5-lypoxygenase (5- LOX) assay. The overall anti-inflammatory activity results for the B. disticha extracts were poor; at low concentrations, the plant displayed negative results. The leaves methanol extracts did show little activity at 0.4 mg/ml.Thesis (MSc) (Botany) -- University of Fort Hare, 202

Evaluation of medicinal potential of Boophone disticha (L.f.) Herb. used by the indigenous people in the Raymond Mhlaba Municipality Eastern Cape

Boophone disticha (L.f.) Herb. is a bulbous plant native to southern African areas of the continent and spreads to tropical Africa. The plant has been noted in literature for its high toxicity and has a long lineage of its use in traditional medicine for the treatment of various diseases. Due to high demand in the conventional trade market, the plant's conservation status has been shown to be declining. The plant has been reported to cause human poisoning, which can lead to death, but the plant is still administered by an indigenous community to treat various diseases. This study investigated the therapeutic potential of B. disticha used by the people of Raymond Mhlaba municipality to show and verify its use in traditional medicine and how it can be used as a possible drug ingredient. This study was also set out to investigate the anti-mycobacterial activity of the plant for the first time for the B. disticha growing in the Eastern Cape region of South Africa. The phytochemical analysis of B. disticha was carried out on four different plant parts (i.e., roots, leaves, bulb inner and outer scales) and the plant was extracted using methanol and distilled water. The qualitative phytochemical analysis displayed the presence of tannins, flavonoids, phenols and alkaloids in all plant parts for both extraction solvents. Anthraquinones were absent in all the plant extracts. The detected phytochemicals (tannins, flavonoids, phenols and alkaloids) were quantified. The roots had the highest phytochemical content for methanol extract for each phytochemical tested [439.67±1.53 mg/g (QE) flavonoids, 2414.67±1.53 mg/g (GAE) phenols and 527.33±2.08 mg/g (GAE) alkaloids] compared to all the plant parts. Methanol extracts from B. disticha revealed highest phenolic contents (2414.67±1.53 mg/g GAE) for the roots, 1395.33±2.52 mg/g (GAE) for the bulb inner scales, 1560±1 mg/g (GAE) for the leaves and 1550.7±18.9 mg/g (GAE) for the bulb outer scales). The total flavonoid content of the bulb outer scales aqueous extract was not detected. The presence of significant amounts of phytochemical compounds indicates that B. disticha has a higher medicinal value and can be extensively investigated to extract bioactive ingredients that are useful to the society, and that could be sold for higher production than using synthetic drugs with side effects. The antimicrobial activity of B. disticha extracts (methanol and distilled water) was evaluated using micro-dilution bioassay in 96-well micro-plates against nine disease-causing bacterial strains (5 Gram-negative and 4 Gram-positive) and three fungal isolates. The results revealed that methanol and aqueous extract of B. disticha demonstrated very good activity, with Gram-positive strains being more sensitive than Gram-negative ones. Boophone disticha aqueous extracts displayed the best activity against Staphylococcus aureus with MIC and MBC values ranging from 0.39 to 0.78 mg/ml. The methanolic extract of B. disticha leaves and outer scales of bulb displayed good activity against Klebsiella pneumoniae at MIC 0.78 mg/ml. The methanolic extract of B. disticha bulb outer scales also displayed good inhibition against Proteus vulgaris at MIC 0.78 mg/ml, with the root extract exhibiting activity against Shigella flexineri (MIC value of 0.078 mg/ml). Concerning antifungal activity, B. disticha extracts showed very poor inhibition properties against the fungal isolates. Anti-mycobacterium potential of B. disticha extracts (methanol and distilled water) was evaluated using micro-dilution bioassay in 96-well microtiter plates. The plant parts tested were the roots, bulb inner scales, leaves and the bulb outer scales. The highest activity against Mycobacterium tuberculosis was observed with the root methanol extract at MIC 0.78 mg/ml. The anti-inflammatory properties of B. disticha were investigated using the 5-lypoxygenase (5- LOX) assay. The overall anti-inflammatory activity results for the B. disticha extracts were poor; at low concentrations, the plant displayed negative results. The leaves methanol extracts did show little activity at 0.4 mg/ml.Thesis (MSc) (Botany) -- University of Fort Hare, 202

Service delivery challenges : King Sabata Dalindyebo local municipality : Mthatha

This study aims to achieve the following four research objectives: - To investigate the challenges that led to the KSDLM experiencing poor municipal service delivery, and its constraints to effective implementation of the IDP. - To develop and propose effective strategies for the continuous improvement of service delivery and good governance in KSDLM with specific reference to the town of Mthatha. - To reveal counterproductive variances between legislation and governance instruments crafted by the municipality which may, as a result of misinterpretation, result in distortions in carrying out the Constitutional mandate. - To work towards achieving conclusive findings to assist political office-bearers at national and provincial sphere to formulate legislation to promote the local government’s effectiveness and efficiency

Implementer and recipient perspectives of community-wide mass drug administration for soil-transmitted helminths in Kwale County, Kenya.

Soil-transmitted helminthiases (STH) are one of 17 neglected tropical diseases (NTDs) earmarked for control or elimination by 2020 in the WHO's Roadmap on NTDs. Deworming programs for STH have thus far been focused on treating pre-school and school-aged children; however, there is a growing consensus that to achieve elimination of STH transmission, programs must also target adults, potentially through community-wide mass drug administration (MDA). There is currently a gap in the literature on what components are required to deliver community-wide MDA for STH in order to achieve high intervention reach and uptake. Nested within the TUMIKIA Project, a cluster randomized trial in Kenya evaluating the effectiveness of school-based deworming versus community-wide MDA, we collected qualitative data from program implementers and recipients in eight clusters where community-wide MDA was delivered. Data collection included semi-structured in-depth interviews (n = 72) and focus group discussions (n = 32). A conceptual framework for drug distribution was constructed to help build an analysis codebook. Case memos were developed for each top-level theme. Community-wide MDA for STH was perceived as a complex intervention with key administrative and social mobilization domains. Key actionable themes included: (1) developing an efficient strategy to allocate reasonable workload for implementers to cover all targeted households; (2) maximizing community drug distributors' motivation through promoting belief in the effectiveness of the intervention and providing sufficient financial incentives; (3) developing effective capacity building strategies for implementers; and (4) implementing a context-adapted community engagement strategy that leverages existing community structures and takes into consideration past community experiences of MDAs. Transitioning from STH control to elimination goals requires significant planning and action to ensure community-wide MDA is delivered with sufficient reach and uptake. We present findings that can inform national deworming programs to increase intervention delivery capacity

Participatory development of a target policy profile to support soil-transmitted helminth elimination

IntroductionSoil-transmitted helminths (STH) are parasitic worms that infect nearly a quarter of the world's population, particularly those living in communities without access to adequate water, sanitation, and housing. Emerging evidence suggests that it may be possible to interrupt transmission of STH by deworming individuals of all ages via community-wide MDA (cMDA), as opposed to only treating children and other focal populations. Transitioning from a policy of STH control to STH elimination in targeted areas would require a fundamental shift in STH policy and programming. This policy change would require updated guidance to support countries as they adapt their current approaches for STH surveillance, supply chain management, community mobilization, and core programmatic activities in pursuit of STH elimination. There is an opportunity to engage with key stakeholders, such as program implementers and implementation partners, to understand what evidence they need to confidently adopt a new policy guideline and to deliver guideline adherent management at scale.MethodsWe aimed to engage with STH stakeholders to develop a Target Policy Profile (TPoP), a single document that describes optimal characteristics and evidence requirements that STH stakeholders prioritized in future potential STH transmission interruption efforts. Steps in TPoP development included a scoping review and key informant interviews (KIIs), which were used to design a two-stage Delphi technique to identify and verify TPoP components.ResultsThe scoping review resulted in 25 articles, and 8 experts participated in KII's. Twenty respondents completed the first Delphi survey and 10 respondents completed the second. This systematic effort resulted in a net of 3 key information domains (background/context, clinical considerations, and implementation considerations) encompassing 24 evidence categories (examples include evidence regarding safety and adverse events, implementation feasibility, or evidence dissemination). For each evidence category, STH stakeholders reviewed, endorsed, or revised a range of options for how the evidence could be presented.DiscussionThis information can be used by guideline committees or global policy makers prior to convening guideline advisory groups. The TPoP tool may also speed the process of stakeholder consensus building around guidelines, accelerating progress towards implementing evidence-based policy at scale

Development and application of an electronic treatment register: a system for enumerating populations and monitoring treatment during mass drug administration.

We developed an electronic treatment register for the DeWorm3 Project, a cluster-randomised, controlled trial in Benin, India, and Malawi testing the feasibility of interrupting transmission of soil-transmitted helminths through community-wide mass drug administration. The electronic treatment register was designed in xlsform, deployed via the SurveyCTO mobile data collection platform, and implemented on smartphones running the Android operating system. The versatile system enables collection of census and treatment status information, facilitates data aggregation and visualisation, and permits real-time feedback loops during implementation of mass drug administration. Here we describe the system's design and use within the DeWorm3 Project and key features, and by sharing the register here, we hope our readers will further explore its use within their research and disease-control activities

Interrupting transmission of soil-transmitted helminths : a study protocol for cluster randomised trials evaluating alternative treatment strategies and delivery systems in Kenya

Introduction: In recent years, an unprecedented emphasis has been given to the control of neglected tropical diseases, including soil-transmitted helminths (STHs). The mainstay of STH control is school-based deworming (SBD), but mathematical modelling has shown that in all but very low transmission settings, SBD is unlikely to interrupt transmission, and that new treatment strategies are required. This study seeks to answer the question: is it possible to interrupt the transmission of STH, and, if so, what is the most costeffective treatment strategy and delivery system to achieve this goal? Methods and analysis: Two cluster randomised trials are being implemented in contrasting settings in Kenya. The interventions are annual mass anthelmintic treatment delivered to preschool- and school-aged children, as part of a national SBD programme, or to entire communities, delivered by community health workers. Allocation to study group is by cluster, using predefined units used in public health provision—termed community units (CUs). CUs are randomised to one of three groups: receiving either (1) annual SBD; (2) annual community-based deworming (CBD); or (3) biannual CBD. The primary outcome measure is the prevalence of hookworm infection, assessed by four cross-sectional surveys. Secondary outcomes are prevalence of Ascaris lumbricoides and Trichuris trichiura, intensity of species infections and treatment coverage. Costs and cost-effectiveness will be evaluated. Among a random subsample of participants, worm burden and proportion of unfertilised eggs will be assessed longitudinally. A nested process evaluation, using semistructured interviews, focus group discussions and a stakeholder analysis, will investigate the community acceptability, feasibility and scale-up of each delivery system. Ethics and dissemination: Study protocols have been reviewed and approved by the ethics committees of the Kenya Medical Research Institute and National Ethics Review Committee, and London School of Hygiene and Tropical Medicine. The study has a dedicated web site. Trial registration number: NCT0239777

Structural readiness to implement community-wide mass drug administration programs for soil-transmitted helminth elimination: results from a three-country hybrid study

BACKGROUND: Current soil-transmitted helminth (STH) control programs target pre-school and school-age children with mass drug administration (MDA) of deworming medications, reducing morbidity without interrupting ongoing transmission. However, evidence suggests that STH elimination may be possible if MDA is delivered to all community members. Such a change to the STH standard-of-care would require substantial systems redesign. We measured baseline structural readiness to launch community-wide MDA for STH in Benin, India, and Malawi. METHODS: After field piloting and adaptation, the structural readiness survey included two constructs: Organizational Readiness for Implementing Change and Organizational Capacity for Change. Sub-constructs of organizational readiness include change commitment and change efficacy. Sub-constructs of organizational capacity include flexibility, organizational structure, and demonstrated capacity. Survey items were also separately organized into seven implementation domains. Surveys were administered to policymakers, mid-level managers, and implementers in each country using a five-point Likert scale. Item, sub-construct, construct, and domain-level medians and interquartile ranges were calculated for each stakeholder level within each country. RESULTS: Median organizational readiness for change scores were highest in Malawi (5.0 for all stakeholder groups). In India, scores were 5.0, 4.0, and 5.0 while in Benin, scores were 4.0, 3.0, and 4.0 for policymakers, mid-level managers, and implementers, respectively. Median change commitment was equal to or higher than median change efficacy across all countries and stakeholder groups. Median organizational capacity for change was highest in India, with a median of 4.5 for policymakers and mid-level managers and 5.0 for implementers. In Malawi, the median capacity was 4.0 for policymakers and implementers, and 3.5 for mid-level managers. In Benin, the median capacity was 4.0 for policymakers and 3.0 for mid-level managers and implementers. Median sub-construct scores varied by stakeholder and country. Across countries, items reflective of the implementation domain 'policy environment' were highest while items reflective of the 'human resource' domain were consistently lower. CONCLUSION: Across all countries, stakeholders valued community-wide MDA for STH but had less confidence in their collective ability to effectively implement it. Perceived capacity varied by stakeholder group, highlighting the importance of accounting for multi-level stakeholder perspectives when determining organizational preparedness to launch new public health initiatives. TRIAL REGISTRATION: NCT03014167

Understanding factors influencing home pregnancy test use among women in western Kenya: A qualitative analysis

BackgroundThere are limited data on home pregnancy test use among women in low-and-middle-income countries. A prior survey found that only 20% of women in western Kenya used a home pregnancy test to confirm their pregnancies before going to antenatal care. This qualitative study aims to understand why women do not use home pregnancy tests in early pregnancy.MethodsFrom April 2021 to July 2021, we interviewed women from four antenatal care clinics in Homa Bay and Siaya counties. We recruited women previously enrolled in the PrEP Implementation for Mothers in Antenatal care (PrIMA) study, a cluster-randomized trial that evaluated the best approaches to implementing PrEP in maternal and child health clinics in Western Kenya (NCT03070600). Interviews were conducted via phone, audio recorded, translated, and transcribed verbatim. We coded and analyzed the transcripts to capture factors influencing women's capability, opportunity, and motivation to use home pregnancy tests.ResultsWe conducted 48 semistructured interviews with women aged 21–42 years. Twenty-seven women did not use a home pregnancy test in their most recent pregnancy. Seventeen of these women reported not using a home pregnancy test before. Lack of knowledge, mistrust in the accuracy of tests, preferring to rely on signs and symptoms of pregnancy or get a test from the health facility, cost, and accessibility were key barriers to home pregnancy test use.ConclusionImproving the uptake of home pregnancy testing during early pregnancy will require efforts to enhance community knowledge of test use and associated benefits and reduce cost burdens by making tests more affordable and accessible