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

Ewart's sign in tuberculous pericarditis

CITATION: Smedema, J. P., et al. 2000. Ewart's sign in tuberculous pericarditis. South African Medical Journal, 90(11):1115.The original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio

Twelve-lead electrocardiography in tuberculous pericarditis

Objectives. This study is part of an ongoing initiative started in 1995 to investigate the therapeutic efficacy of adjuvant corticosteroids in the management of tuberculosis (TB) pericarditis. In this retrospective, descriptive study we describe the changes found on the 12-lead electrocardiogram (ECG) in patients with TB pericarditis, with and without cardiac tamponade. We determined the diagnostic accuracy of ECG parameters for cardiac tamponade. Methods. All patients referred to our department with echocardiographically confirmed large pericardial effusions underwent a thorough clinical assessment followed by pericardiocentesis and drainage using an indwelling pigtail catheter. The amount of drained effusion was measured, and fluid was sent for diagnostic assessment. Patients were grouped into those with or without cardiac tamponade. The following ECG parameters were assessed: rate, rhythm, microvoltage, electrical alternans, PR segment and ST segment abnormalities. Results. Of the 157 patients assessed, 88 were diagnosed with TB pericarditis. All had abnormal ECGs and 83% had changes of chronic pericarditis. Microvoltage in the extremity and/or precordial leads Correlated with the presence of large effusions (> 750 ml). None of the studied parameters correlated with the presence of cardiac tamponade. Conclusions. Twelve-lead ECG is of supportive but not diagnostic value in cardiac tamponade. The presence of microvoltage suggests the presence of a large effusion. The absence of microvoltage makes the presence of cardiac tamponade unlikely.Articl

Antiretroviral treatment in the private sector in Namibia

Antiretroviral treatment (ART) has been available in the private sector in Namibia since 1998. National guidelines were developed by the Ministry of Health and clinicians of the public and private sector in 2003 and launched at the start of the public sector ART programme by the Ministry of Health. The Namibian HIV Clinicians Society was established around this period to promote adherence to the national guidelines and to provide comprehensive training for health professionals. To monitor adherence to national ART guidelines, in 2003, the Society requested access to anonymized data on ART dispensing from the medical insurance industry. Dispensing data from all Namibian medical insurance companies were obtained. ART regimens were categorized as recommended (non-nucleoside reverse transcriptase inhibitor-based and boosted protease inhibitor [PI]-based), not recommended (non-boosted PI-based or stavudine/didanosine-containing regimens), ineffective (dual therapy) and second line or salvage regimens. This analysis was repeated in 2004, 2005 and 2008. In 2003, only 2306 adult private patients received ART, of which only 1527 (66%) were recommended regimens. In 2008, 7010 private patients received ART, of which 6372 (91%) were recommended regimens. The private sector covered about 15% of the total number of 46,732 reported ART patients reported in the year 2008. Many of these private patients might not have accessed ART in the public sector