Concurrent use of traditional medicine and prescribed antibiotics and/or antiviral medicines and their effects on antimicrobial resistance and treatment failure in Ilembe district, Kwazulu-Natal province, South Africa.

Masters Degree. University of KwaZulu-Natal, Westville.Background: Traditional herbal mixtures are generally available, affordable and commonly utilized in developing and developed countries and usually utilized as self-care treatments. However, its incorrect use can lead to fatal outcomes. Antimicrobial resistance (AMR) is driven by many factors such as the careless use of prescribed antimicrobial medicines and the use of traditional medicine, with the result that there is always the danger of misadministration, interaction, and toxicity. AMR is also considered as the major cause of treatment failure and is largely responsible for the declining in eradication rates of infectious diseases worldwide. Individuals may consult both traditional healer practitioners (THPs) and biomedically trained healthcare professionals (BHPs) for the treatment of their bacterial and viral infections. This study aimed at determining whether any antimicrobial resistance and treatment failure could occur among patients, attending outpatient departments of selected healthcare facilities, who used concurrently prescribed antimicrobial medicines and traditional medicine in the Ilembe district, South Africa Methods: This study was a cross-sectional descriptive study using a mixed method approach. First phase was a qualitative study using an interview face to face with a questionnaire. One hundred and thirty two respondents were included with four (4) types of participants: Traditional health practitioners (THPs), Patients seen by THPs, biomedically healthcare professionals (BHPs) and outpatients. Second phase was a quantitative study using a medical chart review of 400 patients’ medical records and who attended the outpatient department in two public healthcare facilities between February and March 2018. Antimicrobials prescribed alone or in association with other medicines and concurrent use of traditional medicine were assessed and reported using descriptive statistics. Where applicable, associations were carried out; a p-value ˂0.05 was estimated as statistically significant. Results: This study found a small number of medicinal plants used by traditional healer practitioners for treating infectious diseases of patients seen by them. The majority of traditional healer practitioners and their patients (21/32, 65.62%) mixed different herbs for the treatment of infectious diseases. Traditional healer practitioners and patients seen by them agreed that the combination of both traditional medicines and prescribed medicines for infectious diseases may lead to interactions, adverse effects; infectious diseases may get worse if the time lapses between the two medicines do not exist. However, biomedically healthcare professionals and outpatients reported that combing traditional with prescribed medicines for infectious diseases may result in drug resistance, especially resistance to antibiotics and they highlighted that the majority of XV patients came to the clinic with several complications such as kidney failure, vomiting, diarrhoea and jaundice after using either TM alone or in combination with prescribed medicines. Besides the perception phase of this study, 400 outpatients’ medical records were documented from two different municipalities, many participants had viral infections (194/400, 48.50%). Overall, 12% of participants (48/400) had documented negative clinical outcomes with adverse effects (30/48) and interactions (18/48). A few participants (15/400, 3.75%) had used traditional medicine in conjunction with prescribed medicines. Among those who used both traditional medicine and prescribed medicines, the majority (80%, 12/15) had documented adverse effects due to the concurrent use of traditional medicine and prescribed medicines. After adjustment, documented adverse effects and interactions were significantly more likely due to the use of traditional medicine (AOR = 0.01, 95% CI = 0.001-0.05) and (AOR = 0.21, 95% CI = 0.37-1.23) respectively. Conclusion: From perceptions stated by respondents in this study, the concurrent use of conventional and traditional herbal medicines may interfere or result in damaging some organs, failure of therapeutic effects and modification of pharmacological actions of administered medicines. Traditional medicine was sparingly used in conjunction with prescribed antimicrobials for viral and bacterial/fungal infectious diseases. However, adverse effects and interactions such as herbal intoxication, persistent rashes, and treatment failure were documented in few medical chart records among outpatients attending the two selected healthcare facilities. Further studies are needed to investigate the effects of concurrent use of traditional medicine and prescribed medicines in other parts of South Africa

Evaluation of concomitant use of prescribed antimicrobial medicines with traditional medicines in iLembe District, South Africa: A medical chart review

AbstractBackground: Antimicrobial resistance in South Africa is driven by many factors, such as the careless use of prescribed antimicrobial medicines and the use of traditional medicines, with the result that there is always the danger of misadministration, interaction, and toxicity. This study was conducted in two different public healthcare facilities in iLembe District, KwaZulu-Natal Province, South Africa to determine whether any interaction occurred among patients attending outpatient departments in selected healthcare facilities in terms of the concurrent use of traditional medicines and prescribed antimicrobial medicines. Methods: This study was a cross-sectional descriptive study using medical chart reviews. Antimicrobials prescribed alone or in association with traditional medicines were assessed and reported using descriptive statistics. Where applicable, associations were carried out; a p-value ˂0.05 was estimated as statistically significant. Results: A total of 400 outpatients’ medical records were documented from two different municipalities, revealing that many participants had viral infections (194/400, 48.5%). Overall, 12% of participants (48/400) had documented adverse effects (30/48) and interactions (18/48). A few participants (15/400) used traditional medicines in conjunction with prescribed medicines. After adjustment, negative clinical outcomes namely adverse effects and interactions were significantly more likely due to the use of traditional medicines (AOR=0.01, 95% CI:0.001-0.05) and (AOR=0.21, 95% CI: 0.37-1.23), respectively. Conclusions: Traditional medicine was used sparingly in conjunction with prescribed antimicrobials for infectious diseases. However, adverse effects and interactions, such as herbal intoxication, persistent rashes, and treatment failure, were documented in a few medical records. Further studies are needed to investigate the effects of the concurrent use of traditional medicine with antimicrobials or other prescribed medicines from the perspectives of traditional healers and biomedically healthcare professionals. [Ethiop. J. Health Dev. 2021; 35(1):58-71] Key words: Concomitant use, prescribed antimicrobials, traditional medicine, antimicrobial resistance, treatment failure, adverse effect

Evidence on collaboration of traditional and biomedical practitioners in the management of antimicrobial resistance in sub-Saharan Africa over 15 years : a systematic review protocol

BACKGROUND : The overuse of prescribed antimicrobials, concurrent use of traditional medicine, and prescribed antimicrobials have led to antimicrobial resistance. The absence of collaboration between traditional health practitioners and biomedically trained healthcare professionals can contribute to antimicrobial resistance, treatment failure, overdose, toxicity, and misadministration. This scoping review explores the evidence on collaboration between traditional health practitioners and biomedically trained healthcare professionals to reduce antimicrobial resistance and treatment failure in bacterial and viral diseases. METHODS : We will search for electronic databases such as Science Direct, Google Scholar, PubMed, and MEDLINE via EBSCOhost. We will also search reference lists of included studies. A two-stage mapping procedure will be carried out. Stage one (1) will consist of the title, abstracts, and full article screening, respectively. A pilot screening form guided by the defined eligibility criteria will be used. In stage two (2), data will be extracted from the included studies. Two reviewers will conduct parallel screening and data extraction. Mixed methods appraisal tool (MMAT) will be used to assess the quality of the included studies. NVIVO version 11 will be employed to aid pertinent thematic analysis. The outcomes of interest will be as follows: Primary outcome will be preventing and reducing antimicrobial resistance. The secondary effect is the effective collaboration between traditional healthcare practitioners and biomedically healthcare professionals. DISCUSSION : This review anticipates uncovering pertinent publications reporting the evidence of collaboration between traditional health practitioners and biomedically trained healthcare professionals to reduce antimicrobial resistance in sub-Saharan Africa. The sum-up of evidence acquired from the included studies will help guide future research. The result of the study will be print and electronically exposed.http://www.systematicreviewsjournal.comdm2022School of Health Systems and Public Health (SHSPH