A preliminary investigation of the effects of labour inducing plant, Cissampelos mucronata, on the outcomes of pregnancy using rat models

BackgroundThe use of traditional remedies in pregnancy has been associated with bad obstetric outcomes including uterine rupture and foetal distress. These outcomes may ultimately lead to maternal and child mortality or morbidity. Few studies have been done to measure the effects of various herbs in pregnant women or a developing fetus. This study investigated the effects of the commonly used labour inducing plant, Cissampelos mucronata, on pregnancy outcomes using a rat model.MethodsPregnant female rats were divided into 3 groups of 10 each. The first group was the control. The second group was treated with the aqueous extract of Cissampelos mucronata at mid-pregnancy. The third group was treated with Cissampelos mucronata close to full term. All the groups were left to give birth and outcomes were recorded.ResultsRats treated at mid-term had significantly low number of pups when compared to the control group as well as the close to term treated group (4.1 ± 0.54 vs. 6.4 ± 0.60; 6.2± 0.56). The mid-term treated rats had pups with significantly lower body weight when compared to the control and the close to term treated groups (3.73 ± 0.36g vs. 5.37 ± 0.16g; 4.27 ± 0.1g). The average gestation period was significantly short in the mid-term treated group when compared to the control and the close to term treated groups (18.16 ± 0.50 days vs. 20.40 ± 0.44 days; 20.12 ± 0.37 days). There were no uterus ruptures observed in all study groups 3 days after delivery.ConclusionAdministration of Cissampelos mucronata during pregnancy leads to early induction of labour

Herbal aphrodisiac use among male adolescents and teenagers in a rural area of Blantyre district, Malawi

Background: This study was carried out to investigate traditional herbal aphrodisiacs use among teenagers and adolescents in Blantyre rural, Malawi.Methods: The study was carried out in villages under Traditional Authority Kuntaja in Blantyre rural, Malawi. A total of 212 teenagers and adolescents participated in this study. A structured questionnaire was administered to participants for data collection.Results: The study found that 65% of the teenagers and adolescents who took part in this study were using traditional herbal aphrodisiacs. Most of them were introduced to aphrodisiacs use by their friends.Conclusions: This study has shown that many adolescents and teenagers are using traditional herbal aphrodisiacs and that the prescription is not done by an experienced traditional healer. Therefore there is need to sensitize the youths on proper ways of using these herbal medicines.

Incidence and impact of hyperviscosity on sperm parameters of Malawian men seeking assisted reproduction

Background: Seminal hyperviscosity has been shown to be associated with male infertility. The aim of this study was to assess the prevalence of hyperviscosity in semen of Malawian males seeking infertility treatment. Methods: A total of 120 men visiting our laboratory for fertility assessment donated semen samples. The semen samples were assessed for hyperviscosity, volume, concentration, total motility, progressive motility, viability, and morphology. Results: Out of the 120 samples analyzed, 34 samples were hyperviscous representing 28.3%. No significant statistical differ-ence in semen volume between samples with normal viscosity compared to those with hyperviscosity (p>0.05). Sperm concen-tration, progressive motility, total motility, viability, and normal morphology were significantly higher in the normal viscosity group when compared to the abnormal viscocity group (p<0.05). Conclusion: Hyperviscosity affects a significant number of men in Malawi and may be the cause of decreased fertility as it was associated with poor sperm concentration, total motility, progressive motility, viability, and morphology

Management of Reduced Bone Mineral Density in HIV: Pharmacological Challenges and the Role of Exercise

Low bone mineral density is becoming more common among people living with HIV following the use of current antiretroviral therapy drugs such as tenofovir. Although pharmacological therapies used to treat low bone mineral density are associated with adverse effects and may increase the pill burden in people living with HIV who are already burdened by antiretroviral therapy drugs, non-pharmacological strategies to prevent and treat reduced bone mineral density resulting from antiretroviral therapy drugs in people living with HIV have not been fully explored. Despite evidence that exercise is effective in increasing bone mineral density, effects of exercise on low bone mineral density resulting from antiretroviral therapy drugs in HIV infected individuals are still unknown. This review highlights gaps in the strategies used to manage reduced bone mineral density resulting from antiretroviral therapy drugs and focuses on exercise as an alternative or adjunctive strategy

EVALUATION OF THE HYPOGLYCAEMIC POTENTIAL OF KIGELIA AFRICANA FRUIT POWDER BEING SOLD IN MALAWIAN RETAIL PHARMACIES

Background: Kigelia africana fruit powder is being sold in Malawian retail pharmacies for the purported purpose of lowering blood sugar in diabetic patients when there is scant data on its hypoglycaemic activity. This study was aimed at evaluating the hypoglycaemic potential of the Kigelia africana fruit powder being sold in Malawian retail pharmacies. Materials and Methods: Hyperglycaemia was induced in rats via intra-peritoneal injection of dexamethasone. Albino rats were randomly allocated into five different groups of eight rats each. Group 1 consisted of non-hyperglycaemic rats receiving no treatment, group 2 consisted of hyperglycaemic rats receiving no treatment, group 3 consisted of hyperglycaemic rats receiving 25mg/kg of metformin, group 4 consisted of hyperglycaemic rats receiving 0.5mL of Kigelia africana fruit powder filtered solution, and group 5 consisted of hyperglycaemic rats receiving 1mL of Kigelia africana fruit powder solution. Results: The Kigelia africana fruit powder filtered solution administered to hyperglycaemic albino rats significantly lowered the sugar level which was comparable to the reduction caused by the pharmacological drug, metformin. Conclusions: Kigelia africana fruit powder has the potential of lowering glucose levels in white albino rats

Male Genital Schistosomiasis Along the Shoreline of Lake Malawi: Baseline Prevalence and Associated Knowledge, Attitudes and Practices Among Local Fishermen in Mangochi District, Malawi

Male genital schistosomiasis (MGS) is an often-overlooked chronic consequence of urogenital schistosomiasis (UGS) associated with Schistosoma haematobium eggs and associated pathologies in the genital system of afflicted men . Despite the first formal description of MGS in 1911 by Madden , its epidemiology, diagnostic testing and case management of today are not well described. However, since several interactions between MGS and the human immunodeficiency virus (HIV) are known, , there is renewed public health interest in MGS across sub-Saharan Africa (SSA). To shed new light upon MGS in Malawi, a longitudinal cohort study was set up among fishermen along the southern shoreline of Lake Malawi in Mangochi District, Malawi. to document its prevalence and assess mens’ knowledge, attitudes and practices (KAP) towards this disease. After providing informed written consent, fishermen (n=376) aged 18+ years (median age: 30 years, range: 18-70 years) were recruited and submitted urine and semen for point-of-care (POC) field and laboratory diagnostic parasitological tests. Individual questionnaires were administered to assess their KAP,. with praziquantel (PZQ) treatment provided to all participants. Baseline prevalence of MGS (S. haematobium eggs in semen) was 10.4% (n = 114, median: 5.0, range: 0.1 – 30.0) while for UGS (S. haematobium eggs in urine) was 17.1% (n = 210, median: 2.3 per 10 ml, range: 0.1 – 186.0) and3.8% were positive by POC circulating cathodic antigen (POC-CCA), indicative of a Schistosoma mansoni infectionJust under 10% of participants reported having experienced symptoms associated with MGS, namely genital or coital pain, or haemospermia. A total of 61.7% reported previous difficulties in accessing PZQ therapy, with 34.8% having received PZQ therapy before. There was a significant correlation between MGS infection and the frequency of fishing in a week (rho = - 0.25, n = 100, p = 0.01) In conclusion, MGS is prevalent among local fishermen yet knowledge of the disease is poor. We therefore call for improved availability and accessibility to MGS diagnostics, PZQ treatment within ongoing control interventions to improve the lives and reproductive health of men, their partners and communities in this shoreline environment of Lake Malawi

Molecular Epidemiological Characterisation of ESBL- and Plasmid-Mediated AmpC-Producing Escherichia coli and Klebsiella pneumoniae at Kamuzu Central Hospital, Lilongwe, Malawi

The global rise in infections caused by multidrug resistant (MDR) Enterobacterales poses a public health problem. We have performed a molecular epidemiological characterisation of representative plasmid-mediated AmpC (pAmpC) and ESBL-positive clinical isolates of Escherichia coli (n = 38) and Klebsiella pneumoniae (n = 17) from a tertiary hospital in Malawi collected in 2017. BlaCTX-M-15 was the most prevalent ESBL-determinant in E. coli (n = 30/38) and K. pneumoniae (n = 17/17), whereas blaCMY-2 was detected in nearly all AmpC-phenotype E. coli (n = 15/17). Whole genome sequencing revealed dominant globally disseminated E. coli sequence types (STs); ST410 (n = 16), ST131 (n = 7), and ST617 (n = 6). The ST distribution in K. pneumoniae was more diverse but included ST101 (n = 2), ST14 (n = 2), and ST340 (n = 2), all considered high-risk MDR clones. The isolates expressed an MDR profile, including resistance against commonly used antibiotics, such as fluoroquinolones, aminoglycosides, and/or trimethoprim-sulfamethoxazole, and harboured corresponding resistance determinants. Clonal analyses of the major STs of E. coli revealed closely related genetic clusters within ST410, ST131, and ST617 supporting within-hospital transmission between patients and/or via a common reservoir. The overall findings add to the limited knowledge on the molecular epidemiology of MDR E. coli and K. pneumoniae in Malawi and may help health policy makers to identify areas to target when addressing this major threat of antibiotic resistance

Pathological Abnormalities Observed on Ultrasonography among Fishermen Associated with Male Genital Schistosomiasis (MGS) along the South Lake Malawi Shoreline in Mangochi District, Malawi

Schistosome eggs cause granulomata and pathological abnormalities, detectable with non-invasive radiological techniques such as ultrasonography which could be useful in male genital schistosomiasis (MGS). As part of our novel MGS study among fishermen along Lake Malawi, we describe pathologies observed on ultrasonography and praziquantel (PZQ) treatment over time. Fishermen aged 18+ years were recruited, submitted urine and semen for parasitological and molecular testing, and thereafter, transabdominal pelvic and scrotal ultrasonography, assessing pathologies in the prostate, seminal vesicles, epididymis and testes. Standard PZQ treatment and follow-up invitation at 1-, 3-, 6- and 12-months’ time-points were offered. A total of 130 recruited fishermen underwent ultrasonography at baseline (median age: 32.0 years); 27 (20.9%, n = 129) had S. haematobium eggs in urine (median: 1.0 egg/10 mL), 10 (12.3%, n = 81) in semen (defined as MGS, median: 2.9 eggs/mL ejaculate) and 16 (28.1%, n = 57) had a positive seminal Schistosoma real-time PCR. At baseline, 9 fishermen (6.9%, n = 130) had abnormalities, with 2 positive MGS having prostatic and testicular nodules. Fewer abnormalities were observed on follow-up. In conclusion, pathologies detected in male genitalia by ultrasonography can describe MGS morbidity in those with positive parasitological and molecular findings. Ultrasonography advances and accessibility in endemic areas can support monitoring of pathologies’ resolution after treatment

Detection of male genital schistosomiasis (MGS) by real-time TaqMan® PCR analysis of semen from fishermen along the southern shoreline of Lake Malawi

Background Male genital schistosomiasis (MGS) is an underappreciated complication of schistosomiasis, first described in 1911. However, its epidemiology, diagnostic testing and case management are not well understood in sub-Saharan Africa. To shed new light on MGS prevalence in Malawi, a longitudinal cohort study was conducted among adult fishermen along the southern shoreline of Lake Malawi using detection of schistosome DNA in participants’ semen by real-time TaqMan® PCR analyses. Methods Upon recruitment of 376 participants, 210 submitted urine samples and 114 semen samples for parasitological tests. Thereafter, the available semen samples were subsequently analysed by real-time TaqMan® PCR. Praziquantel (PZQ) treatment was provided to all participants with follow-ups attempted at 1, 3, 6 and 12-months’ intervals. Results At baseline, real-time PCR detected a higher MGS cohort prevalence of 26.6% (n = 64, Ct-value range: 18.9–37.4), compared to 10.4% by semen microscopy. In total, 21.9% of participants (n = 114) were detected with MGS either by semen microscopy and/or by real-time PCR. Subsequent analyses at 1-, 3-, 6- and 12-month follow-ups indicated variable detection dynamics. Conclusions This first application of a molecular method, to detect MGS in sub-Saharan Africa, highlights the need for development of such molecular diagnostic tests which should be affordable and locally accessible. Our investigation also notes the persistence of MGS over a calendar year despite praziquantel treatment

A systematic review with epidemiological update of male genital schistosomiasis (MGS): A call for integrated case management across the health system in sub-Saharan Africa.

Male genital schistosomiasis (MGS) is a gender specific manifestation of urogenital schistosomiasis (UGS) first described in 1911 by Madden in Egypt. Today, while affecting millions of men and boys worldwide, MGS receives insufficient attention, especially in sub-Saharan Africa (SSA). To provide a systematic review with an epidemiological update of MGS, we inspected both online and hardcopy resources in our appraisal. A total of 147 articles were eventually identified, only 31 articles were exclusively focused on MGS with original or targeted research. From these, we discuss pertinent clinico-pathological features of MGS, highlight the possible connection and interplay with HIV, and assess current diagnostic techniques alongside consideration of their use and application in SSA. To appreciate the burden of MGS more fully, especially in endemic areas, there is a clear need for better surveillance and longitudinal population research to investigate the best point-of-care (POC) diagnostic and its performance through time. Furthermore, to optimise individual case management, exploration of alternative praziquantel dosing regimens is needed for MGS in men with or without HIV co-infection