Traditional Medicinal Uses, Phytoconstituents, Bioactivities, and Toxicities of Erythrina abyssinica Lam. ex DC. (Fabaceae): A Systematic Review

Background. Many studies have been undertaken on the medicinal values of Erythrina abyssinica Lam. ex DC. (Fabaceae). The details, however, are highly fragmented in different journals, libraries, and other publication media. This study was therefore conducted to provide a comprehensive report on its ethnobotany, ethnomedicinal uses, phytochemicals, and the available pharmacological evidence supporting its efficacy and safety in traditional medicine. Method. We collected data using a PROSPERO registered systematic review protocol on the ethnobotany, phytochemistry, and ethnopharmacology of Erythrina abyssinica from 132 reports that were retrieved from electronic databases. Documented local names, morphology, growth habit and habitat, ethnomedicinal and nonmedicinal uses, diseases treated, parts used, method of preparation and administration, extraction and chemical identity of isolated compounds, and efficacy and toxicity of extracts and isolated compounds were captured. Numerical data were summarized into means, percentages, and frequencies and presented as graphs and tables. Results. Erythrina abyssinica is harvested by traditional herbal medicine practitioners in East, Central, and South African communities to prepare herbal remedies for various human and livestock ailments. These include bacterial and fungal infections, tuberculosis, malaria, HIV/AIDS, diarrhea, cancer, meningitis, inflammatory diseases, urinary tract infections, wounds, diabetes mellitus, and skin and soft tissue injuries. Different extracts and phytochemicals from parts of E. abyssinica have been scientifically proven to possess anti-inflammatory, antibacterial, antioxidant, antiplasmodial, antiproliferative, antifungal, antimycobacterial, antidiarrheal, anti-HIV 1, antidiabetic, and antiobesity activities. This versatile pharmacological activity is due to the abundant flavonoids, alkaloids, and terpenoids present in its different parts. Conclusion. Erythrina abyssinica is an important ethnomedicinal plant in Africa harboring useful pharmacologically active phytochemicals against various diseases with significant efficacies and minimal toxicity to mammalian cells. Therefore, this plant should be conserved and its potential to provide novel molecules against diseases be explored further. Clinical trials that evaluate the efficacy and safety of extracts and isolated compounds from E. abyssinica are recommended

Leveraging electronic medical records for HIV testing, care, and treatment programming in Kenya—the national data warehouse project

Abstract Background Aggregate electronic data repositories and population-level cross-sectional surveys play a critical role in HIV programme monitoring and surveillance for data-driven decision-making. However, these data sources have inherent limitations including inability to respond to public health priorities in real-time and to longitudinally follow up clients for ascertainment of long-term outcomes. Electronic medical records (EMRs) have tremendous potential to bridge these gaps when harnessed into a centralised data repository. We describe the evolution of EMRs and the development of a centralised national data warehouse (NDW) repository. Further, we describe the distribution and representativeness of data from the NDW and explore its potential for population-level surveillance of HIV testing, care and treatment in Kenya. Main body Health information systems in Kenya have evolved from simple paper records to web-based EMRs with features that support data transmission to the NDW. The NDW design includes four layers: data warehouse application programming interface (DWAPI), central staging, integration service, and data visualization application. The number of health facilities uploading individual-level data to the NDW increased from 666 in 2016 to 1,516 in 2020, covering 41 of 47 counties in Kenya. By the end of 2020, the NDW hosted longitudinal data from 1,928,458 individuals ever started on antiretroviral therapy (ART). In 2020, there were 936,869 individuals who were active on ART in the NDW, compared to 1,219,276 individuals on ART reported in the aggregate-level Kenya Health Information System (KHIS), suggesting 77% coverage. The proportional distribution of individuals on ART by counties in the NDW was consistent with that from KHIS, suggesting representativeness and generalizability at the population level. Conclusion The NDW presents opportunities for individual-level HIV programme monitoring and surveillance because of its longitudinal design and its ability to respond to public health priorities in real-time. A comparison with estimates from KHIS demonstrates that the NDW has high coverage and that the data maybe representative and generalizable at the population-level. The NDW is therefore a unique and complementary resource for HIV programme monitoring and surveillance with potential to strengthen timely data driven decision-making towards HIV epidemic control in Kenya. Database link ( https://dwh.nascop.org/ )

Flow chart showing distribution of HIV infected individuals starting combination antiretroviral therapy (ART) included in the national data warehouse (NDW) sampling framework and random selection of individuals included in the analysis.

Flow chart showing distribution of HIV infected individuals starting combination antiretroviral therapy (ART) included in the national data warehouse (NDW) sampling framework and random selection of individuals included in the analysis.</p

Fig 3 -

(a) Graph showing time from HIV diagnosis to ART initiation by COVID-19 exposure calendar period when compared to the period prior to the pandemic, and (b) by high infection zone counties, amongst HIV infected individuals >15 years using data from the national data warehouse sampling framework in Kenya (April 01st 2018 to March 31st 2021, N = 7,046).</p

Effect of the SARS-CoV-2 pandemic, defined as the period after the first documented case when compared to the period prior to the pandemic, on virologic non-suppression amongst HIV infected individuals >15 years starting combination antiretroviral therapy using data from the national data warehouse sampling framework in Kenya (April 01^st 2018 to March 31^st 2021, N = 7,406)^b'*'.

Effect of the SARS-CoV-2 pandemic, defined as the period after the first documented case when compared to the period prior to the pandemic, on virologic non-suppression amongst HIV infected individuals >15 years starting combination antiretroviral therapy using data from the national data warehouse sampling framework in Kenya (April 01st 2018 to March 31st 2021, N = 7,406)b'*'.</p

Fig 4 -

(a) Graph showing six-months retention after ART initiation by COVID-19 exposure calendar period when compared to the period prior to the pandemic, and (b) by high infection zone counties, amongst HIV infected individuals >15 years using data from the national data warehouse sampling framework in Kenya (April 01st 2018 to March 31st 2021, N = 7,046).</p

Overall effect of the COVID-19 pandemic, defined as period after the first documented case when compared to the period prior to the pandemic, on initial virologic non-suppression (VnS) amongst HIV infected individuals aged >15 years using data from the national data warehouse sampling framework in Kenya (April 2018 to March 2021, N = 7,046).

Overall effect of the COVID-19 pandemic, defined as period after the first documented case when compared to the period prior to the pandemic, on initial virologic non-suppression (VnS) amongst HIV infected individuals aged >15 years using data from the national data warehouse sampling framework in Kenya (April 2018 to March 2021, N = 7,046).</p

Distribution of HIV infected individuals >15 years old, starting combination antiretroviral therapy, included in the national data warehouse sampling framework and randomly sampled, by COVID-19 exposure status and high infection zones in Kenya (April 01^st 2018 to March 31^st 2021, N = 7,046).

Distribution of HIV infected individuals >15 years old, starting combination antiretroviral therapy, included in the national data warehouse sampling framework and randomly sampled, by COVID-19 exposure status and high infection zones in Kenya (April 01st 2018 to March 31st 2021, N = 7,046).</p

Fig 1 -

(a) Map showing the distribution of health facilities transmitting electronic medical records (EMR) data to the National Data Warehouse (NDW). Polygons represent the 47 counties (regional administrative units), with red colored polygons representing the high infection zone (HIZ) counties. Map reprinted from (https://www.kaggle.com/datasets/ambarish/kenya-counties-shapefile/) under a CC BY license, with permission from the publisher. (b) Graph showing the distribution of estimated number of people living with HIV (PLWH) in Kenya (n = 1,388,168), number of PLWH starting combination antiretroviral therapy between April 2018 and March 2021 in the NDW (n = 352,322), and the number of PLWH randomly sampled and included in the analysis (n = 7,046).</p