Acute toxicity studies of Catharanthus roseus aqueous extract in male Wistar rats

Background: The knowledge of the healing virtues of Catharanthus roseus and a host of other medicinal plants has been in existence since ancient times. Catharanthus roseus is traditionally used more commonly as anti-diabetic and anti-malaria remedy. Lack of adequate pharmacological and toxicological data of natural products to support their use is a major setback. Objective: To establish the acute toxicity effect of Catharanthus roseus crude aqueous extract on some hematological and biochemical parameters. Methodology: Catharanthus roseus aqueous extract was orally administered once to two groups of male rats at 1000 and 5000 mg/kg body weight respectively alongside a control group which received 2ml distilled water. Hematological and biochemical assays were done at 48 hours and the 14th day. The data was analyzed using SPSS 17.0. Results: White blood cells (WBC), creatinine, urea, alanine aminotransferase and aspartate aminotransferase showed significant increase while mean cell volume reduced significantly at 48 hours in the high dose group. The body weight change was also significantly reduced. Discussion: The alterations of the body weight gain, various biochemical and hematological parameters reflect the effect of toxicity after exposure of the tested extract doses. Total proteins concentration was not altered suggesting that the renal and liver functions were not adversely affected. Key words: Catharanthus roseus, acute toxicity, rat

Phytochemical Composition and Brine Shrimp Cytotoxicity Effect of Rosmarinus officinalis

Plant compounds exhibit enormous structural diversity, unfortunately only a small proportion of that diversity has been seriously explored for pharmacological potential. The use and commercialization of non-timber plant products which include medicinal plants has been found to be an important livelihood strategy in developing countries especially for the rural people. The current study was carried out on the crude aqueous extracts of leaves of Rosmarinus officinalis (rosemary) to evaluate the plants phytochemical composition using standard methods. The cytotoxicity and lethality  effects on the  brine shrimp (Artemia salina)  of four organic extracts  and  also an aqueous extract of the rosemary leaves was  studied using  three concentrations (10, 100, 1000 ) µg/ml. The data was analyzed using Finney’s probit analysis method with the help of Biostat 2009. The phytochemical analysis showed presence of; terpenoids, tannins, cardiac glycosides, flavonoids, reducing sugars and saponins. All the extracts gave moderate medial lethal concentration (LC 50) between 220 and 470 µg/ml. Cytogenic compounds in the extract caused the brine shrimp high lethality which corroborates the wide use of rosemary in the health care. Rosemary plant could be seen as a good source for useful drugs.

Validation of Safety and Efficacy of Antitussive Herbal Formulations

Background: Cough is an important defensive pulmonary reflex that removes irritants, fluids or foreign materials from the airways. Frequently, cough is non-productive and requires suppression and opioid receptor agonists such as codeine are commonly used as antitussive agents. However, opioids produce side effects that include sedation, addiction potential and constipation. Novel cough suppressant therapies should maintain or improve upon the antitussive efficacy profile of opioids but with minimum or no side effects. Objective: To evaluate antitussive activity of combination of herbal medicines as formulations in sulphur dioxide - induced cough model in rats. Methodology: Wister rats of either sex, weighing 150 - 200 g, were divided into 7 groups (n = 6). Group 1 served as a control and received normal saline, groups 2 received codeine phosphate, group 3 and 4 received the coded market samples and groups 5, 6 and 7 received the test samples, respectively. Thirty or sixty minutes following administration, the rats were exposed to sulphur dioxide gas for 1 minute and then placed in an open chamber for counting of cough bouts. Results: The formulations exhibited cough inhibitions of between 15 and 27%, and 14 and 38%, with respect to the control group, 30 and 60 minutes after sample administration respectively. Conclusion: The herbal formulations demonstrated significant (p < 0.05) antitussive activity in sulphur dioxide induced cough model. Key words: Antitussive activity; herbal formulations; sulphur dioxide; coug

Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan district hospitals

<p>Abstract</p> <p>Background</p> <p>We have conducted an intervention study aiming to improve hospital care for children and newborns in Kenya. In judging whether an intervention achieves its aims, an understanding of how it is delivered is essential. Here, we describe how the implementation team delivered the intervention over 18 months and provide some insight into how health workers, the primary targets of the intervention, received it.</p> <p>Methods</p> <p>We used two approaches. First, a description of the intervention is based on an analysis of records of training, supervisory and feedback visits to hospitals, and brief logs of key topics discussed during telephone calls with local hospital facilitators. Record keeping was established at the start of the study for this purpose with analyses conducted at the end of the intervention period. Second, we planned a qualitative study nested within the intervention project and used in-depth interviews and small group discussions to explore health worker and facilitators' perceptions of implementation. After thematic analysis of all interview data, findings were presented, discussed, and revised with the help of hospital facilitators.</p> <p>Results</p> <p>Four hospitals received the full intervention including guidelines, training and two to three monthly support supervision and six monthly performance feedback visits. Supervisor visits, as well as providing an opportunity for interaction with administrators, health workers, and facilitators, were often used for impromptu, limited refresher training or orientation of new staff. The personal links that evolved with senior staff seemed to encourage local commitment to the aims of the intervention. Feedback seemed best provided as open meetings and discussions with administrators and staff. Supervision, although sometimes perceived as fault finding, helped local facilitators become the focal point of much activity including key roles in liaison, local monitoring and feedback, problem solving, and orientation of new staff to guidelines. In four control hospitals receiving a minimal intervention, local supervision and leadership to implement new guidelines, despite their official introduction, were largely absent.</p> <p>Conclusion</p> <p>The actual content of an intervention and how it is implemented and received may be critical determinants of whether it achieves its aims. We have carefully described our intervention approach to facilitate appraisal of the quantitative results of the intervention's effect on quality of care. Our findings suggest ongoing training, external supportive supervision, open feedback, and local facilitation may be valuable additions to more typical in-service training approaches, and may be feasible.</p

Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals -- interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies

<p>Abstract</p> <p>Background</p> <p>We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings.</p> <p>Methods</p> <p>Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator) based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research.</p> <p>Results</p> <p>A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped create a soft-contract with senior managers clarifying roles and expectations around desired performance. This, combined with the support of facilitators acting as an expert resource and 'shop-floor' change agent, led to improvements in leadership, accountability, and resource allocation that enhanced workers' commitment and capacity and improved clinical microsystems. Provision of correct care was then particularly likely if tasks were simple and a good fit to existing professional routines. Our findings were in broad agreement with those defined as part of recent work articulating a comprehensive framework for implementation research.</p> <p>Conclusions</p> <p>Using data from multiple studies can provide valuable insight into how an intervention is working and what factors may explain variability in effects. Findings clearly suggest that major intervention strategies aimed at improving child and newborn survival in low-income settings should go well beyond the fixed inputs (training, guidelines, and job aides) that are typical of many major programmes. Strategies required to deliver good care in low-income settings should recognize that this will need to be co-produced through engagement often over prolonged periods and as part of a directive but adaptive, participatory, information-rich, and reflective process.</p

Service delivery in Kenyan district hospitals - what can we learn from literature on mid-level managers?

BACKGROUND: There is a growing emphasis on the need to tackle inadequate human resources for health (HRH) as an essential part of strengthening health systems; but the focus is mostly on macro-level issues, such as training, recruitment, skill mix and distribution. Few attempts have been made to understand the capability of health workers, their motivation and other structural and organizational aspects of systems that influence workforce performance. We have examined literature on the roles of mid-level managers to help us understand how they might influence service delivery quality in Kenyan hospitals. In the Kenyan hospital settings, these are roles that head of departments who are also clinical or nursing service providers might play. METHODS: A computerized search strategy was run in Pub Med, Cochrane Library, Directory of Open Access Journals Social Science Research Network, Eldis, Google Scholar and Human Resources for Health web site databases using both free-text and MeSH terms from 1980 to 2011. In addition, citation searching from excluded and included articles was used and relevant unpublished literature systematically identified. RESULTS AND DISCUSSION: A total of 23 articles were finally included in the review from over 7000 titles and abstracts initially identified. The most widely documented roles of mid-level managers were decision-making or problem-solving, strategist or negotiator and communicator. Others included being a therapist or motivator, goal setting or articulation and mentoring or coaching. In addition to these roles, we identified important personal attributes of a good manager, which included interpersonal skills, delegation and accountability, and honesty. The majority of studies included in the review concerned the roles that mid-level managers are expected to play in times of organizational change. CONCLUSION: This review highlights the possible significance of mid-level managers in achieving delivery of high-quality services in Kenyan public hospitals and strongly suggests that approaches to strengthen this level of management will be valuable. The findings from this review should also help inform empirical studies of the roles of mid-level managers in these settings