MORINGA OLEIFERA LEAF POWDER INFLUENCED THE CHEMICAL PROFILE OF LEONOTIS LEONURUS ESSENTIAL OILS.

Background: Leonotis leonurus is used extensively in African herbal medicine to manage several diseases including diabetes mellitus, epilepsy, hypertension, and skin and respiratory infections. Although L. leonurusis a valuable medicinal plant in Africa, little has been done to improve the plant’s organoleptic and pharmacological properties. The study evaluated the effects of Moringa (Moringa oleifera) leaf powder treatments on the chemical profiles of essential oils from L. leonurus. Methodology: All trials were conducted in experimental greenhouse tunnels. Six-week-old L. Leonurus seedlings were transplanted into individual pots (1 seedling per pot) containing 1kg of GromorTM potting mix (30 dm3) and subjected to varying quantities (0, 1.25, 2.5, 5, 7.5, and 10g) of Moringa leaf powder (MLP) biweekly for eight weeks. Additionally, each seedling received 100 mL of 50 % Hoagland’s solution once every 4 weeks and was watered regularly throughout the trial. At the end of the trial, the plant’s shoots were harvested and essential oils were extracted from them by steam distillation. The oils’ chemical profiles were then determined by Gas Chromatography-Mass Spectroscopy. Results: MLP applications caused each treatment to have a distinct chemical profile. Notable variations in oil yield, number, and concentration of compounds per each sample evaluated were observed. Caryophyllene and humulene were among the bioactive compounds whose concentration increased by 4- to 10-fold in treatments, compared to the control. Caryophyllene, β-copaene, humulene, and phytol were among the most dominant compounds in the oil samples. Conclusions: MLP induced qualitative and quantitative changes in L. leonurus essential oils. The powder could therefore be potentially used to improve the quality and yield of medicinally valuable crucial oils from the plant. Recommendations: Future research could focus on maximizing the use of MLP in natural situations. Such field trials should also investigate the powder's possible use in conjunction with other organic fertilizers

Community-Based Tuberculosis Contact Management: Caregiver Experience and Factors Promoting Adherence to Preventive Therapy

Delivery of tuberculosis preventive therapy (TPT) for children with household exposure to tuberculosis is a globally supported intervention to reduce the impact of tuberculosis disease (TB) in vulnerable children; however, it is sub-optimally implemented in most high-burden settings. As part of a community-based household contact management program, we evaluated predictors of adherence to community based TPT in children and performed qualitative assessments of caregiver experiences. The Vikela Ekhaya (Protect the Home) project was a community-based household contact management program implemented between 2019 and 2020 in the Hhohho Region of Eswatini. At home visits, contact management teams screened children for TB, initiated TPT when indicated and performed follow-up assessments reviewing TPT adherence. TPT non-adherence was defined as either two self-reported missed doses or a pill count indicating at least two missed doses, and risk factors were evaluated using multivariate clustered Cox regression models. Semi-structured interviews were performed with caregivers to assess acceptability of home visits for TPT administration. In total, 278 children under 15 years initiated TPT and 96% completed TPT through the Vikela Ekhaya project. Risk factors for TPT non-adherence among children initiating 3HR included low family income (adjusted hazard ratio (aHR) 2.3, 95%CI 1.2-4.4), female gender of the child (aHR 2.5, 95% CI 1.4-5.0) and an urban living environment (aHR 3.1, 95%CI 1.6-6.0). Children with non-adherence at the first follow-up visit were 9.1 fold more likely not to complete therapy. Caregivers indicated an appreciation for community services, citing increased comfort, reduced cost, and support from community members. Our results are supportive of recent World Health Organization (WHO) recommendations for decentralization of TB preventive services. Here, we identify populations that may benefit from additional support to promote TPT adherence, but overall demonstrate a clear preference for and excellent outcomes with community based TPT delivery

Vikela Ekhaya: A Novel, Community-Based, Tuberculosis Contact Management Program in a High Burden Setting

BACKGROUND: The prevention of tuberculosis (TB) in child contacts of TB cases and people living with human immunodeficiency virus (HIV) is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT. METHODS: Vikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases by using mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants\u27 homes. RESULTS: In total, 945 contacts from 244 households were screened for TB symptoms; 72 (8%) contacts reported TB symptoms, and 5 contacts (0.5%) were diagnosed with prevalent TB. A total of 322 of 330 (98%) eligible asymptomatic household contacts initiated TPT. Of 322 contacts initiating TPT, 248 children initiated 3 months of isoniazid and rifampicin and 74 children and adults living with HIV initiated 6 months of isoniazid; 298 (93%) completed TPT. In clustered logistic regression analyses, unknown HIV status (adjusted odds ratio [aOR] 5.7, P = .023), positive HIV status (aOR 21.1, P = .001), urban setting (aOR 5.6, P = .006), and low income (aOR 5.9, P = .001) predicted loss from the cascade of care among TPT-eligible contacts. CONCLUSION: Vikela Ekhaya demonstrated that community-based TB household contact management is a feasible, acceptable, and successful strategy for TB screening and TPT delivery. The results of this study support the development of novel, differentiated, community-based interventions for TB prevention and control

Clinical perspectives on treatment of rifampicin-resistant/multidrug-resistant TB.

Rapid diagnostics, newer drugs, repurposed medications, and shorter regimens have radically altered the landscape for treating rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB). There are multiple ongoing clinical trials aiming to build a robust evidence base to guide RR/MDR-TB treatment, and both observational studies and programmatic data have contributed to advancing the treatment field. In December 2019, the WHO issued their second 'Rapid Communication´ related to RR-TB management. This reiterated their prior recommendation that a majority of people with RR/MDR-TB receive all-oral treatment regimens, and now allow for specific shorter duration regimens to be used programmatically as well. Many TB programs need clinical advice as they seek to roll out such regimens in their specific setting. In this Perspective, we highlight our early experiences and lessons learned from working with National TB Programs, adult and pediatric clinicians and civil society, in optimizing treatment of RR/MDR-TB, using shorter, highly-effective, oral regimens for the majority of people with RR/MDR-TB

Potential role of vermicompost and its extracts in alleviating climatic impacts on crop production

The past few decades have seen worldwide increases in ambient temperatures due to the continuous accumulation of anthropogenic greenhouse gases (water vapour, carbon dioxide, methane and nitrous oxide) in the atmosphere, a phenomenon known as global warming. Global warming causes a gradual shift in nearly all climatic and weather variables resulting in increased incidence of flooding, droughts, desertification, disease and pest outbreaks. Due to its intrinsic relationship with nature, agriculture is highly vulnerable to the changing climate, and as such, farmers, agricultural experts and other stakeholders need to urgently seek sustainable ways to avert impending food shortages. There is currently little information in the literature on the potential use of vermicompost to mitigate the adverse effects of climate change on agriculture production. However, existing empirical evidence strongly suggests that vermicompost and its derivatives contain humic acids, nutrients, earthworm excretions, rich microbial populations, growth hormones and enzymes, which help crops withstand a wide range of abiotic and biotic stresses. The present review explores various ways in which vermicompost and its products can help minimize climatic impacts on crop production. Online research and journal databases (Google Scholar, ScienceDirect, Scopus, and SpringerLink) were used to obtain reports related to agriculture, climate change, vermicompost, abiotic and biotic stresses. The review reveals some of the manifold attributes of vermicompost which could help augment farm production under changing climatic conditions

Model of care and risk factors for poor outcomes in patients on multi-drug resistant tuberculosis treatment at two facilities in eSwatini (formerly Swaziland), 2011-2013.

INTRODUCTION:Since 2011 Médecins sans Frontières together with the eSwatini Ministry of Health have been managing patients with multi-drug resistant tuberculosis (MDR-TB) at Matsapha and Mankayane in Manzini region. This analysis describes the model of care and outcomes of patients receiving a 20 months MDR-TB treatment regimen between 2011 and 2013. METHOD:We conducted a retrospective observational cohort study of MDR-TB patients enrolled for treatment between May 2011 and December 2013. An extensive package of psychological care and socio-economic incentives were provided including psychological support, paid treatment supporters, transport fees and a monthly food package. Baseline demographic details and treatment outcomes were recorded and for HIV positive patient's univariate analysis as well as a cox regression hazard model were undertaken to assess risk factors for unfavorable outcomes. RESULTS:From the 174 patients enrolled, 156 (89.7%) were HIV co-infected, 102 (58.6%) were female, median age 33 years old (IQR: 28-42), 55 (31.6%) had a BMI less than 18 and 86 (49.4%) had not been previously treated for any form of TB. Overall cohort outcomes revealed a 75.3% treatment success rate, 21.3% mortality rate, 0.6% failure and 0.6% lost to follow-up rate. In the adjusted multivariate analysis, low BMI and low CD4 count at treatment initiation were associated with an increased risk of unfavorable outcome. CONCLUSIONS:A model of care that included psychosocial support and patient's enablers led to a high level of treatment success with a very low lost to follow up rate. Limiting the overall treatment success was a high mortality rate which was associated with advanced HIV and a low BMI at presentation. These factors will need to be addressed in order to improve upon the overall treatment success rate in future