Self-reported adverse effects as barriers to adherence to antiretroviral therapy in HIV-infected patients in Pretoria

Background: Adherence is the key to the effectiveness of antiretroviral therapy. However, many factors have been identified as facilitating or hamper- ing adherence. The aim of this study was to determine barriers and facilitators of adherence with particular emphasis on adverse effects. Methods: A survey of patients, who started antiretroviral treatment between July 2004 and August 2005, was conducted by means of a semi-struc-tured questionnaire. Those who consented to participate were interviewed for the collection of information on sociodemographic characteristics and clinical and other data. Results: The 180 patients who participated had a mean age of 36.7 (±8.1); 68.8% were female, 86.7% unemployed, 73.9% had a high school level of education, and 77.8% were single. Some 8.9% of the respondents used at least one non-prescribed medicine, while 34.4% received disability grants. Overall, 94% of the respondents reported at least one side effect; the mean number of self-reported side effects was 2.6 (± 1.4). With regard to adherence, the mean number of doses missed during the last seven days prior to the interview was 2.7 (±3.9), ranging from 0 to 18. The mean adherence level was 92.3%, ranging from 48.6% to 100.0%; overall, only 57.2% reported taking at least or over 95% of their prescribed doses. The two most common reasons for missing doses were forgetting (26.6%) followed by being away from home (15.6%). In the bivariate analysis, the only facilitator or factor that was significantly associated with at least or over 95% self-reported adherence was eating well (80.6% vs 64.5%; p = 0.025), whereas barriers or factors more likely and significantly associated with with self-reported adherence of at least or over 95% included having used non-prescribed medicines (15.6% vs 3.9%; p = 0.008), having suffered from headaches (28.6 vs 14.6%; p = 0.026) and reported symptoms such as insomnia (27.3% vs 12.6%; p = 0.013) and abdominal pain (20.8% vs 9.7%; p = 0.037). In the multivariate analysis, the facilitators or factors that were significantly associated with self-reported adherence of at least or over 95% were having an initial bodyweight of less than 50 kg (p = 0.026) and viral load of >33 000 copies /ml (p = 0.047). Conclusions: In conclusion, self-reported barriers to optimal adherence included the use of non-prescribed drugs, and the presence of side effects such as insomnia, headaches and abdominal pain; while eating well was a facilitator. These findings emphasise the need for better communication between patients and clinicians, and the need for integrating pharmacovigilance concepts in clinical practice. South African Family Practice Vol. 50 (5) 2008: pp. 49-49

Risk Factors and Outcomes of Food Poisoning in Africa

Food poisoning is one of the common health problems in most African countries. This review was conducted to describe the situation in Africa with regard to specific risk factors and outcomes of food poisoning in the African setting based on published literature

Characteristics of Acute Poisoning at Two Referral Hospitals in Francistown and Gaborone

Background: The epidemiology of acute poisoning in Botswana is not well established due to the limited availability of published data. In an attempt to fill this gap, this study aimed to characterise acute poisoning cases admitted to two urban hospitals in Francistown and Gaborone, Botswana. Methods: This study followed a descriptive methodology involving 116 patients with the primary diagnosis of acute poisoning admitted to two referral hospitals in Botswana from January to June 2005. Data were collected by means of a pre-tested data-collection form. Results: Overall, 58 (50%) of the victims of acute poisoning were female, accidental poisoning occurring in 89 (76.9%) of the cases. Intentional poisoning was reported in 33.3% of the females versus 13.5% of the males. With regard to demographic distribution, the majority of the victims were in the age category of 13 to 19 (20.7% versus 5.2%) for the females and in the 30-year-old group for the males (24.1% versus 10.3%). Poisoning by household chemicals, particularly paraffin, affected mainly children under 12, while poisoning by pharmaceuticals involved mainly teenagers. With regard to outcomes, three of the female victims died, representing a case fatality rate of 2.6%. One death was due to paraffin poisoning and two to traditional medicine. Those who died were two children in the 0 to 12-year group and one adult in the age category of 20 to 30. Conclusion: The acute poisoning involved a variety of toxic agents of which household chemicals and pharmaceuticals predominated. Differences based on age category, sex, the types of toxic agents involved and the outcomes of the poisoning incidents were noted. Future interventions should take these differences into account. South African Family Practice Vol. 50 (3) 2008: pp. 67-67

Risks Associated with International Trading of Medicines by Non-Licensed Entities and Non-Professionals

The making, distribution and trading of medicines can be traced back as far as antiquity. When talking about trading, sale or dispensing of medicines, it is almost impossible to separate this topic with the profession of pharmacy or pharmacists. Although most countries introduced legislations that put the trading of medicines largely in the hand of licensed businesses and professionals mainly pharmacists, informal and international trading of medicines and related substances has continued to be practiced in almost all countries due to loopholes in legislations among other reasons. This chapter highlights the risks associated with the trading of medicines by unlicensed organisations and non-professionals. These risks include the production and sale of counterfeit medicines, encouraging abuse and misuse of medicines, anti-competitive behaviour and so on. The major findings are that concessions made to allow non-licensed businesses and non-professionals to trade in medicines have resulted in several consequences that are threatening the whole world. It is this realisation that has prompted the recommendation that courage from decision makers is required for them to take a stand and hand over back the trading of medicines firmly in the hands of licensed professionals while outlawing loopholes that sustained the trade of medicines by unlicensed entities and non-professionals

Evaluating the anti-proliferative effects of methanol and butanol extracts of lobostemon fruticosus on a pancreatic cancer cell line AsPC-1

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements of the degree of Masters of Science. February 2017.Cancer has become a problematic fatal disease in developing and industrialised countries with pancreatic cancer as the seventh leading cause of cancer-related deaths, with an average survival rate of less than 5%. Environmental risk factors associated with pancreatic cancer include smoking, obesity, diet, alcohol etc. Furthermore, pancreatic cancer is commonly diagnosed at a late stage where its response to current anti-cancer agents is poor. Consequently, with South Africa being a 3rd world country and the cost of chemotherapy being so high, this has led to us trying to identify new, cheaper therapeutics for cancer cells. A majority (80%) of the South African population relies on traditional medicines, hence in this study we aimed to assess Lobostemon fruticosus for anti-proliferative effects on pancreatic cancer cell line (AsPC-1). This was achieved by the use of methanol and butanol extracts of L. fruticosus to screen for induction of apoptosis and inhibition of cell proliferation. The plant was collected, dried, crushed and dissolved in butanol and methanol to obtain experimental extracts. Cytotoxicity of the plant on Aspc-1 was determined using MTT Assay, xCELLigence and cell cycle analysis. MRC-5 cell line was used as a positive control cell line. L. fruticosus extracts induced cell death at IC50 of 60µg/ml (methanol extract) and 50µg/ml (butanol extract) at 48hour treatments on AsPC-1 cell line. Western Blots showed that the methanol and butanol extracts of L. fruticosus led to slight upregulation of the apoptotic gene p53 in AsPC-1 cell line, which was further confirmed by FACS apoptosis detection. Cell cycle analysis further showed the plant extracts do promote cell cycle arrest. LC/MS of the extracts gave spectra of active compounds presumed to play a role in induction of apoptosis on the pancreatic cancer cell line. The data obtained implies that the methanol and butanol extracts of L. fruticosus does have, to a certain extent, growth inhibiting and apoptosis inducing potential on the pancreatic cancer cell line. KEYWORDS: Lobostemon fruticosus, Pancreatic Cancer, methanol extract, butanol extract, AsPC-1LG201

CONTRIBUTION OF PLANTS AND TRADITIONAL MEDICINES TO THE DISPARITIES AND SIMILARITIES IN ACUTE POISONING INCIDENTS IN BOTSWANA, SOUTH AFRICA AND UGANDA

Background: Acute poisoning incidents are one of the leading causes of morbidity and hospitalization in several countries. The purpose of this analysis was to compare the patterns of acute poisoning in three countries namely, Botswana, South Africa and Uganda; and examine the similarities and disparities in the patterns of occurrence of acute poisoning based on the sociodemographic factors of the victims, the toxic agents involved, the circumstances surrounding the incidents and their outcomes. Materials and methods: This paper is based on the re-analysis of data that were collected from January to June 2005 by some Master of Public Health students using a similar data collection tool. A single dataset made of the original individual datasheets was constituted and analysed. Results: Overall, it was found that the mean age of victims of acute poisoning was 20.9 ± 14.5 years; the youngest victim was a 3 months old boy from South Africa; and the oldest was a 75 years old man from Uganda. In descending order, the most common toxic agents involved in poisoning incidents were household products (46.1%), agrochemicals (18.8%), pharmaceuticals (14.0%), animal and insect bites (13.0%), food poisoning (4.5%), as well as plants and traditional medicines (3.6%). Across the three countries, acute poisoning occurred mainly by accident, but the contextual factors of each country led to a pattern of acute poisoning that showed some similarities with regard to the distribution of deliberate self-poisoning among females, teenagers, and young adult victims. There were disparities related to the differential access to toxic agents, based on the age and gender of the victims. Of the 17 deaths reported, 2 (11.7%) were due to traditional medicines; household products were implicated in fatal outcomes in all three countries, though the extent of their involvement varied from country to country. Conclusion: Although plant and traditional medicines caused fewer cases of acute poisoning incidents, they contributed considerably to fatal outcomes