Screening of Indigofera lupatana Baker F. root extracts for antibacterial activities

Herbal remedies as cheap alternatives to conventionalmedicine have contributed significantly to rurallivelihoods. Apart from the traditional healerspracticing herbal medicine, many people are involved incollecting and trading medicinal plants. The WorldHealth Organization (WHO) estimates that 80% of theworld’s population depends on medicinal plants fortheir primary health care (Mothana et al, 2008; Ngoci etal, 2011). The use of traditional medicine has beenexplored globally and is widely used in developingcountries as an alternative or to complementconventional medicine (Rates, 2001; Gupta et al, 2010).Natural products, either as pure compounds or asstandardized plant extracts, provide exceptionalopportunities for new drug leads because of theunmatched chemical diversity of naturally derivedcompounds (Cowan, 1999; Parekh and Chanda, 2007;Mariita et al, 2010; Ngoci et al, 2011). Scientific interestin medicinal plants has burgeoned due to therecognized efficacy of plant derived drugs and everpresentconcerns about the side effects of modernmedicinal substances. This has fuelled the intensiveinvestigation of new molecular structures from theplant kingdom as potential medicinal compounds(Mariita et al, 2010). As a result, drugs derived fromunmodified natural products or semi-synthetic drugsobtained from natural sources accounted for 78% of thenew drugs approved by the United States Food andDrug Administration (FDA) between 1983 and 1994(Suffredini et al, 2006; Ngoci et al, 2011). Thisunderscores the importance of screening naturalproducts.Infectious diseases are a leading cause of human andanimal mortality. This is further aggravated by the rapiddevelopment of multi-drug resistance to available antimicrobialagents (Doughart and Okafor, 2007; Ngoci etal, 2011), their limited anti-microbial spectrum, theirside effects (Huie, 2002), and emergence and reemergenceof opportunistic infections. Therefore,studies aimed at identifying and characterizing of thesubstances that exhibit activity against infectious microorganisms,yet showing no cross resistance withexisting antibiotics, are required (Olila et al, 2001). Inrecent years, pharmaceutical companies have focusedon developing drugs from natural products thatpromises to counter the limitations of conventionalantibiotics (Doughart and Okafor, 2007).The bio-activity of natural products is due tophytochemicals, a group of secondary metabolites oftenelaborated for the plant defense against pests andherbivores or to gain an advantage over competingagents. These phytochemicals inadvertently also protecthumans against pathogens (Ngoci et al, 2011). Somephytochemicals are known to have antimicrobialproperties, immune-modulative properties, providenutrition for normal cell health and repairs, inhibitcarcinogens and act as antioxidants.Indigofera lupatana Baker F., locally called ‘mugiti’ bythe Mbeere community in Kenya, is a woody shrubfound in Acacia-Combretum ecological zones of Mbeere.It is widely used for its perceived medicinal value intreating coughs and diarrhea (Riley and Brokensha,1988; Ngoci et al, 2011), gonorrhea and pleurisy(Kokwaro, 1993; Ngoci et al, 2011).There is apparently no documented scientific report onanti-microbial properties of this plant. This lack ofscientific corroboration has often constituted a majorconstraint to the consideration of the use of herbalremedies in conjunction with or as an affordablealternative to conventional medical treatment (Okeke etal, 2001). Knowledge of the chemical constituents ofplants is desirable not only for the discovery oftherapeutic agents, but also because such informationmay be important in identifying new sources ofsubstances of economic value such as tannins, oils,gums, and precursors for the synthesis of complexchemical substances. In addition, the knowledge of thechemical constituents of plants would further bevaluable in discovering the actual value of folkloricremedies (Mojab et al, 2003).This study was therefore undertaken to determine theantibacterial properties of hexane, ethyl acetate anddichloromethane root extracts of I. lupatana Baker F

Quality Of Antenatal Care In Rural Southern Tanzania: A Reality Check.

Counselling on the danger signs of unpredictable obstetric complications and the appropriate management of such complications are crucial in reducing maternal mortality. The objectives of this study were to identify gaps in the provision of ANC services and knowledge of danger signs as well as the quality of care women receive in case of complications. The study took place in the Rufiji District of Tanzania in 2008 and was conducted in seven health facilities. The study used (1) observations from 63 antenatal care (ANC) sessions evaluated with an ANC checklist, (2) self-assessments of 11 Health workers, (3) interviews with 28 pregnant women and (4) follow-up of 12 women hospitalized for pregnancy-related conditions.Blood pressure measurements and abdominal examinations were common during ANC visits while urine testing for albumin or sugar or haemoglobin levels was rare which was often explained as due to a lack of supplies. The reasons for measuring blood pressure or abdominal examinations were usually not explained to the women. Only 15/28 (54%) women were able to mention at least one obstetric danger sign requiring medical attention. The outcomes of ten complicated cases were five stillbirths and three maternal complications. There was a considerable delay in first contact with a health professional or the start of timely interventions including checking vital signs, using a partograph, and detailed record keeping. Linking danger signs to clinical and laboratory examination results during ANC with the appropriate follow up and avoiding delays in emergency obstetric care are crucial to the delivery of coordinated, effective care interventions

A Single-Arm, Proof-Of-Concept Trial of Lopimune (Lopinavir/Ritonavir) as a Treatment for HPV-Related Pre-Invasive Cervical Disease

BACKGROUND: Cervical cancer is the most common female malignancy in the developing nations and the third most common cancer in women globally. An effective, inexpensive and self-applied topical treatment would be an ideal solution for treatment of screen-detected, pre-invasive cervical disease in low resource settings. METHODS: Between 01/03/2013 and 01/08/2013, women attending Kenyatta National Hospital's Family Planning and Gynaecology Outpatients clinics were tested for HIV, HPV (Cervista®) and liquid based cervical cytology (LBC -ThinPrep®). HIV negative women diagnosed as high-risk HPV positive with high grade squamous intraepithelial lesions (HSIL) were examined by colposcopy and given a 2 week course of 1 capsule of Lopimune (CIPLA) twice daily, to be self-applied as a vaginal pessary. Colposcopy, HPV testing and LBC were repeated at 4 and 12 weeks post-start of treatment with a final punch biopsy at 3 months for histology. Primary outcome measures were acceptability of treatment with efficacy as a secondary consideration. RESULTS: A total of 23 women with HSIL were treated with Lopimune during which time no adverse reactions were reported. A maximum concentration of 10 ng/ml of lopinavir was detected in patient plasma 1 week after starting treatment. HPV was no longer detected in 12/23 (52.2%, 95%CI: 30.6-73.2%). Post-treatment cytology at 12 weeks on women with HSIL, showed 14/22 (63.6%, 95%CI: 40.6-82.8%) had no dysplasia and 4/22 (18.2%, 95%CI: 9.9-65.1%) were now low grade demonstrating a combined positive response in 81.8% of women of which 77.8% was confirmed by histology. These data are supported by colposcopic images, which show regression of cervical lesions. CONCLUSIONS: These results demonstrate the potential of Lopimune as a self-applied therapy for HPV infection and related cervical lesions. Since there were no serious adverse events or detectable post-treatment morbidity, this study indicates that further trials are clearly justified to define optimal regimes and the overall benefit of this therapy. TRIAL REGISTRATION: ISRCTN Registry 48776874

Beacon of hope: Evaluation of the Kenya Girl Guides Association HIV/AIDS program for school children

This Horizons report presents findings from an evaluation of the Kenya Girl Guides Participatory Peer Education Program for HIV and AIDS Prevention. The objective of the program was to train Girl Guide patrol leaders as peer educators, who in turn would communicate key information and concepts about such topics as HIV prevention, relationships, and self-esteem to other Girl Guides, and ultimately to their school peers. The results demonstrate that peer education conducted by Girl Guides is a feasible strategy for imparting HIV and AIDS education to school-going youth; however, such a program would need to be branded, strengthened, and appropriately resourced to attain positive results that extend beyond the Girl Guides to include their peers. The results also demonstrate that school girls in this study are operating in an environment where their male counterparts are more than seven times as likely to be sexually experienced, and may be exerting considerable pressure to have sex even on the strongest of girls. HIV risk-reduction programs directed at school girls may be more successful if they also address the risk behavior of school boys

The quality of antenatal care in rural Tanzania: what is behind the number of visits?

Background: Antenatal care (ANC) provides an important opportunity for pregnant women with a wide range of interventions and is considered as an important basic component of reproductive health care.Methods: In 2008, severe maternal morbidity audit was established at Saint Francis Designated District Hospital (SFDDH), in Kilombero district in Tanzania, to ascertain substandard care and implement interventions. In addition, a cross-sectional descriptive study was carried out in 11 health facilities within the district to assess the quality of ANC and underlying factors in a broader view.Results: Of 363 severe maternal morbidities audited, only 263 (72%) ANC cards were identified. Additionally, 121 cards (with 299 ANC visits) from 11 facilities were also reviewed. Hemoglobin and urine albumin were assessed in 22% - 37% and blood pressure in 69% - 87% of all visits. Fifty two (20%) severe maternal morbidities were attributed to substandard ANC, of these 39 had severe anemia and eclampsia combined. Substandard ANC was mainly attributed to shortage of staff, equipment and consumables. There was no significant relationship between assessment of essential parameters at first ANC visit and total number of visits made (Spearman correlation coefficient, r = 0.09; p = 0.13). Several interventions were implemented and others were proposed to those in control of the health system.Conclusions: This article reflects a worrisome state of substandard ANC in rural Tanzania resulting from inadequate human workforce and material resources for maternal health, and its adverse impacts on maternal wellbeing. These results suggest urgent response from those in control of the health system to invest more resources to avert the situation in order to enhance maternal health in this country. © 2012 Nyamtema et al.;

Prevalence of positive depression screen among post miscarriage women- A cross sectional study

Background: Miscarriages are a common pregnancy complication affecting about 10–15% of pregnancies. Miscarriages may be associated with a myriad of psychiatric morbidity at various timelines after the event. Depression has been shown to affect about 10–20% of all women following a miscarriage. However, no data exists in the local setting informing on the prevalence of post-miscarriage depression. We set out to determine the prevalence of positive depression screen among women who have experienced a miscarriage at the Aga Khan University hospital, Nairobi. Methods: The study was cross-sectional in design. Patients who had a miscarriage were recruited at the post-miscarriage clinic review at the gynecology clinics at Aga Khan University Hospital, Nairobi. The Edinburgh postpartum depression scale was used to screen for depression in the patients. Prevalence was calculated from the percentage of patients achieving the cut –off score of 13 over the total number of patients. Results: A total of 182 patients were recruited for the study. The prevalence of positive depression screen was 34.1% since 62 of the 182 patients had a positive depression screen. Moreover, of the patients who had a positive depression screen, 21(33.1%) had thoughts of self-harm. Conclusion: A positive depression screen is present in 34.1% of women in our population two weeks after a miscarriage. Thoughts of self-harm are present in about a third of these women (33.1%) hence pointing out the importance of screening these women using the EPDS after a miscarriage

Models for short term malaria prediction in Sri Lanka

<p>Abstract</p> <p>Background</p> <p>Malaria in Sri Lanka is unstable and fluctuates in intensity both spatially and temporally. Although the case counts are dwindling at present, given the past history of resurgence of outbreaks despite effective control measures, the control programmes have to stay prepared. The availability of long time series of monitored/diagnosed malaria cases allows for the study of forecasting models, with an aim to developing a forecasting system which could assist in the efficient allocation of resources for malaria control.</p> <p>Methods</p> <p>Exponentially weighted moving average models, autoregressive integrated moving average (ARIMA) models with seasonal components, and seasonal multiplicative autoregressive integrated moving average (SARIMA) models were compared on monthly time series of district malaria cases for their ability to predict the number of malaria cases one to four months ahead. The addition of covariates such as the number of malaria cases in neighbouring districts or rainfall were assessed for their ability to improve prediction of selected (seasonal) ARIMA models.</p> <p>Results</p> <p>The best model for forecasting and the forecasting error varied strongly among the districts. The addition of rainfall as a covariate improved prediction of selected (seasonal) ARIMA models modestly in some districts but worsened prediction in other districts. Improvement by adding rainfall was more frequent at larger forecasting horizons.</p> <p>Conclusion</p> <p>Heterogeneity of patterns of malaria in Sri Lanka requires regionally specific prediction models. Prediction error was large at a minimum of 22% (for one of the districts) for one month ahead predictions. The modest improvement made in short term prediction by adding rainfall as a covariate to these prediction models may not be sufficient to merit investing in a forecasting system for which rainfall data are routinely processed.</p

Predictors of Multidrug- and Extensively Drug-Resistant Tuberculosis in a High HIV Prevalence Community

BACKGROUND: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) have emerged in high-HIV-prevalence settings, which generally lack laboratory infrastructure for diagnosing TB drug resistance. Even where available, inherent delays with current drug-susceptibility testing (DST) methods result in clinical deterioration and ongoing transmission of MDR and XDR-TB. Identifying clinical predictors of drug resistance may aid in risk stratification for earlier treatment and infection control. METHODS: We performed a retrospective case-control study of patients with MDR (cases), XDR (cases) and drug-susceptible (controls) TB in a high-HIV-prevalence setting in South Africa to identify clinical and demographic risk factors for drug-resistant TB. Controls were selected in a 1:1:1 ratio and were not matched. We calculated odds ratios (OR) and performed multivariate logistic regression to identify independent predictors. RESULTS: We enrolled 116, 123 and 139 patients with drug-susceptible, MDR, and XDR-TB. More than 85% in all three patient groups were HIV-infected. In multivariate analysis, MDR and XDR-TB were each strongly associated with history of TB treatment failure (adjusted OR 51.7 [CI 6.6-403.7] and 51.5 [CI 6.4-414.0], respectively) and hospitalization more than 14 days (aOR 3.8 [CI 1.1-13.3] and 6.1 [CI 1.8-21.0], respectively). Prior default from TB treatment was not a risk factor for MDR or XDR-TB. HIV was a risk factor for XDR (aOR 8.2, CI 1.3-52.6), but not MDR-TB. Comparing XDR with MDR-TB patients, the only significant risk factor for XDR-TB was HIV infection (aOR 5.3, CI 1.0-27.6). DISCUSSION: In this high-HIV-prevalence and drug-resistant TB setting, a history of prolonged hospitalization and previous TB treatment failure were strong risk factors for both MDR and XDR-TB. Given high mortality observed among patients with HIV and drug-resistant TB co-infection, previously treated and hospitalized patients should be considered for empiric second-line TB therapy while awaiting confirmatory DST results in settings with a high-burden of MDR/XDR-TB