Potential Beneficial Effects of Tulbaghia violacea William Henry Harvey (Alliaceae) on Cardiovascular System - A Review

Tulbaghia violacea William Henry Harvey (Harv. Alliaceae) is a small bulbous herb belonging to the family Alliaceae. It is used in South Africa to treat fever, colds, asthma, paralysis, and hypertension. Meanwhile, cardiovascular disease accounts for about 30 % of total global death, with most of these deaths occurring in low and middle-income countries. Furthermore, people in low-income countries are still largely dependent on plants in their surroundings for both prophylaxis and treatment of diseases, partly due to limited access to and cost of pharmaceuticals, and folkloric evidence of the potency of medicinal plants and/or local belief systems. Therefore, the present review aims to proffer possible ways by which T. violacea may improve cardiovascular outcomes. An extensive and systematic review of the literature was carried out, and relevant findings presented in this review. There is evidence that T. violacea may modulate the renin-angiotensin system, the autonomic nervous system, oxidative stress and haemostasis, with resultant protection of the cardiovascular system in both health and disease.Keywords: Tulbaghia violacea, Spontaneously hypertensive rats, Hypertension, Blood pressure, Heart rate, Renin-angiotensin aldosterone syste

Improving equity in malaria treatment: Relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria

<p>Abstract</p> <p>Background</p> <p>Equitable improvement of treatment-seeking for malaria will depend partly on how different socio-economic groups perceive the ease of accessing and utilizing malaria treatment services from different healthcare providers. Hence, it was important to investigate the link between socioeconomic status (SES) with differences in perceptions of ease of accessing and receiving treatment as well as with actual health seeking for treatment of malaria from different providers.</p> <p>Methods</p> <p>Structured questionnaires were used to collect data from 1,351 health providers in four malaria-endemic communities in Enugu state, southeast Nigeria. Data was collected on the peoples' perceptions of ease of accessibility and utilization of different providers of malaria treatment using a pre-tested questionnaire. A SES index was used to examine inequities in perceptions and health seeking.</p> <p>Results</p> <p>Patent medicine dealers (vendors) were the most perceived easily accessible providers, followed by private hospitals/clinics in two communities with full complement of healthcare providers: public hospital in the community with such a health provider and traditional healers in a community that is devoid of public healthcare facilities. There were inequities in perception of accessibility and use of different providers. There were also inequity in treatment-seeking for malaria and the poor spend proportionally more to treat the disease.</p> <p>Conclusion</p> <p>Inequities exist in how different SES groups perceive the levels of ease of accessibility and utilization of different providers for malaria treatment. The differentials in perceptions of ease of access and use as well as health seeking for different malaria treatment providers among SES groups could be decreased by reducing barriers such as the cost of treatment by making health services accessible, available and at reduced cost for all groups.</p

Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria

<p>Abstract</p> <p>Background</p> <p>Out-of-pocket spending (OOPS) is the major payment strategy for healthcare in Nigeria. Hence, the paper assessed the determinants socio-economic status (SES) of OOPS and strategies for coping with payments for healthcare in urban, semi-urban and rural areas of southeast Nigeria. This paper provides information that would be required to improve financial accessibility and equity in financing within the public health care system.</p> <p>Methods</p> <p>The study areas were three rural and three urban areas from Ebonyi and Enugu states in South-east Nigeria. Cross-sectional survey using interviewer-administered questionnaires to randomly selected householders was the study tool. A socio-economic status (SES) index that was developed using principal components analysis was used to examine levels of inequity in OOPS and regression analysis was used to examine the determinants of use of OOPS.</p> <p>Results</p> <p>All the SES groups equally sought healthcare when they needed to. However, the poorest households were most likely to use low level and informal providers such as traditional healers, whilst the least poor households were more likely to use the services of higher level and formal providers such as health centres and hospitals. The better-off SES more than worse-off SES groups used OOPS to pay for healthcare. The use of own money was the commonest payment-coping mechanism in the three communities. The sales of movable household assets or land were not commonly used as payment-coping mechanisms. Decreasing SES was associated with increased sale of household assets to cope with payment for healthcare in one of the communities. Fee exemptions and subsidies were almost non-existent as coping mechanisms in this study</p> <p>Conclusions</p> <p>There is the need to reduce OOPS and channel and improve equity in healthcare financing by designing and implementing payment strategies that will assure financial risk protection of the poor such pre-payment mechanisms with government paying for the poor.</p

Cost-effectiveness analysis of rapid diagnostic test, microscopy and syndromic approach in the diagnosis of malaria in Nigeria: implications for scaling-up deployment of ACT

BACKGROUND: The diagnosis and treatment of malaria is often based on syndromic presentation (presumptive treatment) and microscopic examination of blood films. Treatment based on syndromic approach has been found to be costly, and contributes to the development of drug resistance, while microscopic diagnosis of malaria is time-consuming and labour-intensive. Also, there is lack of trained microscopists and reliable equipment especially in rural areas of Nigeria. However, although rapid diagnostic tests (RDTs) have improved the ease of appropriate diagnosis of malaria diagnosis, the cost-effectiveness of RDTs in case management of malaria has not been evaluated in Nigeria. The study hence compares the cost-effectiveness of RDT versus syndromic diagnosis and microscopy. METHODS: A total of 638 patients with fever, clinically diagnosed as malaria (presumptive malaria) by health workers, were selected for examination with both RDT and microscopy. Patients positive on RDT received artemisinin-based combination therapy (ACT) and febrile patients negative on RDT received an antibiotic treatment. Using a decision tree model for a hypothetical cohort of 100,000 patients, the diagnostic alternatives considered were presumptive treatment (base strategy), RDT and microscopy. Costs were based on a consumer and provider perspective while the outcome measure was deaths averted. Information on costs and malaria epidemiology were locally generated, and along with available data on effectiveness of diagnostic tests, adherence level to drugs for treatment, and drug efficacy levels, cost-effectiveness estimates were computed using TreeAge programme. Results were reported based on costs and effects per strategy, and incremental cost-effectiveness ratios. RESULTS: The cost-effectiveness analysis at 43.1% prevalence level showed an incremental cost effectiveness ratio (ICER) of 221 per deaths averted between RDT and presumptive treatment, while microscopy is dominated at that level. There was also a lesser cost of RDT ($0.34 million) compared to presumptive treatment ($0.37 million) and microscopy ($0.39 million), with effectiveness values of 99,862, 99,735 and 99,851 for RDT, presumptive treatment and microscopy, respectively. Cost-effectiveness was affected by malaria prevalence level, ACT adherence level, cost of ACT, proportion of non-malaria febrile illness cases that were bacterial, and microscopy and RDT sensitivity. CONCLUSION: RDT is cost-effective when compared to other diagnostic strategies for malaria treatment at malaria prevalence of 43.1% and, therefore, a very good strategy for diagnosis of malaria in Nigeria. There is opportunity for cost savings if rapid diagnostic tests are introduced in health facilities in Nigeria for case management of malaria

The contributions of muscarinic receptors and changes in plasma aldosterone levels to the anti-hypertensive effect of Tulbaghia violacea

Background: Tulbaghia violacea Harv. (Alliaceae) is used to treat various ailments, including hypertension (HTN) in South Africa. This study aims to evaluate the contributions of muscarinic receptors and changes in plasma aldosterone levels to its anti-hypertensive effect. Methods: In the acute experiments, methanol leaf extracts (MLE) of T. violacea (30–120 mg/kg), muscarine (0.16 -10 μg/kg), and atropine (0.02 - 20.48 mg/kg), and/or the vehicle (dimethylsulfoxide (DMSO) and normal saline (NS)) were respectively and randomly administered intravenously in a group of spontaneously hypertensive (SHR) weighing 300 to 350 g and aged less than 5 months. Subsequently, T. violacea (60 mg/kg) or muscarine (2.5 μg/kg) was infused into eight SHRs, 20 min after atropine (5.12 mg/kg) pre-treatment. In the chronic (21 days) experiments, the SHRs were randomly divided into three groups, and given the vehicle (0.2 ml/day of DMSO and NS), T. violacea (60 mg/kg/day) and captopril (10 mg/kg/day) respectively into the peritoneum, to investigate their effects on blood pressure (BP), heart rate (HR), and plasma aldosterone levels. Systolic BP and HR were measured using tail-cuff plethysmography during the intervention. BP and HR were measured via a pressure transducer connecting the femoral artery and the Powerlab at the end of each intervention in the acute experiment; and on day 22 in the chronic experiment. Results: In the acute experiments, T. violacea, muscarine, and atropine significantly (p < 0.05) reduced BP dose-dependently. T. violacea and muscarine produced dose-dependent decreases in HR, while the effect of atropine on HR varied. After atropine pre-treatment, dose-dependent increases in BP and HR were observed with T. violacea; while the BP and HR effects of muscarine were nullified. In the chronic experiments, the T. violaceatreated and captropril-treated groups had signicantly lower levels of aldosterone in plasma when compared to vehicle-treated group. Compared to the vehicle-treated group, significant reduction in BP was only seen in the captopril-treated group; while no difference in HR was observed among the groups. Conclusion: The results obtained in this study suggest that stimulation of the muscarinic receptors and a reduction in plasma aldosterone levels contribute to the anti-hypertesive effect of T. violacea.IS

in vivo cardiovascular effects of L leonurus diterpenoids

This study assessed the effect of five diterpenoid compounds (dubiin, saponified dubiin, DC8, DC9 and marrubiin) isolated from Leonotis leonurus (Lamiaceae) on blood pressure and heart rate in the anaesthetized normotensive Wistar rat model. L. Leonurus is a medicinal plant indigenous to southern Africa, used in traditional medicines for the treatment of various diseases including cardiovascular diseases, with extracts of the plant leaves reported to produce varying cardiovascular effects in vitro and in vivo. Our hypothesis was that the cardiovascular effects reported with extracts of the plant were due to these diterpenoid compounds previously isolated from the plant. Changes to blood pressure and heart rate with the IV administration of these compounds were recorded in anaesthetized male Wistar rats via a cannulated femoral artery connected to a BP transducer, BP amplifier and a PowerLab. The data presented shows replicate (6) values for blood pressure and heart rate after 3 minutes of infusion of the test compound. Mean and SEM are presented at the bottom of each dose column as well as results of ANOVA testing for significant differences to the control (saline) and positive control (dobutamine 60 ug/kg). Dubiin, DC 8, DC 9 and saponified dubiin produced dose-dependent increases in blood pressure and heart rate, while marrubiin produced dose dependent decreases in blood pressure, with non-significant changes to heart rate

Assessment Of Health Seeking Behaviour And Healthcare Payment Options In Nigeria

Availability of resources, location of residence, and other health related factors affects the health seeking behaviour of people in Nigeria especially people in poor settlements. Many of the citizens pay for their healthcare needs through the regressive out-of-pocket payment method thus this could be a hindrance to seeking better healthcare. This study assessed the health seeking behaviour and payment options of slum dwellers using a one month recall period. Data was collected using a well-structured interviewer-administered questionnaire. The quantitative statistical tools used in the study analysis were tabulations, frequencies and testing of means. The findings showed that about 32.8% of the heads of households and 25% of other household members were sick one month prior to the interview. The major illnesses was presumptive malaria (54.9%) and (55.1%) for heads of household and other household members respectively. Majority of the head of households and other household members first sought for treatment from patent medicine vendors. The major payment option available for slum dwellers to pay for their health needs was through the out-of-pocket and it was used by 62.1% of heads of households and 73.2% of other household members. Only about 3% of the household heads and about 3.9% of other household members had any form of health insurance. The policy implication is the poor health seeking patter where majority seeks care at patent medicine vendors may be improved with a good financial risk protection mechanism such as health insurance, which will improve access

Novel Basic Health Care Provision Fund in Nigeria: Can Workforce for Service Delivery Improve?

Health financing policies are political decisions that involve all stakeholders because of its potentials in altering allocations in the budget and statuesque. This important economic tool should always be used in economic policies of nations especially in developing economies because of the wrongly perceived notion that there is no investment case for health. The government of Nigeria in 2014 signed into law the National Health Act. This Act made provision for additional funding to the health sector through earmarking to the tune of about $200 million annually, with the fund called the Basic Healthcare Provision Fund (BHCPF). The study aims to determine how many more health workers will be employed in the Nigerian health force using the earmarked funds in the health sector at the primary level of care. The study is a quantitative study design that involved the use of primary data from the BHCPF's implementation tracking tool. Data was collected during a health facility assessment in four systematically selected states in a random manner, which is in the first phase of the BHCPF implementation. This study showed that about 91,946 people will be employed directly into the Nigeria's health system if the Basic Health care Provision Fund is successfully implemented. This will in turn bridge the gap in human resource for health especially in the rural areas and improve the quality of service delivery at primary health care level in Nigeria. Therefore more funds should be allocated to the health sector to create jobs and bridge the gap in human resource for health in the underserved areas

Labdane Diterpenoids from Leonotis leonurus

Three known (leoleorins A-C) and eight new (leoleorins D-J and 16-epi-leoleorin F) labdane diterpenoids, were isolated from leaves of Leonotis leonurus. The absolute configurations of leoleorins A and D were established by X-ray crystallographic analyses. In competitive binding assay all isolated compounds showed inhibition in excess of 50% at various CNS receptors. Leoleorin C showed moderate binding affinity (K(i) = 2.9 μM) for the Sigma 1 receptor