Traditional herbal medicine regulatory implementation in Ethiopia: a qualitative study

Background: Approximately 80% of the Ethiopian population predominantly depends on herbal medicines (HMs) for their primary healthcare needs. Nevertheless, worries regarding the safety, efficacy, and standard of herbal-based treatments have been escalating due to the lack of strong regulatory frameworks. Therefore, the study aimed to assess the presence of regulatory frameworks for traditional herbal medicines and their enforcement in Ethiopia.Methods: The qualitative–phenomenological study design was conducted from November 2021 to March 2022 G.C. The study included 25 regulatory official key informants (KIs) who work for national and regional medicine regulatory agencies, and 15 traditional herbal medicine (THM) practitioners who work at the regional level were purposefully selected for an in-depth interview (IDI). An in-depth interview guide was developed through the purposive sampling technique. The collected data were analyzed using thematic content analysis techniques.Results: The study found that the current national medicine proclamation is deemed inadequate in the regulation of THM. Both conventional and traditional herbal medicines are regulated by a single agency. Weak legal enforcement, a lack of government commitment and support, resource constraints, and inadequate regulatory tools are the main challenges faced in THM regulation.Conclusion: Overall, the study found inadequate legal frameworks and weak THM regulatory implementations in Ethiopia. Consequently, it is critical for all regulatory authorities in Ethiopia to exert their utmost efforts to effectively regulate THM

The Use of Laboratory Tests in Diagnosing Lesions of The Mouth and Jaws

Background: Determining odontogenic cysts and tumors necessitates an early diagnosis to avert surgeries involving extensive elimination of infected tissues. This study assesses the accuracy of the YOLO v2 deep learning network in contrast to conventional methods to detect dental caries in panoramic radiographs. Methods: Research was done using 1602 lesions in periapical radiographs taken at Yonsei University Dental Hospital between the years 2010 and 2019. The study divided the participants into those with dentigerous cysts, odontogenic keratocysts, ameloblastoma, and the control group without any lesion. This paper aims to assess the diagnostic performance of YOLO v against that of oral and maxillofacial surgeons and general practitioners by using measures like precision, recall, accuracy, and the F1 score that will be used for objective evaluation.   Results: YOLO showed the highest metric accuracy among the three teams, with particularity percentage and amount of recall being 0.707 and 0.680, respectively. Although the results of the YOLO models did not vary much from clinical performance, none of these differences were statistically observed. Discussion: The results of this study may point towards the possibility of the YOLO version becoming successful in the detection of jaw cysts and tumors in panoramic radiography tests. It is as competent as a human clinician in this case, which makes a potential introduction either an aid to screen patients early and curb those unnecessary morbidities in oral and maxillofacial surgery. Conclusions: The study stresses the benefits that auto-detecting machine learning algorithms like YOLO offer in medical process automation and AI in dentistry. The good performance of YOLO in hunting for lesions and creating pictures on panoramic radiographs shows its ability to facilitate diagnosis and thus influence positive patient outcomes

Perceived risk of infection and death from COVID-19 among community members of low- and middle-income countries: A cross-sectional study [version 1; peer review: awaiting peer review]

Background: Risk perceptions of coronavirus disease 2019 (COVID-19) are considered important as they impact community health behaviors. The aim of this study was to determine the perceived risk of infection and death due to COVID-19 and to assess the factors associated with such risk perceptions among community members in low- and middle-income countries (LMICs) in Africa, Asia, and South America. Methods: An online cross-sectional study was conducted in 10 LMICs in Africa, Asia, and South America from February to May 2021. A questionnaire was utilized to assess the perceived risk of infection and death from COVID-19 and its plausible determinants. A logistic regression model was used to identify the factors associated with such risk perceptions. Results: A total of 1,646 responses were included in the analysis of the perceived risk of becoming infected and dying from COVID-19. Our data suggested that 36.4% of participants had a high perceived risk of COVID-19 infection, while only 22.4% had a perceived risk of dying from COVID-19. Being a woman, working in healthcare-related sectors, contracting pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, as well as seeing or reading about individuals infected with COVID-19 on social media or TV were all associated with a higher perceived risk of becoming infected with COVID-19. In addition, being a woman, elderly, having heart disease and pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, and seeing or reading about individuals infected with COVID-19 on social media or TV had a higher perceived risk of dying from COVID-19. Conclusions: The perceived risk of infection and death due to COVID-19 are relatively low among respondents; this suggests the need to conduct health campaigns to disseminate knowledge and information on the ongoing pandemic

Traditional Herbal Medicine Regulation in Ethiopia: A Critical Evaluation of Legal Basis and Its Implementation

Background: The majority of Ethiopians' primary healthcare relies on herbal medicine (HM) based traditional medicine (TM) products and practices. Therefore, the presence of adequate regulatory framework for traditional herbal medicines (THMs) and its effective implementation is vital to improve the quality and standard of public healthcare system in Ethiopia. Objective: To assess the traditional herbal medicines regulation legal basis and its practical implementation in Ethiopia from November 2021 to March 2022 Methods: An institutional-based descriptive cross-sectional study design mixed with qualitative approach (in-depth interviews) was conducted. The study data was obtained from archival review of legal basis, a survey of random selected 237 regulatory personnel, and in-depth interview conducted with purposely- selected 25 regulatory officials and 15 herbalists. Quantitative data analyzed by SPSS version 26, and a thematic analysis approach was utilized to analyze qualitative data. The study results were presented in text, tables, and figures form. Results: Ethiopia has now regulated THMs based on the 1993 medicine policy and, 2019 proclamation of Ethiopian Food and Drug Authority (EFDA). Current medicine law of Ethiopia has inadequateness on TM/HM product and practice recognition; TMs executive bodies name, power and functions; and regulated TM/HM product sources, categories and requirements. The presence of exclusive regulation (80.7%, n=57) and registration (89.5%, n=57) system for TMs products at EFDA were reported. The majority of EFDA and regional health regulatory (RHR) study participants agreed on the absence of authorized TMs products and manufacturer, and pharmacovigilance (PV) regulation systems. Most of RHR workers were informed the existence of a system for most THM practice and providers basic regulatory activities. Functionality of herbalist registration (97.8%, n=180), and THM practice regulation (87.8%, n=180) were reported. (70.2%, n = 57) of EFDA and 41.7% (n=180) of RHR respondents believed as THM regulatory activities were poorly enforced by their respective offices. The indicators of THM weak practical regulation identified by study participants were HM sells without restriction, registered herbalists small in number, THM not regulated in some regions‟, most THM regulatory tools not available, presence of quack herbalists, and ignorance of THM regulation at rural. THM regulation mainly challenged by weak legal enforcement, weak government commitment and supports, regulatory resources constrains, TM regulatory administrative and activities fragments, and regulatory tools inadequateness. Moreover, the presence of TM healers over suspicion, regions level TM regulation inconstancy, THM regulatory requirement difficultness, federal and RHR offices weak cooperation, HM research and development negligence, and TM healers‟ association weakness were identified common challenges of THM regulatio

Atherogenic Index of Plasma and High-Sensitivity C-Reactive Protein Levels Among People Living With HIV on Dolutegravir and Ritonavir-Boosted Atazanavir-Based Antiretroviral Therapy and Their Correlations to CD4 Cell Counts

Conclusion: From the study conducted, it can be concluded that the higher levels of AIP and hsCRP were seen in patients treated by ATV/r than in DTG-based regimens of ART and in PLWH with low CD4 cell counts. Therefore, routine monitoring of both AIP and hsCRP levels was a good marker of HIV disease progression and cardiovascular disease risk assessment in PLWH, particularly in developing countries where CD4 cell count testing is expensive and not easily available

Medicines dispensing practice during the era of COVID-19 pandemic: a commentary

AbstractThe coronavirus disease 19 (COVID-19) pandemic is putting a huge strain on healthcare systems and is a turning point for the beginning of a global health crisis of an unprecedented condition. As such, the provision of quality pharmacy services particularly, dispensing practice with pre-existing challenges in resource-limited settings is a grave concern in the era of the COVID-19 pandemic. Thus, in this commentary we described the pattern of dispensing practice in the midst of the COVID-19 pandemic by evaluating the current condition of drug dispensing practice in drug retail outlets of Jimma Town.</jats:p

Toll-Like Receptor Signaling in the Pathogenesis of Chronic Dacryocystitis: Implication of c-FOS Transcription Factor and its Downstream Effector Chemokine Genes CCL2, CCL4, CXCL3, CXCR4 with a Shift of the M1/M2 Macrophage Phenotype

Introduction: TLRs are fundamental elements in the orchestration of the innate immune system. These receptors seem to be responsible for the inflammation and fibrosis in chronic dacryocystitis. The aim of the present study was to investigate the role of the toll-Like receptors (TLR2 and TLR4) signaling pathway and its downstream effector chemokine genes in the pathogenesis of chronic dacryocystitis. Method: This study was conducted on 20 patients diagnosed with chronic dacryocystitis and underwent external dacryocystorhinostomy. Estimation of gene expression of TLR2, TLR4, CCL2, CCL4, CXCL3, CXCR4, and c-FOS genes in the lacrimal sac tissues was performed together with the assessment of the inflammatory markers TNFα, IL-1β, IFN-γ, and IL-22. Histopathological examination of the lacrimal sac walls using hematoxylin and eosin (H&amp;E) stain, in addition to immunohistochemical staining of the CD68 and CD163 macrophage markers, was also performed. Results: Our results showed that TLR2, TLR4, and c-FOS gene expressions were significantly increased in the chronic dacryocystitis group with a subsequent increase in their downstream effector chemokine genes CCL2, CCL4, and CXCL3. This up-regulation of genes was accompanied by macrophage shift of polarization toward the M1 pro-inflammatory phenotype (increased CD68 and decreased CD163 expression), leading to increased levels of the pro-inflammatory cytokines (TNF- α, IL-1β and IFN-γ) and decreased anti-inflammatory marker IL-22 with chronic dacryocystitis. Conclusion: It is essential to fine-tune TLR activation through emerging therapeutic approaches. Targeting TLR signaling at the level of receptors or downstream adaptor molecules represents a new challenge for treating chronic dacryocystitis. </jats:sec

Acceptance of COVID-19 vaccination at different hypothetical efficacy and safety levels in ten countries in Asia, Africa, and South America

Vaccine hesitancy, defined as the reluctance or rejection in receiving a vaccine despite its availability, represents a major challenge to global health efforts aiming to control the ongoing COVID-19 pandemic. Understanding the possible factors correlated with COVID-19 vaccine hesitancy using a refined well-informed approach can be helpful to address the phenomenon. The current study aimed to evaluate COVID-19 vaccine acceptance rates using four hypothetical scenarios of varying levels of vaccine efficacy and safety profiles in ten Asian, African and South American countries. These scenarios included: 95% efficacy and 20% side effects (Vaccine A), 75% efficacy and 5% side effects (Vaccine B); 75% efficacy and 20% side effects (Vaccine C) and 50% efficacy and 5% side effects (Vaccine D). This study used a self-administered online survey that was distributed during February–May 2021. The total number of study respondents was 1337 with countries of residence as follows: India (21.1%), Pakistan (12.9%), Sudan (11.2%), Nigeria (9.3%), Iran (8.2%), Bangladesh and Brazil (7.9%), Chile (7.7%), Tunisia (7.6%), and Egypt (6.2%). The overall acceptance rates for COVID-19 vaccination were variable based on varying degrees of safety and efficacy as follows: 55.6% for Vaccine C, 58.3% for Vaccine D, 74.0% for Vaccine A and 80.1% for Vaccine B. The highest levels of COVID-19 vaccine acceptance were observed in Brazil followed by Chile across the four different safety and efficacy scenarios. The lowest COVID-19 vaccine acceptance rates were reported in Egypt and Tunisia for the low safety scenarios (20% side effects), and the low efficacy scenario (50% efficacy). The study revealed the potential effect of vaccine safety and efficacy on the intention to get COVID-19 vaccination. At the same efficacy level, higher possibility of side effects caused a large drop in COVID-19 vaccine acceptance rate. This indicates the importance of accurate communication regarding vaccine safety and efficacy on attitude towards the vaccine and intentions to get vaccinated. Regional differences in COVID-19 vaccine acceptance were observed with the Middle East/North African countries showing the lowest rates and the South American countries displaying the highest vaccine acceptance rates. </jats:p

Acceptance of COVID-19 vaccination at different hypothetical efficacy and safety levels in ten countries in Asia, Africa, and South America

Vaccine hesitancy, defined as the reluctance or rejection in receiving a vaccine despite its availability, represents a major challenge to global health efforts aiming to control the ongoing COVID-19 pandemic. Understanding the possible factors correlated with COVID-19 vaccine hesitancy using a refined well-informed approach can be helpful to address the phenomenon. The current study aimed to evaluate COVID-19 vaccine acceptance rates using four hypothetical scenarios of varying levels of vaccine efficacy and safety profiles in ten Asian, African and South American countries. These scenarios included: 95% efficacy and 20% side effects (Vaccine A), 75% efficacy and 5% side effects (Vaccine B); 75% efficacy and 20% side effects (Vaccine C) and 50% efficacy and 5% side effects (Vaccine D). This study used a self-administered online survey that was distributed during February–May 2021. The total number of study respondents was 1337 with countries of residence as follows: India (21.1%), Pakistan (12.9%), Sudan (11.2%), Nigeria (9.3%), Iran (8.2%), Bangladesh and Brazil (7.9%), Chile (7.7%), Tunisia (7.6%), and Egypt (6.2%). The overall acceptance rates for COVID-19 vaccination were variable based on varying degrees of safety and efficacy as follows: 55.6% for Vaccine C, 58.3% for Vaccine D, 74.0% for Vaccine A and 80.1% for Vaccine B. The highest levels of COVID-19 vaccine acceptance were observed in Brazil followed by Chile across the four different safety and efficacy scenarios. The lowest COVID-19 vaccine acceptance rates were reported in Egypt and Tunisia for the low safety scenarios (20% side effects), and the low efficacy scenario (50% efficacy). The study revealed the potential effect of vaccine safety and efficacy on the intention to get COVID-19 vaccination. At the same efficacy level, higher possibility of side effects caused a large drop in COVID-19 vaccine acceptance rate. This indicates the importance of accurate communication regarding vaccine safety and efficacy on attitude towards the vaccine and intentions to get vaccinated. Regional differences in COVID-19 vaccine acceptance were observed with the Middle East/North African countries showing the lowest rates and the South American countries displaying the highest vaccine acceptance rates

Vaccine hesitancy among communities in ten countries in Asia, Africa, and South America during the COVID-19 pandemic

Vaccine hesitancy is considered one of the greatest threats to the ongoing coronavirus disease 2019 (COVID-19) vaccination programs. Lack of trust in vaccine benefits, along with concerns about side effects of the newly developed COVID-19 vaccine, might significantly contribute to COVID-19 vaccine hesitancy. The objective of this study was to determine the level of vaccine hesitancy among communities in particular their belief in vaccination benefits and perceived risks of new vaccines. An online cross-sectional study was conducted in 10 countries in Asia, Africa, and South America from February to May 2021. Seven items from the WHO SAGE Vaccine Hesitancy Scale were used to measure a construct of belief in vaccination benefit, and one item measured perceived riskiness of new vaccines. A logistic regression was used to determine which sociodemographic factors were associated with both vaccine hesitancy constructs. A total of 1,832 respondents were included in the final analysis of which 36.2% (range 5.6–52.2%) and 77.6% (range 38.3–91.2%) of them were classified as vaccine hesitant in terms of beliefs in vaccination benefits and concerns about new vaccines, respectively. Respondents from Pakistan had the highest vaccine hesitancy while those from Chile had the lowest. Being females, Muslim, having a non-healthcare-related job and not receiving a flu vaccination during the past 12 months were associated with poor beliefs of vaccination benefits. Those who were living in rural areas, Muslim, and those who did not received a flu vaccination during the past 12 months had relatively higher beliefs that new vaccines are riskier. High prevalence of vaccine hesitancy in some countries during the COVID-19 pandemic might hamper COVID-19 vaccination programs worldwide. Programs should be developed to promote vaccination in those sociodemographic groups with relatively high vaccine hesitancy