Antimalarial Activity of Some Plants Used in Traditional Medicine in Uganda

This work was done to identify some of the plants used in the treatment of malaria in Uganda and to investigate their efficacy in the in-vitro assays. Plumbago zeylenica and Cryptolepis sanguinolenta showed marked activity on the chloroquine resistant and chloroquine sensitive strains of Plasmodium falciparum. Plumbagin, a quinone, was isolated from Plumbago zeylenica, and found to have antimalarial activity with IC50 of 178 ng/ml on chloroquine sensitive and 188 ng/ml on chloroquine resistant strains. Cytotoxicity assays on KB cell lines indicated that the extract was selective for Plasmodium falciparum. The Selective Index was 5 in both strains of Plasmodium falciparum. It was concluded that some of the plants used for malaria contain compounds with antimalarial activity, which can be useful leads for the development of new antimalarial drugs. Key Words: Antimalarial activity, Plumbago zeylenica, Cryptolepis sanguinolenta, plumbagin East and Central African Journal of Pharmaceutical Sciences Vol.5(2) 2002: 33-3

Rare, serious and comprehensively described suspected adverse drug reactions reported by surveyed healthcare professionals in Uganda

BACKGROUND:Lack of adequate detail compromises analysis of reported suspected adverse drug reactions (ADRs). We investigated how comprehensively Ugandan healthcare professionals (HCPs) described their most recent previous-month suspected ADR, and determined the characteristics of HCPs who provided comprehensive ADR descriptions. We also identified rare, serious, and unanticipated suspected ADR descriptions with medication safety-alerting potential. METHODS:During 2012/13, this survey was conducted in purposively selected Ugandan health facilities (public/private) including the national referral and six regional referral hospitals representative of all regions. District hospitals, health centres II to IV, and private health facilities in the catchment areas of the regional referral hospitals were conveniently selected. Healthcare professionals involved in prescribing, transcribing, dispensing, and administration of medications were approached and invited to self-complete a questionnaire on ADR reporting. Two-thirds of issued questionnaires (1,345/2,000) were returned. RESULTS:Ninety per cent (241/268) of HCPs who suspected ADRs in the previous month provided information on five higher-level descriptors as follows: body site (206), drug class (203), route of administration (127), patient age (133), and ADR severity (128). Comprehensiveness (explicit provision of at least four higher-level descriptors) was achieved by at least two-fifths (46%, 124/268) of HCPs. Received descriptions were more likely to be comprehensive from HCPs in private health facilities, regions other than central, and those not involved in teaching medical students. Overall, 106 serious and 51 rare previous-month suspected ADRs were described. The commonest serious and rare ADR was Stevens-Johnson syndrome (SJS); mostly associated with oral nevirapine or cotrimoxazole, but haemoptysis after diclofenac analgesia and paralysis after quinine injection were also described. CONCLUSION:Surveyed Ugandan HCPs who had suspected at least one ADR in the previous month competently provided comprehensive ADR descriptions: more, indeed, than are received per annum nationally. Properly analyzed, and with local feed-back, voluntary ADR reports by HCPs could be an essential alerting tool for identifying rare and serious suspected ADRs in Uganda

The prevalence and severity of mental illnesses handled by traditional healers in two districts in Uganda

Background: Little is known about the prevalence and severity of DSM-IV mental disorders treated by traditional healers in Uganda.Objective: To describe the prevalence and severity of DSM-IV disorders handled by traditional healers in Jinja and Iganga districts, Eastern Uganda.Method: Between January and March 2008, Face-to-Face Interviews were conducted with 400 patients attending traditional healers’ shrines for mental health problems, using Self Rating Questionnaire 25 (SRQ-25) for screening, the Mini International Neuropsychiatric Interview (MINI-Plus) for specific DSM-IV diagnosis and the Global Assessment of Functioning (GAF) for severity of illness. Descriptive data analysis and frequency estimates were performed using SPSS version 15.0 for Windows. Pearson’s chi–square tests and odds ratios were used to explore the relationship between severity and combined use of biomedical services andtraditional healing.Results: Of 387 respondents, 60.2% had diagnosable current mental illness and 16.3% had had one disorder in their lifetime. Of the diagnosable current mental illnesses, 29.7% were Psychosis; 5.4% Major depressive episode; 5.6% Anxiety disorders; 3.6% mixedAnxiety-Depression; and 3.9% Suicidality. In terms of severity, 37.7% of the current mental illnesses were severe, 35.1% moderate and 13.2% mild. Patients with moderate to severe symptoms were more likely to use both biomedical services and traditional healers.Conclusion: These findings suggest that a considerable number of patients with DSM-IV diagnosable mental disorders attend traditional healing shrines; the majority had moderate to severe symptoms. Mental health professionals therefore need to come up with ways to co-operate with traditional healers, e.g. as officially designated Traditional Mental Attendants (TMA), for the benefit of their patients.African Health Sciences 2009; 9(S2): 16-2

Microbiological analysis and total aflatoxins levels from shoot powder of Phyllanthus amarus (Schum. and Thonn) from Tororo, Uganda

Phyllanthus amarus (Schum. and Thonn) has been used traditionally for treating over 50 diseases globally including malaria in Tororo, Uganda. Although efficacy and acute toxicity studies of this plant have been determined, safety regarding microbiological analysis and total aflatoxins levels in this Ugandan shoot powder of P. amarus is still lacking. The microbiological analysis was determined according to the procedures recommended in WHO guidelines. Total aflatoxins were determined using Afla Test Kit, VICAM Series (South Africa). In terms of microbial analysis, the herbs were prepared based on indigenous knowledge according to the WHO criteria. Although this herbal shoot powder had microbial safety requirements with key microbial contaminants (i.e. mold fungi, Salmonella typhi, and Escherichia coli) within acceptable ranges, however, aflatoxins in all the investigated samples were beyond acceptable levels. Current results are useful in developing and establishing public health standards for the production and safe handling of herbal products of the Ugandan P. amarus

Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans

Sarah Nanzigu,1,2 Ronald Kiguba,1 Joseph Kabanda,3 Jackson K Mukonzo,1 Paul Waako,1 Cissy Kityo,4 Fred Makumbi31Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; 3Institute of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; 4Joint Clinic Research Centre, Kampala, UgandaIntroduction: CD4 T lymphocytes remain the surrogate measure for monitoring HIV progress in resource-limited settings. The absolute CD4 cell counts form the basis for antiretroviral therapy (ART) initiation and monitoring among HIV-infected adults. However, the rate of CD4 cell change differs among patients, and the factors responsible are inadequately documented.Objective: This study investigated the relationship between HIV severity and ART outcomes among ART-na&iuml;ve Ugandans, with the primary outcome of complete immunological recovery among patients of different baseline CD4 counts.Methods: Patients&#39; records at two HIV/ART sites &ndash; the Joint Clinic Research Centre (JCRC) in the Kampala region and Mbarara Hospital in Western Uganda &ndash; were reviewed. Records of 426 patients &ndash; 68.3% female and 63.2% from JCRC &ndash; who initiated ART between 2002 and 2007 were included. HIV severity was based on baseline CD4 cell counts, with low counts considered as severe immunosuppression, while attaining 418 CD4 cells/&micro;L signified complete immunological recovery. Incidence rates of complete immunological recovery were calculated for, and compared between baseline CD4 cell categories: <50 with &ge;50, <100 with &ge;100, <200 with &ge;200, and &ge;200 with &ge;250 cells/&micro;L.Results: The incidence of complete immunological recovery was 158 during 791.9 person-years of observation, and patients with baseline CD4 &ge; 200 cells/&micro;L reached the end point of immunological recovery 1.89 times faster than the patients with baseline CD4 < 200 cells/&micro;L. CD4 cell change also differed by time, sex, and site, with a faster increase observed during the first year of treatment. CD4 cell increase was faster among females, and among patients from Mbarara.Conclusion: Initiating ART at an advanced HIV stage was the main reason for poor immunological recovery among Ugandans. Earlier ART initiation might lead to better immunological responses.Keywords: baseline CD4 cells, HIV severity, immunological recovery, ART outcome, AR

The efficacy of the crude root bark extracts of Erythrina abyssinica on Rifampicin Resistant Mycobacterium tuberculosis

Tuberculosis (TB) is one of the leading causes of morbidity and mortality with a global mortality rate at two million deaths per year while one third of the world's population is infected with the TB bacillus. To determine the efficacy of the crude extracts of Erythrina abyssinica root bark on rifampicin-resistant TB. Crude extracts of root bark of Erythrina abyssinica, were screened against three strains of Mycobacterium tuberculosis including rifampicin-resistant TMC-331. Susceptibility tests used the disc diffusion method and were done on solid Middle brook 7H10, while the Minimum Inhibitory concentration (MICs) and minimum bactericidal concentration (MBCs) were determined by the Microtitre plate method using Middle brook 7H9 broth.\ud The total crude methanol extract showed activity against all the three strains of mycobacterium used, at 50mg/ml and diameters of zones of inhibition of up to 26 mm. Erythrina abyssinica total crude methanol extract showed the highest activity on the pan sensitive strain H37Rv (0.39±0.0 mg/ml) and the rifampicin resistant strain (TMC-331) (2.35±1.11 mg/ ml) and was also active on Mycobacterium avium (0.39±0.mg/ml. The values for isoniazid were 0.25µg/ml and 9.38µg/ml for H37Rv and TMC-331 respectively, while for rifampicin the MIC value was 0.25µg/ml for H37Rv but it was not active on TMC-331. Acute toxicity test gave an LD50 of 776.2mg/kg body weight while the phytochemical analysis showed the presence of alkaloids, tannins and flavones. The conclusion from the study was that Erythrina abbyssinica has antimycobacterial activity and reasonable safety that merits further research

Pharmacokinetics of the nonnucleoside reverse transcriptase inhibitor efavirenz among HIV-infected Ugandans.

BACKGROUND: Pharmacokinetic variability of the nonnucleoside reverse transcriptase inhibitor efavirenz has been documented, and high variation in trough concentrations or clearance has been found to be a risk for virological failure. Africans population exhibits greater variability in efavirenz concentrations than other ethnic groups, and so a better understanding of the pharmacokinetics of the drug is needed in this population. This study characterized efavirenz pharmacokinetics in HIV-infected Ugandans. METHODS: Efavirenz plasma concentrations were obtained for 66 HIV-infected Ugandans initiating efavirenz- based regimens, with blood samples collected at eight time-points over 24 h on day 1 of treatment, and at a further eight time-points on day 14. Noncompartmental analysis was used to describe the pharmacokinetics of efavirenz. RESULTS: The mean steady-state minimum plasma concentration (C(min) ) of efavirenz was 2.9 µg/mL, the mean area under the curve (AUC) was 278.5 h µg/mL, and mean efavirenz clearance was 7.4 L/h. Although overall mean clearance did not change over the 2 weeks, 41.9% of participants showed an average 95.8% increase in clearance. On day 14, the maximum concentration (C(max) ) of efavirenz was >4 µg/mL in 96.6% of participants, while C(min) was 4 µg/mL, although only half maintained a high concentration until at least 8 h after dosing. CONCLUSION: The findings of this study show that HIV-infected patients on efavirenz may exhibit autoinduction to various extents, and this needs to be taken into consideration in the clinical management of individual patients. Efavirenz CNS toxicity during the initial phase of treatment may be related to C(max) , regardless of the sampling time

An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda

The World Health Organization (WHO) recommends collection of two sputum samples for tuberculosis (TB) diagnosis, with at least one being an early morning (EM) using smear microscopy. It remains unclear whether this is necessary even when sputum culture is employed. Here, we determined the diagnostic yield from spot and the incremental yield from the EM sputum sample cultures among TB-suspected adolescents from rural Uganda. Sputum samples (both spot and early-morning) from 1862 adolescents were cultured by the Lowenstein-Jensen (LJ) and Mycobacterium Growth Indicator Tube (MGIT) methods. For spot samples, the diagnostic yields for TB were 19.0% and 57.1% with LJ and MGIT, respectively, whereas the incremental yields (not totals) of the early-morning sample were 9.5% and 42.9% (P<0.001) with LJ and MGIT, respectively. Among TB-suspected adolescents in rural Uganda, the EM sputum culture has a high incremental diagnostic yield. Therefore, EM sputum in addition to spot sample culture is necessary for improved TB case detection