Recommendations for the Development of Regulatory Guidelines for Registration of Traditional Medicines in South Africa

The regulation and registration of traditional medicines (TM) continues to present challenges to many countries regardless of the fact that an increased number of the population utilises TM for their health care needs. There have been improvements in the legal and policy framework of South Africa based on the WHO guidelines. However, there are currently no guidelines or framework for the registration of TM in South Africa. This article reviews literature and existing guidelines of specific countries and regions and makes recommendations for South African guidelines.     

Plants used to manage type II diabetes mellitus in selected districts of central Uganda

Background

Chronic diseases such as diabetes mellitus are increasing in incidence in sub-Saharan Africa. African traditional medicine is part and parcel of the health care system in Uganda. Majority of the indigenous population will have visited a traditional health care practioner or self-administered herbal medicines before seeking conventional health care. However, documentation of the various medicinal plants is still lacking, necessitating a well-organized information search for such knowledge through research. Such information can lay a firm and clear foundation for scientific investigation of the purported therapeutic benefits of the said plants. The objective of this study was to collect names of medicinal plants used to manage diabetes mellitus type II in selected districts of central Uganda.

Methods

In this ethnobotanical survey, names, of plants used to manage diabetes mellitus type II as well as the methods of preparation, routes of administration and the plant parts used in the districts of Mukono, Kampala, Wakiso and Masaka in the central region of Uganda were documented using a researcher administered questionnaire. Participants were recruited using a snow ball approach in which one individual directed us to another. Informant consensus was determined for each of the plants mentioned.

Results

A total of 18 names of medicinal plants were recorded of which Aloe vera var, Solanum indicum and Vernonia amygydalina were the most commonly mentioned plants and thus had the highest informant consensus. Leaves were the main parts that were used to prepare the herbal medicine while water as the solvent used in all the preparations. In all the cases, only the oral route was used for administration of the medicines.

Conclusion

Documentation of medicinal plants used to manage diabetes can further improve on the formalization process of the Ugandan traditional medicine system as well as lay a basis for further scientific investigation with emphasis on the plants whose informant consensus is high.     

The Eighteenth African Health Sciences Congress: dissemination of research results for utilisation

The African Health Sciences Congress for 1997 will be held in Cape Town, South Africa, from 14 to 18 April. This congress has been an annual event where scientists from across the world meet to present research results and to discuss meaningful approaches to solving some of the world's pressing health problems. The congress which is under the aegis of the African Forum for Health Sciences (AFHES), focusses special attention on ways of finding solutions for problems that afflict the African. The AFHES aims to accentuate, through these meetings, practical approaches that can be used by African governments to tackle health-related matters in order to improve the socio-economic status of the people on the African continent. The common health-related matters that one would be expected to be covered at such a congress are the six major tropical diseases identified by the World Health Organisation (WHO), namely malaria, filariasis, schistosomiasis, leishmaniasis, trypanosomiasis and leprosy. But now, there are other health-related problems on the continent that must be dealt with in order to ensure quality of life. Among them are the new and re-emerging diseases like the haemorrhagic fevers (Ebola and Marbug) and yellowfever, the sexually-transmitted diseases including HIV/AIDS, acute respiratory infections and reproductive health. Then there are the less often mentioned health-related problems currently afflicting the African continent that are not given so much attention as the others. These include sanitation, famine and drought, and malnutrition which arise from political upheavals leading to refugees. The consequences of these socio-economic difficulties further exacerbate the prevalence of the existing tropical and other diseases. Scientists working in Africa should play leading roles in tackling the many health problems that afflict the peoples of Africa. They are well placed to collect direct information on these health issues and to provide practical and meaningful strategies for their solution. The WHO Africa Region has taken a meaningful step towards finding mechanisms of eliminating female mutilation in Africa, and this is highlighted in the Newsdesk pages of this issue of the Journal. This, it is hoped, will be achieved through the use of the African traditional foundation and wisdom. Similarly, the African traditional culture of health should provide the basis for utilising the wisdom of the traditional healers and traditional midwives for dealing with primary health care matters on the African continent. The Journal congratulates all the scientists working in Africa, be they Africans or non-Africans, and those outside Africa, who work tirelessly to solve problems that will pave the way for an acceptable quality of life for the world's peoples. It is earnestly hoped that the scientists in Cape Town during the 18th African Health Sciences Congress will deliberate, discuss and dedicate themselves to solving Africa's pressing health problems. The Journal also acknowledges with gratitude, the organisers of this congress, namely the South African Medical Research Council, the Kenya Medical Research Institute and the Epidemiological Society of Southern Africa (ESSA), which, under the auspices of the African Forum for Health Sciences, have made it possible to hold the Congress in cape Town this year.     

Regulation of blood services in Africa

Blood and blood products save lives and are a part of the WHO Essential Medicines List. Access to safe and quality-assured blood and blood products are essential for health systems strengthening and it is a global concern. Their use is associated with infectious and immunologic risks. At global level, many resolutions have been adopted by the World Health Assembly that urged Member States to ensure regulatory control of access to quality-assured blood and blood products along the entire transfusion chain. The WHO has also developed an action framework to advance universal access to blood. As part of the implementation of these resolutions and guidelines, the WHO Regional Office for Africa and some partners provided support to countries in the region to strengthen their capacity to establish an effective blood regulatory system through organization of regional training workshops on blood regulation, benchmarking of blood regulatory systems, internship at Paul Ehrlich Institut and establishment of the African Blood Regulators Forum. The current status of blood regulation reveals that there are weak transfusion legislation and blood regulatory systems in most African countries, since many national blood transfusion services still rely on self-regulation. However, the national regulatory authorities have reached the maturity level 3 in two countries (Ghana and Tanzania), but only the experience from Ghana has been described in this paper. Like in other low- and middle-income countries, the regulatory systems for associated substances and medical devices including IVDs are not well established in the African region. Misunderstanding by different stakeholders, lack of legislation that provides legal basis, weak capacity and insufficiency of resources are main challenges facing countries to establish an effective national blood regulatory system. To address these challenges, strong advocacy with governments and collaboration with partners are needed to strengthen national blood regulatory systems.     

Towards a better understanding of attitudes and beliefs held by traditional healers and recipients of traditional medicine concerning mental health conditions in post-conflict Liberia: a qualitative investigation

BackgroundA better understanding of attitudes and beliefs held by traditional healers and utilizers of traditional medicine concerning mental health conditions in Liberia is important as Liberia seeks to improve its delivery of mental healthcare in the context of scarce resources and recovery from civil war.MethodsA qualitative research design was used to collect data from 24 Liberian traditional healers, and 11 utilizers of Liberian traditional medicine. Participants were queried about mental health problems in Liberia, treatments, and attitudes towards modern healthcare. Qualitative data were probed and aggregated using content analysis.ResultsMental health problems described by study participants included: Open Mole, African Science, Epilepsy, Depression and Mental Illness (trauma/substance use). Mental health problems were often associated with socioeconomic distress, and participants described their attitudes and beliefs concerning mental healthcare, traditional medicine, and modern healthcare.ConclusionTraditional medicine is an important part of mental healthcare in Africa. Mental illness, social factors, and healthcare access were important problems in Liberia. Mental health problems blended local cultural beliefs with Westernized nosology and social factors. Traditional healer''s attitudes towards Western medicine reflected ambivalence. There is a desire for collaboration with ‘modern’ health care providers, but this will require reciprocal trust-building.     

Status of national research bioethics committees in the WHO African region

Background  

The Regional Committee for Africa of the World Health Organization (WHO) in 2001 expressed concern that some health-related studies undertaken in the Region were not subjected to any form of ethics review. In 2003, the study reported in this paper was conducted to determine which Member country did not have a national research ethics committee (REC) with a view to guiding the WHO Regional Office in developing practical strategies for supporting those countries.     

A cross-sectional study to determine the use of alternative medicines during pregnancy in the district hospitals in Manicaland,Zimbabwe

BackgroundTraditional medicines are widely used in the rapidly growing health system and are of economic importance. The study aimed at determining the frequency, pattern of use and factors that influence traditional medicines use during pregnancy.Materials and methodsA cross-sectional study was carried out at four district hospitals in Manicaland, Zimbabwe, using questionnaire based convenience sampling.ResultsTraditional medicines use was found to be high with 54% (n = 337) of pregnant women using traditional medicines during pregnancy. The major purpose of use of traditional medicine was found to be preparation for delivery; cervical dilation in particular. The following factors showed a significant statistical association for use of traditional medicines: previous mode of delivery (p = 0.006), level of education (p = 0.016), family income (p = 0.007), and residential settlement (p =0.026). Some of the common traditional medicines used during pregnancy include Camellia sinensis, Aloe, Spirostachys Africana, Thumbergia lancifolia, Dalbergiella nyasae, Steganotaenia oraliacea, Stomatostemma monteiroae and Cussonia arboreaConclusionA number of pregnant women use traditional medicines as partus preparators (labour aids) throughout the entire pregnancy period. This calls for obstetricians, general practitioners and midwives to inquire about use of traditional medicine in history.     

Why HIV Positive Patients on Antiretroviral Treatment and/or Cotrimoxazole Prophylaxis Use Traditional Medicine: Perceptions of Health Workers,Traditional Healers and Patients: A Study in Two Provinces of South Africa

The study explored the perceptions, knowledge and attitudes of patients, health workers and traditional healers about the use of traditional medicine and Anti Retroviral Therapy (ART). The study explored the perceptions, knowledge and attitudes of patients, health workers and traditional healers about the use of traditional medicine and Anti Retroviral Therapy (ART), using an exploratory qualitative design in two provinces of South Africa: an urban township health facility in the Western Cape, and a rural district hospital in KwaZulu-Natal (KZN) with antennal HIV rate of 32% and 28%''respectively. In-depth interviews were conducted with 14 participants: six HIV patients on ART and using Traditional Medicine(TM), two doctors, two nurses and four traditional healers. Two focus group discussions -one at each site - were held with community health workers who work with HIV-positive patients (Western Cape [5] and in KZN [4]). Patient said to have used Traditional Healing Practices (THP) before they were diagnosed with HIV, and some who have been diagnosed with HIV continue using TM in conjunction with ART and/or Cotrimoxazole prophylaxis. Patients preferred not to disclose THP to health professionals because of lack of support and understanding. Patients utilize THP because of family expectations, privacy and confidentiality, especially when they have not disclosed their HIV status. Healthcare professionals had strong negative opinions about THP, especially for HIV-positive patients. Traditional healers supported the patient''s rationale for THP use. This study revealed a need to better understand factors involved in patients'' choosing to use THP concurrently with ART.     

Impact of HIV/AIDS on Gross Domestic Product (GDP) in the WHO Africa Region

HIV/AIDS is hypothesized to have substantive negative impact on health status and economic development of individuals, households, communities and nations. The objective of this study was to estimate the burden of HIV/AIDS on GDP in the WHO African Region using a production function approach. The economic burden analysis was done using a double-log econometric model and a cross-sectional data on 45 to 46 countries in the WHO African Region. The data were obtained from WHO, UNAIDS, ECA, UNDP and the World Bank publications. The coefficient for Capital (K), Education (EN), Export (X) and Imports (M) were found to be statistically significant determinants of per capita Gross Domestic Product (GDP) at 5% level of significance (using a one-sided t-distribution test). Unfortunately, HIV/AIDS morbidity (V) and HIV/AIDS deaths (VD), at the same level of significance, were found to have statistically insignificant impact on GDP. However, the coefficients of these variables had negative signs as expected. In all African countries, there is need for more detailed research on the total economic cost of HIV/AIDS (probably estimated using micro-level costing and willingness-to-pay methods) and for economic evaluations of treatment, prevention and promotion programmes.     

Indian Systems of Medicine: A Brief Profile

Medicinal plants based traditional systems of medicines are playing important role in providing health care to large section of population, especially in developing countries. Interest in them and utilization of herbal products produced based on them is increasing in developed countries also. To obtain optimum benefit and to understand the way these systems function, it is necessary to have minimum basic level information on their different aspects. Indian Systems of Medicine are among the well known global traditional systems of medicine. In this review, an attempt has been made to provide general information pertaining to different aspects of these systems. This is being done to enable the readers to appreciate the importance of the conceptual basis of these system in evolving the material medica. The aspects covered include information about historical background, conceptual basis, different disciplines studied in the systems, Research and Development aspects, Drug manufacturing aspects and impact of globalization on Ayurveda. In addition, basic information on Siddha and Unani systems has also been provided.     

The campaign against TB: governments must commit themselves. TB in Africa

This article presents an interview with Pierre Chaulet on the campaign against tuberculosis (TB) in Africa. Chaulet noted during the 9th IUATLD Conference of the Africa Region that the national TB control programs have taken on a new commitment in Africa since the declaration of TB as a global emergency in the 1990s. The TB control program package consists of five principal components: 1) political will of the government and its commitment to support the program; 2) case detection; 3) initiation of short course chemotherapy among detected cases; 4) ensuring the regular supply of essential anti-TB drugs; and 5) establishing a registry and reporting system for program monitoring and evaluation. Of the 40 African countries participating in the conference, 30 have efficient programs. Comparing the management of National TB Control Programs in Francophone and Anglophone Africa, it is noted that both are complementary, although generally, public health issues are more easily integrated into the medical training in the Anglophone countries than they are in the Francophone. Anglophone uses a more comprehensive approach to public health while countries in the Francophone practiced a more traditional university centralization. Finally, Chaulet gives his comment on the role of WHO in addressing concerns over the financial issues involved in TB Control Programs, particularly in the mobilization of resources from nongovernmental organizations and international institutions.     

Traditional medicine: past, present and future research and development prospects and integration in the National Health System of Cameroon

Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being. In the last decade traditional medicine has become very popular in Cameroon, partly due to the long unsustainable economic situation in the country. The high cost of drugs and increase in drug resistance to common diseases like malaria, bacteria infections and other sexually transmitted diseases has caused the therapeutic approach to alternative traditional medicine as an option for concerted search for new chemical entities (NCE). The World Health Organisation (WHO) in collaboration with the Cameroon Government has put in place a strategic platform for the practice and development of TM in Cameroon. This platform aims at harmonizing the traditional medicine practice in the country, create a synergy between TM and modern medicine and to institutionalize a more harmonized integrated TM practices by the year 2012 in Cameroon. An overview of the practice of TM past, present and future perspectives that underpins the role in sustainable poverty alleviation has been discussed. This study gives an insight into the strategic plan and road map set up by the Government of Cameroon for the organisational framework and research platform for the practice and development of TM, and the global partnership involving the management of TM in the country.     

Child and adolescent health and development in a European perspective--a new WHO strategy--secondary publication

In general, children and adolescents in the WHO European Region today have better nutrition, health and development than ever before. There are striking inequalities in health status across the 52 countries in the Region, however, with over ten-fold differences in infant and child mortality rates. Inequalities are also growing within countries, and several health threats are emerging. Against this background, the WHO Regional Office for Europe has developed a European strategy for child and adolescent health and development. The purpose of the Strategy, together with a tool kit for implementation, is to assist member states in formulating their own policies and programmes.     

Understanding of family medicine in Africa: a qualitative study of leaders’ views

Background

The World Health Organization encourages comprehensive primary care within an ongoing personalised relationship, including family physicians in the primary healthcare team, but family medicine is new in Africa, with doctors mostly being hospital based. African family physicians are trying to define family medicine in Africa, however, there is little clarity on the views of African country leadership and their understanding of family medicine and its place in Africa.

Aim

To understand leaders’ views on family medicine in Africa.

Design and setting

Qualitative study with in-depth interviews in nine sub-Saharan African countries.

Method

Key academic and government leaders were purposively selected. In-depth interviews were conducted using an interview guide, and thematically analysed.

Results

Twenty-seven interviews were conducted with government and academic leaders. Responders saw considerable benefits but also had concerns regarding family medicine in Africa. The benefits mentioned were: having a clinically skilled all-rounder at the district hospital; mentoring team-based care in the community; a strong role in leadership and even management in the district healthcare system; and developing a holistic practice of medicine. The concerns were that family medicine is: unknown or poorly understood by broader leadership; poorly recognised by officials; and struggling with policy ambivalence, requiring policy advocacy championed by family medicine itself.

Conclusion

The strong district-level clinical and leadership expectations of family physicians are consistent with African research and consensus. However, leaders’ understanding of family medicine is couched in terms of specialties and hospital care. African family physicians should be concerned by high expectations without adequate human resource and implementation policies.     

《中医方剂大辞典》胃脘痛的用药规律分析

目的 分析《中医方剂大辞典》中胃脘痛方所常用中药,以提高中医药治疗胃痛临床疗效的稳定性。方法 在文献调查、按类统计的基础上,利用频次分析方法筛选,总结中医药防治胃脘痛用药的规律。结果 502首胃脘痛方中,散剂150方,共涉及207味中药,频次≥10的药味共24味;汤剂129首方中,共涉及172味中药,其中频次≥10的药物共32味;丸剂202首方中,共涉及278味中药,其中频次≥20的药物共31味。结论 散剂、汤剂、丸剂3种剂型中,理气药、温里药、化湿药、补脾药、活血化瘀药等为治疗胃脘痛的临床常用中药。     

Adverse Events Associated with Metal Contamination of Traditional Chinese Medicines in Korea: A Clinical Review

This study was performed to review studies carried out in Korea reporting toxic reactions to traditional Chinese medicines (TCMs) as a result of heavy metal contamination. PubMed (1966-August 2013) and International Pharmaceutical Abstracts (1965-August 2013) were searched using the medical subject heading terms of "Medicine, Chinese Traditional," "Medicine, Korean Traditional," "Medicine, Traditional," "Metals, Heavy," and "Drug Contamination". For Korean literature, Korea Med (http://www.koreamed.org), the Korean Medical Database (http://kmbase.medric.or.kr), National Discovery for Science Leaders (www.ndsl.kr), Research Information Sharing Service (http://www.riss.kr), and Google Scholar were searched using the terms "Chinese medicine," "Korean medicine," "herbal medicine," and "metallic contamination" in Korean. Bibliographies of case reports and case series, identified using secondary resources, were also utilized. Only literature describing cases or studies performed in Korea were included. Case reports identified clear issues with heavy metal, particularly lead, contamination of TCMs utilized in Korea. No international standardization guidelines for processing, manufacturing and marketing of herbal products exist. Unacceptably high levels of toxic metals can be present in TCM preparations. Health care providers and patients should be educated on the potential risks associated with TCMs. International advocacy for stricter standardization procedures for production of TCMs is warranted.     

Is there any solution to the "brain drain" of health professionals and knowledge from Africa?

African public health care systems suffer from significant "brain drain" of its health care professionals and knowledge as health workers migrate to wealthier countries such as Australia, Canada, USA, and the United Kingdom. Knowledge generated on the continent is not readily accessible to potential users on the continent. In this paper, the brain drain is defined as both a loss of health workers (hard brain drain) and unavailability of research results to users in Africa (soft brain drain). The "pull" factors of "hard brain drain" include better remuneration and working conditions, possible job satisfaction, and prospects for further education, whereas the "push" factors include a lack of better working conditions including promotion opportunities and career advancement. There is also a lack of essential equipment and non-availability or limited availability of specialist training programs on the continent. The causes of "soft brain drain" include lack of visibility of research results in African journals, better prospects for promotion in academic medicine when a publication has occurred in a northern high impact journal, and probably a cultural limitation because many things of foreign origin are considered superior. Advocates are increasingly discussing not just the pull factors but also the "grab" factors emanating from the developed nations. In order to control or manage the outflow of vital human resources from the developing nations to the developed ones, various possible solutions have been discussed. The moral regard to this issue cannot be under-recognized. However, the dilemma is how to balance personal autonomy, right to economic prosperity, right to personal professional development, and the expectations of the public in relation to adequate public health care services in the developing nations.