Maintaining continuity of essential reproductive, maternal, neonatal, child and adolescent health services during the COVID-19 pandemic in Francophone West Africa.

The study aimed to analyse the challenges and solutions for maintaining the continuity of essential health services during the COVID-19 pandemic in Francophone West Africa. A cross-sectional study involving the managers of Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) and vaccination programmes in Francophone West Africa was designed. The challenges that limited the supply and use of RMNCAH services included: lack of standardized guides and procedures for appropriate care, limited knowledge of health workers on the new coronavirus disease, lack of diagnostic materials and kits, ineffective organization of services, anxieties of health workers and populations, and postponement of immunisation mass campaigns. The solutions proposed to address these challenges, included better organization of services to respect the physical distance, provision of adapted guides and care procedures, enhanced communication, training of health workers, effective use of social media and information and communication technologies. This study showed that the managers of RMNCAH programmes are aware of the challenges that could limit the supply and use of essential services during the COVID-19 pandemic.

Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study.

INTRODUCTION: Evidence on the rate at which the double burden of malnutrition unfolds is limited. We quantified trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa. METHODS: We analysed 102 Demographic and Health Surveys between 1993 and 2017 from 35 countries. We assessed regional trends through cross-sectional series analyses and ran multilevel linear regression models to estimate the average annual rate of change (AARC) in the prevalence of underweight, anaemia, anaemia during pregnancy, overweight and obesity among women by their age, residence, wealth and education levels. We quantified current absolute inequalities in these indicators and wealth-inequality trends. RESULTS: There was a modest decline in underweight prevalence (AARC=-0.14 percentage points (pp), 95% CI -0.17 to -0.11). Anaemia declined fastest among adult women and the richest pregnant women with an AARC of -0.67 pp (95% CI -1.06 to -0.28) and -0.97 pp (95% CI -1.60 to -0.34), respectively, although it affects all women with no marked disparities. Overweight is increasing rapidly among adult women and women with no education. Capital city residents had a threefold more rapid rise in obesity (AARC=0.47 pp, 95% CI 0.39, 0.55), compared with their rural counterparts. Absolute inequalities suggest that Ethiopia and South Africa have the largest gap in underweight (15.4 pp) and obesity (28.5 pp) respectively, between adult and adolescent women. Regional wealth inequalities in obesity are widening by 0.34 pp annually. CONCLUSION: Underweight persists, while overweight and obesity are rising among adult women, the rich and capital city residents. Adolescent girls do not present adverse nutritional outcomes except anaemia, remaining high among all women. Multifaceted responses with an equity lens are needed to ensure no woman is left behind.

Toxicological evaluation of Picralima nitida in rodents.

Picralima nitida (Stapf) T. Durand and H. Durand (Apocynaceae), over the years has shown wide range of usage in African folk medicine and its safety profile in instances of prolonged use and pregnancy are major concerns. The study aimed to extensively investigate the toxicological effects of Picralima nitida in albino rodents and make appropriate extrapolations to humans. In the first phase of the experiment which evaluated the genotoxicity and subchronic toxicity of P. nitida, a total of 40 albino rats (male and female) were randomized into 4 groups of 10 animals per group. Group 1 (control group) was orally administered with 10 ml/kg of distilled water. Animals in Groups 2 to 4 were administered with aqueous seed extract of the plant at 100, 200, 400 mg/kg body weight/day, respectively. Oral administration at the designated doses was continued for 90 days after which they were sacrificed by cervical dislocation for subchronic toxicological assessment. In the genotoxicity phase, 30 female mice were randomized into 5 groups, the control group was treated with 10 ml/kg of distilled water, groups 2 to 4, treated with 100 mg/kg, 200 mg/kg and 400 mg/kg doses of extract, and the 5th group had cyclophosphamide (0.1 mg/kg). The mice were sacrificed on the 28th day for bone marrow sampling for genotoxicity testing. In the second phase of the experiment which evaluated the teratogenicity of P. nitida, graded doses of the extract were administered to pregnant rats from day 1-19. Three groups of 6 female rats per group were administered 75, 150 and 300 mg/kg aqueous extract of P. nitida and a fourth group of 6 rats used as control was administered distilled water at 10 ml/kg. On day 20, 3 dams from each group were sacrificed and the foetuses were harvested through abdominal incision for physical examination. The 3 remaining dams were allowed to litter. The litters were sacrificed at 6 weeks for biochemical, haematological and histological analyses. The LD50 determined was 707.107 mg/kg. The aqueous seed extract of P. nitida was found to be genotoxic at all the test doses. There were no significant alterations in haematologic and renal parameters following subchronic administration. Notable dynamics were observed in hormonal characteristics: there was a significant dose-dependent reduction in FSH while oestradiol and progesterone showed dose-dependent increase. Furthermore, P. nitida may cause hepatopathy as shown by hepatic venous and sinusoidal congestion on hepatic histology. Also, there is non-significant reduction in total cholesterol and LDL. No significant alteration in glucose level. Furthermore, the extract produced a statistically significant decrease in birth weight (p < 0.0001). The extract induced a significant (p < 0.05) increase in creatinine and transaminase levels in the first filial of group 150 mg/kg. The platelet count was increased in all treated group (p < 0.005). All the histology of kidney in 150 mg/kg group showed vascular congestion. In conclusion, the aqueous seed extract of P. nitida has teratogenic effects and should not be used in pregnant women. Also, P. nitida is highly genotoxic and may cause hepatic damage and depletion of glutathione pool on chronic use, thereby causing oxidative stress and its potential sequelae.

The West African experience in establishing steering committees for better collaboration between researchers and decision-makers to increase the use of health research findings.

BACKGROUND: Aware of the advantages of a project steering committee (SC) in terms of influencing the development of evidence-based health policies, the West African Health Organisation (WAHO) encouraged and supported the creation of such SCs around four research projects in four countries (Burkina Faso, Nigeria, Senegal and Sierra Leone). This study was conducted to describe the process that was used to establish these committees and its findings aim to assist other stakeholders in initiating this type of process. METHODS: This is a cross-sectional, qualitative study of the initiative's four projects. In addition to a literature review and a review of the project documents, an interview guide was used to collect data from 14 members of the SCs, research teams, WAHO and the International Development Research Center. The respondents were selected with a view to reaching data saturation. The technique of thematic analysis by simple categorisation was used. RESULTS: To set up the SCs, a research team in each country worked with health authorities to identify potential members, organise meetings with these members and sought the authorities' approval to formalise the SCs. The SCs' mission was to provide technical assistance to the researchers during the implementation phase and to facilitate the transfer and use of the findings. The 'doing by learning' approach used by each research team, combined with WAHO's catalytic role with each country's Ministry of Health, helped each SC manage its contextual difficulties and function effectively. CONCLUSION: The involvement of technical and financial partners motivated the researchers and ministries of health, who, in turn, motivated other actors to volunteer on the SCs. The 'doing by learning' approach made it possible to develop strategies adapted to each context to create, facilitate and operate each SC and manage its difficulties. To reproduce such an experience, a strong understanding of the local context and the involvement of strong partners are required.

The use of medicinal plants in self-care in the Agonlin region of Benin.

AIM OF THE STUDY: To investigate the extent and type of medicinal plants used in self-care by the inhabitants of the Agonlin community in the Republic of Benin. MATERIALS AND METHODS: A semi-structured questionnaire was used to interview a total of one thousand mothers. RESULTS: The prevalence rate of the use of herbal medicines in self-care was found to be 51.04%. One hundred and fourteen (114) plant species belonging to 69 families were reported, each with their local names, medicinal use, and parts used. Of all the indications of the identified plants, fever, headache, abdominal pain, and vomiting were the most frequently reported, with malaria treatment recording the highest usage of plant remedies (22%). The plant part most frequently used was the leaves. CONCLUSIONS: This study showed that self-care using medicinal plants is a major part of health care in the Agonlin area.

Clinical Practices of African Traditional Medicine

In African traditional medicine; the curative; training; promotive and rehabilitative services are referred to as clinical practices. These traditional health care services are provided through tradition and culture prescribed under a particular philosophy; e.g. ubuntu or unhu. Norms; taboos; tradition and culture; which are the cornerstones of clinical practice of traditional medicine; are the major reason for the acceptability of traditional health practitioners in the community they serve. The philosophical clinical care embedded in these traditions; culture and taboos have contributed to making traditional medicine practices acceptable and hence highly demanded by the population. This paper discusses the different traditional health care services; such as curative services; general traditional healthcare; mental healthcare; midwifery; bone setting; rehabilitative and promotional services that increases health awareness and developing positive attitudes and behaviour towards healthier living)

Collaboration between traditional health practitioners and conventional health practitioners: some country experiences

Since the early 1970s; the WHO has repeatedly advocated for the recognition of Traditional Health Practitioners (THPs) as Primary Healthcare (PHC) providers and for the integration of traditional medicine in national health systems. Several calls have been made on governments to take responsibility for the health of their people and to formulate national policies; regulations and standards; as part of comprehensive national health programmes to ensure appropriate; safe and effective use of traditional medicine. One of the priorities of the African Regional Strategy on Promoting the Role of TM in Health Systems is promotion of collaboration between practitioners of traditional and conventional medicine. However; despite the health benefits such collaboration could bring to the populations; decades of disregard of traditional medicine practices and products has created mistrust between the two sectors hampering all the efforts being made to promote this potentially useful partnership. This article outlines the strategies that have been adopted by the WHO to ensure the integration of traditional medicine into national health systems; examples of ongoing collaboration between research institutions and THPs based on research and management of patients; and between THPs and conventional health practitioners in HIV/ AIDS prevention and care and HIV/AIDS/STI/tuberculosis programmes; factors that have contributed to sustaining these partnerships as well as mechanisms for strengthening such collaborations

Towards sustainable local production of traditional medicines in the African Region

The majority of the population in the WHO African Region and other developing countries; particularly rural dwellers use plant-based traditional medicines for health care. Most developing countries are endowed with vast resources of medicinal and aromatic plants; which have been used over centuries for the treatment of diseases. The global resurgence of interest in herbal medicines has created a large market for plant derived remediesthat developing countries could exploit to their advantage; provided they could be produced with acceptable quality and safety specifications. This article highlights the current limitations of traditional medicinal productsin the Member States; the essential requirements for the local production of traditional medicines; the status of local production in WHO African Region; approaches to sourcing plant raw materials as well as challenges. Methods for value addition; processing and product improvement for the commercial utilization of medicinal plants are indicated

Medical provision in Africa -- past and present.

The use of medicinal plants and animal-derived remedies for treating illness by Africans goes back many years. Traditionally, rural African communities have relied mainly on the invaluable spiritual and practical skills of traditional medicine practitioners (TMPs) for their healthcare. Today's society has differing views about sickness, but to the traditional African, sickness is understood as a complex interaction of physical, physiological, psychosocial and spiritual factors. Thus, in contrast to Western medicine, which is based on the biomedical model, traditional African medicine takes a holistic approach: disease, good health, success or failure, are believed to be the products of the actions of individuals and ancestral spirits according to the balance or imbalance between the individual and the social environment. TMPs seek to bring about a link of the person, with the society and the ancestors. The reasons for the continued dependence of Africans on traditional medicine range from their belief systems to the relatively high cost and limited access to Western medicine. This paper therefore provides an overview of traditional African medicine with a view to highlighting its many great benefits vis-à-vis the drawbacks of orthodox medicine. The reasons for the rise in interest in herbal medicine on the continent are explained briefly and the need for stricter regulatory controls of the herbal industry, advocated.

An exploratory ethnobotanical study of the practice of herbal medicine by the Akan peoples of Ghana.

This exploratory ethnobotanical study took place in Kumasi, the capital city of the Asante, one of the Akan tribes. Data was collected using the multi-method approach of descriptive review, semi-structured interviews with traditional medical practitioners, and brief scientific review. Traditional Akan medicine is holistic and does not separate the physical world from the supernatural world. It is deeply rooted in traditional religion, with illness seen as a departure from the natural equilibrium. Traditional healers are either spiritually based or non-spiritually based. This study found the traditional knowledge of healing and use of medicinal plants is disseminated through generations by family members. However, the acquisition of academic qualifications is now a priority, and formal training is taking place in the workplace and a university. Techniques used in diagnosis and treatment consist of a fusion of traditional and biomedical methods. Treatment of hypertension was used as an example, with all practitioners recognizing hypertension's clinical signs and symptoms. Medicinal plants are predominantly wildcrafted and dispensed mainly by decoction, although prepared formulas are given. To prevent self-medication, patients are seen frequently. Scientific evidence validates the pharmacological actions of the medicinal plants. Public health care in Ghana is accessed by a cash and carry system that is only available to those who can afford it. Approximately 75 percent of the population depends on traditional medicine for primary health care. A national health insurance scheme was introduced in 2004, and it has been proposed that traditional medicine will be integrated into this new system.

Phytochemical evaluation of selected antioxidant-containing medicinal plants for use in the preparation of a herbal formula--a preliminary study.

Oxidative damage is implicated in the pathogenesis of a number of diseases. Scientific research shows positive links between accumulated free-radical damage and age-related diseases such as atherosclerosis, Alzheimer, and osteoarthritis. There are reports that plant-derived phenolic compounds such as flavonoids have antioxidant properties capable of reducing the risk of developing these diseases. This work aims to evaluate the antioxidant activity of selected medicinal plants traditionally used by herbalists, in particular for the treatment of arthritis, with a view to developing a formula for treating age and age-related diseases. Thin-layer chromatography (TLC) and high-performance liquid chromatography (HPLC) analyses of each plant confirmed the presence of a number of flavonoids reported in the literature, as well as unidentified compounds. The antioxidant activities of these plants were determined by DPPH (= '1,1-diphenyl-2-picryl-hydrazyl') radical scavenging, and by inhibition of linoleic acid peroxidation. All the crude plant extracts showed marked antioxidant activities in both assays. The extracts' inhibitory effects on linoleic acid peroxidation was concentration-dependent, with the highest activity shown at 0.1% (w/v). These results suggest that the phenolic compounds, particularly the flavonoids, may, in part, be responsible for the antioxidant activity of traditional plant extracts.