Medically important bacteria isolated from commercial herbal medicines in Kampala city indicate the need to enhance safety frameworks.

The high global bacterial infection burden has created need to investigate the neglected potential drivers of pathogenic bacteria, to inform disease prevention. Kampala is facing a proliferation of herbalists, selling herbal medicine (HM), of largely unregulated microbiological quality. We evaluated the bacterial contamination burden in HM sold in Kampala, to support evidence-based redress. The total viable loads (TVL), total coliform counts (TCC), E. coli counts, and prevalence of selected bacterial strains in 140 HM were examined using conventional culture, following the guidelines of World Health Organization (WHO), and Uganda National Drug Authority (NDA). Data were analyzed using D'Agostino-Pearson test, frequencies, proportions, Chi-square, and Mann-Whitney U test with STATA version-15.0. Fifty (35.7%), fifty-nine (42.1%), and twelve (8.6%) HM were unsafe for human use because they exceeded WHO's permissible limits for TVL, TCC, and E. coli counts respectively. Solids had significantly higher mean TVL than liquids. Violation of NDA's guidelines was significantly associated with high TVL. Fifty-nine bacteria, viz., Klebsiella pneumoniae (n = 34; 57.6%), Escherichia. coli (12; 20.3%), Staphylococcus aureus (7; 11.9%), Klebsiella oxytoca (3; 5.1%), Bacillus cereus, Pseudomonas aeruginosa, and Enterobacter spp. (1; 1.7% each), were isolated from 45 (32.1%) samples. These bacteria can cause severe clinical diseases, and promote deterioration of HM potency.

Herbal medicine used for the treatment of diarrhea and cough in Kampala city, Uganda.

BACKGROUND: Globally, diarrheal and respiratory diseases are among the main causes of mortality and morbidity. In Uganda, cities are facing proliferation of trade in herbal medicines (HM), including those for diarrhea and/or cough. Information on the economic, and the ethnopharmacological aspects of these HM is scarce, deterring the sector from achieving optimal capacity to support national development. We profiled the anti-diarrhea and/or anti-cough HM, and the basic economic aspects of HM trade in Kampala city, to support ethnopharmacological knowledge conservation and strategic planning. METHODS: A cross-sectional survey was conducted on 65 herbalists using semi-structured questionnaires. This was supplemented by an observational survey using a high-resolution digital camera. Data were collected following the guidelines for research on HM, established by Uganda National Drug Authority, and World Health organization. RESULTS: Eighty-four plant species from 41 families were documented. Fabaceae and Myricaceae had the highest number of species (9, 10.7% each). Citrus limon (L.) Osbeck was the most commonly cited for cough, with a relative frequency of citation (RFC) of 1.00, and its relative medical importance was not significantly different from the other top 5 species except for Azadirachta indica A.Juss (RFC = 0.87). Entada abyssinica A. Rich (RFC = 0.97) was the most cited for diarrhea. Trees (34, 40.5%) were mostly used, and mainly harvested from wild habitats (55.2%) in 20 districts across Uganda. These HM were mainly sold as powders and concoctions, in markets, shops, pharmacies, and roadside or mobile stalls. The highest prices were Uganda Shillings (UGX) 48,000 ($13.15)/kg for Allium sativum L, and UGX 16,000 ($4.38)/kg for C. limon. All participants used HM trade as a sole source of basic needs; majority (60.0%) earned net monthly profit of UGX. 730,000 ($200) ≤ 1,460,000 ($400). The main hindrances to HM trade were the; disruptions caused by the COVID-19 pandemic (n = 65, 100%), and the scarcity of medicinal plants (58, 89.2%). CONCLUSION: There is a rich diversity of medicinal plant species traded in Kampala to treat diarrhea and cough. The HM trade significantly contributes to the livelihoods of the traders in Kampala, as well as the different actors along the HM value chain throughout the country.

Antibiotic-resistance in medically important bacteria isolated from commercial herbal medicines in Africa from 2000 to 2021: a systematic review and meta-analysis.

BACKGROUND: Antimicrobial resistance is swiftly increasing all over the world. In Africa, it manifests more in pathogenic bacteria in form of antibiotic resistance (ABR). On this continent, bacterial contamination of commonly used herbal medicine (HM) is on the increase, but information about antimicrobial resistance in these contaminants is limited due to fragmented studies. Here, we analyzed research that characterized ABR in pathogenic bacteria isolated from HM in Africa since 2000; to generate a comprehensive understanding of the drug-resistant bacterial contamination burden in this region. METHODS: The study was conducted according to standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We searched for articles from 12 databases. These were: PubMed, Science Direct, Scifinder scholar, Google scholar, HerbMed, Medline, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, Commonwealth Agricultural Bureau Abstracts, African Journal Online, and Biological Abstracts. Prevalence and ABR traits of bacterial isolates, Cochran's Q test, and the I2 statistic for heterogeneity were evaluated using MedCalcs software. A random-effects model was used to determine the pooled prevalence of ABR traits. The potential sources of heterogeneity were examined through sensitivity analysis, subgroup analysis, and meta-regression at a 95% level of significance. FINDINGS: Eighteen studies met our inclusion criteria. The pooled prevalence of bacterial resistance to at least one conventional drug was 86.51% (95% CI = 61.247-99.357%). The studies were highly heterogeneous (I2 = 99.17%; p < 0.0001), with no evidence of publication bias. The most prevalent multidrug-resistant species was Escherichia coli (24.0%). The most highly resisted drug was Ceftazidime with a pooled prevalence of 95.10% (95% CI = 78.51-99.87%), while the drug-class was 3rd generation cephalosporins; 91.64% (95% CI = 78.64-96.73%). None of the eligible studies tested isolates for Carbapenem resistance. Extended Spectrum ß-lactamase genes were detected in 89 (37.2%) isolates, mostly Salmonella spp., Proteus vulgaris, and K. pneumonia. Resistance plasmids were found in 6 (5.8%) isolates; the heaviest plasmid weighed 23,130 Kilobases, and Proteus vulgaris harbored the majority (n = 5; 83.3%). CONCLUSIONS: Herbal medicines in Africa harbor bacterial contaminants which are highly resistant to conventional medicines. This points to a potential treatment failure when these contaminants are involved in diseases causation. More research on this subject is recommended, to fill the evidence gaps and support the formation of collaborative quality control mechanisms for the herbal medicine industry in Africa.

Antibacterial, antioxidant, and sun protection potential of selected ethno medicinal plants used for skin infections in Uganda.

BACKGROUND: Rural populations in Uganda rely heavily on medicinal plants for the treatment of bacterial skin infections. However, the efficacy of these medicinal plants for their pharmacological action is not known. The study aimed at evaluating the antibacterial, antioxidant, and sun protection potential of Spermacoce princeae, Psorospermum febrifugum, Plectranthus caespitosus, and Erlangea tomentosa extracts. METHODS: The plant samples were extracted by maceration sequentially using hexane, dichloromethane, ethyl acetate, methanol, and distilled water. Antibacterial activity of each extract was carried out using an agar well diffusion assay against Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Klebsiella pneumonie, Streptococcus pyogenes, and Salmonella typhi. Acute dermal toxicity of the aqueous extract of S. princeae and P. febrifugum, and E. tomentosa was assessed in young adult healthy Wistar albino rats at a dose of 8000 and 10,000 mg/kg body weight. The antioxidant activity of each extract was carried out using a 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging assay. The sun protection factor was determined using Shimadzu UltraViolet-Visible double beam spectrophotometer between 290 and 320 nm. RESULTS: The plant extracts showed good antibacterial activity against the tested bacterial strains with minimum inhibitory concentration (MIC) ranging between 3.12 and 12.5 mg/ml. There was no significant change in the levels of creatinine, alanine aminotransferase, and aspartate aminotransferase in the rats even at a higher dose of 10,000 mg/kg, which was related to the results of biochemical analysis of the blood samples from the treated and control groups. The aqueous and methanol extracts of S. princeae showed potential antioxidant properties, with half maximal inhibitory concentration (IC50) values of 59.82 and 61.20 µg/ml respectively. The organic and aqueous extracts of P. caespitosus showed high levels of protection against Ultraviolet light with sun protection potential values ranging between 30.67 and 37.84. CONCLUSIONS: The study demonstrated that the selected medicinal plants possessed good antibacterial, antioxidant, and sun protection properties. Therefore, the plants are alternative sources of antibacterial, antioxidant, and sun protection agents in managing bacterial skin infections.

Ethnobotanical survey of medicinal plant species used by communities around Mabira and Mpanga Central Forest Reserves, Uganda.

BACKGROUND: Medicinal plants form an integral part of many health care systems in Uganda. This study aimed at documenting the therapeutic importance of plant species used in primary health care among communities living adjacent to Mabira and Mpanga forest reserves in Central Uganda. METHODS: An ethnobotanical study was conducted between April and June 2018 in 7 villages adjacent to Mpanga and 6 villages adjacent to Mabira central forest reserves. Information was obtained from 28 respondents identified using snowball and purposive sampling techniques and interviewed using semi-structured questionnaires. Descriptive statistics were used to present the data. The quantitative analysis of data was done using fidelity level, informant consensus factor, and percent respondent knowledge indices. RESULTS: A total of 136 medicinal plants were recorded. The plant species classified into 55 families were grouped under 14 medical categories with the highest number of plant species being used for digestive disorders (44%), followed by respiratory (38%) and dermatological disorders (36%). Hoslundia opposita Vahl was mentioned by 71% of the respondents for treating 22 disease conditions. Plant Family Fabaceae was the most represented with 16 species. Informant consensus agreement was high (0.7) for respiratory disorders. The fidelity level was 100% for Bidens pilosa L. and Callistemon citrinus Skeels for treating wounds and cough, respectively. Plant remedies were mainly prepared by decoction (31%) and administered orally (36%). A large number of plants (61%) were harvested from wild habitats. Herbs (50%) and leaves (50%) contributed the highest percentage of plant biological forms and parts used in remedy preparation. CONCLUSION: This study recorded plant species with the potential to treat a wide range of illnesses. This is reflected in the high diversity of the recorded species used for medicinal purposes. Pharmacological studies on the plants with high percentage use values and fidelity levels are needed to validate their uses in the management of the said therapeutic applications. Further research on the isolation and characterization of the plant active compounds could lead to the discovery of new potential drugs.

Prevalence and dynamics of clinically significant bacterial contaminants in herbal medicines sold in East Africa from 2000 to 2020: a systematic review and meta-analysis.

BACKGROUND: Infectious diseases remain a leading cause of mortality and morbidity around the world, and those caused by bacteria are common in the East African region. In this region, trade and consumption of herbal medicine has been expanding in the recent decades. Herbal medicines may be contaminated with pathogenic bacteria; however, there is limited information due to fragmented studies in East Africa. In this meta-analysis, we critically analyzed original research related to the incidence of pathogenic bacterial contaminants of HM in the East African region since 2000. The aim was to create a comprehensive understanding of the extent and dynamics of bacterial contamination in HM, to guide future research and concerted public health protection in the region. METHODOLOGY: The study was conducted according to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched and evaluated published articles from eleven electronic databases (Google Scholar, PubMed, HerbMed, MEDLINE, Science Direct, Scifinder Scholar, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, Biological Abstracts and Commonwealth Agricultural Bureau Abstracts). Prevalences of different bacterial species, Cochran's Q test, and the I2 statistic for heterogeneity were evaluated using a software called MedCalcs. Random and fixed effects models were used to determine the pooled prevalence of clinically significant bacteria from studies which were included in this meta-analysis. The potential sources of heterogeneity were examined through sensitivity analysis, sub-group analysis, and meta-regression at 95% level of significance. RESULTS: Fourteen studies met our inclusion criteria. Overall, the studies were highly heterogeneous (I2 = 98.48%) and there was no evidence of publication bias. Escherichia coli was the most prevalent contaminant. Salmonella spp. and Shigella spp. were the most frequently reported primary pathogens with pooled prevalence of 10.4% and 6.3%, respectively. Our findings are in tandem with recent systematic reviews conducted in Europe and Asia, but are in discrepancy with the reviews recently conducted in southern Africa. CONCLUSION AND RECOMMENDATIONS: The East African herbal medicine industry poses considerable health risks to communities through dissemination of clinically significant bacteria. Presence of enteric bacterial contaminants indicates possible fecal pollution of herbal medicine region-wide. Adequate research pertaining to microbial safety of herbal medicine in the East African countries remains highly desired. The latter will enable establishment of strong, region-wide herbal safety mechanisms in order to support comprehensive public health protection in East Africa.

Ethnobotanical study of indigenous knowledge on medicinal and nutritious plants used to manage opportunistic infections associated with HIV/AIDS in western Uganda.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional medicine plays an important role in the daily lives of the people of Uganda to treat a wide range of health problems. Our study presents results of an ethnobotanical inventory conducted to identify and document medicinal and nutritional plants used in the management of opportunistic infections associated with human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS), the plant parts used, preparation and administration methods of herbal remedies. MATERIALS AND METHODS: We performed semi-structured interviews with 79 respondents (women 78%, men 22%), who included specialists in medicinal plants (such as traditional birth attendants and herbalists) and non specialists with general knowledge of plant use. Respondents answered a semi-structured questionnaire regarding their knowledge of plants and general treatment practices including management of HIV/AIDS opportunistic infections. The reported plants were collected and identified. Data were analyzed using factor informant consensus and fidelity level to determine homogeneity of informants׳ knowledge on medicinal and nutritional plants suitable for different ailment categories and the most preferred plant species used to treat each ailment category in the study areas. RESULTS: The study revealed 148 plant species belonging to 54 families, most of which were herbs (50.7%). Leaves (61.6%) were the most frequently used parts in remedy preparations which were mainly administered orally (72%). The majority of plants (62%) were harvested from wild habitats. The most important species according to fidelity values are Hibiscus sabdariffa L. for anaemia, Mangifera indica L. for cough, Zehneria scabra (L. F.) Sond. for skin infections, Rhus natalensis Bernh.ex.Krauss for diarrhoea and Tarenna pavettoides (Harv.) Sim for appetite boosting. The factor informant consensus highlighted the agreement in the use of plants and showed that the respiratory infections category had the greatest agreement (0.60). Family Asteraceae accounted for 15% of the total species recorded. Sixty plant species (40%) of the plants provide nutritional support. CONCLUSION: The study revealed that folk medicine is still widely practised. Fidelity level values indicate that these plants are the most preferred species for particular ailments. The high consensus value (0.6) indicated that there was high agreement in the use of plants for respiratory ailments among others. These preferred plant species could be prioritized for conservation and subjected to chemical screening to ascertain their pharmacological activities.

Ethnobotanical study of nutri-medicinal plants used for the management of HIV/AIDS opportunistic ailments among the local communities of western Uganda.

ETHNOPHARMACOLOGICAL RELEVANCE: Herbal remedies are a source of therapeutics for nearly 80% of the population in Uganda. Poor health facilities and limited access to antiretroviral drugs have perpetuated and increased the use of traditional medicine especially in rural areas for the treatment of opportunistic ailments of HIV/AIDS. To document the traditional uses of nutri-medicinal plants in the management of immunocompromised ailments associated with HIV/AIDS. To document the parts and growth forms of plants used, methods of preparation and administration of the herbal remedies. MATERIALS AND METHODS: The study was conducted in Mbarara and Isingiro districts of western Uganda between December 2010 and May 2011. Ethnobotanical information was collected from 64 respondents who were sampled based on recommendations of local elders and administrators. Ethnobotanical data on the use of nutri-medicinal plants for traditional treatment of HIV/AIDS opportunistic ailments were collected by employing semi-structured interviews with selected respondents, house hold visits and field observations as described by (Martin, 1995a). The respondents were mainly traditional medical practitioners who treat patients who are already receiving antiretroviral drugs. Fidelity levels of plant species and informant consensus factor were determined to show the percentage of informants claiming the use of certain plant species for the same major purpose and to analyse people's knowledge of plant use. RESULTS: The study revealed 81 plant species most of which were herbs (49%). Leaves (71%) were the most frequently used parts in remedy preparations which were mainly administered orally (85%). The majority of plants (54%) were harvested from wild populations. Hibiscus sabdariffa L., Plumeria obtusa L., and Abutilon guineense (Shumach.) Baker. F and Exell were the nutri-medicinal plants that scored the highest Fidelity level values. The informant's consensus about usages of plants ranged from 0.75 to 0.80. Plants that are presumed to be effective in treating a certain disease have higher informant consensus factor (ICF) values. Family Asteraceae accounted for 18% of the total species recorded. Thirteen species (16%) of the plants are edible and provide nutritional support. CONCLUSION: The study recorded plant species with potential to treat ailments associated with immunocompromised people living with HIV/AIDS in western Uganda. Such studies can help stimulate confidence in traditional medicine and enhance appreciation of herbal medicine among the people and to appreciate the value of the plant resources and therefore enhance conservation efforts of the plant species. The high consensus means the majority of informants agree on the use of plant species and this reflects the intercultural relevance and the agreement in the use of the nutri-medicinal plants to the people. We recommend the documented plants for further Ethnopharmacological studies.