Antibacterial and Antifungal Activities of Ethiopian Medicinal Plants: A Systematic Review.

Background: Podoconiosis and lymphatic filariasis are the most common causes of lower limb lymphoedema in the tropics. Many sufferers experience frequent painful episodes of acute bacterial infection. Plant based traditional medicines are used to treat infections in many countries and are culturally established in Ethiopia. Ethiopian medicinal plants found to have antibacterial and antifungal activities were reviewed with the aim of increasing information about the treatment of wound infections in patients with lymphoedema. Methods: This study collates data from published articles on medicinal plants with antibacterial and antifungal activities in Ethiopia. A systematic search of Scopus, EMBASE, PUBMED/MEDLINE and Google Scholar was undertaken. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. The protocol was registered on PROSPERO with registration number CRD42019127471. All controlled studies of in vitro antibacterial and antifungal activities were considered. All articles containing the descriptors published until June 28, 2019 were included. The outcome was measured as percent inhibition of microbial growth. For quality assessment of individual in vitro studies, OECD guidelines and the WHO-Good Laboratory Practice (GLP) handbook were used. Results: Seventy-nine studies met the inclusion criteria. A total of 150 plant species and three compounds had been tested against 42 species of bacteria, while 43 plant species had been tested against 22 species of fungus. Conclusion: Materials derived from several Ethiopian medicinal plants have been shown to have promising activity against a variety of bacteria and fungi. Those derived from Azadiractha indica A. Juss. and Lawsonia inerms L. are the most extensively studied against a wide range of gram-negative and positive bacteria, and fungal species.

Systematic review of Ethiopian medicinal plants used for their anti-inflammatory and wound healing activities.

ETHNOPHARMACOLOGICAL RELEVANCE: Plant materials are used worldwide as complementary and alternative therapeutics for the treatment of various illnesses. In Ethiopia, folk medicines are utilized across a wide range of cultures and settings. Ethiopia has numerous plant species of which around 12% are endemic, making it a rich source of medicinal plants that are potentially important for human wellbeing. AIM OF THE STUDY: The aim of this study was to assess Ethiopian medicinal plants with anti-inflammatory or wound healing activities, in an attempt to compile the information required for further investigation of their potential role in the management of lymphoedema. METHODS: A systematic review protocol was developed according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The protocol for this review was registered on PROSPERO with registration number CRD42019127471. This review considers all controlled in vivo and in vitro anti-inflammatory and wound healing studies evaluating the efficacy and safety of Ethiopian medicinal plants. The search strategy included all articles containing descriptors such as Ethiopia, medicinal plants, herbal products, care, management, lymphoedema, lymphedema, swelling, podoconiosis, elephantiasis, wound, wound healing, inflammation, an anti-inflammatory that were published until June 28, 2019. Outcomes were measured as the percentage of inflammatory and pro-inflammatory cell inhibition, as the percentage of carrageenan-induced oedema (anti-inflammation) inhibition, and the percentage of cell migration and proliferation (wound healing). For quality assessment of individual animal studies, the Risk of Bias tool for animal intervention studies (SYRCLE's RoB tool) criteria were used. For quality assessment of individual in vitro studies, the OECD guidelines and the WHO Good Laboratory Practice (GLP) handbook were used. RESULTS: A total of 46 articles on anti-inflammatory and 17 articles on wound healing properties were reviewed. For the in vivo studies, Swiss albino mice and Wistar rats were used, and the concentration of plant extracts or fractions administered to the lab animals varied considerably. Acetone extract of Vernonia amygdalina showed the fastest anti-inflammatory activity at lower concentrations in carrageenan-induced paw oedema. CONCLUSION: Lawsonia inermis, Azadirachta indica, Achyranthes aspera, and Cuminum cyminum are the most studied plant species in terms of anti-inflammatory activity, while Lawsonia inermis and Azadirachta indica are the most studied ones for wound healing. The most common in vivo techniques used for the anti-inflammatory and the wound healing assays were carrageenan-induced paw oedema, and excision and incision wound models, respectively.

How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review.

Background: We systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries. Methods: We searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools. Results: Of 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low. Discussion: Studies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers. PROSPERO registration number: CRD42018091088.