Association between culture and the preference for, and perceptions of, 11 routes of medicine administration: A survey in 21 countries and regions.

Medicines can be taken by various routes of administration. These can impact the effects and perceptions of medicines. The literature about individuals' preferences for and perceptions of the different routes of administration is sparse, but indicates a potential influence of culture. Our aim was to determine: (i) any association between one's culture and one's preferred route of medicine administration and (ii) individual perceptions of pain, efficacy, speed of action and acceptability when medicines are swallowed or placed in the mouth, under the tongue, in the nose, eye, ear, lungs, rectum, vagina, on the skin, or areinjected. A cross-sectional, questionnaire-based survey of adults was conducted in 21 countries and regions of the world, namely, Tunisia, Ghana, Nigeria, Turkey, Ethiopia, Lebanon, Malta, Brazil, Great Britain, United States, India, Serbia, Romania, Portugal, France, Netherlands, Japan, South Korea, Hong Kong, mainland China and Estonia, using the Inglehart-Welzel cultural map to ensure coverage across all cultures. Participants scored the pain/discomfort, efficacy, speed of onset and acceptability of the different routes of medicine administration and stated their preferred route. Demographic information was collected. A total of 4435 participants took part in the survey. Overall, the oral route was the most preferred route, followed by injection, while the rectal route was the least preferred. While the oral route was the most preferred in all cultures, the percentage of participants selecting this route varied, from 98% in Protestant Europe to 50% in the African-Islamic culture. A multinomial logistic regression model revealed a number of predictors for the preferred route. Injections were favoured in the Baltic, South Asia, Latin America and African-Islamic cultures while dermal administration was favoured in Catholic Europe, Baltic and Latin America cultures. A marked association was found between culture and the preference for, and perceptions of the different routes by which medicines are taken. This applied to even the least favoured routes (vaginal and rectal). Only women were asked about the vaginal route, and our data shows that the vaginal route was slightly more popular than the rectal one.

Antimalarial activity of the 80%methanol extract and solvent fractions of Cucumis ficifolius A. rich roots against Plasmodium berghei in mice.

Ethnopharmacological relevance: Malaria is still a known health threat, especially in parts of sub-Saharan Africa. It is one of the frequently mentioned issues with hospital admission and outpatient care in Ethiopia. Cucumis ficifolius A. Rich roots are historically used in Ethiopia to treat meningitis, inflammation, and malaria. However, the antimalarial activity of this plant has not been scientifically studied so far. Aim of the study: This study aimed to determine the in vivo antimalarial activity of 80% methanol extract and solvent fractions of the roots of Cucumis ficifolius against Plasmodium berghei infection in mice. Methods: The in vivo antimalarial activity of the 80% methanol extract and solvent fractions of Cucumis ficifolius A. Rich was evaluated by standard chemo suppressive, curative and repository tests using Plasmodium berghei (ANKA strain) in Swiss albino mice at doses of 100, 200 and 400 mg/kg/day. The level of parasitemia, survival time, variation in weight, rectal temperature, and packed cell volume of mice were determined to establish the activity of the extracts. Result: The 80% methanol extract of Cucumis ficifolius A. Rich roots had a promising suppression of parasitemia at 400 mg/kg with a chemosuppression value of 65.21 ± 1.20%. Among the solvent fractions, the chloroform fraction showed the highest antimalarial activity in the four-day suppressive test with a chemosuppression value of 55.9 ± 0.28%, followed by the n-butanol (42.9 ± 0.24%), and aqueous (40.57 ± 0.52%) fractions at a dose of 400 mg/kg. The highest survival times were observed with crude extract (15.4 ± 0.24 days) at 400 mg/kg, and chloroform fraction (13.4 + 0.24 days), though all extracts increased survival time. Conclusion: The findings of the present study collectively indicate the root extract of Cucumis ficifolius has a promising antiplasmodial activity which substantiates the traditional claim of the plant.

Antimalarial Activity of Solvent Fractions of the Stem Bark of Periploca linearifolia Quart.-Dill. & A.Rich. (Asclepiadaceae) Against Plasmodium berghei in Mice.

BACKGROUND: Currently, malaria elimination is intimidated by the emergence of antimalarial drug and insecticide resistance. This scenario urges scientists to develop new antimalarial drugs, where plant-based compounds are the major candidates. OBJECTIVE: The objective of this experiment was to examine the antimalarial activities of the solvent fractions of the stem bark of P. linearifolia in mice. METHODS: The dried hydromethanolic extract was treated with n-hexane, chloroform, and ethyl acetate solvents based on increasing order of polarity. For the suppressive test, after three hours post-inoculation of P. berghei, the first group was administered the vehicle 2 mL/100 g. The second group was given chloroquine 25 mg/kg, whereas the remaining nine groups were administered 100, 200, and 400 mg/kg of each of the chloroform, ethyl acetate and aqueous fractions. Furthermore, the aqueous fraction was evaluated using Rane's model for the curative test. The result was statistically analyzed using a one-way analysis of variance (ANOVA). The results were considered significant at P < 0.05. RESULTS: In the suppressive test, the solvent fractions suppressed parasitemia level significantly (P < 0.01 for 100 mg/kg, P < 0.001 for 200 and 400 mg/kg of the aqueous and P < 0.01 for 200 mg/kg, P < 0.001 for 400 mg/kg of chloroform fractions) as compared to vehicle-treated mice, whereas in the curative model 400 mg/kg of the aqueous fraction (P < 0.01) showed a significant parasitemia level reduction. CONCLUSION: The results of this study indicated that the solvent fractions have promising antiplasmodial activity against Plasmodium berghei, which is consistent with the earlier in vivo study of the hydromethanolic extract.

Complementary and Alternative Medicine Use in a Pregnant Population, Northwest Ethiopia.

BACKGROUND: Complementary and alternative medicine (CAM) appears to be the source of healthcare particularly in the majority of pregnant communities of Africa due to its intrinsic qualities as well as its accessibility and affordability. Despite acknowledged benefits of CAM use in pregnancy, majority of users are unaware of its safety and effects on fetal development. The present study was aimed at examining CAM use among pregnant women in Northwest Ethiopia to provide an opportunity for future investigations on the effectiveness of CAM modalities in the management of pregnancy-related complications across the country. METHODS: This was an institution-based cross-sectional study which was conducted at Poly Clinic Health Center in the Northwest part of Ethiopia between March and May 2018. Two hundred and eighty two Ethiopian women were conveniently recruited to take part in the study. Structured questioners were used for the survey. Descriptive statistics of sociodemographic and CAM use characteristics were expressed in frequencies and proportions. Chi-square test was performed to determine the difference between CAM user and nonuser. Besides, binary logistic regression analyses were performed to examine predictors of CAM use in the study population. The result was considered statistically significant if P value ≤ 0.05. RESULTS: The prevalence rate of CAM use in pregnant women was 89.36% with the commonest practice of spiritual healing (65.2%) and herbal supplement (51.8%) CAM therapies. Use of CAM positively associated with marital status and previous number of children. The odds of using CAM among single/not married women were 3.22 times higher (COR: 3.22, CI: 1.07-9.64) as compared to married women. Pregnant women with no children were 3.30 times more likely (COR: 3.30, CI: 0.92-11.84) to use CAM than those women having ≥3 children. Lower odds of using CAM significantly associated with educational level (COR: 0.20, CI: 0.046-0.93) and antenatal care (COR: 0.45, CI: 0.18-1.13) in a binary logistic regression model. CONCLUSIONS: A considerable number of pregnant women were utilizing CAM including herbal products as part of their maternity care. This finding provides a reference on the use of CAM for policy-makers, health professionals, and parents. Further studies are needed to investigate the effectiveness and safety of specific CAM modalities with particular focus on herbal medicinal products.

Evaluation of Antimalarial Activity of Methanolic Root Extract of Myrica salicifolia A Rich (Myricaceae) Against Plasmodium berghei-Infected Mice.

BACKGROUND: The management and control of malaria has become gradually challenging due to the spread of drug-resistant parasites, lack of effective vaccine, and the resistance of vector to insecticides. Consequently, novel agents are urgently needed from different sources including from medicinal plants. In Ethiopia and Uganda, Myrica salicifolia root is traditionally claimed for the treatment of malaria. The aim of this study was to evaluate the in vivo antimalarial activity of root crude extract of M salicifolia. METHODS: The parasite, Plasmodium berghei was used in this study since it is an appropriate parasite that is most commonly used because of its higher accessibility. A 4-day suppressive test was employed to evaluate the antimalarial effect of crude extract against early infection. The curative and prophylactic effect of the crude extract was further tested by Rane's test and residual infection procedure. Parasitemia, survival time, packed cell volume, body weight, and rectal temperature of mice were used as evaluation parameters. Windows SPSS version 24 was used to analyze the data and analysis of variance followed by Tukey's honestly significant difference to compare results between groups. RESULTS: The root crude extract of M salicifolia significantly (P < .05-.0001) suppressed parasitemia. The crude extract exhibited a chemosuppression of 40.90. CONCLUSION: The development of new antimalarial agents and the finding supports the traditional claims and previous in vitro studies.

Treatments used for malaria in young Ethiopian children: a retrospective study.

BACKGROUND: In Ethiopia, medicinal plants have been used to treat different diseases, including malaria, for many centuries. People living in rural areas are especially noted for their use of medicinal plants as a major component of their health care. This study aimed to study treatment-seeking and prioritize plants/plant recipes as anti-malarials, in Dembia district, one of the malarious districts in Northwest Ethiopia. METHODS: Parents of children aged under 5 years who had had a recent episode of fever were interviewed retrospectively about their child's treatment and self-reported outcome. Treatments and subsequent clinical outcomes were analysed using Fisher's exact test to elicit whether there were statistically significant correlations between them. RESULTS AND DISCUSSION: Of 447 children with malaria-like symptoms, only 30% took the recommended first-line treatment (ACT) (all of whom were cured), and 47% took chloroquine (85% cured). Ninety-nine (22.2%) had used medicinal plants as their first-choice treatment. Allium sativum (Liliaceae), Justicia schimperiana (Acanthaceae), Buddleja polystachya (Scrophulariaceae) and Phytolacca dodecandra (Phytolaccaceae) were the most frequently used. Justicia schimperiana was the one associated with the best clinical outcomes (69% self-reported cure rate). However, the difference in clinical outcomes between the plants was not statistically significant. CONCLUSION: In this study, only 30% of children took the recommended first-line treatment. 22% of children with presumed malaria were first treated with herbal medicines. The most commonly used herbal medicine was garlic, but J. schimperiana was associated with the highest reported cure rate of the plants. Further research is warranted to investigate its anti-malarial properties.

Antiplasmodial activity of Indigofera spicata root extract against Plasmodium berghei infection in mice.

BACKGROUND: In addition to pharmacovigilance and pharmaco-economic concerns, resistance to anti-malarial medicines has been documented in all classes of anti-malarials and this is further worsened by resistance to common insecticides by malaria vector, which is a major threat to malaria control. As a means of facing the challenges of searching for new anti-malarial agents, the current study focused on evaluation of anti-malarial activity of root extract of Indigofera spicata. METHODS: Chloroquine-sensitive rodent malaria parasite, Plasmodium berghei (ANKA strain) was used to infect the Swiss Albino mice in 4-day suppressive and curative models. The crude hydromethanolic root extract of I. spicata at 200, 400 and 600 mg/kg doses was administered to a group of five mice. Important parameters, such as level of parasitaemia, packed cell volume (PCV), survival time, and body weight were determined and the significance of the differences between mean values of the five groups was analysed by one-way ANOVA followed by post hoc Tukey's Multiple Comparison test. RESULTS: In both the suppressive and curative models, 400 and 600 mg/kg doses of the extract suppressed the level of parasitaemia significantly (p < 0.001) compared to the vehicle-treated groups, 34.93 and 53.42%, respectively. However, only the mice which were treated with the 600 mg/kg dose of the extract had significant difference in their mean survival time. In other parameters, namely PCV and mean body weight, there was no statistically significant difference between the extract-treated groups when compared to the negative control. CONCLUSIONS: This study revealed that the root extract of I. spicata possesses anti-malarial activity and necessitates further scientific validation.

Experimental assessment of antidiarrheal and antisecretory activity of 80% methanolic leaf extract of Zehneria scabra in mice.

BACKGROUND: The leaf of Zehneria scabra is traditionally used for the management of diarrhea in Ethiopia. Its use, however, has not been scientifically validated for safety and efficacy. The aim of this study was to investigate antidiarrheal and antisecretory effects of hydroalcolic leaf extract of Z. scabra in mice models. METHODS: For each of antidiarrheal, gastrointestinal motility and antisecretory activity study Swiss albino mice were divided in to five groups. Group I was treated as control group and received 10 ml/kg of 2% Tween-80 orally; Group II served as a positive control and took standard drug in each of the experiments orally; Group III, IV and V were test groups which received the methanolic extract orally at 100, 200 and 400 mg/kg, respectively. Depending on the model total weight of fecal output, total weight of wet feces, total number of fecal output, number of wet faeces, length of intestinal transit and intestinal weight were collected. Finally, data were analyzed using one-way ANOVA followed by Tukey's post test. RESULT: In castor oil induced diarrhea model, the extract dose produced a significant reduction in mean stool score (1.94 ± 0.102) at 200 mg/kg. Moreover, the 100, 200, and 400 mg/kg doses inhibited stool frequency by 40, 45 and 55%, respectively. All test doses of extract and loperamide (3mg/kg) reduced fecal fluid content significantly (p<0.01). The 100 mg/kg dose of extract produced 25.74% reduction of fluid content (p<0.001) while both 200 and 400 mg/kg showed 29.70 % (p<0.001) compared to negative control group. CONCLUSION: The extract of Zehineria scabra showed antidiarrheal and antisecretory activity in mice model. Moreover, the extract found to be safe at dose of 2000mg/kg in mice model. The findings suggest the validity of the acclaimed effect of Zehineria scabra as antidiarrheal agent in Ethiopian traditional herbal medicine.