A Systematic Review of Medicinal Plants of Kenya used in the Management of Bacterial Infections.

Intersectoral collaboration is an instrument that enables better productivity by filling in for possible gaps in knowledge, skills, and competencies in a given department by leveraging them from other departments. In Kenya, there is a paucity of information on intersectoral collaboration in healthcare. This article explores the possibilities of intersectoral collaboration, specifically in maternal healthcare, and what can be done to realize such collaborations to drive universal health coverage (UHC) in Kenya. Free maternity services (FMSs) are among the primary healthcare services that push Kenya towards UHC. In light of the centrality of UHC in driving current health policy, there are still several challenges which must be faced before this goal can be achieved. Moreover, competing priorities in health systems necessitate difficult choices regarding which health actions and investments to fund; these are complex, value-based, and highly political decisions. Therefore, the primary objective of this article is to explore health facility administrators’ views on whether intersectoral collaboration could help with the realization of UHC in Kenya. The study area was Kilifi County, Kenya. The article is based on follow-up qualitative research conducted between March and July 2016 and from January to July 2017, and follow-up interviews conducted during COVID-19 in 2020 and 2021. The data are analyzed through a thematic analysis approach. The findings indicate that through Linda Mama, the expanded free maternity services program is one of the possible pathways to UHC. However, participants noted fair representation of stakeholders, distributed leadership, and local participation, considering bargaining power as a key issue that could enhance the realization of UHC in intersectoral collaboration through Linda Mama. These techniques require a bottom–up strategy to establish accountability, a sense of ownership, and trust, which are essential for UHC.

BackgroundInfectious diseases are a major global public health concern as antimicrobial resistance (AMR) currently accounts for more than 700,000 deaths per year worldwide. The emergence and spread of resistant bacterial pathogens remain a key challenge in antibacterial chemotherapy. This study aims to investigate the antibacterial activity of combined extracts of various Kenyan medicinal plants against selected microorganisms of medical significance.MethodsThe antibacterial activity of various extract combinations of Aloe secundiflora, Toddalia asiatica, Senna didymobotrya and Camelia sinensis against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Methicillin Resistant Staphylococcus aureus was assessed using the agar well diffusion and the minimum inhibitory concentration in-vitro assays. The checkerboard method was used to evaluate the interactions between the various extract combinations. ANOVA test followed by Tukey’s post hoc multiple comparison test was used to determine statistically significant differences in activity (P < 0.05).ResultsAt concentrations of 100 mg/ml (10,000 µg/well), the different combinations of the aqueous, methanol, dichloromethane and petroleum ether extracts of the selected Kenyan medicinal plants revealed diverse activity against all the test bacteria. The combination of methanolic C. sinensis and A. secundiflora was the most active against E. coli (14.17 ± 0.22 mm, diameter of zones of inhibition (DZI); MIC 2500 µg/well). The combination of methanolic C. sinensis and S. didymobotrya was the most active against S. aureus (16.43 ± 0.10 mm; MIC 1250 µg/well), K. pneumonia (14.93 ± 0.35 mm, DZI; MIC 1250 µg/well), P. aeruginosa (17.22 ± 0.41 mm, DZI; MIC 156.25 µg/well) and MRSA (19.91 ± 0.31 mm, DZI; MIC 1250 µg/well). The Minimum Inhibitory Concentration of the different plant extract combinations ranged from 10,000 µg/ well to 156.25 µg/well. The ANOVA test indicated statistically significant differences (P < 0.05) between single extracts and their combinations. The fractional inhibitory concentration indices (FICI) showed that the interactions were either synergistic (10.5%), additive (31.6%), indifferent (52.6%), or antagonistic (5.3%) for the selected combinations.ConclusionThis study findings validate the ethnopractice of selectively combining medicinal plants in the management of some bacterial infections in traditional medicine.

Introduction Maternal sepsis is a leading cause of maternal and neonatal mortality. Despite the availability of management protocols, there is disparity in case fatality rates for pregnancy-related sepsis compared to other maternity-related complications. The main aim of this systematic review was to assess concordance between international evidence-based guidelines for the prevention and management of childbirth-related bacterial infections. Material and methods The PRISMA statement was followed during the conduct and reporting of this review. PubMed was searched electronically from 2009 to November 2019 for clinical guidelines covering the topic of childbirth-related infections and specific searches for relevant guidelines on the websites of the top five international professional bodies most commonly identified by our searches. We did not apply any language restrictions. Guidelines were included if they provided any information about the prevention or management of childbirth-related bacterial infections irrespective of whether the guideline stated a recommendation or not. Two independent reviewers undertook study selection, decisions about inclusion of selected guidelines and data extraction. Extracted information was synthesized under the following topics: Asymptomatic bacteriuria; group B streptococcal infection (GBS); preterm premature rupture of membranes (P-PROM); intrauterine infection; procedures; maternal sepsis; miscellaneous. Concordance was defined as absence of contradictory information between the different guidelines with regards to a specific topic, subtopic or recommendation. Quality of included guidelines was assessed against the AGREE II guideline reporting domains. Results A total of 43 guidelines were selected of which 11 were excluded leaving 32 guidelines that fulfilled our inclusion criteria. None of the guidelines fulfilled all the quality assessment domains and 11 (34%) of the guidelines satisfied 1−2 of domains only. Two guidelines covered the topic of asymptomatic bacteriuria, nine for GBS, five for P-PROM and three covered each of intra-amniotic infections maternal sepsis, obstetric procedures and interventions topics. The remaining guidelines covered miscellaneous topics. Conclusions There was concordance between guidelines with regards to several aspects in the prophylaxis and treatment of bacteriological infections in pregnancy. Nevertheless, there were several areas of discordance, some of which reached the extent of contradictory information as in the case of antenatal screening for GBS.

Introduction:Universal health coverage aims for all populations to access quality healthcare without exposure to financial hardship from expensive out-of-pocket payments for the services. Health entrepreneurs are individuals or organizations who take financial risks to develop innovative and sustainable business models to deliver quality healthcare services and products to populations in various contexts. This study aimed to analyze the influence of health entrepreneurship on accelerating the progress towards the realization of universal health coverage in Kenya and Ghana. Methods:The research applied a cross-sectional, quantitative technique, survey design, and an explanatory analysis to understand the relationships between affordability and accessibility of healthcare services. The study's target respondents were health entrepreneurs running various healthcare services. Results:The study found that health entrepreneurs in Kenya and Ghana contribute to healthcare accessibility and affordability in varying degrees. Accessibility scores highlighted no statistically significant difference between the two settings (t = 0.91, p = 0.38). Similarly, affordability differences were not statistically significant (U = 10.5, p = 0.561). Additionally, the study identified regulatory and financial constraints as key challenges faced by health entrepreneurs in both countries. The study established that opportunities exist in leveraging technology and expanding public-private partnerships to improve healthcare access and affordability. Conclusion:This study underscores and provides empirical evidence that health entrepreneurship is significant in realizing Universal Health Coverage. Through this study's findings, healthcare entrepreneurs demonstrate their role in expanding access to care and ameliorating affordability by applying innovative care delivery approaches.

Hot water extracts from eight medicinal plants representing five families, used for malaria treatment in Kenya were screened for their in vivo antimalarial activity in mice against a chloroquine (CQ) resistant Plasmodium berghei NK65, either alone or in combination with CQ. Extracts of three plants, Toddalia asiatica (root bark), Rhamnus prinoides (leaves and root bark) and Vernonia lasiopus (root bark) showed high chemosuppression in the range 51%-75%. Maytenus acuminata, M. heterophylla, M. senegalensis and Rhamnus staddo had moderate activities of 33%-49% parasitaemia suppression in the root bark and/or leaf extracts, while Withania somnifera (root bark) had a non-significant suppression (21%). In combination with CQ, extracts of V. lasiopus (all parts), leaf extracts of M. senegalensis, R. prinoides and T. asiatica as well as root barks of M. heterophylla, R. staddo and T. asiatica had improved parasitaemia suppression in the range 38%-66%, indicating synergistic interactions. Remarkable parasitaemia suppression by the extracts, either alone or in combination with CQ resulted into longer survival of mice relative to the controls, in some cases by more than 2 weeks. Plants, which showed significant antimalarial activity including V. lasiopus, T. asiatica and R. prinoides, should further be evaluated in the search for novel agents against drug-resistant malaria.

Journal of Pharmaceutical Research International (ISSN: 2456-9119) is dedicated to publish high quality papers in all areas of pharmaceutical Science including pharmaceutical drugs, community pharmacy, hospital pharmacy, clinical pharmacy, compounding pharmacy, consultant pharmacy, internet pharmacy, veterinary pharmacy, nuclear pharmacy, military pharmacy, pharmacy informatics, pharmaceutics, medicinal chemistry, pharmacognosy, pharmacotherapy, pharmacodynamics, pharmacokinetics, clinical pharmacology, neuropharmacology, psychopharmacology, pharmacogenetics, pharmacogenomics, pharmacoepidemiology, toxicology, theoretical pharmacology, posology, pharmacognosy, behavioral pharmacology, environmental pharmacology, medicine development and safety testing, drug legislation and safety, pharmaceutical microbiology, pharmaceutical molecular biology, pharmaceutical biotechnology. The journal also encourages the submission of useful reports of negative results. This is a quality controlled, OPEN peer reviewed, open access INTERNATIONAL journal.

The study was carried out at 8°55’N-9°05’N latitude and 40°50’E-40°51’E longitude, South-Eastern Ethiopia at Jello-Muktar dry afromontane forest to assess variations in distributions and Importance Value Index of woody species under three successional stages. We laid out a total of 90 sample plots for the three suceestional stages. For each successional stage, three sites were selected each with 10 sample plots. The average distance between the plots was 200 m and each plot have radius of 30m. In each plots, identification, counting and measurement of diameter at breast height (DBH) of all trees and shrubs (DBH≥ 10cm) was conducted. Analysis of The Importance Value Index (IVI) at different successional stages and sites was based on the frequency, density and dominance of each species at different successional stages. The result showed a gradual increase in the total number of trees and shrub species from the ES to the IS and MS succession and species of mature forests were present throughout the chrono-sequences of all stages. Species of <i>Vernonia amygdalina, Juniperus procera, Olea africana, Olea capensis, Hagenia abyssinica, Prunus africana, Rosa abyssinica, Discopodium penninervium</i> and <i>Premna resinosa</i> were found in all successional stages. In the ES succession, <i>Vernonia amygdalina</i> was the highest in terms of its IVI of 36.58 followed by <i>Vernonia auriculifera</i> (31.66) and <i>Hagenia abyssinic</i> (30.28). Species of <i>Hagenia abyssinica</i> had the highest IVI of 67 and 23 in IS and MS successions respectively. There must be conservation strategies and priorities for those species that occurred only once in one of the sites and species with low IVI in addition to the dominant ones.

Bacterial infections are the major cause of morbidity and mortality, with high financial impacts among human beings globally. Antibiotics are used in the treatment of bacterial infections. They eliminate or prevent bacteria from reproducing and spreading. Since they do so at different rates, some bacteria may mutate with an under-dose and resist antibiotic treatment through natural selection. The bacteria develop acquired antimicrobial resistance to several drugs due to increased use and misuse of antibiotics. This has resulted in increased interest in the use of medicinal plants in the treatment of bacterial infections. The plants serve as resistance modifying agents from the metabolites that they produce. Previous studies show that metabolites such as tannins, alkaloids and polyphenols may have antimicrobial and resistance-modifying properties. They destroy the microorganisms and interfere with the crucial events in the pathogenic process, reducing the bacteria's ability to develop resistance to botanicals.&#x0D; Colocasia esculenta (L) Schott leaves were previously tested against Pseudomonas aeruginosa and the extracts showed higher activity against bacterial infections compared to the use of the antibiotic drug Clarithromycin. Leaves of aqueous and ethanolic extracts of Colocasia esculenta in previous studies were found to contain steroids, Flavonoids, saponins, terpenoids, Anthroquinones and Alkaloids. The extracts were found to have anti-diabetic activity and anti-helminthic activity compared to the standard drug, Piperazine citrate. This study determined phytochemicals present in ethanolic extracts of the bark and tuber of Colocasia esculenta (L) Schott in Kenya. A qualitative research design was adopted in this study. Colocasia esculenta plant samples used in this study were purposely obtained from Kaimosi Friends University farm in Vihiga County. They were taken to the laboratory of Botany at Maseno University, where they were washed with sterile distilled water, separated into bark and tuber, dried, crushed into powder, packed separately in airtight plastic containers, labelled and stored for later use. Plant ethanolic extracts were prepared separately (from powders) in triplicate for use in experiments. Screening for the presence of phytochemicals was done using standard methods. Qualitative analysis of the plant samples was used to check for the presence of flavonoids, saponins, steroids, tannins, alkaloids, glycosides, phenolic compounds and anthraquinones. Data were collected and then analyzed. Results were presented in the form of a table as the presence or absence of the specific phytochemicals. Results showed that Saponins, steroids, tannins, alkaloids, glycosides and phenolic compounds were present in both the tuber and bark ethanolic extracts of Colocasia esculenta. Interestingly, the bark extract had more saponins and tannins than the tuber extract. The results of this study can be used to further determine the antibacterial activity of the extracts on selected sidearm bacteria. The findings could be of commercial interest to both the Kenya Ministry of Health and pharmaceutical companies in the world in the production of new antibacterial drugs. Policymakers may help reduce the increasing mortality due to bacterial infections by using results from this study. The results can also support Kenya's Vision 2030 of ensuring adequate health care for all by integrating traditional healthcare practices into the national healthcare system for the realization of universal health coverage.

Extended-spectrum β-lactamases producing Enterobacteriaceae (ESBL-PE) prevalence in Nepal: A systematic review and meta-analysis

IntroductionResult-Based Financing (RBF) is an umbrella term for financial mechanisms that link incentives to outputs or outcomes. International development agencies are promoting RBF as a viable financing approach for the realization of universal health coverage, with numerous pilot trials, particularly in low- and middle-income countries (LMICs). There is limited synthesized evidence on the performance of these mechanisms and the reasons for the lack of RBF institutionalization. This study aims to review the evidence of RBF schemes that have been scaled or institutionalized at a national level, focusing on maternal, newborn, and child health (MNCH) programming in LMICs.MethodsA systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors identified and reviewed country-level RBF evaluation reports for the period between January 2000 and June 2019. Data were extracted from both published and gray literature on RBF application in MNCH using a predesigned matrix. The matrix headers included country of application; program setting; coverage and duration; evaluation design and methods; outcome measures; and key findings. A content thematic analysis approach was used to synthesize the evidence and emerging issues.ResultsThe review identified 13 reports from 11 countries, predominantly from Sub-Saharan Africa. Performance-based financing was the most common form of RBF initiatives. The majority of evaluation designs were randomized trials. The evaluations focused on outputs, such as coverage and service utilization, rather than outcomes. RBF schemes in all 11 countries expanded their scope, either geographically or accordingly in terms of performance indicators. Furthermore, only three studies conducted a cost-effectiveness analysis, and only two included a discussion on RBF’s sustainability. Only three countries have institutionalized RBF into their national policy. On the basis of the experience of these three countries, the common enabling factors for institutionalization seem to be political will, domestic fund mobilization, and the incorporation of demand-side RBF tools.ConclusionRBF evidence is still growing, partial, and inconclusive. This limited evidence may be one of the reasons why many countries are reluctant to institutionalize RBF. Additional research is needed, particularly regarding cost-effectiveness, affordability, and sustainability of RBF programs.

The aim of this systematic review and meta-analysis is to evaluate available prevalence and viral sequencing data representing chronic hepatitis B (CHB) infection in Kenya. More than 20% of the global disease burden from CHB is in Africa, however there is minimal high quality seroprevalence data from individual countries and little viral sequencing data available to represent the continent. We undertook a systematic review of the prevalence and genetic data available for hepatitis B virus (HBV) in Kenya using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 checklist. We identified 23 studies reporting HBV prevalence and 8 studies that included HBV genetic data published in English between January 2000 and December 2021. We assessed study quality using the Joanna Briggs Institute critical appraisal checklist. Due to study heterogeneity, we divided the studies to represent low, moderate, high and very high-risk for HBV infection, identifying 8, 7, 5 and 3 studies in these groups, respectively. We calculated pooled HBV prevalence within each group and evaluated available sequencing data. Pooled HBV prevalence was 3.4% (95% CI 2.7-4.2%), 6.1% (95% CI 5.1-7.4%), 6.2% (95% CI 4.64-8.2) and 29.2% (95% CI 12.2-55.1), respectively. Study quality was overall low; only three studies detailed sample size calculation and 17/23 studies were cross sectional. Eight studies included genetic information on HBV, with two undertaking whole genome sequencing. Genotype A accounted for 92% of infections. Other genotypes included genotype D (6%), D/E recombinants (1%) or mixed populations (1%). Drug resistance mutations were reported by two studies. There is an urgent need for more high quality seroprevalence and genetic data to represent HBV in Kenya to underpin improved HBV screening, treatment and prevention in order to support progress towards elimination targets.

The aim of this systematic review and meta-analysis is to evaluate available prevalence and viral sequencing data representing chronic hepatitis B (CHB) infection in Kenya. More than 20% of the global disease burden from CHB is in Africa, however there is minimal high quality seroprevalence data from individual countries and little viral sequencing data available to represent the continent. We undertook a systematic review of the prevalence and genetic data available for hepatitis B virus (HBV) in Kenya using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 checklist. We identified 23 studies reporting HBV prevalence and 8 studies that included HBV genetic data published in English between January 2000 and December 2021. We assessed study quality using the Joanna Briggs Institute critical appraisal checklist. Due to study heterogeneity, we divided the studies to represent low, moderate, high and very high-risk for HBV infection, identifying 8, 7, 5 and 3 studies in these groups, respectively. We calculated pooled HBV prevalence within each group and evaluated available sequencing data. Pooled HBV prevalence was 3.4% (95% CI 2.7–4.2%), 6.1% (95% CI 5.1–7.4%), 6.2% (95% CI 4.64–8.2) and 29.2% (95% CI 12.2–55.1), respectively. Study quality was overall low; only three studies detailed sample size calculation and 17/23 studies were cross sectional. Eight studies included genetic information on HBV, with two undertaking whole genome sequencing. Genotype A accounted for 92% of infections. Other genotypes included genotype D (6%), D/E recombinants (1%) or mixed populations (1%). Drug resistance mutations were reported by two studies. There is an urgent need for more high quality seroprevalence and genetic data to represent HBV in Kenya to underpin improved HBV screening, treatment and prevention in order to support progress towards elimination targets.

Malaria is a deadly disease caused by a protozoan parasite whose mode of transmission is through a female Anopheles mosquito. It affects persons of all ages; however, pregnant mothers, young children, and the elderly suffer the most due to their dwindled immune state. The currently prescribed antimalarial drugs have been associated with adverse side effects ranging from intolerance to toxicity. Furthermore, the costs associated with conventional approach of managing malaria are arguably high especially for persons living in low-income countries, hence the need for alternative and complementary approaches. Medicinal plants offer a viable alternative because of their few associated side effects, are arguably cheaper, and are easily accessible. Based on the fact that studies involving antimalarial medicinal plants as potential sources of efficacious and cost-effective pharmacotherapies are far between, this research was designed to investigate antiplasmodial and cytotoxic activities of organic and aqueous extracts of selected plants used by Embu traditional medicine practitioners to treat malaria. The studied plants included Erythrina abyssinica (stem bark), Schkuhria pinnata (whole plant), Sterculia africana (stem bark), Terminalia brownii (leaves), Zanthoxylum chalybeum (leaves), Leonotis mollissima (leaves), Carissa edulis (leaves), Tithonia diversifolia (leaves and flowers), and Senna didymobotrya (leaves and pods). In vitro antiplasmodial activity studies of organic and water extracts were carried out against chloroquine-sensitive (D6) and chloroquine-resistance (W2) strains of Plasmodium falciparum. In vivo antiplasmodial studies were done by Peter's four-day suppression test to test for their in vivo antimalarial activity against P. berghei. Finally, cytotoxic effects and safety of the studied plant extracts were evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) rapid calorimetric assay technique. The water and methanolic extracts of T. brownii and S. africana and dichloromethane extracts of E. abyssinica, S. pinnata, and T. diversifolia leaves revealed high in vitro antiplasmodial activities (IC50 ≤ 10 μg/ml). Further, moderate in vivo antimalarial activities were observed for water and methanolic extracts of L. mollissima and S. africana and for dichloromethane extracts of E. abyssinica and T. diversifolia leaves. In this study, aqueous extracts of T. brownii and S. africana demonstrated high antiplasmodial activity and high selectivity indices values (SI ≥ 10) and were found to be safe. It was concluded that T. brownii and S. africana aqueous extracts were potent antiplasmodial agents. Further focused studies geared towards isolation of active constituents and determination of in vivo toxicities to ascertain their safety are warranted.

Essential oils of eight plants, selected after an ethnobotanical survey conducted in Bukusu community in Bungoma County, western Kenya (Tagetes minuta, Tithonia diversifolia, Juniperus procera, Solanecio mannii, Senna didymobotrya, Lantana camara, Securidaca longepedunculata, and Hoslundia opposita), were initially screened (at two doses) for their repellence against brown ear tick, Rhipicephalus appendiculatus, using a dual-choice climbing assay. The oils of T. minuta and T. diversifolia were then selected for more detailed study. Dose-response evaluations of these oils showed that T. minuta oil was more repellent (RD50 = 0.0021 mg) than that of T. diversifolia (RD50 = 0.263 mg). Gas chromatography-linked mass spectrometric (GC-MS) analyses showed different compositions of the two oils. T. minuta oil is comprised mainly of cis-ocimene (43.78%), dihydrotagetone (16.71%), piperitenone (10.15%), trans-tagetone (8.67%), 3,9-epoxy-p-mentha-1,8(10)diene (6.47%), β-ocimene (3.25%), and cis-tagetone (1.95%), whereas T. diversifolia oil is comprised mainly of α-pinene (63.64%), β-pinene (15.00%), isocaryophyllene (7.62%), nerolidol (3.70%), 1-tridecanol (1.75%), limonene (1.52%), and sabinene (1.00%). The results provide scientific rationale for traditional use of raw products of these plants in controlling livestock ticks by the Bukusu community and lay down some groundwork for exploiting partially refined products such as essential oils of these plants in protecting cattle against infestations with R. appendiculatus.

Medicinal plants used to treat infectious diseases in Bunda district, Tanzania, were screened for activity against Plasmodium falciparum and Human Immunodeficiency Virus Type 1 (HIV-1, IIIB strain) and Type 2 (HIV-2, ROD strain). Antiplasmodial activity was observed for the 80 % MeOH extract of Ormocarpum kirkii (root; MIC = 31.25 microg/mL), Combretum adenogonium (leaves), Euphorbia tirucalli (root), Harrisonia abyssinica (root), Rhynchosia sublobata (root), Sesbania sesban (root), Tithonia diversifolia (leaves), and Vernonia cinerascens (leaves; MIC value of 62.5 microg/mL). With regard to HIV, 80 % MeOH extracts of Barleria eranthemoides (root), Combretum adenogonium (leaves and stem bark), Elaeodedron schlechteranum (stem bark and root bark), Lannea schweinfurthii (stem bark), Terminalia mollis (stem bark and root bark), Acacia tortilis (stem bark), Ficus cycamorus (stem bark) and Indigofera colutea (shoot), as well as H2O extracts from Barleria eranthemoides (root), Combretum adenogonium (leaves and stem bark), and Terminalia mollis (stem bark and root bark) exhibited IC50 values below 10 microg/mL against HIV-1 (IIIB strain). The highest anti-HIV-1 activity value was obtained for the B. eranthemoides 80 % MeOH root extract (IC50 value 2.1 microg/mL). Only a few extracts were active against HIV-2, such as the 80 % MeOH extract from Lannea schweinfurthii (stem bark) and Elaeodedron schlechteranum (root bark), showing IC50 values < 10 microg/mL.