Abstract
BackgroundInfectious 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.MethodologyThe 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 s, EMBASE, Biological s and Commonwealth Agricultural Bureau s). 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.ResultsFourteen 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 recommendationsThe 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.
Highlights
Botanical therapies are ranked among the world’s most frequently used medications [1]
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
Though not commonly observed among the herbal medicine (HM) contaminants in East Africa, most bacterial contaminants such as Rahnella aquatilis that were reported in Southern Africa are of potential risk to public health since they are abundant in soil, water, and most livestock, yet these bacteria are associated with human diseases [20, 21]
Summary
Botanical therapies are ranked among the world’s most frequently used medications [1]. The ongoing increase in global consumption and trade of herbal medicine has raised safety concerns in many regions including East Africa. These concerns are mainly related to microbial contamination, heavy metal, and phytochemical toxicities [8]. 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; 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
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