African Medicine Research Articles

Envisioning African Intersex: Challenging Colonial and Racist Legacies in South African Medicine, Amanda Lock Swarr

Envisioning African Intersex: Challenging Colonial and Racist Legacies in South African Medicine, Amanda Lock Swarr

Ethnobotanical Survey of Medicinal Plants Used in Traditional Medicine in Africa

Traditional medicine plays a vital role in healthcare delivery across Africa, where access to modern healthcare facilities may be limited. This review article provides a comprehensive ethnobotanical survey of medicinal plants used in traditional African medicine. Drawing upon a wide range of scholarly sources, ethnographic studies, and indigenous knowledge systems, the review explores the rich diversity of medicinal plants utilized by traditional healers and community members for the prevention and treatment of various ailments. The article examines the botanical diversity, therapeutic properties, preparation methods, and cultural significance of commonly used medicinal plants across different regions of Africa. Additionally, the review discusses the importance of preserving traditional knowledge, sustainable harvesting practices, and the integration of traditional medicine into modern healthcare systems. By documenting and promoting the use of medicinal plants in traditional African medicine, this review contributes to the conservation of biodiversity, preservation of cultural heritage, and enhancement of healthcare accessibility and affordability for diverse populations in Africa.

Nanomedicine and regulatory science: the challenges in Africa

The integrated approach in the development of nanotechnology is allowing its introduction into multiple fields, including pharmaceutical research, in which there are now several medicines containing nanomaterials or at least making nano-based claims. As a result of increasing research in nanotechnology, pre-existing medicines have been reformulated, and new medicines have been developed. This has brought challenges to the current regulatory frameworks in Europe and the United States. These regulatory agencies are known to be stringent because they have both the human capacity and skills and conducive policies and the landscape to manage new technology, unlike the agencies in most African countries. Because the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) have embraced regulatory science (RS) as a means of proactive analysis of regulatory principles, those agencies will be able to address nanomedicine challenges in a straightforward manner. African countries currently do not have a harmonized regulatory framework because different national regulatory authorities are at different levels of development. The pharmaceutical sector in Africa is facing many challenges, including the non-existence of research and development partnerships between industry, universities, and research institutions that foster nanomedicine development. Now that the African Medicine Agency (AMA) is in place, Africa should see the rapid implementation of the AU Model Law on Medical Products Regulation that will assist in putting in place capacity-building programs in nanomedicine RS.

Fabaceae: South African Medicinal Plant Species Used in the Treatment and Management of Sexually Transmitted and Related Opportunistic Infections Associated with HIV-AIDS

The use of medicinal plants, particularly in the treatment of sexually transmitted and related infections, is ancient. These plants may well be used as alternative and complementary medicine to a variety of antibiotics that may possess limitations mainly due to an emerging enormous antimicrobial resistance. Several computerized database literature sources such as ScienceDirect, Scopus, Scielo, PubMed, and Google Scholar were used to retrieve information on Fabaceae species used in the treatment and management of sexually transmitted and related infections in South Africa. The other information was sourced from various academic dissertations, theses, and botanical books. A total of 42 medicinal plant species belonging to the Fabaceae family, used in the treatment of sexually transmitted and related opportunistic infections associated with HIV-AIDS, have been documented. Trees were the most reported life form, yielding 47.62%, while Senna and Vachellia were the frequently cited genera yielding six and three species, respectively. Peltophorum africanum Sond. was the most preferred medicinal plant, yielding a frequency of citation of 14, while Vachellia karoo (Hayne) Banfi and Glasso as well as Elephantorrhiza burkei Benth. yielded 12 citations each. The most frequently used plant parts were roots, yielding 57.14%, while most of the plant species were administered orally after boiling (51.16%) until the infection subsided. Amazingly, many of the medicinal plant species are recommended for use to treat impotence (29.87%), while most common STI infections such as chlamydia (7.79%), gonorrhea (6.49%), syphilis (5.19%), genital warts (2.60%), and many other unidentified STIs that may include “Makgoma” and “Divhu” were less cited. Although there are widespread data on the in vitro evidence of the use of the Fabaceae species in the treatment of sexually transmitted and related infections, there is a need to explore the in vivo studies to further ascertain the use of species as a possible complementary and alternative medicine to the currently used antibiotics in both developing and underdeveloped countries. Furthermore, the toxicological profiles of many of these studies need to be further explored. The safety and efficacy of over-the-counter pharmaceutical products developed using these species also need to be explored.

Burnout in emergency department staff: The prevalence and barriers to intervention.

Burnout impacts patient care and staff well-being. Emergency department (ED) staff are at an elevated risk for burnout. Despite an acceleration in burnout research due to the coronavirus disease 2019 (COVID-19) pandemic, there is limited data on the nature and prevalence of burnout in the South African emergency medicine setting. This study determined the prevalence of burnout in ED staff (doctors, nurses and non-clinical staff) at Tygerberg Hospital and explored staff awareness and utilisation of interventions. The study was conducted at Tygerberg Hospital, South Africa. This cross-sectional study used the Maslach Burnout Inventory to assess burnout via a self-administered electronic survey in a convenience sample of 109 ED staff. Quantitative data were analysed with descriptive and inferential statistics. Qualitative data were analysed using thematic analysis. A total of 46 participants (45.10%) experienced burnout, with 73 participants (71.57%) at high risk for emotional exhaustion or depersonalisation. The prevalence of burnout in doctors was 57.89%, non-clinical staff was 25.93%, and nursing staff was 50.00%. Burnout was higher in doctors and nursing staff compared to non-clinical staff, with high emotional exhaustion and depersonalisation found in interns and specialist professional nurses. The level of intervention awareness was 41.8% and the level of intervention utilisation was 8.82%. Thematic analysis identified awareness, accessibility and reactive utilisation as barriers to utilisation with opportunities to reduce burnout and enhance resilience. Coordinated health system and organisational efforts are required to optimise intervention strategies to reduce burnout. Guidance on the design and planning of intervention strategies considering at risk groups, intervention-related factors, and non-clinical staff.

The response to substandard and falsified medical products in francophone sub-Saharan African countries: weaknesses and opportunities

Assuring the quality of medical products manufactured, imported or distributed in francophone sub-Saharan Africa remains a challenge, despite positive signals like the growing engagement in the benchmarking of regulatory authorities and -particularly- in the establishment of the African Medicines Agency. In this short report, we describe the existing activities to prevent, detect and respond to substandard and falsified products (SF) in this region, either through African multilateral organizations and initiatives led by the World Health Organization, or through the contribution of other stakeholders, such as local universities and procurement agencies. We underline that these emerging local stakeholders may play a pivotal role to guide and inform the national regulatory authorities about the prevalence and patterns of SF medical products, complementing the market surveillance and control, and building awareness of the importance of pharmaceutical quality assurance for public health.

Inhibition of pro-inflammatory cytokines by selected southern African medicinal plants in LPS-stimulated RAW 264.7 macrophages

Ethnopharmacological relevanceBark is frequently used in southern African traditional medicine to treat inflammation, yet it remains to be rigorously examined for its immunological and anti-inflammatory activity. Aim of the studyBarks obtained from ten important and popular southern Africa plants were evaluated for their anti-inflammatory and immunomodulatory properties against the secretion of some pro-inflammatory cytokines (interleukin (IL)-1β, IL-6, tumour necrosis factor-α (TNF-α), and interferon-gamma (IFN-γ) as well as chemokines (monocyte chemoattractant protein 1 (MCP-1) and macrophage inflammatory protein (MIP)-2) in murine RAW 264.7 macrophages. Materials and methodsThe inhibitory effects of aqueous and ethanol extracts were determined using cytokine multiplex-bead assays in lipopolysaccharide (LPS)-stimulated and unstimulated RAW 264.7 cells. ResultsOverall, the ethanol extracts were more potent cytokine inhibitors compared to the aqueous extracts. The LPS-stimulated cells treated with the ethanol extracts of Erythrina lysistemon Hutch., Pterocelastrus rostratus Walp. Syzygium cordatum Hochst. ex Krauss and Warburgia salutaris (G. Bertol.) Chiov., demonstrated significant (p < 0.005) inhibition up to 85% of IL-1β, IL-6, and TNF-α secretion compared to the LPS control. Additionally, P. rostratus and S. cordatum aqueous bark extracts substantially decreased the secretion of all the tested cytokines and chemokines. Chemical investigation of the S. cordatum extract resulted in the identification of four ellagic acid derivatives: ellagic acid 4-O-α-rhamnopyranoside (1), ellagic acid 4-O-α-4″-acetylrhamnopyranoside (2), 3-O-methylellagic acid 4′-O-α-3″-O-acetylrhamnopyranoside (3) and 3-O-methylellagic acid 4′-O-α-4″-O-acetylrhamnopyranoside (4), along with mixtures of ellagic acid 4-O-α-2″-acetylrhamnopyranoside (5), ellagic acid 4-O-α-3″-acetylrhamnopyranoside (6) and ellagic acid (7). Their structures were confirmed by mass spectrometry, NMR spectroscopy, and comparison with data from literature. ConclusionThe cytokine inhibition properties of most of the medicinal plants screened herein are reported for the first time. Our results provide insights into the mechanism of action by which the selected southern African medicinal plants regulate inflammation.

An inventory and analysis of the medicinal plants of Mozambique

Ethnopharmacological relevanceA comprehensive checklist and analysis of medicinal plant species and their uses in Mozambique, and a comparison with South Africa provided a more profound understanding of the broad concept of Traditional African Medicine as a healing culture and the need for a more informative classification system. Aims of the studyThis study was aimed at recording all medicinal plants reported in Mozambique according to literature and answer four main questions. 1. How many medicinal plant species have been recorded for Mozambique? Of those, how many are indigenous to Mozambique, and how many are introduced or cultivated exotics? 2. What are the main medicinal uses in Mozambique and which species are used for which ailments? 3. What are the similarities and differences between the medicinal floras of Mozambique and South Africa – are the same species used for the same ailments and is there evidence of cultural exchange? 4. Do the data provide new insights into Traditional African Medicine as one of the oldest medicine systems in the world? Materials and methodsA literature survey was done to compile the medicinal checklist of Mozambique using 29 available literature sources, which were found from published books, journal articles, reports, unpublished theses, dissertations, and online databases. ResultsA total of 731 medicinal plant species and infraspecific taxa from 447 genera and 120 families was recorded for Mozambique. Of these, 590 (81%) are indigenous, and 87 are non-indigenous (50 naturalised and 37 cultivated exotics). Of the 731 medicinal plant species, 494 (68%) are also used medicinally in South Africa and 148 (30%) are used for the same or similar ailments. Many of the shared taxa and uses have been recorded in the adjoining KwaZulu-Natal Province of South Africa, which has similar vegetation types. ConclusionThe similarity between Mozambique and South Africa (and especially the KwaZulu-Natal Province) not only suggest an exchange of traditional knowledge but also indicates the existence of a hitherto unnamed medicinal system of the southern and eastern African Bantu-speaking cultures that is in need of detailed comparative studies.

Potential of Selected African Medicinal Plants as Alternative Therapeutics against Multi-Drug-Resistant Bacteria.

Antimicrobial resistance is considered a "One-Health" problem, impacting humans, animals, and the environment. The problem of the rapid development and spread of bacteria resistant to multiple antibiotics is a rising global health threat affecting both rich and poor nations. Low- and middle-income countries are at highest risk, in part due to the lack of innovative research on the surveillance and discovery of novel therapeutic options. Fast and effective drug discovery is crucial towards combatting antimicrobial resistance and reducing the burden of infectious diseases. African medicinal plants have been used for millennia in folk medicine to cure many diseases and ailments. Over 10% of the Southern African vegetation is applied in traditional medicine, with over 15 species being partially or fully commercialized. These include the genera Euclea, Ficus, Aloe, Lippia. And Artemisia, amongst many others. Bioactive compounds from indigenous medicinal plants, alone or in combination with existing antimicrobials, offer promising solutions towards overcoming multi-drug resistance. Secondary metabolites have different mechanisms and modes of action against bacteria, such as the inhibition and disruption of cell wall synthesis; inhibition of DNA replication and ATP synthesis; inhibition of quorum sensing; inhibition of AHL or oligopeptide signal generation, broadcasting, and reception; inhibition of the formation of biofilm; disruption of pathogenicity activities; and generation of reactive oxygen species. The aim of this review is to highlight some promising traditional medicinal plants found in Africa and provide insights into their secondary metabolites as alternative options in antibiotic therapy against multi-drug-resistant bacteria. Additionally, synergism between plant secondary metabolites and antibiotics has been discussed.

Acute Antidepressant Activity Investigation of Selected African Medicinal Plants in Mice: A Preliminary Study

The therapeutic gap arising from high global incidence of depressive disorders and the efficacy and toxicity shortcomings of existing antidepressant drugs indicate a need to further search the plant kingdom with the goal of discovering novel antidepressant pharmacotherapeutic agents. Crude 50% ethanol Terminalia catappa (CETC), Tapinanthus dodoneifolius (CETD) and Bryophyllum pinnatum (CEBP) leaf extracts were investigated for their acute antidepressant activity on the forced swim (FST) and tail suspension (TST) tests. Groups of mice (n = 6) were each exposed to the tests 1 hour following oral administration of distilled water (10 ml/kg), extracts (125, 250 and 500 mg/kg body weight) and fluoxetine (20 mg/kg), using the mean immobility time as endpoint. Qualitative phytochemical analysis of these crude extracts indicated the presence of alkaloids, cardiac glycosides, saponins, phenolic compounds, tannins, steroids, carbohydrates, flavonoids, terpenoids and anthraquinones. Compared to distilled water treatments (FST, 84.16 ±3.92; TST, 82.85 ±5.84), CETC (FST, 84.17 ±4.44, 71.67 ±1.89, &amp; 44.31 ±8.23*; TST, 79.03 ±2.62, 74.10 ±3.11, &amp; 52.57 ±6.00*) and CEBP (FST, 77.02 ±2.70, 66.11 ±4.42 &amp; 49.99 ±4.20*; TST, 69.51 ±7.24, 49.73 ±11.85* &amp; 46.39 ±5.68**) treatments caused dose-dependent and significant (P &lt; 0.05) reductions in the mean immobility times on both paradigms while CETD caused dose-dependent and significant (P &lt; 0.05) reductions of this parameter only on the TST. Overall, acute antidepressant activities at the highest dose level (500 mg/kg) of all extracts approximated that of the standard antidepressant fluoxetine (20 mg/kg). The findings of this study are a justification for the widespread ethnomedicinal uses of extracts of these plants. There is a need to further characterize their antidepressant and other neuropharmacological effects. 1.

What makes joint assessment procedures attractive to the innovative industry: successes, challenges, and proposed improvements.

Regulatory harmonization and convergence have been identified as the key driver in promoting efficient evaluation of medicines, reducing workload, and supporting earlier access to medicines on the African continent. There has been great progress to date in enhancing regulatory harmonization and convergence on the African continent via the Regional Economic Communities (RECs) and with the establishment of the Africa Medicines Agency (AMA). In this article, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Africa Regulatory Network (ARN) presents its perspective based on the available literature review and results from a survey conducted with innovative biopharmaceutical companies to gather experiences using regional joint assessment procedures (JAPs) in Africa, such as the East African Community Medicines Regulatory Harmonization (EAC-MRH), the West African Medicines Regulatory Harmonization (WA-MRH), and the Southern African Development Community Medicines Regulatory Harmonization (SADC-MRH) initiative through the ZAZIBONA Collaborative Procedure for Medicines Registration (ZaZiBoNa), and provides best practices in this evolving landscape. The article also assesses other collaborative registration pathways available to facilitating registration of pharmaceutical products in African countries, such as WHO Collaborative Registration Procedures (CRP), Swissmedic's Marketing Authorisation for Global Health Products (MAGHP) and EU Medicines for All (EU-M4ALL). Benefits and challenges of each of the existing pathways are discussed in this article. Main benefits include building more expert capacity and improved collaboration amongst experts, as well as shorter review timelines in some cases. Key challenges include the lack of predictability in the adherence to procedural timelines as defined per guidelines, lengthy timeline to achieve national marketing authorization following joint assessment, the lack of dedicated personnel, administrative issues during the submission process as well as additional country-specific requirements on top of JAP-specific requirements. Our recommendations for improvements include harmonization of requirements across countries and regions and with international standards, appropriate resource allocation for JAP activities to ensure adherence to timelines, use of JAPs throughout the entire product lifecycle and all product categories, adequate use of digital technologies, and improved communication and transparency with applicants. These improvements will allow industry to better plan their filing strategies for the region which will lead to overall improved usability of the JAPs in Africa and enable faster patient access.

Alignment in the registration, selection, procurement and reimbursement of essential medicines for childhood cancers in South Africa

IntroductionThe effectiveness of a health system in providing access to medicines is in part determined by the alignment of several core pharmaceutical processes. For South Africa’s public health sector, these...

Honey flower dermatitis: Contact allergy to ellagic acid in Melianthuscomosus.

A case study is reported whereby a patient with no prior allergies developed a strong and spreading delayed-type hypersensitivity reaction to Melianthus plants, nectar and synthetic pigment derived from it after frequent handling of these substances. The lesions improved after treatment with topical steroids and allergen avoidance within 1-2 weeks. Subsequent patch testing with the plants, nectar and synthetic ingredients identified ellagic acid (EA) as the sensitizing agent. This is the first proven case of allergic contact dermatitis to EA, a phenolic substance present in numerous plants, fruits, and nuts regularly consumed by humans. Melianthus use is growing worldwide as an ornamental plant. Moreover, it is used in traditional South African medicine for its anti-inflammatory effects. In recent years, these extracts and EA have been added to natural, plant-based topical formulations for the treatment of inflammatory skin disorders. Our observation that the EA found in Melianthus can induce severe contact allergy should caution for the possible dangers of specific allergic sensitizations to these increasingly used additives in natural medicines.

Standardized seed extract of Cajanus cajan (L) Millsp. produced antinociceptive and anti-inflammatory actions through inhibition of inflammatory mediators and activation of opioidergic signaling

Background and PurposePeripheral tissue damage and diseases could lead to persistent pain beyond possible resolution suggestive of disease-promoting condition which gives rise to chronic pain. The inability of current medications to manage some chronic inflammatory and painful conditions necessitate the need for better treatment options. Natural products have been a veritable source for the discovery of more efficacious and safer therapeutics. Cajanus cajan (L) Millsp, (Fabaceae) is used in traditional African medicines for the treatment of painful, gut disturbance and inflammatory conditions. Hence, the current study aims to investigate the anti-inflammatory and antinociceptive actions of the ethanol seed extract of Cajanus cajan (CC) in rodents and possible mechanisms of action. MethodsHigh performance liquid chromatography coupled with diode-array detection (HPLC-DAD) was used to identify 8 major flavonoids in CC. Antinociceptive activity was investigated using the acetic acid-induced writhing reflex, biphasic formalin-induced flinching behaviour and supraspinal hot plate-evoked nociception in mice. Carrageenan-induced rat paw oedema test was used to evaluate the anti-inflammatory action of CC in rats. Possible mechanism of antinociception and anti-inflammatory actions were examined using both in vivo model and molecular docking procedures against µ-opioid receptor (MOR), cyclooxygenase-2 (COX-2) and phospholipase A2 (PLA2) proteins, respectively. ResultsThe chromatographic procedure qualitatively and quantitatively confirmed the presence of rutin, quercetin, gallic acid, luteolin, pinostrobin, BiochaninA, formononetin and apigenin in CC. The in vivo nociceptive assay, showed that CC (50, 100, or 200 mg/kg, p.o.) significantly decreased mean number of writhing reflex with peak effect at 50 mg/kg (72% inhibition) when compared with vehicle control in mouse writhing test. Similarly, the biphasic formalin-induced nociception was significantly reduced by CC (50 mg/kg) with 24.61 and 66.73% inhibition of nociceptive reactions in both the early and late phases of formalin-induced inflammatory pain, respectively. In addition, CC significantly increased supraspinal thermally mediated pain threshold with maximum possible effects of 42.25 and 52.16% at CC 50 and 100 mg/kg, respectively, in hot-plate test. Similarly, CC100mg/kg caused time course inhibition of carrageenan-induced paw oedema in rat with peak effect (65.78%, CC 100 mg/kg; 6 h). Interestingly, the antinociceptive action of CC was blocked by the pre-treatment of mice with l-NG-nitro arginine methyl ester (L-NAME) or naloxone. The molecular docking analysis revealed prominent interactions of pinostrobin, physcion and lupeol with MOR, COX-2, and PLA2, respectively. ConclusionFindings from this study showed that Cajanus cajan seeds extract possesses anti-nociceptive and anti-inflammatory through inhibition of inflammatory mediators (PLA2/COX-2) and activation of opioidergic signalling.

Ecological Study of Aspilia africana and Sida acuta and the Comparative Study of Their Phytochemical Constituents

Aspilia africana and Sida acuta are two plant species that are widely distributed across Africa and are used in traditional medicine for various ailments. In this study, we aimed to compare their ecological characteristics and phytochemical constituents. Field surveys were conducted in selected sites across Nnamdi Azikiwe University, Awka, Nigeria to assess the distribution and abundance of the two species. Data on soil type, rainfall, temperature, and altitude were also collected to determine the ecological factors that influence their growth and distribution. Our results showed that A. africana was more widely distributed and had a higher abundance than S. acuta. A. africana was found in a wide range of ecological conditions, including grasslands, savannas, and secondary forests. S. acuta, on the other hand, was found mainly in disturbed habitats such as farmlands, roadsides, and waste grounds. Both species were found to be adaptable to a wide range of soil types, but A. africana had a higher preference for sandy soils while S. acuta was more commonly found in loamy soils. Phytochemical screening was carried out on samples of the two species collected from different sites. The presence of secondary metabolites such as alkaloids, flavonoids, tannins, and phenols was determined using standard procedures. Our results showed that both species contained varying concentrations of these secondary metabolites. A. africana had higher concentrations of alkaloids, saponins and tannins (4.20±0.05 mg/100g) of total saponins, (1.18±0.04 mg/100g) of total glycosides, (8.22±0.40 mg/100g) of total alkaloids, (0.40±0.01 mg/100g) of total steroids, and (2.23±0.03 mg/100g) of total tannins, while S. acuta had higher concentrations of flavonoids and saponins (0.28±0.05mg/100g) of total saponins, (0.55±0.02 mg/100g) of total flavonoids, (2.31±0.03 mg/100g) of total alkaloid, (1.51±0.02 mg/100g) of alkaloids, (1.85±0.04 mg/100g) of total steroids. These findings suggest that A. africana and S. acuta may have different medicinal properties and potential applications. Flavonoids and phenols have been reported to have antioxidant, anti-inflammatory, and anticancer properties, while alkaloids and tannins are known for their antimicrobial and analgesic activities. Further studies are needed to explore the pharmacological activities of their phytochemical constituents and validate their traditional uses in African medicine.

An introduction to gender affirming healthcare: What the family physician needs to know.

Gender affirming healthcare (GAHC) is a relatively new field in primary health care that describes a range of gender affirming practices, including hormone therapy, for transgender and gender diverse (TGD) people. In 2019, gender affirming hormones were approved by South African National Essential Medicine List Committee (NEMLC) for tertiary-level care, and in October 2021 the Southern Africa HIV Clinicians Society published a GAHC guideline for South Africa. Unfortunately, TGD people still experience discrimination and stigmatisation in healthcare facilities in South Africa, leading to poor access to care and higher health risks with poorer outcomes. Gender affirming care in the primary health care clinic can improve access to health care, with improved provision of preventative services. This article defines key transgender concepts, describes the informed consent process and outlines the initiation and monitoring of both feminising and masculinising hormone treatment for TGD people. Staff at healthcare facilities need to receive training on gender affirming practices and how to ensure a safe environment for TGD clients.

For a shift of paradigm in healthcare systems in sub-Saharan Africa: Moving from current unequal access to modern care to sustainable health systems encompassing African traditional medicine

Background: Health is one of the major challenges for the development of Africa, whether it is to improve the current state of health of Africans or to allow the emergence of a healthy workforce able to contribute to the economic growth of Africa. Objectives: This paper aims to highlighting gaps in access to modern care, to identify attraction factors for traditional African medicine helping with the current health crisis due to Covid-19, to propose ways of uilding synergies and to encourage more efficient and consistent health systems. Methods: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We evaluated sources of heterogeneity by keywords (health system, health care providers, Africa, diseases), and pooled heterogeneity analysis addressed by authors, using meta-analysis methods. Results: With Covid-19, African health systems have been less overwhelmed and health consequences less dramatic than those of European and American countries, but the pandemic has exposed the flaws of health systems that have reached their limits. Conclusion: Because health is one of the relatively neglected challenges in development policies in Africa and because health will become a strategic development issue in the coming years, it is therefore becoming increasingly important to re-think the organization and functioning of health systems in Africa.

Workplace-based learning opportunities in a South African family medicine training programme.

Workplace-based learning (WBL) provides authentic learning opportunities to develop fit-for-practice healthcare workers. Different types of WBL opportunities have been described in high-income countries, but the opportunities in the district health systems of sub-Saharan Africa have not been characterised. This study explored family physicians' (FPs) and registrars' perceptions of WBL opportunities in a decentralised postgraduate family medicine registrar training programme. The study was conducted at five decentralised training sites across two provinces affiliated with the University of the Witwatersrand in South Africa. This instrumental case study involved semi-structured qualitative interviews with 11 FPs and 11 registrars purposively sampled across the training sites. The verbatim transcripts were thematically analysed using Braun and Clark's six-step approach. Workplace-based learning opportunities were grouped into four themes: Learning from interpersonal interactions, learning from district activities, self-directed learning and contextual influences on learning opportunities. Registrars learnt from patients, peers, FPs and other professionals. Feedback, self-reflection, portfolio use, involvement in various district events, such as student and staff teaching, and continuous medical education augmented learning. Contextual influences originated from health facilities, resource availability, district management and university support, excessive workload and a need for standardised district learning opportunities. Registrars are exposed to several types of WBL opportunities in district health systems. Effective engagement with available opportunities and addressing contextual challenges could enhance registrar learning.Contribution: Maximising learning opportunities to promote registrars' acquisition of required skills and competencies to efficiently address community needs in a middle-income country such as South Africa.

Envisioning African Intersex: Challenging Colonial and Racist Legacies in South African MedicineEnvisioning African Intersex: Challenging Colonial and Racist Legacies in South African Medicine Amanda Lock Swarr Duke University Press, 2023. 248 pp.

Envisioning African Intersex: Challenging Colonial and Racist Legacies in South African MedicineEnvisioning African Intersex: Challenging Colonial and Racist Legacies in South African Medicine Amanda Lock Swarr Duke University Press, 2023. 248 pp.

Registration of essential medicines in Kenya, Tanzania and Uganda: a retrospective analysis.

To audit national drug registers (NDRs) in Kenya, United Republic of Tanzania and Uganda with respect to national Essential Medicine Lists (EMLs) and to conduct an analysis of highly registered products including a sub-analysis of highly registered antimicrobial products. Retrospective analysis of registration of essential medicines and medicinal products on NDRs as of February 2018. Not applicable. None. Registration status of essential medicines by country, essential medicine status of registered products by country and medicines with more than 50 registrations across all three countries. A high proportion of essential medicines are not registered: Kenya 28% (175/632), United Republic of Tanzania 50% (400/797) and Uganda 40% (266/663). Of registered products on the NDRs, more than half are not essential: Kenya 71% (4350/6151), United Republic of Tanzania 64% (2278/3590) and Uganda 58% (2268/3896). When the three NDRs were combined, there were 42 medicines with over 50 registered products, accounting for 30% (4153/13637) of products, many of which were non-essential. Non-registration of essential medicines is a barrier to availability. Over-registration of medicines, particularly non-essential medicines, diverts regulatory resources towards registering non-priority and, sometimes, clinically sub-optimal medicines. The East African Community Medicines Registration Harmonization Project has the potential to improve access to key medicines if registration of essential medicines is prioritised and registration of non-essential medicines is restricted.