Medicine For Primary Health Care Research Articles

Observations from the European Young Family Doctors’ Movement (EYFDM) Austria Preconference Exchange Program: The Role of Complementary Medicine in Primary Healthcare

Observations from the European Young Family Doctors’ Movement (EYFDM) Austria Preconference Exchange Program: The Role of Complementary Medicine in Primary Healthcare

Deciphering the role of Andrographis paniculata in pharmaceutical field and chromatographic evaluation of Andrographis paniculata in the solution of methanol and hexane through HPTLC

This article explores the medicinal potential of Andrographis paniculata (Kalmegh) in Ayurveda, focusing on its hepato protective and anti febrile properties. The paper emphasizes the importance of herbal medicines in primary health care due to their availability, compatibility, and affordability. Additionally, it discusses the rich herbal medicinal wealth in India and the historical significance of Ayurveda. The study delves into the pharmacological actions of Andrographis paniculata including anti-inflammatory, anti-diabetes, anti-viral, and immune stimulating pro-perties. The main objective is chromate-graphic evaluation using High-Performance Thin Layer Chromatography (HPTLC) to analyze the chemical composition of Andrographis paniculata. The HPTLC method is detailed, which is used in qualitative analysis of Andrographis paniculata. The article concludes with the qualitative analysis of Andrographis paniculata, comparing chromatograms in different solvents and wavelengths. Methanol is identified as the superior solvent providing a clearer chromatogram. Chemical constitution analysis reveals the number of visible chemicals at different wavelengths, offering insights into the herb's composition. The study provides valuable information for pharmaceutical quality control and the analysis of medicinal plant.

Studi Literatur: Tanaman Herbal Indonesia yang Berkhasiat sebagai Penurun Hipertensi

Introduction: Hypertension or what is often referred to as high blood pressure is a degenerative disease or PTM that often appears without symptoms. Hypertension is a disturbance in blood circulation that can be life- threatening for individuals when blood pressure is above systolic and diastolic pressure which is unstable. Other hypertension treatments can use good herbal plants to treat various diseases. Various kinds of active substance components which have been widely studied have therapeutic effects derived from herbal plants. About 75- 80% of the worlds population, especially in developing countries, use herbal medicines for primary health care because of their better acceptance of the human body. Objective of the research: The purpose of this literature review is to find out the nutritious herbal plants in Indonesia as traditional medicines to reduce hypertension. Method: The method used in writing this article is a literature review approach by searching literature using the Google Schoolar website database. Result: The results of the study found 15 plants as herbal medicines as drugs to reduce hypertension, namely celery leaves (Apium graveolens L), ginger (Zingiber officinale), basil leaves (Ocimum basilicum), Moringa leaves (Moringa oleifera), garlic (Allium sativum), Turmeric (Curcuma longa), butterfly pea flower (Clitoriaternatea), papaya leaves (Carica papaya), betel leaves (Piper Betle Linn), cucumber (Cucumis sativus), gotu kola leaves (Centella asiatica), carrots (Daucus carota L), bay leaves (Syzygium polyanthum), meniran leaves (Phytallantus niruri), soursop leaves (Annona muricata Linn). Conclusion: Traditional medicine using herbal plants is believed to be able to treat hypertension which has been part of public belief from time to time. The utilization of these traditional plants takes into account aspects such as ease of obtaining, saving costs, and not containing chemicals that cause other side effects.

Perceptions on the Inclusion of Traditional Medicine in Primary Health Care in Allandale Village in Mpumalanga Province in South Africa

This article seeks to explore perspectives on the potential incorporation of traditional medicine into primary health care. Academic discourse examines in depth the historical stigmatisation and demonization of African traditional practices, including traditional medicine. However, the renaissance of scholarly de-colonial and Afro-centric research frameworks re-awakens the need to generate knowledge systems and analytical lenses that pragmatically and sustainably address global challenges using contextually relevant resources that have been maligned for centuries due to colonialism. The 21st century presents opportunities and challenges that require a re-evaluation of the role of traditional medicine in contributing holistically to primary health care. The study adopted Afro-centricity approach as theoretical framework. Within the framework of qualitative research, this study adopted an explorative qualitative design, using semi-structured interviews to generate data. The study findings revealed that traditional medicine deserved a more prominent consideration for the inclusion in primary health. Reasons given for such inclusion included affordability, ease of access, socio-cultural relevance, spiritual significance, holistic approach and potency which could address some of the key challenges facing the primary health care system in South Africa.

Complementary and alternative medicine in Primary Health Care: professionals' perceptions about the provision of services in the metropolitan region of Goiania, Brazil

Resumo Embora políticas públicas vigentes em âmbito federal e estadual instituam as Práticas Integrativas e Complementares no rol dos serviços ofertados na Atenção Primária à Saúde, ainda não sabemos como elas são implementadas na região metropolitana de Goiânia. Nesse sentido, este estudo objetiva compreender as percepções dos profissionais de saúde que ofertam Práticas Integrativas e Complementares sobre a utilização desses serviços de Atenção Primária à Saúde na região metropolitana de Goiânia. Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa. Entrevistas semiestruturadas foram realizadas com 20 profissionais e, em seguida, transcritas e tratadas com a análise de conteúdo temática. Compreendemos que a oferta das Práticas Integrativas e Complementares depende dos profissionais, os quais têm sofrido com a falta de apoio da gestão e desarticulação do seu trabalho perante a equipe, bem como com a ausência de infraestrutura adequada e despadronização do registro nos prontuários dos usuários. Concluímos que a oferta de Práticas Integrativas e Complementares tem sofrido as consequências de uma integração parcial e precária na Atenção Primária à Saúde.

Undiagnosed comorbidities among individuals hospitalised with COVID-19 in South African public hospitals.

Previous studies have reported comorbid disease, including hypertension, diabetes mellitus, chronic cardiac and renal disease, malignancy, HIV, tuberculosis (TB) and obesity, to be associated with COVID‑19 mortality. National demographic surveys have reported a high proportion of undiagnosed and untreated comorbid disease in South Africa (SA). To determine the number of individuals with previously undiagnosed HIV, TB and non-communicable diseases (NCDs) among patients hospitalised with COVID‑19, and the level of medical control of these chronic diseases. We conducted a sentinel surveillance study to collect enhanced data on HIV, TB and NCDs among individuals with COVID‑19 admitted to 16 secondary-level public hospitals in six of the nine provinces of SA. Trained surveillance officers approached all patients who met the surveillance case definition for inclusion in the study, and consenting patients were enrolled. The data collection instrument included questions on past medical history to determine the self-reported presence of comorbidities. The results of clinical and laboratory testing introduced as part of routine clinical care for hospitalised COVID‑19 patients were collected for the study, to objectively determine the presence of hypertension, diabetes, HIV and TB and the levels of control of diabetes and HIV. On self-reported history, the most prevalent comorbidities were hypertension (n=1 658; 51.5%), diabetes (n=855; 26.6%) and HIV (n=603; 18.7%). The prevalence of self-reported active TB was 3.1%, and that of previous TB 5.5%. There were 1 254 patients admitted with COVID‑19 (39.0%) who met the body mass index criteria for obesity. On clinical and laboratory testing, 87 patients were newly diagnosed with HIV, 29 with TB, 215 with diabetes and 40 with hypertension during their COVID‑19 admission. There were 151/521 patients living with HIV (29.0%) with a viral load >1 000 copies/mL and 309/570 (54.2%) with a CD4 count <200 cells/μL. Among 901 patients classified as having diabetes, 777 (86.2%) had a glycated haemoglobin (HbA1c) level ≥6.5%. The study revealed a high prevalence of comorbid conditions among individuals with COVID‑19 admitted to public hospitals in SA. In addition, a significant number of patients had previously undiagnosed hypertension, diabetes, HIV and active TB, and many and poorly controlled chronic disease, as evidenced by high HbA1c levels in patients with diabetes, and high viral loads and low CD4 levels in patients with HIV. The findings highlight the importance of strengthening health systems and care cascades for chronic disease management, which include prevention, screening for and effectively treating comorbidities, and ensuring secure and innovative supplies of medicines in primary healthcare during the COVID‑19 pandemic.

A Short Review on Role of Some Natural Herbs in the Treatment of Hypertension

The medical term for elevated blood pressure is hypertension (HTN). It's harmful since it strains the heart and increases the risk of heart disease and stroke as well as atherosclerosis (hardening of the arteries). Congestive heart failure, renal damage, and blindness are all possible outcomes of HTN. Many adverse effects are commonly associated with traditional antihypertensives. For the most part, people in underdeveloped nations prefer herbal medicines for primary health care since they are more tolerable by the human body and have less adverse effects. A great deal of effort has been made over the last three decades to discover native plants that have hypotensive and antihypertensive medicinal properties. It has been established that some of these medicinal herbs have hypotensive and antihypertensive properties, whereas others have been discredited. In order to evaluate the efficacy and clarify the safety profile of such herbal treatments for their antihypertensive potential, additional scientific study must be conducted to combine ayurveda expertise with modern medicine.&#x0D;

Study on heavy metals in some Ayurvedic herbal products and risk assessment of their calculated average daily dose intake in humans

IntroductionAccording to the World Health Organisation, 80% of the world population relies on plant material based herbal medicines for primary health care. Nine herbal products used in Ayurvedic medicine were studied for heavy metal content and assessed for their health risks. MethodsNine herbal plant products Tagar (Valeriana jatamansi), Arjun (Terminalia arjuna), Guggulu (Commiphora wightii), Pushkarmoola (Inula racemosa), Shilajeet (Asphaltum punjabianum), Shallaki (Boswellia serrata), Haritaki (Terminalia chebula), Neem (Azadirachta indica), and Bahera (Terminalia bellirica), were collected from the local market and analyzed for heavy metals (Cd, Pb, Zn, Ni, Fe, Cu, Mn, Cr) using Atomic Absorption Spectrophotometer. The risk assessment of heavy metals in Ayurvedic herbal products in terms of the Average Daily Dose was calculated to assess the long-term consumption risk of the medicine, the estimated daily intake (EDI) was determined and the health risk due to the consumption of herbal medicine is described in term of target hazard quotient (THQ). The health risk of each herbal medicine due to the cumulative effect of the heavy metals was assessed in terms of hazard index (HI). ResultAll the Ayurvedic products tested contained heavy metals, in low quantities. Chromium was below the detectable limit. Discussions and conclusionsIn terms of standards given by various agencies for heavy metals dietary intake the studied Ayurvedic products when consumed in the recommended dose were found to contain heavy metals within the standard limits and pose insignificant health risks (HI= >1). The essentiality of certain heavy metals at low and ultra-low concentrations, for proper growth and physiological functioning in animals, is discussed. The study concludes that the human uptakes of heavy metals through the recommended medicinal dose of the studied Ayurvedic plant products are within the safe limits recommended by various agencies and pose a minimal health risk in short term as well as in long term consumption.

To Start Comprehensive Health Care System with Combination of Traditional, Herbal, Allopathy, Complementary Medicine and Integrative Medicines in Primary Health Care.

We are reporting an unusual case of a 26-year-old immunocompetent patient of miliary tuberculosis of cerebellum with meningitis and lung involvement, presenting with ataxia without any evidence of systemic inflammation. Since, prognosis depends on correct diagnosis and timely treatment, recognition and prompt diagnosis are important for overall outcome.

Public financing for primary health care is the key to universal health coverage and strengthening health security

Public financing for primary health care is the key to universal health coverage and strengthening health security

Differences in prescribed medicine availability in Primary Health Care: evidence from the Prover Project.

This is a cross-sectional study on the availability of prescribed medicines in Primary Health Care (PHC), with a probabilistic sample of 1,221 users of public pharmacies in a health pole municipality in Minas Gerais, in 2017. Medicine availability indicators were estimated, and a hierarchical logistic regression was performed, according to the behavioral model of health service use. Only 39.3% of patients received all medicines in the prescribed quantities. The most and the least available medicines were, respectively, those for the digestive system/metabolism, and for blood and hematopoietic organs. Full availability of the prescribed treatment was associated with higher schooling (≥ 8 years OR: 1.7; 95% CI: 1.3-2.4); proximity to the pharmacy (≤15 min OR: 1.7; 95% CI: 1.2-2.3); absence of out-of-pocket expenditure on medicines (OR: 2.2; 95% CI: 1.7-2.9), and a smaller number of prescription drugs (≤ 2 OR: 3.2; 95% CI: 2.3-4.4; 3/4 OR: 1.6; 95% CI: 1.2-2.1). These results showed differences in medicine availability within the Brazilian Unified Health System (SUS), and highlighted the need to reorganize the dispensing services network and pharmaceutical procurement planning, as well as to develop public policies to protect the vulnerable population.

Formulation Optimization of an Improved Traditional Medicine from the Stem Bark Extract of Mangifera indica L. using Design of Experiments (DOE) Strategy

Introduction: Improved Traditional Medicines (ITMs), a recent concept by the World Health Organization (WHO) was introduced to promote the rational use of herbal medicine for primary health care in developing countries. The ITM by WHO andAIPO have categorized into 4 categories with respect to the quality of the active ingredient. However, this category needs more research in finding a greater variety of acceptable dosage forms. There is a need to account for formulation and process variables in these dosage forms to maintain product properties hence performance of plant extract, ensuring consistent quality. One of the methods to account for formulation and process variables is by using the Design of Experiments (DoE) approach.&#x0D; Objective: The main objective of this work was to optimize the formulation of a category 2 Improved Traditional Medicine containing Mangifera indica L. stem bark aqueous extract using Design of Experiments.&#x0D; Methods: Mangifera indica L. stem bark was collected and identified at the National herbarium. It was dried, ground and the powder used for extraction using digestion method using water as solvent (at 70°C). Phytochemical screening was done on the extract. The extract then proceeded unto pharmaceutical development. The formulation optimization of Mangifera indica aqueous stem bark extract (MIABE) started with the definition of the Quality Target Product Profile (QTPP) that was expected for the final product; which is an orodispersible tablet that will facilitate patient compliance and promote a rapid disintegration. These QTPPs formed the basis of the Critical Quality Attributes (CQAs) which were identified (as hardness, disintegration time and mass uniformity) and used for all experiments. The experimental part was divided into 2 main manufacturing processes; direct compression and wet granulation techniques. Each process was investigated for drug product optimization. &#x0D; A risk assessment was undertaken to identify the formulation variables that impact product quality.&#x0D; For direct compression, a 32 full factorial Design of Experiment (DoE) was used to investigate the effect of superdisintegrant (25%) and lubricant level (0.25-5%) on powder flow characteristics. For wet granulation, a 22 full factorial DoE was used to investigate the effect of superdisintegrant (2-5%) and binder (5-10%) on flow properties and tablet properties.&#x0D; Results: The design and evaluation of the formulations in this study resulted in successful formulation optimization of an Improved Traditional Medicine. DoE proved to be an excellent method to optimize formulations of ITMs, providing several tools that increase a much better understanding of the formulation and manufacturing process. Further studies on this formulation DoE are needed to evaluate the effect of more process variables (compression force and speed) and more formulation variables such as palatability.&#x0D; Conclusion: Optimization models were developed for the various responses (disintegration time, wetting time and hardness) showing the influence of formulation variables on these responses. Therefore, the formulation optimization of a category 2 ITM containing Mangifera indica L. stem extract using Design of Experiment is a suitable approach to save time, money and improve drug product understanding.

Ethnozoological study of medicinal animals and animals’ products used by traditional medicinal practitioners and indigenous people in Motta city administration and Hulet Eju Enessie District, East Gojjam, Northwest Ethiopia

BackgroundIn Ethiopia, many ethnic communities use traditional/indigenous medicine for primary health care. However, this indigenous medicinal practice is being neglected and continued to be lost due to poor documentation as they are transferred from generation to generation through oral tradition. Therefore, this ethnozoological study aimed to assess and document the medicinal use of animals and animals’ products used by traditional medicinal practitioners and indigenous people in Motta city administration and Hulet Eju Enessie Districts, East Gojjam Zone, Ethiopia. MethodsCross-sectional ethnozoological survey was conducted using a Semi-structured questionnaire among purposively selected respondents in Motta city administration and Hulet Eju Enessie District, East Gojjam Zone, Ethiopia from September 2020 to June 2021 GC. The ethnozoological data were analyzed using SPSS version 26 and Microsoft Excell Spreadsheet. Fidelity level, use-value, and informant consensus factor were determined. ResultsA total of 25 animal species were reported to be used for the treatment of different ailments by 33 informants. The majority of animals (64%) were mammals followed by birds (16%). The fidelity level ranged from 18.2 (Hyena for bad spirit) to 100% (stingless be for asthma, Tiger for rabies virus, Whisper for nightmare). ConclusionThis study showed the wide use of medicinal animals and their parts/products for meeting the primary healthcare needs of the community in the study area. Therefore, this ethnozoological medicinal knowledge needs to be integrated with modern medicine to use animals/animals’ products as a potential source of effective drugs for different ailments.

Práticas Integrativas e Complementares ofertadas pela enfermagem na Atenção Primária à Saúde

ABSTRACT The aim of this study was to assess and analyze the provision of Complementary and Alternative Medicine in primary health care by nurses in the city of São Paulo, and the impact of the Covid-19 pan- demic on this provision. This was a descriptive time series study conducted with secondary data from the official database of the Informatics Department of the Unified Health System for the period from 2018 to 2020. The results showed that complementary therapies provided by nurses totaled 10,933 procedures in 2018, 24,684 in 2019, and 12,651 in 2020. Between 2018 and 2019, there was a 120% increase in provision, a trend that was interrupted in 2020 due to the Covid-19 pandemic. The provision of these therapies by nurses is a form of holistic care and expanded understanding of the health and disease process. However, despite the great potential for the application of this approach to health care, this category accounts for a small percentage of total services in the community studied.

Ethnobotanical study on assessment of Practice on Traditional Plant Medicine Use among People of Wonchi District, central Ethiopia

Ethiopia is a country characterized by a wide range of climate and ecological condition which helped to have high diversity of medicinal plants and up to 80% of the population use traditional medicine for primary health care. Studies on the current practices of the communities in the area are vital to document the basic information in these regars. Therefore, this study was aimed in assessing the practices of traditional plant medicine use among communities of Wonchi District. Results: The most widely used route of administration in the study area was oral accounted for (56.67%) followed by dermal (29.63%) This is the reason that oral and dermal routes permit rapid physiological reaction of the prepared medicines with the pathogens and increase its curative power. The prepared traditional medicines were applied in a number of ways, among which drinking (37.57%), creaming (16.76%), and eating (10.40%) were mentioned frequently.

Implementation of pharmaceutical services in Brazilian primary health care: a cross-sectional study

BackgroundIn the Brazilian public health system, primary health care (PHC) is provided by the municipalities and is considered the entry level of the Unified Health System (SUS). Governmental pharmaceutical services (PharmSes) are part of the SUS, including PHC, and are the most significant way in which patients access medicine and services. Considering the diversity of the country, the municipalities have the autonomy to decide how PharmSes are implemented. Even though policies and procedures should be implemented as expected by policy makers and experts, municipality characteristics may interfere with implementation fidelity. Therefore, this study evaluated the degree to which the PharmSes in PHC were delivered as intended in Brazilian municipalities.MethodsWe analysed data from a secondary database originating from a cross-sectional nationwide study carried out by the Ministry of Health and the World Bank from 2013 to 2015. Data on 465 municipalities and the Federal District were collected from 4939 governmental PharmSes. A rating system comprising 43 indicators was developed and applied to the dataset to obtain the implementation degree (ID) of each PharmSe. Additionally, the IDs of the two PharmSes dimensions and the nine components were measured.ResultsOverall, the ID of the PharmSes in Brazilian PHC was evaluated as critical. The ID was critical in 81% of the municipalities (n = 369), incipient in 14% (n = 65) and unsatisfactory in 4.8% (n = 22). Regarding the PharmSes dimensions, the ‘medicine management’ (MM) ID was considered critical (Mean = 46%), while the ‘care management’ (CM) ID was incipient (Mean = 22%). In terms of the PharmSes components, the highest ID was achieved by ‘forecasting’ (58%). In contrast, ‘continuing education and counselling’ showed the lowest figure (ID = 11%) in the whole sample, followed by ‘information and communication’ and ‘teamwork’.ConclusionsThe degree to which PharmSes were implemented was critical (ID< 50%). This analysis demonstrated that PharmSes were implemented with low fidelity, which may be related to the low availability of medicine in PHC. Although the care management component requires more attention, considering their incipient ID, all components must be reviewed. Municipalities must increase their investment in PharmSes implementation in order to maximize the benefits of these services and guarantee the essential right of access to medicine.

A Case Study of Complementary Alternative Medicines in Primary Healthcare in Ghana

Background: The embryonic field of complementary alternative medicine in Ghana is gradually taking shape. Alternative medicine in Ghana is an important system of medical practice with legislation currently pending for promulgation.&#x0D; Objectives: To support this embryonic industry for potential role into our primary healthcare and public health system, there is a need for robust health care policy in the area of standardization coupled with strong political willpower and research in Ghana. The aim of this case study is to reflect the role of complementary alternative medicine in primary healthcare in Ghana.&#x0D; Methods: The study incorporates a mixed method engaged in integrated data analysis to investigate the challenges of practitioners of complementary alternative medicines as primary healthcare givers. Additionally, it evaluates the pull factors that drive consumers to complementary alternative remedies from the perspectives of the practitioners and finally, to evaluate the opinions of practitioners on consumers’ push factors from mainstream medicine using Ghana as a case model.&#x0D; Results: This study demonstrates that there is a role of complementary alternative medicine in primary healthcare delivery as well as the public health system. However, there are multifactorial challenges in the sector as respondents outlined lack of standardization, disunity and mistrust between complementary alternative medicine and mainstream medical practice. Some of these opposing forces prevent recognition of these remedies into the national healthcare delivery system. &#x0D; Conclusion: While our findings demonstrate that there is a role of complementary alternative medicines in our public health and primary healthcare in Ghana, we recommend collaboration between complementary alternative and conventional medical practitioners for improvement of quality of life the consumers. We are of the view that, unhealthy competition between the two medical systems should be controlled.

Concept of Zaght al-Dam-Qawi (Hypertension) and its Management Modalities in Unani System of Medicine

The scope of Unani medicine is increasing day by day as people are becoming more interested in herbal and organic world. However, Unani (herbal) knowledge needs to be coupled with scientific documented research done to verify its efficacy. The aim of this paper is to provide updated knowledge on hypertension and its management in the Unani system of medicine. Hypertension is a major health hazard globally especially in developed countries. In the Unani system of medicine, there are mudirrat (diuretics) to reduce body fluids and minerals, and musakkin (relaxants) and munawwim (sedatives) are also advised by Unani physicians to reduce anxiety. Unani physician, Razi recommends venesection for this particular ailment. Unani physicians have given the concept of hypertension as “Imtila-ba-Hasb-ul-Auiya” and have said that this occurs due to sue-e-mizaj damwi and comes under the heading of Imtila. Literally ‘Imtala’ means gathering and fullness of the body with madda (fluids). To be precise, it means there is a buildup of normal or abnormal fluids in the body. Unani physicians were all aware of the concept of Zaghta e damwi (blood pressure). Systole as ‘Zaghta-e-Inqabazi’ and diastole as ‘Zaghta-e-Inbesati’ is well depicted in the Unani literature. Most of the world’s population, mainly in developing countries, use herbal medicines for primary health care because of their ancient tradition, culture, and minor side effects. Various kinds of research have been conducted regarding the hypotensive and antihypertensive therapeutic values of local medicinal plants in the recent past, and they have provided evidence for the antihypertensive effects of some of these plants.

Evaluation of Microwave-Assisted Extraction Method for Preparation and Assessment of Thai Herbal Medicine Oral Tablets With Enriched Phytochemical Compounds.

In developing countries, populations have employed herbal medicines for primary health care because they are believed to be more appropriate to the human body and have less side effects than chemically synthesized drugs. The present study aimed to develop and evaluate herbal tablets incorporated with a Thai traditional medicinal extract, U-pa-ri-waat (URW), using microwave-assisted extraction (MAE). The extraction efficiency for URW using MAE and traditional solvent extraction was compared based on the percent yield after spray drying. URW tablets were prepared using the dry granulation method. The optimized products were assessed using standard characterization methods based on the United States and British Pharmacopeias. DPPH and ABTS radical scavenging assays were performed to analyze the antioxidant capacity of the microwave-assisted extracts. The results revealed that the flowability of the dry granule with added maltodextrin was improved compared to a granule without additives, as indicated by an angle of repose of 33.69 ± 2.0°, a compressibility index of 15.38 ± 0.66, and a Hausner's ratio of 1.18 ± 0.06. The resulting formulation produced flat tablets with uniform weight variation, hardness, thickness, friability, and optimum disintegration time. The URW extracts showed antioxidant activity and MAE with maltodextrin carrier displayed the strongest DPPH and ABTS radical activities with IC50 values of 1.60 ± 0.02 μg/mL and 4.02 ± 0.24 μg/mL, respectively. The URW tablet formulation passed the quality control tests. Storage of the formulation tablets for 90 days under accelerated conditions had minimal effects on tablet characteristics.

Primary Care Case Management of Febrile Children: Insights From the ePOCT Routine Care Cohort in Dar es Salaam, Tanzania.

Aim: To provide insight in the primary health care (PHC) case management of febrile children under-five in Dar es Salaam, and to identify areas for improving quality of care.Methods: We used data from the routine care arm of the ePOCT trial, including children aged 2–59 months who presented with an acute febrile illness to two health centers in Dar es Salaam (2014–2016). The presenting complaint, anthropometrics, vital signs, test results, final diagnosis, and treatment were prospectively collected in all children. We used descriptive statistics to analyze the frequencies of diagnoses, adherence to diagnostics, and prescribed treatments.Results: We included 547 children (47% male, median age 14 months). Most diagnoses were viral: upper respiratory tract infection (60%) and/or gastro-enteritis (18%). Vital signs and anthropometric measurements taken by research staff and urinary testing failed to influence treatment decisions. In total, 518/547 (95%) children received antibiotics, while 119/547 (22%) had an indication for antibiotics based on local guidelines. Antibiotic dosing was frequently out of range. Non-recommended treatments were common (29%), most often cough syrup and vitamins.Conclusion: Our study points to challenges in using diagnostic test results, concerns regarding quality of antibiotic prescriptions, and frequent use of non-evidence-based complementary medicines in PHC in Tanzania. Larger studies on diagnostic and treatments processes in PHC in Tanzania are needed to inform effective solutions to support PHC workers in case management of children.