Pharmaceutical Sciences

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Access to healthcare : investigating the barriers to accessing antiretroviral treatment at a public sector antiretroviral clinic in Durban, South Africa.
(2013) Kriel, Yolandie.; De la Porte, Susan.; Magula, Nombulelo Princess.
South Africa has the largest HIV/AIDS epidemic in the world and due to the rapid scale up of access to antiretroviral drugs now has the largest antiretroviral program in the world. However access to antiretroviral treatment remains a challenge and the scale up of the drug programs has caused an additional burden on an already stretched and stressed public healthcare sector. At present there are only two lines of drug regimens available to the general public that rely on the public healthcare sector for the supply of their antiretroviral drugs. Resistance to the current regimens is a major concern that is not effectively being addressed. One of the major aspects that can contribute to a rise in resistance is barriers to continually accessing antiretroviral treatment. This ethnographic investigation into the barriers to accessing antiretroviral treatment was conducted in a public health sector clinic based at a large hospital in Durban. The specific objectives of the study were to elucidate the major barriers to accessing the treatment as perceived by the patients of the clinic, to understand the structural drivers behind the barriers and to capture the patients’ reactions to these obstacles that they face on a continuous basis. Unlike most studies that focuses only on adherence this study’s focus was rather on the concept of access to healthcare and how barriers perceived by the patients influence their ability to effectively access their treatment. Thus the concept of access to healthcare is explored in detail and an argument is made for the importance of understanding and applying the holistic concept of access to healthcare within the ART setting. An ethnographic approach was adopted to conduct this study, and the study utilized a triangulation of data collection techniques including participant observation, in-depth interviews, focus groups and a questionnaire. The research was done over a period of seven months and focused on adults who were already part of a regimen for a period of at least one year. Antiretroviral treatment regimens are for life and once people start with these regimens they cannot stop. However this study found that a range of barriers exist that present obstacles for patients to continually access ART drugs. Structural violence theory provided the framework for contextualizing the specific barriers that were reported and is important in terms of situating the barriers within the larger structures that create them. What is evident is that poor healthcare related policies, stigma, discrimination, economic inequality, gender and poverty are the structural drivers behind barriers to accessing ART. By incorporating a broader understanding of access to healthcare a deeper understanding of the barriers is gained and better interventions can be created to prevent disengagement from life-long ART services.
Accessing antiretroviral treatment in the rural Eastern Cape : patients' perceptions of a decentralised pre-packing model of care and the impact on direct out-of-pocket spending.
Lines, Monique.; Suleman, Fatima.
Background: With an estimated 5.51 million HIV infected South Africans, HIV/AIDS contributes significantly to the burden of disease in the country, with far-reaching socio-economic implications particularly for poor and vulnerable groups. High out-of-pocket health expenditure associated with HIV/AIDS care has a serious impact on vulnerable individuals and is likely to severely affect the wellbeing of the affected household. Geographic inaccessibility of centralised, hospital-based antiretroviral treatment (ART) services and excessive transportation costs may contribute to patient attrition and these barriers are exacerbated in rural populations. Aim: The objectives of this study are to ascertain the out-of-pocket expenses that are incurred by patients travelling to their ART down-referral site, and compare this with the out-of-pocket expenses of those patients from the same catchment area still receiving their ART from the central hospital. The study also aims to determine whether or not the down-referral programme has impacted the patients’ economic status and improved their treatment experience. Methods: A semi-quantitative cross sectional study design was employed. Zithulele Hospital ARV Clinic and five different PHC collection points within the hospital’s catchment area were selected as the study sites. Included in the study were 44 hospital-based patients and 73 clinic-based patients registered on the Zithulele Hospital HIV Programme. Using a standard questionnaire, all socio-economic data and information related to mode of transportation and associated costs, as well as other out-of-pocket spending associated with accessing ART, was collected. Clinical data was recorded from patient medical records during the interview. Results: The average monthly household income was R1653 (R301.05 per capita) for hospital-based patients and R1617 (R392.66 per capita) for clinic-based patients. Income was predominantly sourced from either child support or pension grants. Study participants had an overall unemployment rate of 94% and, subsequently, 75% of hospital-based patients and 68.5% of clinic-based patients were living below the food poverty line of R400 per month. A higher proportion of hospital-based patients used taxis (80.5% versus 28.8%) while more clinic-based patients walked to the facility for their treatment (71.2% versus 14.6%). In terms of monthly transport costs, hospital-based patients spent on average R71.92, significantly more than the R25.81 spent by clinic-based patients. With a point estimate of 1.169, regression analysis indicated that for every one Rand increase on transport, the odds of the patient being hospital-based rather than clinic-based are 16.9% higher. There were higher levels of satisfaction recorded amongst the hospital-based group (95.5% compared to 89%) but despite this, 100% of the clinic-based patients listed their respective clinic as their preferred ART collection point. Conclusion: Decentralisation and down-referral of patients to their nearest primary healthcare clinic minimises out-of-pocket spending in rural communities while maintaining good levels of satisfaction with the healthcare service provided. It is important to consider the social, geographical and cultural context of the individuals seeking and utilizing healthcare before interventions are implemented.
Adenosine monophosphate-activated protein kinase as a potential target for synthetic chalco-naringenin analogs and putative therapeutic applications.
(2017) Nyane, Ntsoaki Anna.; Bangalee, Varsha.
Introduction: Diabetes mellitus is a multifactorial chronic metabolic disorder that is characterized by defects in endogenous insulin secretion or action, or both, resulting in chronic hyperglycemia, a clinical hallmark of diabetes. Metformin is currently the first-line drug of choice for the treatment of type 2 diabetes (T2D), being prescribed to at least 120 million people worldwide. It exerts its antidiabetic effects by reducing hepatic glucose production and increased peripheral glucose utilization through activation of AMP-activated protein kinase (AMPK). However, despite significant gains with metformin as a monotherapy in T2D, some patients experience gastrointestinal disturbances and lactic acidosis although the latter is very rare. Moreover, some patients still fail to achieve optimum glycemic control when treated on metformin only. Naringenin, a flavonoid exerts its antidiabetic effects by inhibition of gluconeogenesis through upregulation of AMPK, hence metformin-like effects. Because of these similar pharmacological effects between naringenin and metformin, our laboratory synthesized analogs of chalco-naringenin compounds which could be more permeable to the plasma membrane and hence putatively increased pharmacological effects. Aims: To identify AMPK as a potential target of synthetic chalco-naringenin analogs and putative therapeutic applications. Methods: A novel series of 4-[(cyclopropylcarbonyl)amino] chalco-naringenin analogs, compound 5a to 5k, were synthesized and characterized by IR, 1H-NMR and 13C-NMR. In silico screening of the compounds was conducted to evaluate potential antidiabetic activity of the novel chalco-naringenin series. Compounds 2-chlorophenyl (5b) and 5k (2,3-dimethoxyphenyl) had highest binding affinity to AMPK hence were chosen for a study. C2C12 and Chang cells were cultured in dulbecco's modified eagle medium (DMEM) and eagle's minimum essential medium (EMEM) media, respectively, allowed to grow to 80% confluence, and then exposed to different concentrations. MTT assay was used to determine cell viability and chalcones were subjected for 12, 24 and 48 hours at concentrations (10-750 μM). Cells were exposed to metformin (2-10 mM), naringenin (50-500 μM) and chalcones (10-500 μM) for 48 hours and further subjected to phospho-AMPKα (Thr172) sandwich ELISA Kit to determine phosphorylation of AMPK. To measure the amount of glycogen in cells after exposure to metformin, naringenin and chalcones for 48 hours, cells were harvested (1x106 per mL) and the glycogen assay performed according to Seifter et al. (1950). Results: A chalcone series of eleven compounds were successfully synthesized using the Claisen-Schmidt reaction. The absorbance values and peaks observed on the IR spectra confirmed the different functional groups observed on the compounds. The synthesized compounds were also characterized through 13C-NMR and 1H-NMR spectroscopy. The 13C-NMR spectras indicated the presence of the CH2 group of the cyclopropylcarbonyl amide and there were certain distinct peaks on the spectras that identify carbon atoms found on the compounds. In 1H-NMR, the chemical shift for all the CH2 groups on the cycloalkane resonated around δ 1,16 – 0,80 ppm as multiplets, while the other CH multiplet resonated around δ 1,62 – 1,58 ppm. Docking scores of the chalco-naringenin series suggested a good binding affinity of these compounds to AMPK, with compound 5b showing the highest binding affinity to AMPK. Cell viability as determined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) assays were found to be dose-dependent for all compounds and compound 5k exerted reduced cell viability as compared to 5b. Furthermore, compound 5b presented with higher IC50 values compared to 5k. The effects of chalcones on AMPK phosphorylation were potentiated by co-treatment with metformin or naringenin. Metformin, naringenin and chalcone 5b significantly reduced synthesis of glycogen as compared to control (p < 0.05). Conclusions: Chalco-naringenin analogs showed potential in expression of AMPK through computational chemistry, however in the in vitro model the effects of chalcones on AMPK were potentiated by metformin and naringenin. The chalcones could further be explored for their potential on AMPK activity on primary hepatocytes and/ or in vivo studies.
Adherence to ARVs in a rural paediatric cohort.
(2015) Smith, Chanelle.; Gengiah, Tanuja Narayansamy.
Abstract available in PDF file.
Adverse drug reactions associated with antiretroviral therapy in South Africa.
(2016) Birbal, Sumeshni.; Oosthuizen, Frasia.; Ojewole, Elizabeth Bolanle.
Abstract available in PDF file.
Annual costs incurred on managing adverse drug reactions attributable to fixed-dose combination Highly Active Anti-Retroviral Therapy (HAART) in an outpatient ARV clinic in Gauteng.
(2020) Chikeya, Grace.; Bangalee, Varsha.; Oosthuizen, Frasia.
Objective The aim of the study is to identify adverse drug reactions attributable to tenofovir- and zidovudine-based fixed-dose combinations of highly active anti-retroviral therapy and, subsequently, to determine the annual costs incurred managing these adverse drug reactions and the budget implications of these costs at an outpatient anti-retroviral clinic in Mamelodi, Pretoria. Methods This retrospective cohort study reviewed de-identified clinical data for adverse drug reactions. The study was carried out at Stanza Bopape ARV Clinic in Mamelodi, Pretoria. De-identified medical charts of HIV-positive patients were analysed for clinical information and laboratory data of adult patients who started on HAART between July 2017 and June 2018. Data collection commenced in October 2018. Based on the costs and the incidence rates of adverse drug reactions observed in the analysis, a decision tree model was established to estimate the cost impact of adverse drug reaction management on the clinic¶s budget. Results A total of 469 patient files were analysed (62% female vs 38% male). The mean age at the start of anti-retroviral therapy for the cohort was 36.6yrs (95% CI 35.74-37.45) and the mean baseline CD4 count was 380 (95% CI 343-418). Incidence of adverse drug reactions to tenofovir- or zidovudine-based fixed-dose combinations of anti-retroviral therapy was found to be 24.95%. The ADRs reported with the use of TDF and AZT based HAART regimens were rash (n=45, 27%), decreased glomerular filtration rate (n=34, 21%), trouble sleeping (n=39, 21%), severe diarrhoea (n=19, 12%), nausea and vomitting (n=18, 11%), decreased heamoglobin or anaemia (n=4, 2%), headaches (n=4, 2%), dizziness (n=2, 5.3%). The study revealed that ZAR427.30 was the cost attributed to adverse drug reactions due to tenofovir-based regimens whilst ZAR467.94 was the cost attributed to adverse drug reactions due to zidovudine-based regimens, per patient, annually. Costs attributed to gastro-intestinal related adverse drug reactions were the highest in comparison to other adverse drug reactions. Estimated total cost of adverse drug reactions attributed to zidovudine-based therapy was ZAR8003.98 (US$556.40) and estimated total cost of adverse drug reactions attributed to tenofovir-based anti-retroviral therapy per annum was ZAR33 788, 23 (US$2348.80) for 1221patients initiated on antiretroviral therapy between July 2017 and June 2018. Conclusion Despite our estimated costs to the clinic, due to adverse drug reactions, being lower than similar studies, there remains a notable budget impact on a resource-limited setting.These estimates will allow for cost due to adverse drug reactions caused by tenofovir- and zidovudine-based anti-retroviral therapy to be accounted for in budgets at the antiretroviral clinic.
Anti-diabetic and anti-dyslipidaemic effects of grapefruit juice.
Ngubane, Sanelisiwe Precious.; Owira, Peter Mark Oroma.
Background Hypoglycaemic effects of grapefruit juice in diabetic rats have been previously reported. The mechanisms by which grapefruit juice lowers blood glucose are not known. This study aimed to investigate the hypoglycaemic and anti-dyslipidaemic effects of grapefruit juice, as well as to elucidate the possible mechanism/s of action of this juice. Materials and Methods Male Wistar Rats (Rattusnovergicus) of 200-300 g body weight (BW) were randomly divided into five groups (n=6). Animals in group 1 were treated with 3.0 ml/kg of water for 60 days, by oral gavage. Groups 2, 4 and 5 were rendered diabetic by a single intraperitoneal injection of 60 mg/kg BW of streptozotocin. Group 5 was further treated with 4.0 U/kg of insulin (subcutaneously, twice daily), while groups 3 and 4 were orally treated with 3.0 ml/kg of GFJ. Fasting blood glucose and glucose tolerance tests were done in all the groups. Plasma insulin levels were also measured. Hepatic glycogen content, glucokinase and glucose-6-phosphatase (G6Pase) activities were measured in homogenised liver tissues. Plasma lipid levels were measured and hepatic enzymes (Acetyl-Coenzyme Aacetyl Transferase (ACAT) and 3-Hydroxy-3-Methyl-Glutaryl-CoA (HMG-CoA reductase) expression was determined. Results Diabetic rats showed significantly reduced weight gain, but higher water consumption in comparison to the controls. Fasting blood glucose was significantly higher in the diabetic group compared to controls, but were significantly (p<0.05) attenuated in GFJ-treated diabetic group, compared to the control. Diabetic rats exhibited significantly impaired glucose tolerance compared to controls, which was, however, improved in GFJ-treated groups in comparison to the diabetic non-treated group. GFJ treatment did not improve fasting plasma insulin in diabetic animals. Glucokinase activity and hepatic glycogen concentrations were significantly increased by GJF treatment, but G6Pase was alternatively suppressed by GFJ treatment. HDL-C levels were significantly increased in GFJ treated diabetic animals. Liver ACAT and HMG-CoA reductase enzyme expression were significantly suppressed in GFJ treated diabetic animals in comparison to the non-treated diabetic animals. Conclusion The findings show that GFJ has both hypoglycaemic and anti-dyslipidaemic effects. Although it not insulinotrophic, GFJ improves glucose intolerance in diabetic animals by supressing hepatic gluconeogenesis. Furthermore, GFJ improved plasma lipid profiles and supressed the liver expression of ACAT and HMG-CoA reductase enzymes.
Anti-diabetic and anti-dyslipidemic effects of Naringin.
(2015) Cobongela, Sinazo Zezethu Zongeziwe.; Owira, Peter Mark Oroma.
The incidence of diabetes is expected to dramatically increase over the next decade. Dyslipidemia is the greatest risk factor of coronary heart diseases in patients with diabetes. Antidiabetic and anti-dyslipidemic effects of naringin were investigated in type 1 diabetes. Male Sprague-Dawley rats (n = 7) were treated daily with 3.0 ml/kg body weight (BW) of water (group 1), naringin (50 mg/kg BW) (groups 2, 4 and 7, respectively), regular insulin (4 U/kg BW, subcutaneously, twice daily) (group 3 and 7), and simvastatin (20 mg/kg BW) in group 6. On treatment day 45, halothane overdose was used to sacrifice the animals and blood samples were collected via cardiac puncture for plasma insulin and lipid profile analysis. Rat livers were excised, rinsed in normal saline and stored at -80⁰C for glycogen content analysis. Group 3, 4, 5, 6 and 7 exhibited weight loss, polydipsia and hyperglycemia after injection with 60 mg/kg body weight of streptozotocin. Naringin with or without insulin significantly prevented weight loss in diabetic animals compared to non-treated diabetic animals. Insulin with/without naringin, but not naringin, significantly lowered fasting blood glucose levels in diabetic rats. Naringin with/without insulin significantly improved hepatic glycogen content compared to nontreated diabetic rats. Naringin with/without insulin significantly increased the plasma insulin levels in diabetic animals compared to non-treated diabetic animals. Plasma total cholesterol, triglycerides, very low density lipoprotein, low density lipoprotein cholesterol concentrations were significantly higher in non-treated diabetic rats compared to non-diabetic controls. High density lipoprotein cholesterol was significantly higher in non-treated diabetic rats compared to non-diabetic control. Naringin with/without insulin improved lipid profile in diabetic animals, whereas simvastatin decreased only total cholesterol and triglycerides compared to non-treated diabetic animals. Naringin with/without insulin significantly decreased coronary risk index in diabetic animals compared to non-treated diabetic animals. Atherogenic index was significantly decreased by insulin or naringin with/without insulin in diabetic rats compared to non-treated rats. Naringin is not hypoglycemic but improves coronary risk index and atherogenic index in type 1 diabetes. However, naringin with insulin showed synergistic effects. This study was conducted to investigate the effect of naringin on blood glucose regulation dyslipidemia in type 1 diabetes. The results showed that naringin is not hypoglycemic, however, it improved fasting plasma insulin and hepatic glycogen. Naringin also showed anti-dyslipidemic effects by decreasing the antherogenic lipids and increasing the high density lipoprotein cholesterol. The findings suggests that naringin can be used as a dietary supplement to ameliorate diabetic dyslipidemia.
Antibiotic prescribing in treatment of non-severe paediatric Community Acquired Pneumonia at Limbe Health Centre, Blantyre.
(2018) Matambo, Ernest.; Solomon, Vernon Philip.; Småbrekke, Lars.; Katundu, Kondwani.
Introduction Pneumonia is one of the diseases with high child mortality worldwide. Appropriate antibiotic treatment is vital for treatment success and minimising emergence of antibiotic resistance. Adherence of prescribers to guidelines in the treatment of non-severe Community Acquired Pneumonia (CAP) is one aspect that can optimise treatment outcome and help mitigate emergence of antibiotic resistance. This study was conducted to investigate antibiotic prescribing patterns of clinical officers and medical assistants in the treatment of non-severe paediatric CAP at Limbe Health Centre (LHC). Materials and methods The study was conducted at LHC. Prescriptions of 53 children aged 2-59 months diagnosed and treated for non-severe CAP were reviewed for analysis of demographic and treatment data. Data collection was conducted from March to May 2017. Prescribed antibiotics by medical assistants and clinical officers were compared using Fischer’s exact test. Correctly and incorrectly prescribed antibiotic daily doses in the two groups of prescribers were compared using Chi-square test. In addition, we also analysed demographic and academic qualification data for prescribers. Results The 53 prescriptions included were either for cotrimoxazole (n=29), amoxicillin (n=19) or erythromycin (n=5). There was no significant difference in choice of antibiotic for the treatment of non-severe paediatric CAP between medical assistants and clinical officers (p=0.2). Based on age or weight of the participant, distribution of correctly and incorrectly prescribed daily doses was not significantly different in the two groups of prescribers (p>0.5). Of the 53 participants, 30 (57%) were under-dosed. Ten participants were under-dosed by 33%, while 20 participants were under-dosed by 34-50% of the recommended antibiotic daily dose. Participants were either prescribed a 5-day (n=51) or a 3-day (n=2) antibiotic treatment. Conclusion Amoxicillin, cotrimoxazole and erythromycin were prescribed for the treatment of non-severe paediatric CAP at LHC. More than half of the included patients were under-dosed. Antibiotic treatment for paediatric CAP at LHC was either for 3 or 5 days. Understanding antibiotic prescribing patterns is necessary in designing interventions aimied at improving antibiotic treatment and curbing the emergence of antibiotic resistance.
Antibiotic prophylaxis in a primary level hospital: a medicines use evaluation to assess compliance in caesarean sections.
(2016) Govender, Seshnee.; Gray, Andrew Lofts.
Introduction: Caesarean section births are the most important known common factor that has been linked with post-partum bacterial infections. According to the current Standard Treatment Guidelines, the prophylactic dose in surgical prophylaxis is a single dose of cefazolin, equal to the standard therapeutic dose, and given as a single stat dose prior to surgery. Multiple-dose regimes are associated with higher costs compared to a single-dose regime, not just in terms of acquisition costs but also in terms of staff time. Aim: To contribute to the rational use of antibiotics, through the application of a medicines use evaluation in a district hospital. Methods: A retrospective Medicine Use Evaluation (MUE) was carried out at Heidelberg Hospital in Gauteng. The quantitative data was collected over a 3 month study period in which the medical records of 120 female patients who delivered through Caesarean section was captured using the Medicine Use Evaluation data sheet. The qualitative phase involved structured interviews with medical officers to establish reasons for non-compliance. A total of 7 medical officers participated in the interviews. Results: None of the 120 patients received the stipulated regimen as recommended in The Standard Treatment Guidelines. Patients either received: 1 day of cefazolin, administered every 8 hours intravenously (83/120, 69.2%) or 3 days’ of cefazolin administered every 8 hours (37/120, 30.8%). Every HIV-uninfected woman (83/120, 69.2%) received 3 doses of cefazolin, whereas every HIV-infected woman received 9 doses of cefazolin and metronidazole intravenously. All patients also received 5 days’ of oral antibiotics on discharge. Eighty-five percent of patients did not have a justifiable reason for receiving a full therapeutic course. Discussion: Clear evidence was provided that the administration of antibiotic prophylaxis for Caesarean section deliveries at Heidelberg Hospital was irrational. Using MUE methods, the study identified different elements of non-compliance with the national recommendations. The study did not provide any justifications for the therapeutic use of antibiotics in patients without established or suspected infections post-operatively. Recommendations: The Standard Treatment Guidelines should provide unambiguous recommendations for the use of prophylaxis in women undergoing Caesarean sections in addition to the management of women suspected of having an established infection, and who deserve a full therapeutic course of antibiotics.
The antibiotic treatment of gram negative bacteremia-pharmacokinetics and dynamics.
Rheeders, Malie.; Miller, Raymond Martin.
Abstract available in PDF file.
Antidiabetic and hepatoprotective effects of moringa oleifera leaf extras in streptozotocin-induced diabetes in rats.
(2018) Muzumbukilwa, Willy Tambwe.; Owira, Peter Mark Oroma.; Nlooto, Manimbulu.
Diabetes Mellitus is one of the major causes of degenerative diseases worldwide. Long term complications of diabetes include hepatic injury characterized by cirrhosis, inflammation, apoptosis, and microvascular and macrovascular aberrations. Mechanisms by which diabetes induces liver damage include the development of lipotoxicity-induced mitochondrial dysfunction and activation of inflammatory pathways that lead to progressive liver damage. Previous studies have reported that the leading cause of death in patients with diabetes mellitus is chronic liver disease. The liver is a metabolically active organ involved in many vital life functions. It performs many activities that are critical for survival. Due to its important activities, the liver is exposed to a number of insults and is one of the body's organs most subject to injury. Despite considerable progress in modern medicine, there are very few therapeutic agents that can protect the liver from hyperglycemia-induced oxidative damage and restore normal liver functions. As a result, the search for novel therapies that would be cheaper and effective in the management of liver diseases is paramount. Moringa oleifera (MO) is a multipurpose plant traditionally used for its medicinal and nutritional properties in many countries, especially in Durban, KwaZulu-Natal/ South Africa where the material for this study has been harvested. It has been shown to possess antihyperglycemic, antioxidant and anti-inflammatory properties and could possibly prevent liver injury. This study, therefore, investigated whether MO leaf extracts could mitigate hepatotoxicity associated with diabetes mellitus. Methods Male Wistar rats (250-300 g) were divided into six groups (n=7). Group A was orally treated daily with 3.0 ml/kg body weight (BW) of distilled water; group C was similarly treated with MO (500 mg/kg/BW) daily. Groups B, D, E, and F were rendered diabetic by a single intraperitoneal injection of streptozotocin (STZ) (45 mg/kg/BW in 0.1M citrate buffer, pH4.5). Diabetes was confirmed 3 days later. Additionally, group D was treated with subcutaneous insulin (2 U/kg/BW, bid) while groups E and F were orally treated daily with MO 250 mg/kg/BW and 500 mg/kg/BW, respectively. Glucose tolerance tests (GTT) were done on day 47 of the animal treatment. After an overnight fast for 8 hours, rats in all groups were intraperitoneally dosed with a D-glucose solution (3.0 g/kg BW) in 0.9% normal saline. This solution was prepared by dissolving 45 g of D-glucose anhydrous in 60 ml distilled water (0.75 g/ml). Blood glucose concentrations were measured by tail pricking at 0, 30, 60, 90, and 120 minutes, using glucometer (OneTouch select®; Lifescan Inc., Milpitas, California, USA). On day 54 of treatment, animals were sacrificed by halothane overdose. Blood was collected by cardiac puncture in heparinized tubes then separated into plasma and stored at -80˚C for further biochemical analysis. Livers were excised, snap-frozen in liquid nitrogen and similarly stored for histological analysis. Results: Diabetic animals had significantly (p<0.05) elevated Fasting Blood Glucose (FBG) and reduced insulin levels compared to controls. Treatment with either insulin or MO significantly (p<0.05) reduced FBG compared to non-treated diabetic rats. Treatment with 500 mg/kgBW significantly reduced FBG compared to treatment with 250 mg/kgBW. Calculated Areas-Under-the Curve (AUCs) from OGTT suggested that untreated diabetic rats exhibited glucose intolerance but treatment with either insulin or MO extracts significantly (p<0.05) reversed this. Liver function tests defined by Aspartate Aminotransaminase (ASAT), Alanine Aminotransaminase (ALAT),gamma-glutamyl aminotransaminase (GGT) and albumin were significantly (p<0.05) elevated in untreated diabetic group but treatment with either insulin or MO extracts significantly (p<0.05) reversed this. Treatment with 500 mg/kgBW of MO significantly (p<0.05) reduced GGT levels compared to treatment with 250 mg/kgBW. Untreated diabetic, unlike MO-treated rats, exhibited degeneration of hepatocytes and inflammatory cells infiltration with the fragmentation of the nucleus and cell lysis, necrotic hepatocytes, hepatic vein congestion, and vesicular cytoplasm compared to normal controls. Conclusion: This study has shown that methanolic leaf extracts of MO have dose-dependent antidiabetic effects. Liver function tests (ASAT, ALAT, GGT) and albumin were significantly elevated in untreated diabetic rats than those treated with MO extracts. This may justify the hepatoprotective effects of MO extracts in streptozotocin-induced diabetic rats.
Antimicrobial and chemical analyses of selected bulbine species.
(2000) Mocktar, Chunderika.; Essack, Sabiha Yusuf.; Rogers, B. C.; Dangor, Cassim Mahomed.
The use of plant materials for the treatment of various diseases is very common in African countries. As traditional medicine used by the rural people does not always have a proper scientific basis, research programmes have to be undertaken to evaluate their therapeutic efficacy and safety. In traditional African medicine various Bulbine species are used to treat a number of conditions including sexually transmitted diseases, wound infections, dysentery and urinary tract infections. The Bulbine species belong to the family Asphodelaceae. There are over fifty South African Bulbine species and they are mostly herbs. Their leaves are evergreen and succulent in appearance. Bulbine species have thick fleshy tuberous roots, are easy to grow, are able to withstand drought and heat and are able to grow in poor soil. There is very little documented information on the antimicrobial activity and chemical properties of the Bulbine species. Therefore research programmes of this nature have to be undertaken. Various Bulbine species, viz., B. natalensis Bak, B. frutescens Willd (yellow flowers), B. narcissifalia Salm Dyck, B. abyssinica A Rich and B. frutescens Willd (orange flowers) were collected. The plants were washed with tap water, air dried and separated into the different components. Each component was cut into small pieces and immersed in methanol: dichloromethane (1:1, v/v) for extraction. The organic solvent was decanted from the plant material and evaporated under reduced pressure. The resultant crude extracts were stored in glass vials in the freezer. In addition, the roots, stems and leaves of B. natalensis and B. frutescens (yellow flowers) were extracted aqueously. The crude organic and aqueous were subjected to various tests to evaluate their antimicrobial and cytotoxic potential. To evaluate their antibacterial activities, the Disk Diffusion and Bore Well Methods were employed. The crude extracts were tested against various pathogens implicated in wound and urinary tract infections and dysentery. In these experiments the Disk Diffusion Method produced better results than the Bore Well Method. The crude organic and aqueous extracts were found to be effective against many of the bacteria used in this study including K. pneumoniae, S. aureus, S. typhi and S. flexneri which are considered to be troublesome pathogens. The TLC bioassay was employed to evaluate the antifungal potential of the various crude extracts against Aspergillus and Penicillium and the Disk Diffusion and Bore Well methods were used to evaluate the antifungal potential of C. albicans. The Bulbine species displayed no antifungal activity against Penicillium and limited antifungal activity against Aspergillus. The two method used to evaluate the antifungal activity of. C albicans was chosen because C. albicans grows in a similar manner to bacteria on solid and liquid culture media. Only the root extracts of the two B. frutescens varieties were inhibitory to C. albicans. The Brine Shrimp Bioassay was used to ascertain the cytotoxic potential of the crude extracts. The majority of the extracts were cytotoxic at the most concentrated dilution (i.e., dilution 1) but not cytotoxic at the lower dilutions. The only extracts that were not cytotoxic at the most concentrated dilution were the organic extract of the root of B. frutescens (yellow flowers), the organic extract of the root of B. narcissifolia and the organic extract of the leaf of B. abyssinica. TLC and column chromatography was carried out to evaluate the chemical composition of the Bulbine species. The TLC indicate that this technique could be a valuable tool in identifying the different species in the genus Bulbine. Column chromatogram was carried out on the extract which displayed a significant amount of antibacterial activity against the bacteria used in this study. The stem extract of B. natalensis was chosen for further analysis. The stem extract was fractitioned into different fractions but unfortunately none of the chemical component could be identified. According to the results obtained in this study, there is considerable scope for further studies of this genus.
Antimicrobial prescribing in the surgical and medical wards at a private hospital in KwaZulu-Natal.
(2020) Jacob, Valencia Tamzyn.; Mahomed, Saajida.
Background: Appropriate antimicrobial use is imperative due to the misuse of antimicrobials that has resulted in a growing burden of antimicrobial resistance. Evidence-based guidelines should be adhered to in order to ensure the sustainability of effective antimicrobials. Objectives: To assess the appropriateness of antimicrobial prescribing at a private hospital in Durban, KwaZulu-Natal. Methods: The records of patients admitted to the surgical and medical wards from June 2019 to July 2019 were reviewed to assess the choice of antimicrobials prescribed, dose and duration. The guidelines used to determine appropriateness were the Standard Treatment Guidelines and the Essential Medicines List for South Africa (hospital level for adults, 2015 edition), the South African Medicines Formulary (13th edition, 2019), the South African Antibiotic Stewardship Programme guidelines (2014 edition) and the evidence-based surgical prophylaxis guidelines (2017 edition) developed by the hospital group where the research was conducted. Results: During the study period, 466 patients were admitted and prescribed an antimicrobial, of which 220 (47.2%) were admitted to the surgical ward and 246 (52.8%) were admitted to the medical wards. A total of 779 antimicrobials were prescribed. Of the 660 antimicrobials prescribed for empiric treatment, 305 (46.2%) antimicrobials were appropriately prescribed based on drug choice, dose and duration. Of the 38 antimicrobials that were classified as targeted, 36 (94.7%) were prescribed according to the correct dose and 33 (86.8%) were prescribed according to the correct duration. Of the 81 antimicrobials prescribed for surgical prophylaxis, only 32 (39.5%) met the criteria for appropriateness in terms of drug choice, dose and duration. Conclusion: Our findings suggest that compliance with evidence-based guidelines for the use of antimicrobials is not optimal in hospitals in the private sector. Antimicrobials are prescribed inappropriately both for empiric treatment and for surgical prophylaxis. Private hospital groups should consider adopting antimicrobial prescribing guidelines that are mandatory for doctors to adhere to in order to promote rational antimicrobial prescribing and thereby reduce the burden of antimicrobial resistance.
Antimicrobial resistance and antibiotic stewardship: knowledge, attitudes and perceptions amongst final-year undergraduate health professional students in a South African university.
(2016) Singh, Shanay.; Essack, Sabiha Yusuf.
Antimicrobial resistance (AMR) is a major threat to human health. The World Health Organization (WHO) and subsequently the South African Department of Health have developed detailed plans to combat AMR including recommendations to implement Antibiotic Stewardship (ABS) in the curricula of healthcare students. A number of studies have measured the knowledge, attitudes and perceptions (KAP) of healthcare students globally. However, in South Africa, no multidisciplinary studies have been performed. This study thus ascertained KAP on AMR and antibiotic stewardship amongst final year medical, nursing and pharmacy students at a South African university by means of a cross-sectional questionnaire based survey. A total of 132 questionnaires were completed (response rate 33%), with individual response rates of 63% (n=63), 86% (n=46) and 9% (n=23) for pharmacy, nursing and medical students respectively. The mean correct knowledge score was 88.9%, with significantly lower scores seen for nursing students when compared to other two groups. The perceived seriousness of AMR at international, national and local levels was also significantly lower amongst nursing students. Only a third of all students and 45% of nursing students agreed that use of antibiotics contributes to AMR. Large percentages of nursing and medical students prefer to take antibiotics for viral illnesses whilst, 76% of all students consult a doctor before starting an antibiotic. Several knowledge gaps were identified, as well as key differences between the student groups. Curriculum review to educate students about their role in contributing to AMR and antimicrobial stewardship is imperative as sub-optimal KAP are likely to lead to negative patient outcomes.
Assessment of factors affecting adherence to chronic medicines among stable patients registered onto the Centralized Chronic Medicines Dispensing and Distribution (CCMDD) programme: the case of eThekwini Metropolitan Health District, South Africa.
(2018) Naidoo Pillay, Mary-Anne.; Nlooto, Manimbulu.
Abstract Background Globally more deaths are due to chronic disease compared to infectious disease. In South Africa, the number of patients has been increasing over the years for those who have been diagnosed with chronic diseases and thus requiring chronic treatment. The Centralized Chronic Medicine Dispensing and Distribution (CCMDD) programme is a national programme with the aim to improve patients access to medicines in the public health sector. To establish the implications of factors that affect patient adherence to chronic medication on the CCMDD programme in eThekwini Metropolitan Health district. Methods A descriptive cross-sectional study was conducted among stable chronic patients on the CCMDD programme in five public health facilities in eThekwini Metropolitan Health District South Africa between May and August 2017. The researcher administered face-to-face interviews were carried out using a semi-structured questionnaire with open and closed-ended questions. Results Most patients reported never experiencing out of stock of medicines at PUPs (365/417, 87 .5%, 95%CI [84.1-90.5]) and never received an incomplete parcel (324/417, 77.7%, 95%CI [73.7-81.7]). Many respondents rated their relationship with CCMDD as good (221/417, 53.0%, 95%CI [48.12-57.79]); they were satisfied to collect their medicines without counselling at PUPs (411/417, 98.6%, 95%CI [97.47-99.73]) and rarely experienced challenges with the CCMDD programme (345/417, 82.7%, 95%CI [79.07-86.33]). Majority ofrespondents reported a waiting time less than 30 minutes (411/417, 98.6%, 95%CI [97.47-99.3]) after CCMDD programme implementation compared to two hours (398/417, 95.4%, 95%CI [93.39-97.41]) before CCMDD program implementation. Most respondents (370/417, 88.7%, 95%CI [85.66-91.74]) reported not missing their appointment for collection of their medicines. Conclusion Most respondents reported neither experiencing medicine stock-outs nor receiving incomplete medicine parcels, they had a good relationship with the CCMDD programme, were satisfied with no counselling at the PUPs and rarely experienced challenges. Majority respondents reported a significant decrease in the waiting time for the collection of their medicines after CCMDD programme implementation. Missed appointments for collection of medicine parcels were significantly low among study participants. These findings can suggest high levels of adherence to such a programme.
Assessment of factors affecting adherence to chronic medicines among stable patients registered onto the Centralized Chronic Medicines Dispensing and Distribution (CCMDD) programme: the case of eThekwini Metropolitan Health District, South Africa.
(2018) Naidoo, Mary-Anne.; Nlooto, Manimbulu.
Background Globally more deaths are due to chronic disease compared to infectious disease. In South Africa, the number of patients has been increasing over the years for those who have been diagnosed with chronic diseases and thus requiring chronic treatment. The Centralized Chronic Medicine Dispensing and Distribution (CCMDD) programme is a national programme with the aim to improve patients access to medicines in the public health sector. To establish the implications of factors that affect patient adherence to chronic medication on the CCMDD programme in eThekwini Metropolitan Health district. Methods A descriptive cross-sectional study was conducted among stable chronic patients on the CCMDD programme in five public health facilities in eThekwini Metropolitan Health District South Africa between May and August 2017. The researcher administered face-to-face interviews were carried out using a semi-structured questionnaire with open and closed-ended questions. Results Most patients reported never experiencing out of stock of medicines at PUPs (365/417, 87 .5%, 95%CI [84.1-90.5]) and never received an incomplete parcel (324/417, 77.7%, 95%CI [73.7-81.7]). Many respondents rated their relationship with CCMDD as good (221/417, 53.0%, 95%CI [48.12-57.79]); they were satisfied to collect their medicines without counselling at PUPs (411/417, 98.6%, 95%CI [97.47-99.73]) and rarely experienced challenges with the CCMDD programme (345/417, 82.7%, 95%CI [79.07-86.33]). Majority ofrespondents reported a waiting time less than 30 minutes (411/417, 98.6%, 95%CI [97.47-99.3]) after CCMDD programme implementation compared to two hours (398/417, 95.4%, 95%CI [93.39-97.41]) before CCMDD program implementation. Most respondents (370/417, 88.7%, 95%CI [85.66-91.74]) reported not missing their appointment for collection of their medicines. Conclusion Most respondents reported neither experiencing medicine stock-outs nor receiving incomplete medicine parcels, they had a good relationship with the CCMDD programme, were satisfied with no counselling at the PUPs and rarely experienced challenges. Majority respondents reported a significant decrease in the waiting time for the collection of their medicines after CCMDD programme implementation. Missed appointments for collection of medicine parcels were significantly low among study participants. These findings can suggest high levels of adherence to such a programme.
Assessment of factors affecting healthcare workers involved in the Centralised Chronic Medicines Dispensing and Distribution (CCMDD) Programme: the case of eThekwini Metropolitan Health district, South Africa.
(2018) Maharaj, Lerisha.; Nlooto, Manimbulu.
This study aimed to assess the current role of Healthcare workers (HCWs) involved in the Centralised Chronic Medicine Dispensing and Distribution (CCMDD) programme and determine if the challenges experienced by HCWs result in an increased pressure. HCWs play a vital role in the provision of Healthcare services to patients however, little is known about the influence of training, work experience and factors contributing to the innovation in chronic medicine dispensing by HCWS. Methods A descriptive cross sectional study was conducted from October 2017 to December 2017 in seven public Healthcare facilities approved by the eThekwini Health district. A self-administered questionnaire with both closed-ended and open-ended questions was distributed to 245 eligible HCWs. The questionnaire was separated into sections and included amongst others socio-demographic characteristics of participants and sections on the implementation of the CCMDD programme by HCWs. Results The questionnaires were fully completed by two hundred HCWs yielding a response rate of 81.63% (200/245). In terms of training 62.5% (125/200) of all HCWs that participated in the study had undergone training. Many of the HCWs (112/200, 56.0%) were unaware of the CCMDD patient enrolment targets at their facilities. The majority of HCWs (162/200, 81.0%) were aware of SOPs and had sufficient knowledge of the National Health Insurance White paper (139/200, 69.5%). Almost all HCWs in this study (185/200, 92.50%) believed that the CCMDD programme had the potential to meet the objectives for which it was created. This study found a visible decrease in the congestion of patients at the Healthcare facilities (147/200, 73.50%). Conclusion Most of the HCWs in this study recognised the role played by the CCMDD programme in achieving a visible decrease in facility congestion. The majority of respondents agreed to have been trained and received adequate preparation enabling them to embark in the CCMDD programme. Many of the HCWs involved in the CCMDD programme received training before being involved in the running and implementation of the programme. More investigations should be carried out to gather the views and perceptions of patients attending the CCMDD programme. Further studies may look at the readiness of private sector providers and their roles in the implementations of public and private chronic medicines dispensing programmes. Keywords: Centralised chronic medicines dispensing and distribution, national health insurance, Healthcare workers, central dispensing unit, remote automated dispensing units, chronic medicines.
An assessment of the level of knowledge of diabetics and primary health care providers in a primary health care setting : on diabetes mellitus.
(2006) Moodley, Lushendran Manikum.
Attitude and practices about the coronavirus disease and its’ impact on the mental well-being on university students: a cross-sectional study amongst pharmacy students in the University of KwaZulu-Natal.
(2023) Ebrahim, Nabeela.; Bangalee, Varsha.; Moudgil, Khayati.
Student mental health at a tertiary level of education has become a growing concern since the beginning of the COVID-19 pandemic. University students in South Africa face academic challenges as well as a cascade of socio-economic challenges making them more at risk for anxiety and depression. The restrictions, and challenges that COVID-19 brought has intensified these risks. The effect of the COVID-19 pandemic on the psychological well-being of South African university students has a major role to play in analyzing the future implications for the populations’ mental health. The steps that were taken to prevent the spread of COVID-19 including lockdown measures, social distancing and quarantine have introduced significant threats to the mental health of the public at large. The current study aims to determine the attitude, practices impact of COVID-19 on the mental health of Pharmacy students at University of KwaZulu-Natal (UKZN). Method This study was designed to be a cross-sectional quantitative study which was carried out as a survey questionnaire to fulfil the required objectives. Data was collected via a survey questionnaire; hard copies of the survey were distributed to third-and-fourth year pharmacy students at UKZN once on-site learning at the campus resumed after a period of remote learning as a result of COVID-19. The data was entered into Microsoft® Excel® and analyzed using Statistical Package for the Social Science® (SPSS®), version 28. Descriptive and inferential statistics were calculated, the results were discussed, and conclusions were drawn. Results A total of 190 participants completed the survey. There were no exclusions as all the participants were over the age of 18 and were studying in third- or fourth-year pharmacy at UKZN. Majority of the participants (72.5%) perceived the COVID-19 virus as a threat to their community and 83% of students felt scared towards the COVID-19 pandemic. Increased levels of anxiety, loneliness, depression, and substance abuse was also reported. Most students found trouble concentrating (75.9%), which impacts academic and daily functioning and 77.6% found that the lockdown had a negative impact on their academic experience. Conclusion The current study was able to provide a comprehensive assessment of the attitudes and practices about the Coronavirus Disease (COVID-19) and its’ impact on the mental well-being on university students amongst pharmacy students in the University of KwaZulu-Natal. The findings suggest that the Covid-19 outbreak has globally introduced many hurdles for tertiary education institutions and challenges for students’ mental health. A variety of factors that are linked to the pandemic such as financial difficulty, a weakened social circle, trouble sleeping, fear of contracting the virus, trouble concentrating, and loneliness have increased anxiety and stress among university students. The study also reports a thorough analysis of the students and their range of feelings during the pandemic and consequent lockdown to evaluate their energy levels, prepotent feelings and challenges faced as a result. Our findings highlight that most participants displayed negative feelings and experienced many challenges as a result of the lockdown. In light of these findings, it is imperative that proactive measures are implemented to address the mental health concerns of students. Such efforts should not only encompass addressing the immediate challenges posed by the pandemic but also address the pre-existing vulnerabilities that have been exacerbated. By recognizing the multifaceted nature of these challenges and the diverse emotional responses they elicit, institutions and governments can work in tandem to provide comprehensive support systems that aid students in navigating these unprecedented times.

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