Browsing by Author "Kakudidi, Esezah K."

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    Antibiotic‑resistance in medically important bacteria isolated from commercial herbal medicines in Africa from 2000 to 2021: a systematic review and meta‑analysis
    (Antimicrobial Resistance & Infection Control, 2022) Walusansa, Abdul; Asiimwe, Savina; Nakavuma, Jesca. L.; Ssenku, Jamilu. E.; Katuura, Esther; Kafeero, Hussein. M.; Aruhomukama, Dickson; Nabatanzi, Alice; Anywar, Godwin; Tugume, Arthur K.; Kakudidi, Esezah K.
    Antimicrobial resistance is swiftly increasing all over the world. In Africa, it manifests more in pathogenic bacteria in form of antibiotic resistance (ABR). On this continent, bacterial contamination of commonly used herbal medicine (HM) is on the increase, but information about antimicrobial resistance in these contaminants is limited due to fragmented studies. Here, we analyzed research that characterized ABR in pathogenic bacteria isolated from HM in Africa since 2000; to generate a comprehensive understanding of the drug-resistant bacterial contamination burden in this region. Methods: The study was conducted according to standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We searched for articles from 12 databases. These were: PubMed, Science Direct, Scifinder scholar, Google scholar, HerbMed, Medline, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, Commonwealth Agricultural Bureau Abstracts, African Journal Online, and Biological Abstracts. Prevalence and ABR traits of bacterial isolates, Cochran’s Q test, and the I2 statistic for heterogeneity were evaluated using MedCalcs software. A random-effects model was used to determine the pooled prevalence of ABR traits. The potential sources of heterogeneity were examined through sensitivity analysis, subgroup analysis, and meta-regression at a 95% level of significance. Findings: Eighteen studies met our inclusion criteria. The pooled prevalence of bacterial resistance to at least one conventional drug was 86.51% (95% CI = 61.247–99.357%). The studies were highly heterogeneous (I2 = 99.17%; p < 0.0001), with no evidence of publication bias. The most prevalent multidrug-resistant species was Escherichia coli (24.0%). The most highly resisted drug was Ceftazidime with a pooled prevalence of 95.10% (95% CI = 78.51–99.87%), while the drug-class was 3rd generation cephalosporins; 91.64% (95% CI = 78.64–96.73%). None of the eligible studies tested isolates for Carbapenem resistance. Extended Spectrum β-lactamase genes were detected in 89 (37.2%) isolates, mostly Salmonella spp., Proteus vulgaris, and K. pneumonia. Resistance plasmids were found in 6 (5.8%) isolates; the heaviest plasmid weighed 23,130 Kilobases, and Proteus vulgaris harbored the majority (n = 5; 83.3%). Conclusions: Herbal medicines in Africa harbor bacterial contaminants which are highly resistant to conventional medicines. This points to a potential treatment failure when these contaminants are involved in diseases causation. More research on this subject is recommended, to fill the evidence gaps and support the formation of collaborative quality control mechanisms for the herbal medicine industry in Africa.
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    Global evidence on the potential of some Ugandan herbal medicines to mitigate antibiotic resistance: a systematic review and meta-analysis from 1996 to 2021
    (Research Square, 2022) Walusansa, Abdul; Ssenku, Jamilu. E.; Tugume, Arthur. K.; Asiimwe, Savina; Kafeero, Hussein. M.; Aruhomukama, Dickson; Nakavuma, Jesca. L.; Kakudidi, Esezah K.
    Diarrheal and respiratory ailments are major causes of global deaths, and are mostly escalated by antibiotic-resistant bacteria (ARB), warranting novel therapies against ARB. In Uganda, plants like C. pyrrhopappa, E. abyssinica, C. limon, M. foetida, C. flexuosus, and C. citrinus are often used to treat diarrhea and/or cough. Some of these are reported to demonstrate antibacterial properties in some countries, but the evidence is limited due to fragmented studies. We evaluated global antibacterial research on these plants, to derive practical insights, able to stimulate new thinking and inform drug development. Methods Electronic articles on antibacterial effects of the named plants (with a special focus on efficacy against ARB), were identified from 14 electronic databases. The eligible articles were examined using Standard Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Sensitive ARB to the plant-extracts, Cochran’s Q test, and heterogeneity were evaluated with MedCalcs software, using a random-effects model. Sources of heterogeneity were examined through sensitivity analysis, subgroup analysis, and meta-regression (p < 0.05). Publication bias was assessed using Begg’s test and funnel plot asymmetry. Results Sixty-one articles met the inclusion criteria. Of these, 20 assessed the plants against 237 ARB invitro. C. flexuosus had the greatest efficacy (89.8%), while C. pyrrhopappa had the least (0.0%). Efficacy differences between C. flexuosus (the most efficacious species), and the rest of the plants were not significant except for M. foetida and C. pyrrhopappa (χ2, p < 0.05). The multidrug-resistant strains (resistant to at least three drug-classes), with 100% sensitivity to plant extracts included A. baumannii, S. aureus, and P. aeruginosa. Heterogeneity was high (I2 = 86.85%), with no evidence of publication bias, hence suggesting robust results. Conclusion Some herbal medicines in Uganda have vast potential to avert the global antibacterial resistance menace. Their efficacy against globally circulating bacteria that are resistant to vital drugs, such as carbapenems, shows possible treatment success if these species are used in drug development. More research is desired, especially on the potential efficacy of these plants against the world’s leading strains of resistant bacteria like K. pneumoniae and E. coli. Also, in-vivo studies are recommended due to their importance in drug discovery.
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    Herbal medicine used for the treatment of diarrhea and cough in Kampala city, Uganda
    (Tropical Medicine and Health, 2022) Walusansa, Abdul; Asiimwe, Savina; Ssenku, Jamilu E.; Anywar, Godwin; Namara, Milbert; Nakavuma, Jesca L.; Kakudidi, Esezah K.
    Globally, diarrheal and respiratory diseases are among the main causes of mortality and morbidity. In Uganda, cities are facing proliferation of trade in herbal medicines (HM), including those for diarrhea and/or cough. Information on the economic, and the ethnopharmacological aspects of these HM is scarce, deterring the sector from achieving optimal capacity to support national development. We profiled the anti-diarrhea and/or anti-cough HM, and the basic economic aspects of HM trade in Kampala city, to support ethnopharmacological knowledge conservation and strategic planning. Methods: A cross-sectional survey was conducted on 65 herbalists using semi-structured questionnaires. This was supplemented by an observational survey using a high-resolution digital camera. Data were collected following the guidelines for research on HM, established by Uganda National Drug Authority, and World Health organization. Results: Eighty-four plant species from 41 families were documented. Fabaceae and Myricaceae had the highest number of species (9, 10.7% each). Citrus limon (L.) Osbeck was the most commonly cited for cough, with a relative frequency of citation (RFC) of 1.00, and its relative medical importance was not significantly different from the other top 5 species except for Azadirachta indica A.Juss (RFC = 0.87). Entada abyssinica A. Rich (RFC = 0.97) was the most cited for diarrhea. Trees (34, 40.5%) were mostly used, and mainly harvested from wild habitats (55.2%) in 20 districts across Uganda. These HM were mainly sold as powders and concoctions, in markets, shops, pharmacies, and roadside or mobile stalls. The highest prices were Uganda Shillings (UGX) 48,000 ($13.15)/kg for Allium sativum L, and UGX 16,000 ($4.38)/kg for C. limon. All participants used HM trade as a sole source of basic needs; majority (60.0%) earned net monthly profit of UGX. 730,000 ($200) ≤ 1,460,000 ($400). The main hindrances to HM trade were the; disruptions caused by the COVID-19 pandemic (n = 65, 100%), and the scarcity of medicinal plants (58, 89.2%). Conclusion: There is a rich diversity of medicinal plant species traded in Kampala to treat diarrhea and cough. The HM trade significantly contributes to the livelihoods of the traders in Kampala, as well as the different actors along the HM value chain throughout the country
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    Medicinal plants used in Malaria treatment by Prometra Herbalists in Uganda
    (Journal of Ethnopharmacology, 2014) Adia, Madina Mohamed; Anywar, Godwin; Byamukama, Robert; Kamatenesi-Mugisha, Maud; Sekagya, Yahaya; Kakudidi, Esezah K.; Kiremire, Bernard T.
    Ethnopharmacological relevance: The aimofthesurveywastodocumentmedicinalplantsusedin malaria treatmentbyPrometra(Promociondelamedicinatradicionalamazonica)TraditionalMedical Practitioners (TMPs)ofUgandaandforsearchofnewantiplasmodialherbalmedicines(HMs)forfurther phytochemicalanalysis. Materials andmethods: In thisstudy,semistructuredguidedopenandcloseendedquestionnaireswere used. FocusgroupdiscussionswereconductedandkeyinformantswerechosenwithintheTMPswho helped infurtherdiscussionsofhowtheherbalremedieswherecollected,preparedandadministered. Results: A samplesizeof51respondentswasrandomlyselectedamongtheTMPswiththehelpoftheir leader.86speciesdistributedover81generaand39familieswerereportedlybeingusedasherbal remedies inmalariatreatment.TheTMPsusesymptomslikehightemperature,shivering,amongothers in malariadiagnosisanindicationthattheyunderstandmalaria.Theyemphasizedtheuseofleavesand bark intreatmentbecausetheycanregenerateandthereforeensuresustainableuseofplantsratherthan the useofrootswhichwouldbedestructive.TheseTMPStreatandalsoadvisetheirpatientson preventivemeasuresagainstmalariaattackslikesleepingundermosquitonets,clearingbushesnear homesteads, amongotherswhichisanindicationthattheyhelpinthepreventionandmitigationof malaria incidencesandprevalenceintheareaswheretheylive.TheInformantConsensusFactor(FIC) valueof0.8demonstratedthattheTMPsofPrometra-Ugandatendtoagreewitheachotherintermsof the plantspeciestheyuseinmalariatreatmentanindicationofqualitycontrolinasfarasadministration of theherbalremedies. Vernoniaamygdalina Delile, Bidens pilosa L., Justicia betonica L. werehighlycited as beingusedinmalariatreatmentwithfrequenciesofmentionof38,28and25,respectively. Conclusion: TMPs ofPrometra-Ugandaunderstandandtreatmalariausingtheavailableplantdiversity from theirhugeforestandtheherbalgardenswithinBuyijaforest.Thehealersareverykeenatplant conservationwhichisagoodpractice.Specieslike Justica betonica may beinvestigatedfurtherfor antiplasmodial assaystojustifyitsefficacy.
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    Prevalence and dynamics of clinically significant bacterial contaminants in herbal medicines sold in East Africa from 2000 to 2020: a systematic review and metaanalysis
    (Tropical Medicine and Health, 2021) Walusansa, Abdul; Asiimwe, Savina; Kafeero, Hussein M.; Iramiot, Stanley J.; Ssenku, Jamilu E.; Nakavuma, Jesca L.; Kakudidi, Esezah K.
    Infectious diseases remain a leading cause of mortality and morbidity around the world, and those caused by bacteria are common in the East African region. In this region, trade and consumption of herbal medicine has been expanding in the recent decades. Herbal medicines may be contaminated with pathogenic bacteria; however, there is limited information due to fragmented studies in East Africa. In this meta-analysis, we critically analyzed original research related to the incidence of pathogenic bacterial contaminants of HM in the East African region since 2000. The aim was to create a comprehensive understanding of the extent and dynamics of bacterial contamination in HM, to guide future research and concerted public health protection in the region. Methodology: The study was conducted according to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched and evaluated published articles from eleven electronic databases (Google Scholar, PubMed, HerbMed, MEDLINE, Science Direct, Scifinder Scholar, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, Biological Abstracts and Commonwealth Agricultural Bureau Abstracts). Prevalences of different bacterial species, Cochran’s Q test, and the I2 statistic for heterogeneity were evaluated using a software called MedCalcs. Random and fixed effects models were used to determine the pooled prevalence of clinically significant bacteria from studies which were included in this meta-analysis. The potential sources of heterogeneity were examined through sensitivity analysis, sub-group analysis, and meta-regression at 95% level of significance.