Mixed influence of COVID-19 on primary maternal and child health services in sub-Saharan Africa: a scoping review.

Introduction: The COVID-19 pandemic profoundly affected the provision of and demand for routine health services in the world. The objective of this scoping review was to synthesize the influence of the COVID-19 pandemic on primary maternal and child health (MCH) services in sub-Saharan Africa. Methods: The studies searched original studies reporting on the influence of the COVID-19 pandemic on primary MCH services. Four scientific databases (Pubmed, AJOL, CAIRN, CINAHL) and one gray literature database (Google Scholar) were used for this search. We also searched through the snowball citation approach and study reference lists. Results: The influence of the COVID-19 pandemic on primary MCH services has been mixed in sub-Saharan Africa. Attendance at some health centers declined for antenatal care, deliveries, immunization, and pneumonia cases. Other health centers did not experience a significant influence of the pandemic on some of these services. In fact, antenatal care increased in a number of health centers. MCH service indicators which declined during COVID-19 were linked on the demand side to regulatory measures against COVID-19, the perceived unavailability of resources for routine services, the perceived negative attitude of staff in these facilities, the perceived transmission risk in primary health care facilities and the perceived anticipated stigma. On the supply side, factors included the lack of equipment in primary facilities, the lack of guidelines for providing care in the pandemic context, the regulatory measures against COVID-19 taken in these facilities, and the lack of motivation of providers working in these facilities. Conclusion: This study recommends prioritizing the improvement of infection prevention measures in primary health care facilities for resilience of MCH indicators to epidemic crises. Improvement efforts should be tailored to the disparities in preventive measures between health centers. The identification of best practices from more resilient health centers could better guide these efforts.

Biological and Phytochemical Investigations on Caesalpinia benthamiana, a Plant Traditionally Used as Antimalarial in Guinea.

Caesalpinia benthamiana is widely used as antimalarial in Guinean traditional medicine. Leaf extracts of the plant were tested for their in vitro antiprotozoal activity against Trypanosoma brucei brucei and T. cruzi and the chloroquine-sensitive Ghana strain of Plasmodium falciparum along with their cytotoxicity on MRC-5 cells. The methanolic extract showed the strongest antiprotozoal activity against P. falciparum (IC50 4 µg/ml), a good activity against T. brucei (IC50 13 µg/ml), and a moderate activity against T. cruzi (IC50 31 µg/ml) along with an IC50 on human MRC-5 cells of 32 µg/ml. Bioassay-guided fractionation from the methanolic extract led to antiplasmodially active subfractions. A prospective, placebo-controlled ethnotherapeutic trial assessed the antimalarial effectiveness and tolerability of C. benthamiana syrup administered orally to children with uncomplicated malaria as compared with chloroquine syrup. Phytochemical screening of the leaf extracts indicated the presence of flavonoids, terpenoids, tannins, saponins, and iridoids.

Antiplasmodial activity of Mezoneuron benthamianum leaves and identification of its active constituents.

ETHNOPHARMACOLOGICAL RELEVANCE: Decoctions of the leaves of M. benthamianum Baill. are used by traditional healers in Guinea to treat malaria and this use was validated by a preliminary clinical assay. AIM OF THE STUDY: To evaluate the in vitro antiplasmodial activity and to identify active compounds from extracts of M. benthamianum leaves. MATERIAL AND METHODS: Antiplasmodial activity of extracts, fractions and pure compounds was evaluated in vitro against a chloroquine-sensitive strain of Plasmodium falciparum (3D7) using the measurement of the plasmodial lactate dehydrogenase activity. Selectivity of extracts and purified compounds for Plasmodium parasites was evaluated by using WST-1 test on HeLa human cells. Compounds were isolated using normal phase silica gel column chromatography and prepHPLC and their structures elucidated using extensive spectroscopic analysis. RESULTS: Hydroethanolic extracts (70% v/v) of M. benthamianum leaves showed a moderate in vitro activity against P. falciparum 3D7, with IC50 in the range 22.5 - 32.6µg/mL, depending on the batch; while a dark precipitate formed during ethanol evaporation showed higher activity (IC50 =6.5µg/mL). The fractionation was performed on this most active fraction and was followed by in vitro antiplasmodial assay. Active compounds (5, 7, 8) belong to several phytochemical classes, contributing together to the global antiplasmodial activity of the hydroethanolic extract against P. falciparum parasite. This study finally allowed the isolation of three diterpenes including two new compounds named Mezobenthamic acids A (1) and B (2) and neocaesalpin H (3), as well as quercetin (4), kaempferol (7), resveratrol (6), gallic acid (9) and its ethylester (5), ß-sitosterol glucoside (10) and 13b-hydroxy-pheophorbide a (8). CONCLUSION: This study gives some concrete evidence to support the ethnopharmacological use of Mezoneuron benthamianum leaves extract in the management of malaria. The active compounds can be further studied for their antiplasmodial potential, as well as their suitability to be used as quality markers for the standardization of this herbal drug from the Guinean traditional pharmacopeia.