Advances in training of the specialized human resources for health in Tanzania: the case of Muhimbili University of Health and Allied Sciences.

BACKGROUND: Increasing the number of specialized human resources for health is paramount to attainment of the United Nations sustainable development goals. Higher learning institutions in low-and middle-income countries must address this necessity. Here, we describe the 5-years trends in accreditation of the clinical and non-clinical postgraduate (PG) programmes, student admission and graduation at the Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, highlighting successes, challenges and opportunities for improvement. METHODS: This was a retrospective longitudinal study describing trends in PG training at MUHAS between 2015 and 2016 and 2019-2020. Major interventions in the reporting period included university-wide short course training programme to faculty on curricula development and initiation of online application system. Data were collected through a review of secondary data from various university records and was analyzed descriptively. Primary outcomes were the number of accredited PG programmes, number of PG applicants as well as proportions of applicants selected, applicants registered (enrolled) and students graduated, with a focus on gender and internationalization (students who are not from Tanzania). RESULTS: The number of PG programmes increased from 60 in 2015-2016 to 77 in 2019-2020, including programmes in rare fields such as cardiothoracic surgery, cardiothoracic anesthesia and critical care. The number of PG applications, selected applicants, registered applicants and PG students graduating at the university over the past five academic years had steadily increased by 79, 81, 50 and 79%, respectively. The average proportions of PG students who applied, were selected and registered as well as graduated at the university over the past five years by gender and internationalization has remained stably at 60% vs. 40% (male vs. female) and 90% vs. 10% (Tanzanian vs. international), respectively. In total, the university graduated 1348 specialized healthcare workers in the five years period, including 45 super-specialists in critical fields, through a steady increase from 200 graduates in 2015-2016 to 357 graduates in 2019-2020. Major challenges encountered include inadequate sponsorship, limited number of academic staff and limited physical infrastructure for teaching. CONCLUSION: Despite challenges encountered, MUHAS has made significant advances over the past five years in training of specialized and super-specialized healthcare workforce by increasing the number of programmes, enrollment and graduates whilst maintaining a narrow gender gap and international relevance. MUHAS will continue to be the pillar in training of the specialized human resources for health and is thus poised to contribute to timely attainment of the health-related United Nations sustainable development goals in Tanzania and beyond, particularly within the Sub-Saharan Africa region.

DNA barcoding augments conventional methods for identification of medicinal plant species traded at Tanzanian markets.

ETHNOPHARMALOGICAL RELEVANCE: In Africa, traditional medicine is important for local healthcare and plants used for these purposes are commonly traded. Identifying medicinal plants sold on markets is challenging, as leaves, barks and roots are often fragmented or powdered. Vernacular names are often homonymic, and identification of material lacking sufficient morphological characters is time-consuming, season-dependent and might lead to incorrect assessments of commercialised species diversity. AIM OF THE STUDY: In this study, we identified cases of vernacular heterogeneity of medicinal plants using a tiered approach of literature research, morphology and DNA barcoding. MATERIAL AND METHODS: A total of 870 single ingredient medicinal plant samples corresponding to 452 local names were purchased from herbal markets in Dar-es-Salaam and Tanga, Tanzania, and identified using conventional methods as well as DNA barcoding using rbcL, matK and nrITS. RESULTS: Using conventional methods, we could identify 70% of samples to at least family level, while 62% yielded a DNA barcode for at least one of the three markers. Combining conventional methods and DNA barcoding, 76% of the samples could be identified to species level, revealing a diversity of at least 175 species in 65 plant families. Analysis of the market samples revealed 80 cases of multilingualism and over- and under-differentiation. Afzelia quanzensis Welw., Zanthoxylum spp., Allophylus spp. and Albizia anthelmintica Brongn. were the most evident cases of multilingualism and over-differentiation, as they were traded under 8-12 vernacular names in up to five local languages. The most obvious case of under-differentiation was mwingajini (Swahili), which matched to eight scientific species in five different plant families. CONCLUSIONS: Use of a tiered approach increases the identification success of medicinal plants sold in local market and corroborates findings that DNA barcoding can elucidate the identity of material that is unidentifiable based on morphology and literature as well as verify or disqualify these identifications. Results of this study can be used as a basis for quantitative market surveys of fragmented herbal medicine and to investigate conservation issues associated with this trade.

Quantitative market survey of non-woody plants sold at Kariakoo Market in Dar es Salaam, Tanzania.

ETHNOPHARMACOLOGICAL RELEVANCE: In Tanzania, traditional medicine plays a significant role in health care and local economies based on the harvesting, trade and sale of medicinal plant products. The majority of this plant material is said to originate from wild sources, and both traditional healers and vendors are concerned about the increasing scarcity of certain species. AIM OF THE STUDY: A market survey of non-powdered, non-woody medicinal plants was conducted at Kariakoo Market in Dar es Salaam, the major hub for medicinal plant trade in Tanzania, to assess sustainability of traded herbal medicine. MATERIALS AND METHODS: For this study, fresh and dried herbs, seeds and fruits were collected and interviews were conducted to obtain information on vernacular names, preparation methods, monthly sales, uses and prices. Bundles of herbal medicine offered for sale were weighed and counted to calculate the value and volumes of daily stock at the market. RESULTS: A total of 71 medicinal plant products belonging to 62-67 different species from at least 41 different plant families were identified. We identified 45 plant products to species level, 20 products to genus level and four to family level. Plant species most encountered at the market were Suregada zanzibariensis, Myrothamnus flabellifolia and Sclerocarya birrea. The major use categories reported by the vendors were ritual purposes, digestive disorders and women's health. Annual sales are estimated to be in excess of 30 t and close to 200,000 USD, and trade in herbal medicine at Kariakoo Market provides subsistence income to many local vendors. CONCLUSIONS: A large diversity of wild-harvested plant species is traded as medicinal products in Tanzania, including species listed on CITES Appendices. Identifying and monitoring temporal changes in availability per season and from year to year will reveal which species are most affected by this trade, and help relevant authorities in Tanzania to find alternative sources of income for dependent stakeholders and initiate targeted efforts to protect threatened plant species.

Vernacular dominance in folk taxonomy: a case study of ethnospecies in medicinal plant trade in Tanzania.

BACKGROUND: Medicinal plants are traded as products with vernacular names, but these folk taxonomies do not always correspond one-to-one with scientific plant names. These local species entities can be defined as ethnospecies and can match, under-differentiate or over-differentiate as compared to scientific species. Identification of plant species in trade is further complicated by the processed state of the product, substitution and adulteration. In countries like Tanzania, an additional dimension to mapping folk taxonomies on scientific names is added by the multitude of ethnicities and languages of the plant collectors, traders and consumers. This study aims to elucidate the relations between the most common vernacular names and the ethnicity of the individual traders among the medicinal plant markets in Dar es Salaam and Tanga regions in Tanzania, with the aim of understanding the dynamics of vernacular names in plant trade. METHODS: A total of 90 respondents were interviewed in local markets using semi-structured interviews. The ethnicity of each respondent was recorded, as well as the language of each ethnospecies mentioned during the interviews. Voucher collections and reference literature were used to match ethnospecies across languages. RESULTS: At each market, the language of the majority of the vendors dominates the names for medicinal products. The dominant vendors often represent the major ethnic groups of that region. Independent of their ethnicity, vendors offer their products in the dominant language of the specific region without apparently leading to any confusion or species mismatching. CONCLUSIONS: Middlemen, traders and vendors adapt their folk classifications to those of the ethnic groups of the region where they conduct their trade, and to the ethnicity of their main customers. The names in the language of the traders are not forgotten, but relegated in favor of the more salient names of the dominant tribe.

Methanolic extracts of Aloe secundiflora Engl. inhibits in vitro growth of tuberculosis and diarrhea-causing bacteria.

BACKGROUND: The emergence of resistance to antimicrobials by pathogens has reached crisis levels, calling for identification of alternative means to combat diseases. OBJECTIVE: To determine antimicrobial activity of crude methanolic extract of Aloe secundiflora Engl. from Lake Victoria region of Kenya. MATERIALS AND METHODS: Extract was tested against four strains of mycobacteria (Mycobacterium tuberculosis, M. kansasii, M. fortuitum and M. smegmatis), Salmonella typhi, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and a fungus Candida albicans. activity of the extract was determined using BACTEC(™) MGIT(™) 960 system. General antibacterial and antifungal activity was determined using standard procedures: zones of inhibition, Minimum Inhibitory Concentrations (MICs) and Minimum Bactericidal/Fungicidal Concentrations (MBCs/MFCs). RESULTS: The extract was potent against M. fortuitum, M. smegmatis and M. kansasii where it completely inhibited growth (Zero growth units (GUs)) in all the extract concentrations used. It gave strong antimycobacterial activity (157 GUs) against M. tuberculosis. It showed strong antimicrobial activity (P≤0.05), giving inhibition zones ≥9.00 mm against most microorganisms, such as P. aeruginosa (MIC 9.375 mg mL(-1) and MBC of 18.75 mg mL(-1)), E. coli (both MIC and MBC of 18.75 mg mL(-1)), S. aureus and S. typhi (both with MIC and MBC of 37.5 mg mL(-1)). Preliminary phytochemistry revealed presence of terpenoids, flavonoids and tannins. CONCLUSION: The data suggests that Aloe secundiflora could be a rich source of antimicrobial agents. The result gives scientific backing to its use by the local people of Lake Victoria region of Kenya, in the management of conditions associated with the tested microorganisms.

Multi-plant or single-plant extracts, which is the most effective for local healing in Tanzania?

Use of multi-plant extracts against infectious diseases is increasing in rural Tanzania. The study evaluated this ethnomedicinal practice by using mixed root extracts of Carisa edulis, Ximenia caffra, Harrisonia abyssinica and Euclea natalensis against single extracts of the same plants. Disc diffusion assay and Tube dilution techniques were used to compare bioactivity of plant extracts in-vitro. The ANOVA test indicated significant difference (P < 0.05) between these extracts types. Multi-plant extracts had inhibition zones of up to 26 mm as compared to 14 mm for single extracts. Minimum Inhibitory Concentration for multi-plant extract was 8.3 microg/ml against 69 microg/ml for single extracts. Multi-plant extracts inhibited all the five test bacterial species while single extracts inhibited three species. Eight out of ten multi-plant extracts (80%) were bactericidal while only two out of four single extracts (50%) were bactericidal. Generally, multi-plant extracts were more superior over single plant extracts and could be developed into more potent antibiotics against resistant pathogens.

The effect of a local mineral kadosero towards the antimicrobial activity of medicinal plant's extract: case of Lake Victoria Basin, Tarime Tanzania.

The effect of kadosero, a crude mineral used by traditional healers as a supplement to plant extracts against microbial infections was evaluated. A sample of kadosero from a local market was both analyzed for its basic composition and its role on bioactivity of plant extract. Titrimetric, Gravimetric and Atomic Absorption Spectrometric analyses were used to determine contents of the mineral kadosero. Disc Diffusion Assay was used for bioactivity screening in-vitro. Chemical analysis of kadosero revealed the presence of SO4-2 (0.0038 mg/g), Fe(2) (0.0027 mg/g), Cl(-) (232.683 mg/g) and Na(+) (151.25 mg/g). In-vitro tests revealed that supplementing extract of Balanites aegyptiaca with a mineral kadosero by using untreated well water reduced number of bacterial from 100 colony forming units to nil at a mass of a mineral between 60-100 mg. On the other hand, a mineral kadosero did not increase bioactivity of the extract of B. aegyptiaca against the test microbes in agar disc diffusion assay. This was attributed by interaction between the mineral kadosero and nutrient agar medium. The crude mineral kadosero can be supplemented to other plant extracts used locally for treatment of general bacterial infections for increased bioactivity. Further study is recommended to determine mechanisms for bacterial vulnerability to this mineral supplement.