The use and potential abuse of psychoactive plants in southern Africa: an overview of evidence and future potential.

Background: Most Bantu ethnic groups in southern Africa utilize indigenous herbal medicines, some of which have psychoactive properties. Traditional medical practitioners (TMPs) commonly use them not only for divinatory purposes but to treat and manage mental and other illnesses. Unfortunately, the research on their results, risks, and benefits do not align. Little is known about their potential abuse among TMPs and community members in southern Africa. Herbal medicines are complex because whole plants are sometimes used, unlike in other treatments which use only one active ingredient. However, if the key mechanisms of action of these ethnomedicinal plants can be identified through socio-pharmacological research, useful botanical agents can be developed. A review of socio-pharmacological studies to evaluate the consequences of exposure to ethnomedicinal plants with psychoactive properties was conducted with the aim of identifying harm reduction strategies and investigating how the plants could be developed into useful botanicals. Method: The search methods involved retrieval of records from PubMed/MEDLINE, Embase, Web of Science, Dissertations and Theses Global, and OpenGrey. The English language and human subjects were used as filters. In addition, some information was obtained from TMPs and community members. Results: The following psychoactive plants were found to be commonly used or abused: Boophone disticha, Cannabis sativa, Datura stramonium, Leonotis leonurus, Psilocybe cubensis, and Sceletium tortuosum. The commercialization of Cannabis, L. leonurus, S. tortuosum, and Aspalathus is growing fast. The abuse liability of B. disticha, D. stramonium, and P. cubensis appears not to be appreciated. Five countries were found to have TMP policies and three with TMP Councils. Conclusion: TMPs in the region are aware of the CNS effects of the identified psychoactive plants which can be explored further to develop therapeutic agents. There is a need to work closely with TMPs to reduce harm from the abuse of these plants.

The acute phase response to parturition: a cross-sectional study in Zimbabwe.

Parturition triggers an acute phase response, but its magnitude, duration and predictors are not well described. We determined serum alpha1-antichymotrypsin (ACT) and C-reactive protein (CRP) among 216 women attending postpartum services in south-eastern Zimbabwe. Serum CRP peaked during the first week and serum ACT around 9 days postpartum. Serum ACT, but not serum CRP, was lower among HIV infected women. Multiparity was a negative, and preterm delivery and caesarean section were positive predictors of both serum ACT and CRP. There is a need for a better understanding of the acute phase response to parturition.

HIV Self-Testing, Self-Stigma and Haart Treatment at the University of Limpopo: Health Sciences Students' Opinion and Perspectives.

HIV self-testing (HIVST) is an empowering process in which an individual performs an HIV rapid diagnostic test and interprets the result in privacy. Policy makers have turned to it to facilitate greater uptake, earlier diagnosis, access to prevention, care and treatment services. The University of Limpopo now has an established HIV counselling and testing (HCT) service. Unfortunately, the uptake of this HCT service by the student body is not encouraging. It was against this background that a study was carried out among health sciences students, to assess the potential of HIVST to increase access to and uptake of HIV testing on campus. Information was gathered through focus group discussions and the social media Whatspp, among 300 health sciences students, to provide a 'yes' or 'no' response to an enquiry, about HIVST and the pregnancy test. One on one discussion on the same issues was also held with the staff at the student Health Centre which now stocks ARVs. About 51% of the students, the majority being females indicated that they would go for the HIVST. Students' opinion and perspectives appeared to suggest that there was a potential for the HIVST to increase uptake for HIV testing.

Effect of multimicronutrient supplementation on gestational length and birth size: a randomized, placebo-controlled, double-blind effectiveness trial in Zimbabwe.

BACKGROUND: Multiple micronutrient deficiencies may contribute to low birth weight, which is a major global determinant of mortality. OBJECTIVE: We assessed the effect of prenatal multimicronutrient supplementation on gestational length and birth size. DESIGN: We conducted a randomized, placebo-controlled, double-blind effectiveness trial among antenatal care attendees in Harare, Zimbabwe. Pregnant women (22-35 wk of gestation) were randomly allocated to receive a multimicronutrient or placebo supplement daily until delivery. Supplementation with iron and folic acid was part of antenatal care. RESULTS: Of 1669 women, birth data were available from 1106 (66%), of whom 360 (33%) had HIV infection. The mean gestational length was 39.1 wk, and 16.6% of the women had a gestational length < 37 wk. The mean birth weight was 3030 g, and 10.5% of the infants had a birth weight < 2500 g. Multimicronutrient supplementation was associated with tendencies for increased gestational length (0.3 wk; 95% CI: -0.04, 0.6 wk; P = 0.06), birth weight (49 g; -6, 104 g; P = 0.08), and head circumference (0.2 cm; -0.02, 0.4 cm; P = 0.07) but was not associated with low birth weight (birth weight < 2500 g) (relative risk: 0.84; 0.59, 1.18; P = 0.31). The effect of multimicronutrient supplementation on birth weight was not significantly different between HIV-uninfected (26 g; -38, 91 g) and HIV-infected (101 g; -3, 205 g) subjects (interaction, P > 0.10). CONCLUSION: Antenatal multimicronutrient supplementation may be one strategy to increase birth size.

Reference values and predictors of white blood cell subset counts: a cross-sectional study among HIV seronegative pregnant women in Zimbabwe.

OBJECTIVE: To identify predictors and develop reference values of white blood cell subset counts for pregnant black women in Zimbabwe. STUDY DESIGN: In this cross-sectional study, multiple linear regression (MLR) analysis was employed to assess the relationship of WBC subset counts with age, gestational age, gravidity, season, serum retinol, beta-carotene, ferritin, folate and alpha-1 antichymotrypsin among 998 women 22-35 weeks pregnant attending antenatal care (ANC) in Harare, Zimbabwe. RESULTS: Mean age was 24.0 (95% CI; 23.6-24.4), range 14-45 years. The mean gestational age was 29.2 (95% CI; 29.0-29.4), range 22-35 weeks. Median gravidity was 2, range 1-9. Predictors of neutrophil counts were gestational age, season and serum ferritin, the latter in interaction with gravidity (interaction, p = 0.016). Mean lymphocyte count was 0.13 x 10(9)cells/l higher in gravida >4 than gravida 1-3, and 0.35 x 10(9)cells/l higher in the late rainy than other seasons. Predictors of monocyte counts were gestational age, serum folate and season, while eosinophil counts declined with advancing gestation. Reference values adjusted or unadjusted for identified predictors were different from those of pregnant and non-pregnant white women reported in the literature. CONCLUSIONS: Gravidity, season and micronutrient status influence WBC counts during pregnancy and therefore are of physiological and clinical importance. WBC reference values in the literature were not applicable obviating the need for local reference values.

Factors influencing treatment outcomes in tuberculosis patients in Limpopo Province, South Africa, from 2006 to 2010: A retrospective study.

BACKGROUND: South Africa has a high burden of tuberculosis (TB), with high human immunodeficiency virus (HIV)-TB co-infection rates and the emergence of multidrugresistant TB. OBJECTIVES: To describe treatment outcomes and factors influencing outcomes amongst pulmonary TB (PTB) patients in the Limpopo Province. METHOD: A retrospective review was conducted of data on the provincial electronic TB register (ETR.net) for the years 2006 to 2010 (inclusive), and a random sample of 1200 records was selected for further analysis. The Chi square test was used to examine the influence of age, gender, health facility level, diagnostic category and treatment regimen on treatment outcomes. RESULTS: Overall 90 617 (54.6% male) PTB patients were registered between 2006 and 2010. Of the sampled 1200 TB cases, 72.6% were in persons aged 22 to 55 years and 86.2% were new cases. The TB mortality rate was 13.6% (much higher than the World Health Organization target of 3%), whilst the default rate was 9.8%. There was a strong association between age (P < 0.001), diagnostic category (P < 0.001), treatment regimen (P < 0.001), and health facility level (P < 0.001) and treatment outcome. Those aged 22­55, and 56­74 years were more likely to die (P < 0.05). Poor treatment outcomes were also associated with initial treatment failure, receiving treatment at hospital and treatment regimen II. CONCLUSION: The poor TB treatment outcomes in Limpopo, characterised by a high mortality and default rates, call for strengthening of the TB control programme, which should include integration of HIV and/or AIDS and TB services.

Dual job holding by public sector health professionals in highly resource-constrained settings: problem or solution?

This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. Such activity is generally driven by a lack of resources in the public sector and low pay, and has been associated with the unauthorized use of public resources and corruption. It is also typically poorly regulated; regulations are either lacking, or when they exist, are vague or poorly implemented because of low regulatory capacity. This paper draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. The approach taken in highlighting these broader social objectives seeks to avoid the value judgements regarding dual working and some of its associated forms of behaviour that have tended to characterize previous analyses. Dual practice is viewed as a possible system solution to issues such as limited public sector resources (and incomes), low regulatory capacity and the interplay between market forces and human resources. This paper therefore offers some support for policies that allow for the official recognition of such activity and embrace a degree of professional self-regulation. In providing clearer policy guidance, future research in this area needs to adopt a more evaluative approach than that which has been used to date.

Maternal body composition, HIV infection and other predictors of gestation length and birth size in Zimbabwe.

The role of maternal infections, nutritional status and obstetric history in low birth weight is not clear. Thus, the objective of the present study was to assess the effects of maternal HIV infection, nutritional status and obstetric history, and season of birth on gestation length and birth size. The study population was 1669 antenatal care attendees in Harare, Zimbabwe. A prospective cohort study was conducted as part of a randomised, controlled trial. Maternal anthropometry, age, gravidity, and HIV status and load were assessed in 22nd-35th weeks gestation. Outcomes were gestation length and birth size. Birth data were available from 1106 (66.3%) women, of which 360 (32.5%) had HIV infection. Mean gestation length was 39.1 weeks with 16.6% <37 weeks, mean birth weight was 3030 g with 10.5% <2500 g. Gestation length increased with age in primigravidae, but not multigravidae (interaction, P=0.005), and birth in the early dry season, low arm fat area, multiple pregnancies and maternal HIV load were negative predictors. Birth weight increased with maternal height, and birth in the late rainy and early dry season; primi-secundigravidity, low arm fat area, HIV load, multiple pregnancies and female sex were negative predictors. In conclusion, gestation length and birth weight decline with increasing maternal HIV load. In addition, season of birth, gravidity, maternal height and body fat mass, and infant sex are predictors of birth weight.

HIV-1 viral load and elevated serum alpha(1)-antichymotrypsin are independent predictors of body composition in pregnant Zimbabwean women.

Human immunodeficiency virus (HIV) infection affects body composition, but their relationship has not been studied in pregnant women. We conducted a cross-sectional study among 1669 women receiving antenatal care between 22 and 35 wk of gestation in Harare, Zimbabwe. The role of HIV-1 status and viral load, malaria and elevated serum alpha(1)-antichymotrypsin (ACT, an acute phase protein) in weight, body mass index (BMI), arm circumference (AC), triceps skinfold thickness (TSF), and arm muscle (AMA) and fat (AFA) area were assessed using multiple linear regression analysis. The mean (range) age was 24.4 (14-45) y and gestational age 29 (22-35) wk. HIV infection was present in 31.5% of the women, malaria parasitemia in 0.4% and 11.4% had serum ACT >0.4 g/L. There was no difference in any anthropometric variable between HIV-infected and uninfected women. However, women with viral loads (genome equivalents/mL) between 4 and 5 and >5 log(10) had 1.1 [95% confidence interval (CI): -0.3, 2.3] and 2.5 (95% CI: 0.1, 5.1) kg lower weights compared with uninfected women; this was explained by losses of both AFA and AMA. Malaria parasitemia was associated with 6 cm(2) (95% CI: 0.4; 11.8) or 25% lower AMA. Elevated serum ACT was a negative predictor of all anthropometric variables, i.e., levels between 0.3 and 0.4, 0.4 and 0.5 and >0.5 g/L were associated with 1, 2 and 6 kg lower mean body weights, respectively. Despite the limitations of a cross-sectional design, we conclude that arm fat and muscle areas, reflecting body fat and lean body mass, seem to be unaffected in the majority of HIV-infected pregnant women, but decline with increasing viral loads. The effects of viral load are not explained by elevated serum ACT, which is a strong independent predictor of all anthropometric variables.

Iron, haptoglobin phenotype, and HIV-1 viral load: a cross-sectional study among pregnant Zimbabwean women.

BACKGROUND: Viral load is a determinant of HIV-1 progression and transmission. Iron status and the phenotype of haptoglobin, a heme-binding acute phase reactant, may be determinants of viral load. We aimed to describe the effect of iron status, haptoglobin phenotype (Hp), and other predictors on HIV-1 viral load. METHODS: Based on a cross-sectional study among 1669 antenatal care attenders (22-35 weeks) in Zimbabwe, 526 (31.5%) were found to be HIV infected. The role of season, age, gravidity, gestational age, malaria parasitemia, Hp, and elevated serum alpha(1)-antichymotrypsin (ACT) as well as serum ferritin, folate, retinol, and beta-carotene on HIV viral load among the 526 HIV-infected women was assessed using multiple linear regression analysis. RESULTS: The distribution of Hp 1-1 (32%), Hp 2-1 (48%), and Hp 2-2 (20%) was not different from that of 53 uninfected women. Mean viral load was 3.85 log(10) (95% CI: 3.77-3.93) genome equivalents (geq)/mL, ranging from 3.77 (95% CI: 3.64-3.90) geq/mL in women with Hp 1-1 to 4.05 (95% CI: 3.81-4.21) geq/mL in women with Hp 2-2. With elevated serum ACT controlled for, women with Hp 2-2 had viral loads twice (95% CI: 1.4-4.0, p =.002) that of women with Hp 1-1, whereas those with serum ferritin <6 micro g/L had viral loads less than one third (95% CI: 0.13-0.53, p =.013) that of women with serum ferritin >24 micro g/L. Viral loads were also higher in women enrolled in the early rainy season compared with the dry season, in gravidae 4+ compared with gravidae 1 through 3, and in those with moderately elevated compared with low serum alpha(1)-antichymotrypsin, but neither age, gestational age, serum folate, serum retinol, nor serum beta-carotene were predictors. CONCLUSION: Storage iron, Hp 2-2, and elevated ACT are independent positive predictors of HIV-1 viral load. The positive relationship between serum ferritin and viral load was not the result of an acute phase response or iron accumulation with advanced HIV infection. A possible detrimental role of iron in HIV infection would have serious public health implications.