Factors limiting traditional medicine integration into modern health systems in Africa: protocol for a systematic review of qualitative studies.

OBJECTIVES: It was recognised in the 1978 Alma-Ata Declaration that the integration of traditional medicine into modern health systems is a major lever for achieving universal health coverage. In several African countries, the integration of traditional medicine still faces constraints, despite the development of policies and regulations in favour of this integration. The objective of this study is to conduct a systematic review of the limitations of integrating traditional medicine in Africa. STUDY DESIGN: This is a systematic review protocol for qualitative studies. METHODS: The aim will be to conduct a systematic review of qualitative studies according to PRISMA guidelines. Given the qualitative nature of the primary studies, the COREQ guidelines will also be used to complement PRISMA. The search for primary studies will be conducted in Medline, Science Direct, Hinari and Google Scholar databases, using search equations designed based on the keywords constituting the thesauri of the search question. This will be done independently by two authors. The screening steps of the identified articles will be presented in PRISMA 2009 flowchart. The assessment of the risk of bias of the primary studies and the strength of the conclusions or recommendations will be performed by the GRADE tool. RESULTS: The results of this systematic review will consist of the primary qualitative studies on the limitations of integrating traditional medicine into conventional health systems in African countries. These will be categorised into policy, legal, organisational and sociocultural limitations. They will be reported in accordance with the PRISMA and COREQ guidelines. CONCLUSION: A systematic qualitative study of the limitations of effective integration of traditional medicine into conventional health systems in Africa is needed to guide national policies and regulations on traditional medicine. The application of PRISMA and COREQ standards to this review will ensure its quality and reproducibility. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID: CRD42022318699.

[The professions of colonial pharmacist in French West Africa]. / Les métiers de pharmacien colonial en Afrique occidentale française.

During the twentieth century, French colonial rule in West Africa was marked by the establishment of a homogeneous health organization in the colonies. It was based on the health service of the colonial troops, the hospital service under the general service and other services such as health police, epidemics and hygiene. This health system made it possible to protect the colonizers and indigenous populations from the major endemics of the time, to conduct research on new diseases hitherto unrecognized and to bring "civilization" to the overseas territories. The pharmacist's missions in the colonial health system were manifold. Our study aims to shed light on the profession of colonial pharmacist in the health history of French West Africa. To do this, it concerned the period between the creation of the Federation of French West Africa (1895) and the end of colonization (1960). Drawing on the available documentation, including archival material and bibliographic sources, this article shows that the colonial pharmacist was already exercising a multidisciplinary profession. He was in fact hospital manager, wholesaler-distributor, pharmacy, biologist, chemist, botanist, teacher, central actor in public health.

[Literature review on pharmacovigilance of medicines derived from traditional pharmacopoeias. Part I: Risks identification]. / Revue de la littérature sur la pharmacovigilance des médicaments issus des pharmacopées traditionnelles. Partie I : identification des risques.

Globally, the use of drugs from traditional pharmacopoeias is a major subject. The confidence of the populations in these drugs is linked to their presumption of safety and also to the fact that geographically and financially they are more accessible than synthetic drugs. In view of the high exposure of the world population to traditional medicines, they are subject to pharmacovigilance guaranteeing their safety in use. Thus, this review aims to take stock of the risks identified by the national pharmacovigilance systems. It is based on research referenced in PubMed, Embase, ScienceDirect and GoogleScholar. These studies indicate that the use of traditional drugs can involve risks including adverse effects, interactions with synthetic drugs, adulteration and contamination. The spontaneous notification system was the basis for their identification. Strengthening this system and making populations aware of these risks constitute the key levers for traditional medicines pharmacovigilance progress.

[Literature review on pharmacovigilance of medicines derived from traditional pharmacopoeias. Part II: Risks assessment and prevention]. / Revue de la littérature sur la pharmacovigilance des médicaments issus des pharmacopées traditionnelles. Partie II : évaluation et prévention des risques.

After the initial stage of the pharmacovigilance process for medicines from traditional pharmacopoeias - which concerns the identification of the risks associated with their use - the risk assessment should now be approached. The latter makes it possible to detect potential signals early and to take preventive measures. We sought to understand, from a review of the literature, the steps and methods of risk assessment relating to traditional medicines, as well as the prevention strategies applied to them. All of the work carried out on the subject has shown that the steps and methods for assessing and preventing drug risks are the same for both conventional and traditional medicines. Risk assessment includes analysis of the quality of individual notifications, assessment of causality, detection and evaluation of signals. The World Health Organization method is the most widely used for causality assessment internationally, while disproportionality measures are the most applied for signal detection. Regarding prevention, risk communication is the main strategy for the risks associated with traditional medicines. This review suggests the involvement of traditional medicine practitioners both in the notification system and in the communication strategy on the risks associated with their products.

[Wholesale distribution and delivery of plant-based medicinal products through the pharmaceutical system of Burkina Faso]. / Distribution en gros et délivrance des médicaments à base de plantes à travers le circuit pharmaceutique du Burkina Faso.

OBJECTIVE: In order to improve the contribution of medicines from traditional pharmacopoeia to health care, African countries like Burkina Faso have adopted for several years, policies and regulations organizing their distribution. This study aims to analyze the situation of the wholesale and retail sale of herbal medicines imported by the official pharmaceutical facilities. METHOD: This is a retrospective study involving all 18 drug wholesalers and 115 pharmacies in the city of Ouagadougou (Burkina Faso). It consisted of a collection of sales data of herbal medicines from 2013 to 2016 and interviews of the pharmacists responsible for the facilities surveyed. RESULTS: All the pharmacies surveyed obtain their supplies from national wholesalers, but eleven of them do so directly from manufacturers or non-wholesalers. Only 40% (44/111) of herbal medicines distributed by wholesalers and pharmacies had valid marketing authorizations. Also, although the average growth rates of annual sales by wholesalers and private pharmacies, respectively 23.67% and 11.94%, are significant, the turnover generated from their sale remains low. CONCLUSION: Supporting local producers with appropriate funding and adequate promotion of herbal medicines is still needed to boost the share of the national herbal medicines market.

[Bioequivalence in vitro evaluation of some antibacterial generic dosage forms]. / Evaluation in vitro de la bio-équivalence de quelques formes génériques d'antibactériens.

In this work, bioequivalence between generic and corresponding original brand-name dosage forms of some antibacterial drugs, frequently prescribed in developing countries, have been examined using in vitro dissolution testing. For this purpose, tablet or hard capsule formulations of five active substances (amoxycillin, ampicillin, co-trimoxazole (sulphamethoxazole/trimethoprim), metronidazole and penicillin V) have been retained. For each active substance, batch samples of three generic and one test formulations have been submitted to the pharmaceutical quality control and dissolution testing. Results obtained have shown that all samples examined met the specifications of quality edited by the pharmacopeias. On the other hand, interchangeability between generic and corresponding test formulations should be possible since their dissolution profiles are superposables enough.

Effect of pectinolytic enzymes on the theophylline release from pellets coated with water insoluble polymers containing pectin HM or calcium pectinate.

Theophylline pellets were coated with cellulosic (Aquacoat ECD 30, Surelease clear) or acrylic (Eudragit NE30D, RS30D) polymer aqueous dispersions, containing 10% (related to the insoluble polymer content) of pectin HM or calcium pectinate, using a Uni-Glatt fluidized-bed coating apparatus. When commercial pectinolytic enzymes were added to the dissolution media (0.05 M acetate - phosphate buffer, pH 6.0), the release of theophylline from the coated pellets was generally slower than that observed in the media without enzymes. The enzymatic slowing down of the drug release, depending on the type of the aqueous polymer dispersion used, is more important with mixed Eudragit NE/calcium pectinate coated pellets. The results obtained have been examined with regard to the validity of the approach based on the combination of pectins and the insoluble polymer aqueous dispersions intended for specific-delivery of drugs to the colon. The mechanism of the hydrophilic drug release from pellets coated with insoluble polymer aqueous dispersions containing an aqueous gel-forming polymer has been also discussed.

Studies of pectin HM/Eudragit RL/Eudragit NE film-coating formulations intended for colonic drug delivery.

Theophylline pellets were coated with Eudragit NE30D aqueous dispersions, containing various pectin HM/Eudragit RL30D ionic complexes, using an Uni-Glatt fluidized-bed apparatus. Dissolution studies were then carried out on the coated pellets at pH 6.0, in absence and in presence of commercial pectinolytic enzymes. The theophylline release from the coated pellets, after an initial latency phase, occurred linearly as a function of time. The theophylline release rate was dependent on the pectin HM content of the complexes incorporated in the coatings. The lowest theophylline release from the coated pellets was obtained when the pectin HM content of the complexes was 20.0% w/w (related to Eudragit RL), i.e. when the complexation between pectin HM and Eudragit RL is optimal. The theophylline release from the coated pellets was slower in presence of the pectinolytic enzymes when the pectin content of complexes is higher than 20% w/w. On the other hand, the effect of the enzymes induced an increase of the theophylline release when the pectin HM content of the coatings ranged between 10.0 and 15.0% w/w (related to Eudragit RL).