Perceived barriers and enablers influencing health extension workers toward home-based hypertension screening in rural northwest Ethiopia: interpretive descriptive study.

BACKGROUND: Hypertension, a major but modifiable risk factor for cardiovascular diseases, is a global health problem including Ethiopia. In a limited infrastructure task sharing of hypertension screening for community health workers is a feasible strategy to improve hypertension management. Recent finding have shown that trained health extension workers (HEWs) can identify high blood pressure, which was effective and feasible. Identifying barriers and enablers for home-based hypertension screening by HEWs is crucial for its implementation. This study aimed to explore barriers and enablers that influence health extension workers' home-based hypertension screening in the community. METHODS: The interpretive descriptive design was implemented. In-depth interviews were conducted during October, 2020. A total of 26 participants including HEWs, supervisors, and heads of district health office were purposively selected. They were asked to describe their perception toward home-based hypertension screening by the HEWs. The interviews were audio-recorded, transcribed verbatim into Amharic, and translated into English. The transcripts were coded and themes were identified. Thematic approach was used for data analysis. RESULTS: The participants identified key perceived barriers and enablers of HEWs home-based hypertension screening. The most common barriers were a lack of hypertension training, blood pressure measuring devices, blood pressure guidelines and manuals, skilled HEWs, financial incentives, and poor community awareness of the disease. The most common enablers were support from community leaders, presence of functional development army and community trust for HEWs, presence of routine campaign on vaccination and community based health insurance, and an integrated health system. CONCLUSIONS: Our findings have implications for the HEWs' ongoing implementation of home-based hypertension screening. Successful implementation of this strategy requires scaling up of hypertension training programs for health extension workers and their supervisors, provision of standardized protocols, provision of adequate blood pressure measuring equipment, and regular supportive supervision.

Investigating In Vitro Antibacterial Activities of Medicinal Plants Having Folkloric Repute in Ethiopian Traditional Medicine.

Medicinal plants are targeted in the search for new antimicrobial agents. Nowadays, there is an alarmingly increasing antimicrobial resistance to available agents with a very slow development of new antimicrobials. It is, therefore, necessary to extensively search for new agents based on the traditional use of herbal medicines as potential source. The antibacterial activity of 80% methanol extracts of the leaves of Verbena officinalis (Vo-80ME), Myrtus communis (Mc-80ME), and Melilotus elegans (Me-80ME) was tested against 6 bacterial isolates using agar well diffusion technique. In each extract, 3 concentrations of 10, 20, and 40 mg/well were tested for each bacterium. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were also determined. Vo-80ME and Mc-80ME exhibited promising antibacterial activity against Staphylococcus aureus with the highest zone of inhibition being 18.67 and 26.16 mm, respectively at concentration of 40 mg/well. Regarding gram-negative bacteria, Vo-80ME exhibited an appreciable activity against Escherichia coli and Salmonella typhi. Mc-80ME displayed remarkable activity against all isolates including Pseudomonas aeruginosa with the maximum zone of inhibition being 22.83 mm. Me-80ME exhibited better antibacterial activity against E coli, but its secondary metabolites had little or no activity against other gram-negative isolates. The MIC values of Vo-80ME ranged from 0.16 to 4.00 mg/mL. The lowest MIC was observed in Mc-80ME, with the value being 0.032 mg/mL. Mc-80ME had bactericidal activity against all tested bacterial isolates. Mc-80ME showed remarkable zone of inhibitions in all tested bacterial isolates. Besides, Vo-80ME showed good antibacterial activity against S aureus, E coli, and S typhi. Conversely, Me-80ME has shown good activity against E coli only. Generally, M communis L and V officinalis have good MIC and MBC results.

Magnitude and factors associated with adherence to Iron and folic acid supplementation among pregnant women in Aykel town, Northwest Ethiopia.

INTRODUCTION: Physiological changes during pregnancy, foetal growth and development increase the requirement for Iron and Folic Acid. The increased demand of these nutrients is not meet through diet alone due to decreased bioavailability of nutrients during pregnancy. In 2004, Ethiopia adopted the global Iron and Folic Acid supplementation strategy targeting to reduce the prevalence of Iron deficiency anemia in women of reproductive age and children under five, by one third. However, the prevalence of anemia remains high and only 5% of pregnant women took Iron and Folic Acid tablets for 90 days or more during their most recent pregnancy in Ethiopia. Therefore, we conducted this study to assess the magnitude and associated factors of adherence to Iron and Folic Acid supplementation during pregnancy. METHODS: A facility based cross sectional study was conducted from February to May, 2018 among pregnant women in Northwest Ethiopia. Systematic random sampling technique was used to select 418 study subjects. Bivariable and multivariable logistic regression analyses were computed to identify predictor variables. RESULTS: Rate of adherence to Iron and Folic Acid supplementation among pregnant women was 47.6%. Pregnant women who had a past history of abortion, knowledge of anemia and received health education were more likely to be adherent with Iron and Folic Acid supplementation. Furthermore, knowledge about benefits of the supplement and not facing any problem in the health facilities during Iron and Folic Acid tablet collection were factors associated with Iron and Folic Acid supplementation adherence. CONCLUSIONS: Rate of adherence to Iron and Folic Acid supplementation was low in Aykel town. Therefore, strengthening and promoting health education, creating awareness and avoiding discouraging conditions in health facilities during tablet collection are very crucial to improve and increase the low rate of Iron and Folic Acid supplementation adherence in the study area.

Antimalarial activity of hydromethanolic extract and its solvent fractions of Vernonia amygdalina leaves in mice infected with Plasmodium berghei.

BACKGROUND: Vernonia amygdalina Del. (Asteraceae) is reported to be traditionally used for the treatment of malaria. Based on folkloric repute of this plant in Ethiopian traditional medicine and crude extract-based ethnopharmacological studies conducted in few countries, this study was undertaken to evaluate the in vivo antimalarial activity of 80% methanol extract and its solvent fractions of the leaves of V. amygdalina in mice infected with Plasmodium berghei. METHODS: A 4-day suppressive test was conducted on mice infected with P. berghei to find out antimalarial effect of chloroform, butanol and aqueous fractions obtained from the 80% methanol crude extract. In all the activity tests, mice were randomly assigned in five groups (three tests and two controls) of six animals in each and received respective treatments. Data were analyzed using one way analysis of variance followed by Tukey's post hoc test for multiple comparisons. RESULTS: Acute oral toxicity test showed that all solvent fractions of the leaves of V. amygdalina revealed neither mortality nor overt signs of toxicity up to 2000 mg/kg. This study indicated that the percentage parasitemia suppression of 80% methanol extract was 32.47% (±2.65), 35.40% (±3.14) and 37.67% (±2.50) at 200, 400 and 600 mg/kg, respectively. All doses of the 80% methanol extract of V. amygdalina prolonged survival time and prevented weight loss and packed cell volume reduction in infected mice. All doses of chloroform and butanol fractions significantly suppressed parasitemia (p < 0.05), increased survival time (p < 0.05) compared to negative control and exhibited a significant reduction in rectal temperature (p < 0.05). All solvent fractions significantly prevented weight loss (p < 0.05) at all tested doses. The 80% methanol extract and chloroform and butanol fractions significantly (p < 0.05) prevented further reduction in rectal temperature of P. berghei-infected mice at all doses. CONCLUSION: The results of this study indicated that 80% methanol extract and solvent fractions of the leaves of V. amygdalina demonstrated promising antimalarial activity. The study corroborated the folklore use of this plant for the treatment of malaria in ethnomedicine in Ethiopia.

Evaluation of the Antispasmodic and Antisecretory Activities of the 80% Methanol Extracts of Verbena officinalis L: Evidence From In Vivo Antidiarrheal Study.

Verbena officinalis L. has a folkloric repute for the management of digestive disorders, including diarrhea. However, the safety and efficacy of the plant material has not been scientifically validated yet. This study was, therefore, aimed to evaluate the overall antidiarrheal activity of the 80% methanol extracts of V officinalis in mice. The antidiarrheal activity of the 80% methanol extracts of the roots (R-80ME) and the leaves (L-80ME) of V officinalis was tested in castor oil-induced diarrhea in mice. R-80ME was further evaluated using charcoal meal and entero-pooling. In each test, group I and group II (controls) received 10 mL/kg distilled water and standard drug (5 mg/kg loperamide), respectively, whereas groups III, IV, and V (test groups) received 100, 200, and 400 mg/kg of the 80ME, respectively. The R-80ME at 200 mg/kg (P < .01) and 400 mg/kg (P < .001) significantly delayed the onset of diarrhea compared with negative control. Both R-80ME and L-80ME at 200 and 400 mg/kg significantly decreased the frequency of wet fecal outputs (P < .01). Generally, 70.24% inhibition of the number of wet fecal output was recorded at R-80ME 400 mg/kg. Results from the charcoal meal test revealed that the R-80ME at 200 (P < .01) and 400 mg/kg (P < .001) produced a significant antimotility effect. In entero-pooling test, the R-80ME, at 200 and 400 mg/kg doses (P < .01), showed a significant decline in both the volume and weight of intestinal contents. The maximum in vivo antidiarrheal index was determined to be 95.25 at dose of 400 mg/kg R-80ME. This study demonstrated that the 80ME, mainly the root extract, produced promising antidiarrheal activity and hence provides a scientific support for acclaimed traditional use of the plant material for treatment of diarrheal diseases.

Resistance profile of clinically relevant bacterial isolates against fluoroquinolone in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Fluoroquinolones are among the most frequently utilized antibacterial agents in developing countries like Ethiopia. Ciprofloxacin has become the most prescribed drug within this class and remains as one of the top three antibacterial agents prescribed in Ethiopia. However, several studies indicated that there is a gradual increase of antibacterial resistance. Therefore, this meta-analysis aimed to quantitatively estimate the prevalence of ciprofloxacin resistance bacterial isolates in Ethiopia. METHODS: Literature search was conducted from electronic databases and indexing services including EMBASE (Ovid interface), PubMed/MEDLINE, Google Scholar, Science Direct and WorldCat. Data were extracted with structured format prepared in Microsoft Excel and exported to STATA 15.0 software for the analyses. Pooled estimation of outcomes was performed with DerSimonian-Laird random-effects model at 95% confidence level. Degree of heterogeneity of studies was presented with I2 statistics. Publication bias was conducted with comprehensive meta-analysis version 3 software and presented with funnel plots of standard error supplemented by Begg's and Egger's tests. The study protocol has been registered on PROSPERO with reference number ID: CRD42018097047. RESULTS: A total of 37 studies were included for this study. The pooled prevalence of resistance in selected gram-positive bacterial isolates against ciprofloxacin was found to be 19.0% (95% confidence interval [CI]: 15.0, 23.0). The degree of resistance among Staphylococcus aureus, Coagulase negative Staphyloccoci (CoNS), Enterococcus faecalis and Group B Streptococci (GBS) was found to be 18.6, 21.6, 23.9, and 7.40%, respectively. The pooled prevalence of resistance in gram-negative bacteria was about 21.0% (95% CI: 17, 25). Higher estimates were observed in Neisseria gonorrhea (48.1%), Escherichia coli (24.3%) and Klebsiella pneumonia (23.2%). Subgroup analysis indicated that blood and urine were found to be a major source of resistant S. aureus isolates. Urine was also a major source of resistant strains for CoNS, Klebsiella and Proteus species. CONCLUSION: Among gram-positive bacteria, high prevalence of resistance was observed in E. faecalis and CoNS whereas relatively low estimate of resistance was observed among GBS isolates. Within gram-negative bacteria, nearly half of isolates in N. gonorrhoea were found ciprofloxacin resistant. From enterobacteriaceae isolates, K. pneumonia and E. coli showed higher estimates of ciprofloxacin resistance.

Self-Medication and Contributing Factors Among Pregnant Women Attending Antenatal Care at Public Hospitals of Harar Town, Ethiopia.

Background: Self-medication has been increasing in many developing and developed countries. Its use during pregnancy presents a major challenge due to potential undesirable effects on mother and the fetus. So the aim of this study was to assess the prevalence of self-medication and contributing factors, among pregnant women. Methodology: Institution based cross sectional study was conducted among 244 pregnant women attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal Hospital from February to March, 2017. A structured questionnaire based interview was used to collect data from each study subject. Then, data were categorized and analyzed using SPSS version 20 software. Logistic regression analysis was used to determine the significance of the association between the outcome and independent variables. P-value <0.05 was considered as a statistically significant in multivariate analysis. Results: The prevalence of self-medication during current pregnancy was 69.4%; out of which, 40.6% uses only herbal medicines to self-medicate. Time saving (50.7%) and prior experience of the drug (25.35%) were the main reasons for self-medication using conventional medicines while fewer side effects (59.86%) and effectiveness (35.92%) were the common reasons for self-medication using herbal medicines. Common cold and headache were among the common indications for self-medication. Friends (28.17%) and the pharmacist/druggist (23.94%) were the commonest source of information for conventional medicines while family/friends (69.72%) and neighbors (26.76%) were the common source of information for herbal medicines. Community drug retail outlets and neighbors were the commonly used sources of conventional medicines; while market place and self-preparation were the common sources of herbal medicines. Previous history of self-medication was significantly associated (P < 0.05) with current self-medication with conventional drugs and being a farmer by occupation and poor monthly income were significantly associated with herbal medicine use during pregnancy (P < 0.05). Conclusion: The prevalence of self-medication during pregnancy was very high in this study which showed a need for public trainings for all women of reproductive age about the risks of inappropriate self-medication.

Ethnobotanical, Ethnopharmacological, and Phytochemical Studies of Myrtus communis Linn: A Popular Herb in Unani System of Medicine.

Myrtus communis L (Myrtaceae) is one of the popular drugs being used in the Unani system of phytomedicine since ancient Greece period. From time immemorial, different parts of this plant and essential oil have been used for a variety of purposes such as cosmetics (hair fall control), flavoring of food and drinks as well as extensive therapeutic purposes. Ethnobotanical information revealed that M communis L has been a folkloric repute for the treatment of several diseases like gastric ulcer, diarrhea, dysentery, cancer, rheumatism, hemorrhage, deep sinuses, leucorrhoea, hemorrhoid, inflammation, dyspepsia, anxiety, insomnia, diabetes, hypertension, pulmonary disorders, and skin diseases. Moreover, ethnopharmacological studies revealed that the plant is endowed with extensive pharmacological activities, including antimicrobial, antidiarrheal, antidiabetic, antispasmodic, vasodilator, antiulcer, antioxidant, anticancer, anxiolytic, sedative-hypnotic, and anti-inflammatory activities, among others. The plant has been known to contain phenolic acids, tannins, flavonoids, glycosides, and terpenes. The myrtle oil was also found to be rich in a variety of bioactive monoterpenes and sesquiterpenes with their derivatives. Most of these studies validate the aforementioned traditional claims of this medicinal plant. Further studies are needed to unravel other pharmacological activities of this plant in the long run.

Evaluation of the antidiarrheal activity of the leaf extracts of Myrtus communis Linn (Myrtaceae) in mice model.

BACKGROUND: Myrtus communis L. has a folkloric repute for the management of diarrhea and dysentery in different parts of the world. However, the safety and efficacy of the leaf extract have not been scientifically validated in animal model. This study was, therefore, aimed to investigate the antidiarrheal effect of 80% methanol extract (80ME) and solvent fractions of the leaves of Myrtus communis L. in mice. METHODS: The antidiarrheal activity of the 80ME and solvent fractions was evaluated against castor oil induced diarrheal model, charcoal meal and enteropooling tests. For the 80%ME, the test groups received 100, 200 and 400 mg/kg of the extract. In case of fractions, the test groups received various doses of fractions (200, 300, 400 mg/kg and an additional dose of 800 mg/kg for the aqueous fraction (AF)), where as negative controls received the vehicle (10 ml/kg) and positive controls received loperamide (3 mg/kg). RESULTS: The 80ME at 200 mg/kg (p < 0.05) & 400 mg/kg (p < 0.01) as well as the chloroform fraction (CF) and methanol fraction (MF) at 400 mg/kg (p < 0.05) significantly delayed the onset of diarrhea. Besides, the 80ME (at all tested doses) and both of these fractions (at 300 & 400 mg/kg) significantly decreased the frequency and weight of fecal outputs. Results from the charcoal meal test revealed that the 80ME, at all doses, (p < 0.001) as well as the CF and MF at 300 mg/kg (p < 0.05) & 400 mg/kg (p < 0.001) produced a significant anti-motility effect. Similarly, in the entero-pooling test, the 80ME (at all tested doses) (p < 0.01) as well as the CF and MF (at 300 & 400 mg/kg, p < 0.05) produced a significant decline in the weight and volume of intestinal contents, whereas the AF revealed significant effect (p < 0.05) at dose of 800 mg/kg only. CONCLUSION: The study demonstrated that the 80ME and solvent fractions contain bioactive constituents that have antidiarrheal activity. Therefore, this study provides a scientific support for the acclaimed traditional use of Myrtus communis L for the treatment of diarrheal diseases.

Evaluation of the diuretic activity of the aqueous and 80% methanol extracts of the root of Euclea divinorum Hiern (Ebenaceae) in Sprague Dawley rats.

BACKGROUND: Diuretics are drugs that increase the formation of urine and are important for the treatment of various diseases including hypertension and edema. The root decoction of Euclea divinorum has been used as a diuretic agent in the traditional medicine. Therefore, this study was aimed to evaluate the diuretic activity of the crude extracts of the roots of Euclea divinorum in Sprague Dawley rats. METHODS: The aqueous extract (AE) and 80% methanol extract (80ME) of the plant were prepared using decoction and maceration, respectively. Vehicle (distilled water, 10ml/kg), standard drug (hydrochlorothiazide, 10mg/kg) and three doses (100mg/kg, 200mg/kg and 400mg/kg) of the AE and 80ME were given to male rats by oral gavage. Parameters like urine volume (for 5h), electrolyte concentration and pH were measured (at 5th h) and analyzed. Data were analyzed using one way analysis of variance (ANOVA) followed by Tukey post hoc test. Linear regression was also applied to show the dose dependency nature of the diuretic effect. RESULTS: The result indicated that the 80ME of the plant significantly (p<0.05) produced diuresis at 200mg/kg and 400mg/kg. Furthermore, the AE produced significant diuresis (p<0.05) at all doses. With regard to the electrolyte excretion, the AE produced significant natriuresis and kaliuresis at all tested doses (p<0.001), while the 80ME showed significant natriuresis and kaliuresis at 200mg/kg (p<0.01) and 400mg/kg (p<0.001). Preliminary phytochemical screening revealed the presence of secondary metabolites, including saponins, flavonoids, glycosides, steroids, tannins and terpinoids in both extracts. These constituents might be responsible for the diuretic activity of Euclea divinorum. Both extracts were also found to be safe at 2000mg/kg on the acute toxicity study. CONCLUSION: This finding provides a scientific support for the acclaimed traditional use of the roots of Euclea divinorum as a diuretic agent.