Acculturation and use of traditional medicine among African migrant women in Sydney: a mixed method study.

BACKGROUND: More than 80% of the African population depend on traditional medicine as a primary healthcare. Although the African migrant community is increasing in Australia, there is no research documenting if and how African migrant communities have maintained or changed their use of traditional health practices after migration. This study aims to answer the following research questions: does acculturation influence the use of traditional medicine? and how are cultural health practices or beliefs manifested among African migrant women in Australia? METHOD: A mixed methods design which involved a cross-sectional survey (n = 319) and individual interviews (n = 15) was conducted. Survey data were analysed using SPSS (version 23) and logistic regression model was used to test associations. Qualitative data were analysed thematically using NVivo 11 software to identify themes and conceptual categories in the participants' responses. The study was informed by acculturation theory. RESULT: Both the survey and the interview data indicated that cultural health practices were retained as an important form of healthcare for African migrant women in Sydney. The findings indicated that African migrants continued to use traditional medicines as part of their cultural identity and to build cohesive ethnic community to share traditional values and cultural practices. Women who relatively stayed for shorter period of time in Australia and migrated at a later age were more likely to use TM. CONCLUSION: Acculturation proxy measures increased the likelihood of TM use suggesting African migrant women retain their cultural health practices in Australia and use of TM was manifested as part of their cultural identity. The findings have implications to improve the provision of culturally sensitive and responsive health services when caring for African migrant women.

Use of traditional and complementary medicine for maternal health and wellbeing by African migrant women in Australia: a mixed method study.

BACKGROUND: Traditional medicine serves as a form of primary health care for more than 80% of African populations. Currently, there is no research documenting if and how African migrant communities engage with their traditional health practices and beliefs after they resettle in Western countries. The aim of this study was to examine African migrant women's experiences and perspectives about traditional and complementary medicine use in relation to their maternal health and wellbeing in Australia. METHODS: We conducted a mixed method study between December 2016 and October 2017. Questionnaires were completed by 319 women and 15 in-depth interviews were conducted among African migrant women residing across the Sydney metropolitan area, Australia. Survey data were analysed using SPSS (version 23) and logistic regression model was used to test associations. Qualitative data were analysed thematically using NVivo 11 software to identify themes and conceptual categories in the participants' responses. The study was informed by Andersen's Socio-behavioural model of health service utilisation. RESULTS: The findings indicated that use of traditional and complementary medicine was high and continued to be well used following African women's resettlement in Australia. The survey found that 232 (72.7%) women use some form of traditional and complementary medicine for maternal health and wellbeing purposes. Most women (179, 77.2%) reported that maintaining their maternal health and wellbeing was the most common reason for use. The interview findings indicated that access to traditional medicine included making requests from relatives and friends who travelled to Africa looking for a similar medicinal plant in Australia and preparing home remedies with advice from family members and healers back in Africa. Age ≥ 35 years (OR, 16.5; 95%CI, 6.58-41.5; p < 0.001), lower education (OR, 24; 95%CI, 8.18-71.1; p < 0.001), parity (OR, 7.3; 95%CI, 1.22-42.81; p = 0.029), and lower income (OR, 2.7; 95%CI, 1.23-5.83; p = 0.013) were strong predictors of traditional medicine use. CONCLUSION: Use of traditional and complementary medicine among African migrant women in Sydney remained high following resettlement in Australia. As noted in Andersen's sociobehavioural model of health service utilisation, specific predisposing and enabling factors including age, education and income were associated with use of traditional and complementary medicine.

Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis.

This was a systematic review and meta-analysis to examine the efficacy, effectiveness and safety of acupuncture as an adjunct to embryo transfer compared with controls to improve reproductive outcomes. The primary outcome was clinical pregnancy. Twenty trials and 5130 women were included in the review. The meta-analysis found increased pregnancies (risk ratio [RR] 1.32, 95% confidence interval [CI] 1.07-1.62, 12 trials, 2230 women), live births (RR 1.30, 95% CI 1.00-1.68, 9 trials, 1980 women) and reduced miscarriage (RR 1.43, 95% CI 1.03-1.98, 10 trials, 2042 women) when acupuncture was compared with no adjunctive control. There was significant heterogeneity, but no significant differences between acupuncture and sham controls. Acupuncture may have a significant effect on clinical pregnancy rates, independent of comparator group, when used in women who have had multiple previous IVF cycles, or where there was a low baseline pregnancy rate. The findings suggest acupuncture may be effective when compared with no adjunctive treatment with increased clinical pregnancies, but is not an efficacious treatment when compared with sham controls, although non-specific effects may be active in both acupuncture and sham controls. Future research examining the effects of acupuncture for women with poorer IVF outcomes is warranted.

The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: A systematic review and meta-analysis.

BACKGROUND: Depression and anxiety are common during the antenatal and postnatal period, and are known to have a significant impact on the woman and her unborn infant. Pregnant women state a preference for non-pharmacological treatment options, and use complementary medicines and therapies to manage these symptoms. We examined the effectiveness and safety of these modalities on depression and anxiety during pregnancy. METHODS: CENTRAL, EMBASE and PubMed databases were searched for randomised controlled trials comparing complementary therapies and medicines to a control, for pregnant women with depression or anxiety. The primary outcome measure was antenatal depression or anxiety. RESULTS: Twenty randomised controlled trials containing 1092 women were included in the review. We found some evidence of reduced antenatal depression from three modalities. Acupuncture reduced the number of women diagnosed with antenatal depression (RR 1.68, 95% CI 1.06-2.66, 1 trial). Massage reduced the severity of antenatal depression in one trial of 149 women (SMD -0.73, 95%CI -1.07--0.39). One small trial of bright light therapy found reduced antenatal depression (RR 4.80, 95% CI -8.39--1.21, 27 women). There was no evidence of a reduction in depression and anxiety from relaxation, yoga, mindfulness and fish oils. Overall the risk of bias was high or unclear for the majority of studies. LIMITATIONS: There are few high quality randomised controlled trials of complementary medicines and therapies examining the effect on anxiety and depression. CONCLUSION: Acupuncture, bright light therapy, and massage may reduce antenatal depression. There is a need for high quality and larger studies that include postnatal follow up and maternal and neonatal outcomes.

The use of traditional medicine in maternity care among African women in Africa and the diaspora: a systematic review.

BACKGROUND: There is a paucity of literature describing traditional health practices and beliefs of African women. The purpose of this study was to undertake a systematic review of the use of traditional medicine (TM) to address maternal and reproductive health complaints and wellbeing by African women in Africa and the diaspora. METHOD: A literature search of published articles, grey literature and unpublished studies was conducted using eight medical and social science databases (CINAHL, EMBASE, Infomit, Ovid Medline, ProQuest, PsychINFO, PubMed and SCOPUS) from the inception of each database until 31 December 2016. Critical appraisal was conducted using a quality assessment tool (QAT). RESULT: A total of 20 studies conducted in 12 African countries representing 11,858 women were included. No literature was found on African women in the diaspora related to maternal use of TM or complementary and alternative medicine (CAM). The prevalence of TM use among the African women was as high as 80%. The most common TM used was herbal medicine for reasons related to treatment of pregnancy related symptoms. Frequent TM users were pregnant women with no formal education, low income, and living far from public health facilities. Lack of access to the mainstream maternity care was the major determining factor for use of TM. CONCLUSION: TM is widely used by African women for maternal and reproductive health issues due to lack of access to the mainstream maternity care. Further research is required to examine the various types of traditional and cultural health practices (other than herbal medicine), the beliefs towards TM, and the health seeking behaviors of African women in Africa and the diaspora.

Methanol leaves extract Hibiscus micranthus Linn exhibited antibacterial and wound healing activities.

BACKGROUND: Infectious diseases are the most common causes of morbidity and mortality in developing countries. Wound and wound infections are also major health problem. Nowadays, medicinal plants play a major role in treatment of infectious diseases and wound healing and they are easily available and more affordable as compared to synthetic compounds. The aim of this study is therefore, to investigate the antibacterial and wound healing activities of 80% methanol extract of Hibiscus micranthus leaves using disc diffusion methods and rat excision model respectively. METHODS: In vitro antibacterial screening was carried out against S. aureus, S.pneumoniae, S. pyogenes, E. coli, P. aeruginosa, K. pneumoniae and P. mirabilis bacterial strains using disc-well diffusion assay. Would healing activity was done in rats divided into four groups each consisting of six animals. Group I was served as a negative control (ointment base), Group II served as a positive control Nitrofurazone (NFZ 0.2% ointment), Groups III and IV was treated 5 and 10% extracts respectively. The acute oral toxicity test and skin sensitivity test were also performed before conducting the actual study. The extract was analyzed for secondary metabolites using standard methods. RESULTS: Preliminary phytochemical screening have revealed the presence of alkaloids, flavonoids, saponins, tannins, steroids, phenols, diterpines, anthraquinones and the absence of glycosides, terpinoides and triterpines. Based on acute oral toxicity test the extract was found to be safe up to a dose of 2 g/kg. In addition, acute dermal toxicity test indicated no sign of skin irritation. The leaves extract exhibited varying degrees of sensitivity with zones of inhibition ranging from 14.00 ± 0.333 (S.pyogenes) to 22.67 ± 1.202 mm (S.aureus). It was found that S. aureus and S. pneumonia (p < 0.05) were the most sensitive to the extracts of the leaves at concentrations of 800 µg/ml and 400 µg/ml respectively followed by P. aeuruginosa [(18.33 ± .333 mm) (p < 0.05)] at a concentration of 400 µg/ml. However, E. coli and P. mirabilis were found to be resistant to the extract at any of the applied doses. In the wound healing study, the 5 and 10% w/w extract exhibited significant wound contraction rate of 99.30% and 99.13% as compared to NFZ ointment and simple ointment base treated groups from 6th to 16th day, respectively (p < 0.05). CONCLUSION: The present study suggests that the methanol extract of the leaves exhibited a potential antibacterial activity against the tested microorganisms and wound healing activity.

Antidiarrheal activity of methanolic extract of the root bark of Cordia africana.

An ethnobotanical study in Agew-Awi and Amhara peoples in northwest Ethiopia reported that Cordia africana is used traditionally in the treatment of liver disease, amebiasis, stomachache, and diarrhea. The root and root bark are reported to be used in the treatment of diarrhea. Therefore, this study was intended to evaluate the antidiarrheal effect of C. africana against castor oil-induced diarrhea in mice. The antidiarrheal effect of the plant was tested on castor oil-induced diarrhea in mice (23-25 g) of either sex. Number of diarrheic defecations, intestinal length traveled by the charcoal meal, and weight of intestinal fluid were taken as important parameters to evaluate the antidiarrheal activity of the plant extract. In preliminary phytochemical screening tests, the methanolic extract of C. africana was found to contain phenols, flavonoids, terpenoids, and saponins. Reduction in the number of diarrheic drops was observed in groups of mice that received 200 mg/kg (P<0.05) and 400 mg/kg (P<0.01) of the extract compared to the negative controls. The percent inhibition of intestinal fluid accumulation was 26.83%, 46.34%, and 53.66% at the doses of 100, 200, and 400 mg/kg of the extract, respectively. Relative to the negative control group, the mean percent of intestinal length moved by the charcoal meal was decreased by 24.41%, 39.89%, and 51.66% in groups of mice given 100, 200, and 400 mg/kg of the plant extract, respectively. To iterate the finding, the root bark extract of C. africana was found to be effective in preventing castor oil-induced diarrhea and intestinal motility in a dose-dependent manner. This reveals that the plant material has promising antidiarrheal activity as it is claimed in traditional medical practice.

Effect of hydroalcoholic leaves extract of Indigofera spicata Forssk. on blood glucose level of normal, glucose loaded and diabetic rodents.

BACKGROUND: Diabetes mellitus is found in all parts of the world and is rapidly increasing in its coverage with alarming rate especially in Asia and Africa. Research is increasingly done with the aim of developing a relatively safe and efficacious anti-diabetic plant based products. Parallelly, this investigation was carried out to evaluate the effect of the hydro alcoholic leaves crude extract of Indigofera spicata (ISP) on the blood glucose level(BGL) of normoglycemic, oral glucose loaded and alloxan induced diabetic rodents. METHODS: The animals were randomly divided into five groups (n = 6) for all the aforementioned three models. In all models, group-I mice provided 2%tween-80, group-II were treated with 5 mg/kg glibenclamide and the remaining three groups (III, IV & V) were treated with 100, 200, and 400 mg/kg dose of the extract respectively. Statistical significance of differences in BGLs within and between groups was analyzed by SPSS version-21 using one way ANOVA followed by Tukey's post hoc multiple comparison. RESULT: 200 mg/kg and 400 mg/kg extract treated groups of normoglycemic mice showed significant (p < 0.05) BGL reduction compared to the pre-exposure level. In case of OGTT model BGL reduction was statistically significant (p < 0.05) in only 400 mg/kg exposed groups at the 120 min of post-exposure compared to the initial level. However, the BGL reducing effect of doses of the extract at the 4(th), 6(th) and 10(th) hours of post treatment on diabetic mice was found statistically significant compared to both the negative control (p < 0.001) and their respective pretreatment levels (p < 0.05). CONCLUSION: As it is claimed in ethnobotanical studies, the hydroalcoholic crude extract of ISP leaves have shown prominent anti-diabetic effect and can be therefore used as a good insight for new anti-diabetic drug source with a call for further studies.

Methanolic leaf exctract of Otostegia integrifolia Benth reduces blood glucose levels in diabetic, glucose loaded and normal rodents.

BACKGROUND: Although the leaves of Otostegia integrifolia traditionally claimed in Ethiopian folklore medicine for management of diabetes mellitus, it has not been validated. The aim of this study was therefore to investigate the antidiabetic activity of Otostegia integrifolia in rodents. METHODS: Male rats or mice were randomly divided into five groups for diabetic, hypoglycemic and glucose tolerance test (OGTT) studies. In all models, group I received Tween 80, 2% v/v, Group II (GL5) treated with 5 mg/kg of glibenclamide and the remaining group: III, IV and V were given the plant extract at doses of 100 mg/kg 200 mg/kg and 400 mg/kg respectively. Blood glucose levels (BGL) were measured by collecting blood samples at different time points. Data was analyzed using one way ANOVA followed by Dunnet's post hoc test to carry out between and within group comparisons. P < 0.05 was considered as statistically significant. RESULTS: Inter-group analysis revealed that O. integrifolia at 100 mg/kg and 200 mg/kg reduced the 4(th) hour fasting blood BGL significantly (p < 0.001) compared to the control group. The intra-group analysis result has shown O. integrifolia at 200 mg/kg produced a significant (p < 0.05) reduction in BGL at the 1(st), 2(nd), 3rd and 4th hours of post treatment compared to their respective initial levels. Moreover, in the hypoglycemic and OGTT models, O. integrifolia extract at 200 mg/kg, has shown a significant reduction in blood glucose levels compared to negative controls and across all time points. CONCLUSION: The crude extract of O. integrifolia has shown significant antidiabetic, hypoglyceamic and oral glucose tolerating effects. The effective dose of the extract was found to be 200 mg/kg in time dependent manner.

Subacute administration of crude khat (Catha edulis F.) extract induces mild to moderate nephrotoxicity in rats.

BACKGROUND: Although various studies have been conducted to shed light on the pharmacological actions of khat, little or no data are available regarding khat's effect on the renal redox system. The aim of this study was therefore to investigate the potential of nephrotoxicity associated with khat exposure in rats. METHODS: Sprague Dawely rats were randomly assigned into eight experimental groups. Animals were treated with Tween80, gentamicin 100 mg/kg and khat at various doses (100, 200 and 400 mg/kg) alone or in combination with gentamicin for ten days. The animals were then sacrificed to obtain blood and renal tissues for subsequent analysis. Renal markers, including creatinine, blood urea nitrogen, antioxidant enzymes as well as markers for lipid peroxidation were determined using established protocols. In addition, histopathological changes were evaluated with hematoxilin and-eosin staining technique. RESULTS: Lower and moderate doses of khat did not alter the measured parameters compared to controls. By contrast, higher dose (400 mg/kg) of khat not only increased levels of serum creatinine and blood urea nitrogen (p < 0.001) but also levels of malondialdehyde (p < 0.01). Moreover, 400 mg/kg of khat significantly decreased enzymatic activities of superoxide dismutase (p < 0.01) and catalase (p < 0.001). When khat was administered with gentamicin, it was again the higher dose that significantly accentuated gentamicin-induced alterations in the renal system. CONCLUSIONS: Khat treatment at high dose is demonstrated to induce mild to moderate renal damage. Moreover, it creates synergy when combined with nephrotoxic drugs such as gentamicin.