Nutritional factors affecting camel (Camelus dromedarius) milk composition.

Saharan population in Algeria still depending on bovine milk, which suffers from serious constraints undermining its sustainability. Camelus dromedarius milk has experienced growing demand following the emerging market requirements for livestock production and dairy farming over the past decade. The present work aimed at analysing the effect of nutritional regime on milk quality. The differences in pH, Acidity D°, Ash and Fats were significant. The pH was negatively influenced by the intensification conditions such as the much higher use of concentrates. The major constituents of milk were strongly and positively correlated with barley, wheat bran, TN/Kg.DM (Total Nitrogen/ Kg. Dry Matter), Kg.DM, Concentrates and daily watering. The results showed that a good energy-protein balance around 73 g PDI/UFL (Protein Digestible in the Intestine/Energetic Forage Unit for milk production) was beneficial for a better milk protein ratio. The use of corn, soybeans, palm dates and VM-premix (Vitamin Mineral) supplementation were also favourable to the synthesis of fats. Crude fiber and cell walls were better valued in the synthesis of fats with the availability of concentrates and the increasing of TN /Kg.DM and VM-premix rate in dietary regime. The vitamin C content elevate following high ratio of UFL /Kg.DM and PDI/UFL. For thus, the influence of nutritional status can lead to major improvements that need also more advanced and detailed studies.

Assessment of heavy metals and macromineral in frequently used medicinal plants from Algerian Sahara traditional ethnopharmacopeia.

In this study, a total of 15 elements, both physiological and causing toxic effects, have been determined in 9 medicinal plants collected from their natural environment in the Algerian Sahara regions. The concentrations of elements were determined by inductively coupled plasma optical emission spectrometry (ICP-OES) after acid digestion and by the X-ray fluorescence spectrometry (XRF). By analyzing the spiked test and the reference materials, the accuracy of the measurements was determined. Our findings show differences in elements composition and concentration between the species under investigation, indicating differences in physiological function of the plant as a result of elemental interactions within it. The elements were quantified (in µg/g): Br (0.04-5.44), Cd (1.21-1.34), Co (1.12-64.35), Cr (1.51-59.05), Cu (1.81-9.28), Fe (94.26-668.55), Mn (16.34-70.77), Ni (1.5-53.64), Pb (1.18-2.55), Zn (1.21-310.80) and (in mg/g): Ca (4.23-4.70), Cl (21.98-117.91), P (28.92-30.49), S (4.15-11.95), Si (1.99-2.36). Mean element levels in medicinal plants were established in decreasing order as follows: Zn>Mn>Cu>Cr>Ni>Pb>Cd>Co. Except for nickel, which reached 53.64µg/g in the Capparis spinosa L species, heavy metal concentrations were found to be low in all samples. Based on traditional use, we can cautiously conclude that these medicinal plants pose no risk to users.

Oral Cholecalciferol Supplementation in Sahara Black People with Chronic Kidney Disease Modulates Cytokine Storm, Oxidative Stress Damage and Athero-Thromboembolic Risk.

The 25-hydroxyvitamin D3 (25OHD3) deficiency in chronic kidney disease (CKD) is associated with immune system dysfunction (pro-inflammatory cytokines storm) through macrophages renal infiltration, oxidative stress (OxS) damage and athero-thromboembolic risk. Conversely, cholecalciferol supplementation (25OHD-S) prevents kidney fibrosis by inhibition of vascular calcification and nephrotic apoptosis (nephrons reduction). The objective of this study was to investigate the pleiotropic effects of 25OHD-S on immunomodulation, antioxidant status and in protecting against thromboembolic events in deficiency CKD Black and White individuals living in the Southern Sahara (SS). The oral 25OHD-S was evaluated in 60,000 IU/month/36 weeks versus in 2000 IU/day/24 weeks in Black (n = 156) and White (n = 150). Total serum vitamin D was determined by liquid chromatography-tandem mass spectrometry. All biomarkers of pro-inflammatory cytokines (PIC) were assessed by ELISA tests. OxS markers were assessed by Randox kits. Homocysteine and lipoproteine (a) were evaluated by biochemical methods as biomarkers of atherothromboembolic risk. All statistical analyses were performed with Student's t-test and one-way ANOVA. The Pearson test was used to calculate the correlation coefficient. The means will be significantly different at a level of p value < 0.05. Multiple logistic regressions were performed using Epi-info and Statview software. Vitamin D deficiency alters the PIC profile, OxS damage and atherothrombogenic biomarkers in both SS groups in the same manner; however, these disorders are more acute in Black compared to White SS individuals. The results showed that the serum 25OHD3 concentrations became normal (>75 nmol/L or >30 ng/mL) in the two groups. We have shown that the dose and duration of 25OHD-S treatment are not similar in Black SS residents compared to White SS subjects, whilst the same inhabit the south Sahara environment. It appears that a high dose intermittent over a long period (D60: 36 weeks) was more efficient in Black people; while a lower dose for a short time is sufficient (D2: 24 weeks) in their White counterparts. The oral 25OHD-S attenuates PIC overproduction and OxS damage, but does not reduce athero-thromboembolic risk, particularly in Black SS residents.

Pregnant women's decision-making capacity and adherence to iron supplementation in sub-Saharan Africa: a multi-country analysis of 25 countries.

BACKGROUND: Anaemia and related complications during pregnancy is a global problem but more prevalent in sub-Sahara Africa (SSA). Women's decision-making power has significantly been linked with maternal health service utilization but there is inadequate evidence about adherence to iron supplementation. This study therefore assessed the association between household decision-making power and iron supplementation adherence among pregnant married women in 25 sub-Saharan African countries. METHODS: We used data from the Demographic and Health Surveys (DHS) of 25 sub-Saharan African countries conducted between 2010 and 2019. Women's decision-making power was measured by three parameters; own health care, making large household purchases and visits to her family or relatives. The association between women's decision-making power and iron supplementation adherence was assessed using logistic regressions, adjusting for confounders. The results were presented as adjusted odds ratio (AOR) with 95% confidence intervals (CIs). RESULTS: Approximately 65.4% of pregnant married women had made decisions either alone or with husband in all three decisions making parameters (i.e., own health care, making large household purchases, visits to her family or relatives). The rate of adherence to iron medication during pregnancy was 51.7% (95% CI; 48.5-54.9%). Adherence to iron supplementation was found to be higher among pregnant married women who had decision-making power (AOR = 1.46, 95% CI; 1.16-1.83), secondary education (AOR = 1.45, 95% CI; 1.05-2.00) and antenatal care visit (AOR = 2.77, 95% CI; 2.19-3.51). Wealth quintiles and religion were significantly associated with adherence to iron supplementation. CONCLUSIONS: Adherence to iron supplementation is high among pregnant women in SSA. Decision making power, educational status and antenatal care visit were found to be significantly associated with adherence to these supplements. These findings highlight that there is a need to design interventions that enhance women's decision-making capacities, and empowering them through education to improve the coverage of antenatal iron supplementation.

Anti-Ulcerogenic and Cytoprotective Effects of Saharian (Sidr) Honey from Algeria.

AIM AND OBJECTIVE: This study aimed at investigating the gastro-protective effects of Algerian Sahara (Sidr) honey from Apis mellifera intermissa against HCl/Ethanol-induced gastric ulcers in rats. MATERIALS AND METHODS: Total phenolic content, antioxidant activity and phenolic compounds were determined. Then, three groups of rats (control, HCl/ Ethanol-induced ulcer, and orally administered honey) were used for the determination of gastro-protective effect of Sidr honey. RESULTS: Total phenolic content, total flavonoid content, and DPPH activity of the honey sample were determined as 47.35±3.35 mg GAE/ 100 g, 2.13±0.17 mg QE/ 100 g, and 229.24±0.02 mg/mL, respectively. Oral pretreatment of rats with honey (1.2 g/Kg body weight orally at an interval of 2 days) protected gastric mucosa against HCl/Ethanol-induced damage by decreasing ulcer score, the volume and acidity of gastric juice and increasing pH. CONCLUSION: These results were confirmed by the histological assessment, which demonstrated a significant gastro-protective activity of Saharian (Sidr) honey against HCl/Ethanol-induced stomach ulcer. Plasma tumor necrosis factor-α, IL-6 and PGE2 were also measured. Sahara honey significantly decreased the plasma TNF-α, PGE2, and IL-6 concentrations.

The role, impact, and support of informal caregivers in the delivery of palliative care for patients with advanced cancer: A multi-country qualitative study.

BACKGROUND: Cancer is increasing in its prevalence in sub-Saharan Africa. Informal caregivers are key to supporting engagement and interaction with palliative care services, but limited literature on their role impedes development of supportive interventions. AIM: We aimed to understand the role, impact, and support of informal caregivers of patients with advanced cancer when interacting with palliative care services in Nigeria, Uganda, and Zimbabwe. DESIGN: Secondary analysis of qualitative interview transcripts. The dataset was assessed for fit and relevance and framework approach was used. SETTING/PARTICIPANTS: Interview transcripts of informal caregivers included participants aged over 18 years of age recruited from palliative care services across participating countries. RESULTS: A total of 48 transcripts were analyzed. Mean age was 37 (range 19-75) with equal numbers of men and women. Five themes emerged from the data: (1) caregivers are coordinators of emotional, practical, and health service matters; (2) caregiving comes at a personal social and financial cost; (3) practical and emotional support received and required; (4) experience of interacting and liaising with palliative care services; and (5) barriers and recommendations relating to the involvement of palliative care. CONCLUSIONS: The role of informal caregivers is multi-faceted, with participants reporting taking care of the majority of medical, physical, financial, and emotional needs of the care recipient, often in the face of sacrifices relating to employment, finances, and their own health and social life. Efforts to develop comprehensive cancer control plans in sub-Saharan Africa must take account of the increasing evidence of informal caregiver needs.

Phytochemicals, Antioxidant Activity and Ethnobotanical Uses of Balanites aegyptiaca (L.) Del. Fruits from the Arid Zone of Mauritania, Northwest Africa.

Phytochemicals and antioxidant activity of fruits of 30 B. aegyptiaca trees naturally growing in the hyper-arid and arid zones in Mauritania were evaluated by following standard procedures. Ethnobotanical uses of fruit pulps and kernel were assessed using a structured questionnaire. Balanites aegyptiaca fruit pulp is a good source of sugars (33 g/100 g dry matter (DM)), polyphenols (264 mg GAE/100 g DM) and flavonoids (34.2 mg/100 g DM) with an average antioxidant activity of 519 µmol TEAC/100 g DM. The fruit kernel is rich in lipids (46.2 g/100 g DM) and proteins (29.5 g/100 g DM). Fruits from the hyper-arid zone exhibited high level of polyphenols, antioxidant activity and soluble tannins. Almost all of the informants (97.14%) reported the use of fruit pulp in folk medicine to treat diabetes, while 72.86% reported using the fruit pulp to treat hypertension. Kernel oil is mainly employed as ointments in the treatment of paronychia (57.14%) and dermal infections (35.71%). The predominant methods for preparing/administering fruit pulp/Kernel were maceration (58.8%), sucking fruit pulp (25.7%) and decoction (24.2%). Balanites aegyptiaca fruit contain both nutritional and health-promoting phytochemicals that could be of interest in the development of strategies for sustainable use of this neglected indigenous fruit tree.

Adherence to HIV Care and Associated Health Functioning among Youth Living with HIV in Sub-Saharan Africa.

Older adolescents and young adults (youth) living with HIV (YLH) in sub-Saharan Africa (SSA) are at high risk for poor HIV treatment adherence and associated negative health outcomes including viral nonsuppression. To describe this risk, we conducted a comprehensive review of studies involving YLH. Eligible studies compared youth adherence or adherence-related health functioning to older or younger samples, examined factors associated with adherence or health outcomes among YLH, or evaluated adherence interventions with YLH. Databases searched included MEDLINE, Web of Science, Global Health, CINAHL, Africa-Wide Information, PsycINFO, and the Cochrane Library. Of the 7054 articles found, 156 were reviewed and 130 were eligible. Across 16 adherence-related behaviors or health outcomes such as lost to follow-up, retention in care, antiretroviral use, CD4 count, viral suppression, and mortality, 73% of studies comparing YLH to other age groups (n = 106) found worse outcomes among YLH. In 22 studies, barriers and facilitators to adherence were identified, some unique to YLH (e.g., conflicting treatment expectations of providers) and some common to other age groups. Finally, of the eight adherence interventions with YLH reviewed, five showed evidence of being effective. Our findings suggest that YLH in SSA faces numerous obstacles to engaging in HIV treatment across a range of shifting social contexts. Accounting for this group's transition to treatment self-management, developmentally tailored and holistic interventions should be the focus of adherence promotion efforts.

African Plants with Antidiabetic Potentials: Beyond Glycaemic Control to Central Nervous System Benefits.

BACKGROUND: For centuries, humans have used medicinal plants in the management of both acute and chronic diseases. Currently, the practice of using medicinal plants to manage diseases is becoming increasingly-common; especially in medium to low-income economies where the cost of, or ease of access to orthodox medications are limitations to their effective and sustained use. Diabetes mellitus is a chronic disease whose prevalence continues to increase worldwide. An aspect of diabetes mellitus that causes significant morbidity is its neurological complications, which are known to be associated with an enormous economic burden and reduction in quality of life. OBJECTIVES: While research continues to demonstrate that a wide range of plants that are indigenous to Africa have significant antihyperglycaemic properties, scientific information on the neurobehavioural and/or neuromorphological effects of these plants appear to be lacking. Also, their possible benefits in the prevention or amelioration of the neurological complications of diabetes mellitus remain generally unexamined. METHODOLOGY: In this narrative review, we the examine available scientific literature dealing with the neurobehavioural and/or neuromorphological profiles of selected African plants with substantiated antihyperglycaemic properties; aiming to highlight their potential applications in the prevention and management of the neurological complications of diabetes mellitus. RESULTS: This review demonstrates that a number of the African plants with antidiabetic properties also exhibit central nervous system effects. CONCLUSION: While the neurobehavioural and neuromorphological effects of some of these plants had been investigated in animal models of DM; their possible roles in the prevention or amelioration of the neurological complications of DM are yet to be established.

Risk factors of low back pain and the relationship with sagittal vertebral alignment in Tanzania.

BACKGROUND: LBP is a common and serious problem affecting vast populations of the world. However, only few studies on LBP in sub-Saharan Africa have been conducted. Studies report that LBP and pelvic angle are interrelated, and African residents have a high pelvic tilt. The strategy to prevent LBP should focus on activities that promote holistic health. For that purpose, it is important to grasp the state of LBP and how it affects people's lifestyle in Tanzania to clarify the direction of implementation of physiotherapy treatment and reduce the incidences of LBP among adults. This study aimed to investigate the prevalence and presentation of low back pain (LBP) and the relationship between anthropometric measurements and LBP among people in Moshi city, Kilimanjaro region Tanzania. METHODS: Following signing consent forms, participants were given questionnaires regarding LBP and then grouped accordingly into either asymptomatic or symptomatic cohorts. Anthropometric measurements of participants' height, weight, curvature of the spine, and pelvic angle were obtained. RESULTS: A Mann-Whitney U test analysis showed a significant difference in pelvic angle, body mass index (BMI), and thoracic kyphosis angle between the asymptomatic group and the symptomatic group. No significant differences in lumbar lordosis angle or abdominal muscle strength were found between the two groups. CONCLUSIONS: A person with symptomatic LBP in Tanzania has a large anteversion of the pelvic tilt and a thoracic kyphotic posture. This study shows a relationship between sagittal spinal alignment and LBP in Tanzania, which could allow for prospective identification of subjects prone to developing LBP in the future.

Nurse and midwife researcher collaboration in eastern sub-Saharan Africa: a social network analysis.

AIM: To investigate the collaborative networks among expert clinical nurse and midwifery researchers in eastern and southern Africa. METHODS: Thirty-eight clinical nurse and midwifery researchers completed an online survey to analyse collaboration between respondents. Data were analysed using social network analysis, generating a network map and associated measurements. RESULTS: Regional collaboration was poor. Those links that did exist centred on geographic proximity and participation in regional and international organizations. CONCLUSION: These results help us to understand better ways to strengthen and support nursing and midwifery clinical research in eastern and southern Africa. IMPLICATIONS FOR NURSING POLICY: Clinical nursing and midwifery research capacity building efforts should focus on supporting collaboration networks among individuals and institutions in the region.

Concomitant occurrence of anthropogenic air pollutants, mineral dust and fungal spores during long-distance transport of ragweed pollen.

Large-scale synoptic conditions are able to transport considerable amounts of airborne particles over entire continents by creating substantial air mass movement. This phenomenon is observed in Europe in relation to highly allergenic ragweed (Ambrosia L.) pollen grains that are transported from populations in Central Europe (mainly the Pannonian Plain and Balkans) to the North. The path taken by atmospheric ragweed pollen often passes through the highly industrialised mining region of Silesia in Southern Poland, considered to be one of the most polluted areas in the EU. It is hypothesized that chemical air pollutants released over Silesia could become mixed with biological material and be transported to less polluted regions further North. We analysed levels of air pollution during episodes of long-distance transport (LDT) of ragweed pollen to Poland. Results show that, concomitantly with pollen, the concentration of air pollutants with potential health-risk, i.e. SO2, and PM10, have also significantly increased (by 104% and 37%, respectively) in the receptor area (Western Poland). Chemical transport modelling (EMEP) and air mass back-trajectory analysis (HYSPLIT) showed that potential sources of PM10 include Silesia, as well as mineral dust from the Ukrainian steppe and the Sahara Desert. In addition, atmospheric concentrations of other allergenic biological particles, i.e. Alternaria Nees ex Fr. spores, also increased markedly (by 115%) during LDT episodes. We suggest that the LDT episodes of ragweed pollen over Europe are not a "one-component" phenomenon, but are often related to elevated levels of chemical air pollutants and other biotic and abiotic components (fungal spores and desert dust).

Pollen metabarcoding as a tool for tracking long-distance insect migrations.

Insects account for a large portion of Earth's biodiversity and are key players for ecosystems, notably as pollinators. While insect migration is suspected to represent a natural phenomenon of major importance, remarkably little is known about it, except for a few flagship species. The reason for this situation is mainly due to technical limitations in the study of insect movement. Here, we propose using metabarcoding of pollen carried by insects as a method for tracking their migrations. We developed a flexible and simple protocol allowing efficient multiplexing and not requiring DNA extraction, one of the most time-consuming part of metabarcoding protocols, and apply this method to the study of the long-distance migration of the butterfly Vanessa cardui, an emerging model for insect migration. We collected 47 butterfly samples along the Mediterranean coast of Spain in spring and performed metabarcoding of pollen collected from their bodies to test for potential arrivals from the African continent. In total, we detected 157 plant species from 23 orders, most of which (82.8%) were insect-pollinated. Taxa present in Africa-Arabia represented 73.2% of our data set, and 19.1% were endemic to this region, strongly supporting the hypothesis that migratory butterflies colonize southern Europe from Africa in spring. Moreover, our data suggest that a northwards trans-Saharan migration in spring is plausible for early arrivals (February) into Europe, as shown by the presence of Saharan floristic elements. Our results demonstrate the possibility of regular insect-mediated transcontinental pollination, with potential implications for ecosystem functioning, agriculture and plant phylogeography.

Quercetin 3-O-glucoside recovered from the wild Egyptian Sahara plant, Euphorbia paralias L., inhibits glutamine synthetase and has antimycobacterial activity.

Tuberculosis remains a major health problem accentuated by the rise of resistance to all available drugs. Therefore, this study was launched to discover a novel antituberculosis agent from wild Egyptian Sahara plants. Twelve such plants were screened, in vitro, for their activity against various Mycobacterium species. The most active plant, Euphorbia paralias, was further fractionated with different organic solvents, and the activity of the obtained fractions was determined by the agar diffusion and broth microdilution methods. The methanol fraction was the most active against Mycobacterium spp., and was non-toxic in doses up to 10 g/kg of animal weight. Its main component was separated by column chromatography, and then identified by ultraviolet spectroscopy and nuclear magnetic resonance analysis as quercetin-3-O-ß-D-glucoside. Docking analysis suggested that quercetin-3-O-ß-D-glucoside inhibits the glutamine synthetase enzyme, a promising target for the development of antituberculosis drugs. This prediction was confirmed by an in vitro glutamine synthetase biosynthetic assay. To the best of our knowledge, and based on bioinformatics mining of the BioPhytMol database, this is the first report on the antimycobacterial activity of Euphorbia paralias plant. It is also the first report on the inhibition of mycobacterial glutamine synthetase by the flavonoid quercetin.

The role of Nucularia perrinii Batt. (Chenopodiaceae) in the camel-based Sahrawi social-ecological system.

BACKGROUND: Pastoral social-ecological systems (SESs) are adaptive and complex systems rooted in the extensive exploitation of forage plants for livestock-based livelihoods and culture. There are species and relations that are foundational to the existence of these SESs. Nucularia perrinii Batt. (Chenopodiaceae) is an endemic halophyte plant of central and western Sahara seldom cited in the scientific literature. The objective of this study was to investigate the role of this plant in the SES of the Sahrawi camel nomads of Western Sahara. METHODS: The data analyzed were collected in the Sahrawi refugee camps of Algeria and in Western Sahara between 2006 and 2010. Fieldwork included semi-structured (n = 38) and retrospective (n = 12) interviews with Sahrawi refugees, nomads, and camel owners about N. perrinii and associated topics (e.g. distribution, importance for camels, camel diseases, associated grazing practices, other forage plants, etc.). RESULTS: Askaf, as the Sahrawi call the plant, is crucial to camels' survival, providing salts and water even during dry spells. It holds a pivotal role in the Sahrawi culture, defining the geographical boundaries of the Sahrawi SES and relating the grazing territory with the taste it gives to camel milk, which support the inclusion of askaf as a main element of Sahrawi cultural identity. CONCLUSIONS: We argue that N. perrinii ties the ecology of the western Sahara desert with camel husbandry and associated livelihoods, and further with the culture and worldview of the Sahrawi nomads. We stress the keystone role that some forage plants may have in extensive pastoral SESs worldwide.

Perceived competency deficits and challenges of family medicine trainees in sub-Saharan Africa.

BACKGROUND: A competency-based approach to family medicine (FM) post graduate (PG) training falls short of a holistic process if it focuses only on patients' needs without eliciting those of trainees. AIM: To identify perceived competency deficits of trainees and challenges hindering achievement of learning outcomes. SETTING: PG FM programmes in sub-Saharan Africa. METHODS: We conducted a cross-sectional survey using a web-based questionnaire with a list of competency items and challenges. Common Factor Analysis was used to ascertain which competency items and challenges accounted for the highest shared variability. A perceived competency deficit was assumed for any item with a component loading of <0.5. For challenges, higher component loadings denoted higher levels of agreement with the annotated item. Data were analysed using SPSS (version 16). RESULTS: A total of 150 trainees took the survey. Appraising and utilising scientific knowledge was the item with a perceived competency deficit, while poor mentor-mentee relationship was considered the foremost challenge that hindered learning outcomes. CONCLUSION: Critical appraisal and utilisation of scientific knowledge should be part of every stage of the African FM trainee's learning experience. To achieve this and other learning outcomes, improving mentor-mentee relationships are essential.

Community perceptions of pre-eclampsia and eclampsia in southern Mozambique.

BACKGROUND: Sub-Saharan Africa has the highest maternal mortality ratio at 500 deaths per 100,000 live births. In Mozambique maternal mortality is estimated at 249-480 per 100,000 live births and eclampsia is the third leading cause of death. The objective of this study was to describe the community understanding of pre-eclampsia and eclampsia, as a crucial step to improve maternal and perinatal health in southern Mozambique. METHODS: This qualitative study was conducted in Maputo and Gaza Provinces of southern Mozambique. Twenty focus groups were convened with pregnant women, partners and husbands, matrons and traditional birth attendants, and mothers and mothers-in-law. In addition, ten interviews were conducted with traditional healers, matrons, and a traditional birth attendant. All discussions were audio-recorded, translated from local language (Changana) to Portuguese and transcribed verbatim prior to analysis with QSR NVivo 10. A thematic analysis approach was taken. RESULTS: The conditions of "pre-eclampsia" and "eclampsia" were not known in these communities; however, participants were familiar with hypertension and seizures in pregnancy. Terms linked with the biomedical concept of pre-eclampsia were high blood pressure, fainting disease and illness of the heart, whereas illness of the moon, snake illness, falling disease, childhood illness, illness of scaresand epilepsy were used to characterizeeclampsia. The causes of hypertension in pregnancy were thought to include mistreatment by in-laws, marital problems, and excessive worrying. Seizures in pregnancy were believed to be caused by a snake living inside the woman's body. Warning signs thought to be common to both conditions were headache, chest pain, weakness, dizziness, fainting, sweating, and swollen feet. CONCLUSION: Local beliefs in southern Mozambique, regarding the causes, presentation, outcomes and treatment of pre-eclampsia and eclampsia were not aligned with the biomedical perspective. The community was often unaware of the link between hypertension and seizures in pregnancy. The numerous widespread myths and misconceptions concerning pre-eclampsia and eclampsiamay induceinappropriatetreatment-seeking and demonstrate a need for increased community education regarding pregnancy and associated complications. TRIAL REGISTRATION: NCT01911494.

Trends and challenges toward integration of traditional medicine in formal health-care system: Historical perspectives and appraisal of education curricula in Sub-Sahara Africa.

The population residing Sub-Sahara Africa (SSA) continues to suffer from communicable health problems such as HIV/AIDS, malaria, tuberculosis, and various neglected tropical as well as non-communicable diseases. The disease burden is aggravated by shortage of medical personnel and medical supplies such as medical devices and minimal access to essential medicine. For long time, human beings through observation and practical experiences learned to use different plant species that led to the emergence of traditional medicine (TM) systems. The ancient Pharaonic Egyptian TM system is one of the oldest documented forms of TM practice in Africa and the pioneer of world's medical science. However, the medical practices diffused very fast to other continents being accelerated by advancement of technologies while leaving Africa lagging behind in the integration of the practice in formal health-care system. Challenging issues that drag back integration is the development of education curricula for training TM experts as the way of disseminating the traditional medical knowledge and practices imbedded in African culture. The few African countries such as Ghana managed to integrate TM products in the National Essential Medicine List while South Africa, Sierra Leone, and Tanzania have TM products being sold over the counters due to the availability of education training programs facilitated by research. This paper analyses the contribution of TM practice and products in modern medicine and gives recommendations that Africa should take in the integration process to safeguard the SSA population from disease burdens.

Community perceptions of pre-eclampsia and eclampsia in southern Mozambique

Background: Sub-Saharan Africa has the highest maternal mortality ratio at 500 deaths per 100,000 live births. In Mozambique maternal mortality is estimated at 249-480 per 100,000 live births and eclampsia is the third leading cause of death. The objective of this study was to describe the community understanding of pre-eclampsia and eclampsia, as a crucial step to improve maternal and perinatal health in southern Mozambique. Methods: This qualitative study was conducted in Maputo and Gaza Provinces of southern Mozambique. Twenty focus groups were convened with pregnant women, partners and husbands, matrons and traditional birth attendants, and mothers and mothers-in-law. In addition, ten interviews were conducted with traditional healers, matrons, and a traditional birth attendant. All discussions were audio-recorded, translated from local language (Changana) to Portuguese and transcribed verbatim prior to analysis with QSR NVivo 10. A thematic analysis approach was taken. Results: The conditions of "pre-eclampsia" and "eclampsia" were not known in these communities; however, participants were familiar with hypertension and seizures in pregnancy. Terms linked with the biomedical concept of pre-eclampsia were high blood pressure, fainting disease and illness of the heart, whereas illness of the moon, snake illness, falling disease, childhood illness, illness of scaresand epilepsy were used to characterizeeclampsia. The causes of hypertension in pregnancy were thought to include mistreatment by in-laws, marital problems, and excessive worrying. Seizures in pregnancy were believed to be caused by a snake living inside the woman's body. Warning signs thought to be common to both conditions were headache, chest pain, weakness, dizziness, fainting, sweating, and swollen feet. Conclusion: Local beliefs in southern Mozambique, regarding the causes, presentation, outcomes and treatment of pre-eclampsia and eclampsia were not aligned with the biomedical perspective. The community was often unaware of the link between hypertension and seizures in pregnancy. The numerous widespread myths and misconceptions concerning pre-eclampsia and eclampsiamay induceinappropriatetreatment-seeking and demonstrate a need for increased community education regarding pregnancy and associated complications.

Safety and Mortality Benefits of Delivering Vitamin A Supplementation at 6 Months of Age in Sub-Saharan Africa.

BACKGROUND: Vitamin A supplementation (VAS) among children 6 to 59 months of age reduces vitamin A deficiency (VAD)-related mortality. Child health days (CHDs) only reach an estimated 16.7% of children at exactly 6 months, leaving uncovered children at risk of VAD-related mortality; similarly, VAS provided at 9 months of age with measles-containing vaccine leaves infants unprotected for 3 months. OBJECTIVE: Using data from sub-Saharan Africa, we estimated the mortality benefits and safety of providing VAS at age 6 months, compared to delivery through CHDs and at 9 months. METHODS: We modeled VAS-preventable mortality benefits at 6 months as a function of published VAS effect sizes, intervention coverage, and proportion of infant deaths occurring between 6 and 11 months. To evaluate safety, we modeled the effect of different VAS coverage scenarios on maximum hepatic vitamin A concentrations (HVACs). RESULTS: VAS linked to a 6-month visit could reduce infant mortality by an additional 1.95 (95% confidence interval [CI]: 1.38-2.52) and 1.63 (95% CI: 1.15-2.11) percentage points compared to VAS through CHDs and at 9 months, respectively. The HVAC models indicate that VAS at 6 months is safe even in the presence of a second VAS dose 1 month later and other food-based vitamin A control strategies. CONCLUSION: Advancing the first VAS dose to 6 months should be considered in settings where VAS is currently given first at 9 months. A 6-month VAS dose should also be considered in settings where VAS is delivered through CHDs. VAS delivery at 6 months could also serve as a platform to deliver other high-impact interventions.