Prevalence and Predictors of Gestational Diabetes Mellitus in Sub-Saharan Africa: A 10-Year Systematic Review.

BACKGROUND: Gestational diabetes mellitus (GDM) remains a global public health problem, which affects the well-being of mothers and their children in sub-Saharan Africa (SSA). Studies conducted in different geographical areas provide varied results on its prevalence and predictors. Understanding the extent and predictors of GDM in SSA is important for developing effective interventions and policies. Thus, this review aimed to investigate the prevalence of GDM and its predictive factors in sub-Saharan Africa. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards in this review. An extensive search of the PubMed, Web of Sciences and EMBASE databases was carried out covering papers from 2012 to 2022 to assess the prevalence and predictors of GDM. Microsoft Excel 2019 was utilised for study management. GraphPad Prism Version 8.0 and the MedCalc statistical software were employed for data analysis. The findings were analysed using textual descriptions, tables, forest plots and heat maps. RESULTS: Using 30 studies with 23,760 participants that satisfied the inclusion criteria, the review found the overall prevalence of GDM in SSA to be 3.05% (1.85%-4.54%). History of preterm delivery, alcohol consumption, family history of diabetes, history of stillbirths, history of macrosomia, overweight or obesity and advanced mother age were all significant predictors of gestational diabetes. Additionally, various biomarkers such as haemoglobin, adiponectin, leptin, resistin, visfatin, vitamin D, triglycerides and dietary intake type were identified as significant predictors of GDM. CONCLUSION: In sub-Saharan Africa, there is a high pooled prevalence of gestational diabetes mellitus. In the light of the predictors of GDM identified in this review, it is strongly recommended to implement early screening for women at risk of developing gestational diabetes during their pregnancy. This proactive approach is essential for enhancing the overall well-being of both mothers and children.

Evaluating circulating soluble markers of endothelial dysfunction and risk factors associated with PE: A multicentre longitudinal case control study in northern Ghana.

Serpin E1/PAI-1, N-terminal pro-brain natriuretic peptide (NTpro-BNP) and neuropilin-1 are markers which have been associated with endothelial dysfunction. However, data on the levels of these markers in PE is limited. The limited data on the pathophysiology of PE in relation to these markers necessitated the study. This was a multicentre case-control study conducted at the Obstetrics and Gynaecology Department of the Tamale Teaching Hospital, the Bawku Presbyterian Hospital and the Bolgatanga Regional Hospital. Out of 520 consenting pregnant women, 127 pregnant women met the inclusion criteria (53 with PE and 74 controls) and were included in this study. Venous, placental, cord and peripheral blood were collected for biomarker assay, haematological parameters and placental parasite determination. Placental tissue sections were obtained for placental malaria and histopathological lesions associated with hypoperfusion. Maternal heart rate and foetal umbilical artery Doppler impedance indices; resistance index (RI) and systolic diastolic (SD) ratio were determined to confirm utero-placental hypoperfusion. Significantly higher proportions of foeto-maternal complications; eclampsia, low birth weight (LBW), neonatal intensive care unit admissions (NICU), intrauterine growth restriction (IUGR), caesarian deliveries and early gestational age at delivery were associated with PE. Women with PE had lower concentrations of platelet (p = 0.02) whereas red cell distribution width (RDW) was markedly elevated (p = 0.01). NTPro-BNP concentration was markedly elevated (p = 0.01) in women with PE whereas neuropilin-1 concentration was lower (p = 0.03) compared to the non-PE group. Maternal heart rate was elevated in women with PE and Doppler resistance indices (RI and SD) were significantly elevated in foetuses of PE women than foetuses of the controls. Placental mal-perfusion lesions were higher in women with PE compared to the non-PE group. Women with PE had increased risk of adverse foeto-maternal complications, significantly associated with placental mal-perfusion lesions, had reduced platelet concentration and elevated RDW-CV levels. NTPro-BNP, RI and SD are elevated in women with PE whereas neuropilin-1 concentration is reduced. Significant changes in these pathological variables in PE women is indicative of significant derangement in endothelial function culminating in adverse maternal and perinatal outcomes of pregnancy.

Luteolin normalizes blood pressure via its antioxidant activity and down-regulation of renal Angiotensin II receptor and Mineralocorticoid receptor expressions in rats co-exposed to Diclofenac and sodium fluoride.

This study was designed to investigate the modulatory role of Luteolin (Lut), a flavonoid phytochemical, on haemodynamic parameters and the potential mechanisms involving renal Angiotensin II (AT2R) and Mineralocorticoid (MCR) receptors in renal toxicity induced by co-exposure to Diclofenac (Dcf) and sodium fluoride (NaF) in rats.Male Wistar rats were administered with either vehicle (control), Dcf only (9 mg/kg orally) or concurrently with NaF (300 ppm in drinking water). Other groups were treated with LutA (100 mg/kg) or LutB (200 mg/kg) along with Dcf and NaF exposures. All treatments lasted 8 days, following which blood pressure indices were measured using tail-cuff plethysmography. Renal expressions of AT2R and MCR were studied with immunohistochemistry, while biomarkers of oxidative and antioxidant status were also measured in the kidneys. Systolic, diastolic and mean arterial pressures were significantly (p<0.05) reduced in Dcf-treated rats, compared to control values. However, co-treatment with NaF or Lut restored these parameters. While the expression of AT2R and MCR was high in the Dcf and Dcf+NaF groups, treatment with Lut caused obvious reduction in the renal expression of these receptors. Increased lipid peroxidation (Malondialdehyde) and protein oxidation (protein carbonyls) with a lowering of reduced glutathione levels contributed to the renal toxicity of Dcf, and these were significantly ameliorated in Lut-treated rats. In conclusion, the preservation of haemodynamic indices by Lutin the experimental ratsprobably included mechanisms involving down-regulation of renal expressions of AT2R and MCR, reduction of oxidative stress and an improvement of renal antioxidant status.

Hura crepitans stem bark extract: A potential remedy to sub-acute liver damage.

ETHNOPHARMACOLOGICAL SIGNIFICANCE AND AIM: Hura crepitans is commonly used to treat liver diseases in Nigeria and Ghana. Previous studies have supported its ethnomedicinal use in protecting the liver. The present study aimed at assessing the effect of H. crepitans stem bark on the subacute carbon tetrachloride (CCl4)-induced liver damage in rats. MATERIALS AND METHODS: The protective activities of ethanolic extract of H. crepitans stem bark was evaluated in CCl4-induced subacute liver damage in rats (1:1 v/v in olive oil, intraperitoneally (i.p.), twice weekly for 8 weeks). Blood samples were obtained from the rats and used for some biochemical analysis such as liver function test (Aspartate transaminase, AST; Alanine aminotransferase, ALT; and Alkaline phosphatase, ALP), liver fibrotic indices (Aspartate platelet ratio index, APRI; AST/ALT and AST/PLT ratios) and oxidative stress markers (Malondialdehyde, MDA; Reduced glutathione, GSH; Glutathione S-transferase, GST; Glutathione peroxidase, GPx; and superoxide dismutase, SOD). Histopathological analyses were carried out to determine the expression of pro-inflammatory (NF-κB, COX-2, IL-17 and IL-23) using immunohistochemical techniques. RESULTS: Oral administration of H. crepitans to CCl4-induced hepatic injured rats significantly decreased oxidative stress, increased the levels of SOD, GSH, GST and GPx with reduced MDA levels. The plant also mitigated liver injury as evidenced in the significantly reduced levels of AST, ALT and ALP, while it inhibited the inflammatory process via the inhibition of NF-κB, and consequently down-regulateed the pro-inflammatory cytokines COX-2, IL-17 and IL-23, respectively. Biochemical observations were supported by improvement in liver microarchitecture. CONCLUSION: The Hura crepitans demonstrated antioxidant, antiinflammatory and antifibrotic effect in hepatic injured rats. The study in a way justifies the traditional use of the plant for the treatment of subacute liver diseases in Nigerian Traditional medicine.

Modulation of Oxidative Stress and Inflammatory Cytokines as Therapeutic Mechanisms of Ocimum americanum L Extract in Carbon Tetrachloride and Acetaminophen-Induced Toxicity in Rats.

Liver diseases have now become a global canker due to increasing drug abuse and several viral infections. The current medicines on the market are woefully inadequate and limited in the application against these diseases. Fortunately, medicinal plants continue to serve as a potential source of drug discovery that could be explored to improve the situation. The present study, therefore, evaluated the hepatoprotective activities of the aqueous extract of various parts (leaves, flower and stem) of Ocimum americanum L on carbon tetrachloride (CCl4)- and acetaminophen-induced toxicity in rats. The protective effect of the plant was assessed using biochemical parameters, histology, levels of liver antioxidants, and expression of some pro-inflammatory cytokines (NF-κß and IL-1) in the liver. The leaves and stem extracts, orally administered for 7 days at 250 mg/kg, effectively prevented CCl4-induced elevation of serum biochemical parameters, prooxidants, as well as the expression of NFk-B and IL-1, which were comparable to Silymarin (standard drug). A comparative histopathological analyses of the liver exhibited virtually normal architecture compared with CCl4-treated group. The findings showed that the hepatoprotective effect of Ocimum americanum was probably due to the inhibition of oxidative stress and downregulation of proinflammatory cytokines by the effective parts of the medicinal plant.

Palm Weevil Larvae (Rhynchophorus phoenicis Fabricius) and Orange-Fleshed Sweet Potato-Enriched Biscuits Improved Nutritional Status in Female Wistar Albino Rats.

Edible insects have emerged as an inexpensive alternative source of protein for reducing the burden of malnutrition worldwide. However, there is a dearth of evidence on its efficacy, and thus, the aim of this study was to investigate the effect of edible insect consumption on the nutritional status of female Wistar albino rats. The study assessed the subchronic effect of palm weevil larvae (PWL) and orange-fleshed sweet potato- (OFSP-) enriched biscuits (fortified biscuits (FB), plain biscuits (PB), biscuits fortified with PWL (PWB), and biscuits fortified with OFSP only (SPB)) as a model to predict the potential of PWL to improve the nutritional status of pregnant women in Ghana. Twenty-five female Wistar albino rats were randomly assigned to five experimental groups to receive one of the five feed supplements for 28 days. After which, the effects of treatment on haematological and biochemical parameters including lipid profile were assessed. No significant differences were observed with haematological (Hb) parameters. However, total cholesterol levels of the FB, PB, PWB, and SPB were significantly higher than in the N group. Apart from elevated total cholesterol concentrations, biscuits fortified with PWL had no adverse effects and can be a nutritious snack for maintaining acceptable HB levels.

Evaluation of the Acute Hepatoprotective Potential of Hydroethanolic Extract of Duranta erecta L. Parts.

Liver disease is a major health problem and its treatment is costly in most developing countries with attendant adverse effects. This study aimed at determining the acute hepatoprotective efficacy of Duranta erecta hydroethanolic extracts of leaves, ripe and unripe fruits against CCl4-, and acetaminophen-induced hepatotoxicity in animals. Materials and Methods. CCl4 (1 mL/kg body weight in olive oil) and acetaminophen (500 mg/kg b.wt) were used to induce hepatotoxicity in the animals. Animals were treated with extracts at 250 mg/kg b.wt and standard drug, silymarin (100 mg/kg), for 7 days. Hepatoprotective efficacy was assessed by assaying serum biochemical markers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (γGT), bilirubin (Bil), antioxidative biomarkers including reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione transferase (GST), superoxide dismutase (SOD), malondialdehyde (MDA), hydrogen peroxidase (H202), and nitric oxide (NO), as well as histological observations. Results. Exposure of the animals to CCl4 and acetaminophen resulted in liver injury as evidenced by elevated ALT, AST, ALP, γGT, Bil, MDA, H2O2, and NO levels with resultant derangement in liver microarchitecture. Pretreatment with hydroethanolic extracts, particularly ripe fruits of Duranta erecta, led to a reduction in these indicators and an increase in GSH, GPx, GST, and SOD levels. Biochemical data were supported by improvement in liver structure. Conclusion. The findings suggest that hydroethanolic Duranta erecta ripe fruits extract possesses hepatoprotective and antioxidative activities against CCl4- and acetaminophen-induced toxicity and could be developed as a potent agent for drug-induced liver diseases.

Phytochemical, Antimicrobial, and Antioxidant Profiles of Duranta erecta L. Parts.

The use of plant-based medicine is popular amongst individuals and communities in developing countries. Duranta erecta has been used in Africa and Asia to treat a wide range of diseases. This study evaluated the phytochemical profile and antioxidant and antimicrobial activities of D. erecta to ascertain its health benefits in traditional medicine. Phytochemical constituents and antimicrobial effect of the hydroethanolic extract of D. erecta leaves (DRL), unripe fruits (DRU), and ripe fruits (DRR) were investigated by standard methods. Elemental analyses were carried out by atomic absorption spectroscopy (AAS) on the raw sample and extract. FTIR and UV-VIS spectroscopy were used to identify functional groups. Extracts were screened for their possible antioxidant activities by three tests. The total phenolic and total tannin contents were evaluated by using the Folin-Ciocalteu method. Total flavonoid content was determined by the aluminium chloride colorimetric assay method. The antioxidant activities were evaluated using the DPPH scavenging activity. The results of phytochemical screening showed the presence of triterpenoids, sterols, alkaloids, flavonoids, saponins, glycosides, and tannins. FTIR analysis revealed the presence of alcohols, phenols, alkanes, aldehydes, ketones, aromatics, aliphatic amines, aromatic amines, amides, carboxylic acids, esters, nitro compounds, alkynes, primary and secondary amines, and alkyl halides. Iron, zinc, and copper were also detected. Total phenolic and tannin contents ranged from 2.20 ± 0.15 to 14.54 ± 0.29 mg gallic acid equivalent (GAE)/100 g and 3.55 ± 0.07 to 13.82 ± 0.04 mg GAE/100 g, respectively. Total flavonoid content varied from 41.76 ± 0.96 to 343.49 ± 3.45 µg quercetin equivalent (QE)/100 g. The highest DPPH scavenging activity was recorded in the methanolic fraction of the leaves. The antimicrobial assay of the extract or fractions recorded no activity against the test organisms. The outcome of this study affirmed that D. erecta contains phytochemicals and bioactive compounds that could be of health benefit.

Phytochemical and Safety Evaluation of Hydroethanolic Leaf Extract of Tecoma stans (L.) Juss. ex Kunth.

Tecoma stans (yellow bell) is a popular ornamental plant mostly found in the tropical regions. It is reported to have significant pharmacological activity and has gained attention by natives of various cultures. This study focused on the phytoconstituents screening, antioxidant activity, and heavy metal analysis as well as the acute and subchronic toxicity of the hydroethanolic leaf extract (TSE) using standard methods. The presence of flavonoids, alkaloids, cardiac glycosides, saponins, coumarins, and terpenoids in the raw leaf of the plant was observed while the hydroethanolic extract contained coumarins, saponins, cardiac glycosides, and flavonoids. The DPPH percentage scavenging activity of the crude extract was 64.32% while the fractions, ethyl acetate (55.26%), methanol (60.72%), and hydro (36.97%.), gave varying activities. The UV-Vis and FT-IR indicated the presence of alcohols, phenols, alkanes, alkenes, carbonyls (general), aliphatic amines, aromatics, ketones, ethers, esters, carboxylic acids, alkyl halides, saturated aliphatic acids, 1° and 2° amines, amides, and α,ß-unsaturated aldehydes. The heavy metal analysis showed a high level of iron (Fe) and zinc (Zn) in the raw leaf. The median acute toxicity (LD50) of the extract was determined to be <5000mg/kg body weight in mice. Subchronic use for 28 days resulted in significant weight gain, reduction in platelet levels, decrease in WBCs, and increase in blood glucose compared to the normal. TSE caused no adverse effects on vital organs. No mortality was recorded. The hydroethanolic extract of T. stans could therefore be considered safe in moderate doses.

Prevalence and Determinants of Diabetic Foot Ulcers and Lower Extremity Amputations in Three Selected Tertiary Hospitals in Ghana.

BACKGROUND: The occurrence and complications of diabetes are increasing worldwide. This study examined the prevalence and determinants of diabetic foot ulcers and lower extremity amputations in three selected tertiary hospitals in Ghana. METHODS: A cross-sectional multicenter study involving 100 subjects was carried out. Subjects were selected through simple random sampling from three selected tertiary hospitals in Ghana. A structured questionnaire was used to document information on sociodemographic, medical history, lifestyle, and physical characteristics of subjects. Foot ulcers and lower extremity amputations were also investigated. Total cholesterol, triglycerides, low-density lipoproteins, high-density lipoproteins, serum urea, serum creatinine, and estimated glomerular filtration rate of subjects were assessed. Data analysis was done using SPSS version 22. RESULTS: The study revealed that 31% and 69% were males and females, respectively, with a mean age of 53.8 ± 13.8 years. Among the patients, 11% had diabetic foot ulcers whilst 3% had lower extremity amputations. In the multivariate binary logistic regression analysis, previous history of foot ulcers (OR = 40.4, 95% CI = 5.5-299.9) and foot deformities (OR = 14.4, 95% CI = 1.3-161.2) were identified as independent predictors of diabetic foot ulcers. Foot deformity (p = 0.043) and serum urea (p = 0.002) were associated with diabetic lower extremity amputations in the univariate analysis. CONCLUSION: This study showed that the prevalences of diabetic foot ulcers and lower extremity amputations are high among diabetes patients. Foot deformities and previous history of foot ulcers are determinants of diabetic foot ulcers. Foot deformity and serum urea are associated with diabetic lower extremity amputations.

Geophagia, nutrition and health of women with pregnancy-induced hypertension.

BACKGROUND: Calcium is a major nutrient implicated in pregnancy-induced hypertension (PIH). Aside dietary sources, geophagia has been reported to provide calcium needed to prevent PIH. These soils are shown to contain significant amount of heavy metals which have been associated with hypertension. OBJECTIVE: The aim of this study was to determine the relationship between geophagia and PIH, assess the dietary intakes and health of participants. METHODS: This study was a case-control involving 30 women with PIH and 70 normotensive pregnant women. RESULTS: Geophagia was not significantly associated with PIH. Women with PIH practicing geophagia recorded significantly low levels of haemoglobin, calcium and ferritin. Hypertensives recorded impaired fasting blood glucose (5.77±1.71mmol/L, p=0.051), higher levels of urea (3.60±1.29 mmol/L, p=0.000) and creatinine (382.67±11.66 µmol/L, p=0.000). Percentage intakes of macronutrients for normotensives were within the Adequate Macronutrient Distribution Range and PIH group recorded higher intakes of carbohydrate (72.75±16.16 %), lower protein (9.77±5.61 %) and fat (17.15±11.99%). Dietary calcium intakes in both groups were lower than recommended (< 1,000 mg/day). CONCLUSION: In this study, geophagia during pregnancy is not directly associated with PIH but is detrimental to maternal health. The pregnant women in this study had considerably low intakes of energy and nutrients. There is a need for measures to ensure adequate maternal nutrition for a positive health and pregnancy outcomes.

Pica practice among pregnant women in the Kumasi metropolis of Ghana.

Pica, an eating disorder in which non-nutritional objects are frequently eaten, has negative health implications. Despite this, pica is less studied in many African communities where it is believed to be highly prevalent. This study therefore sought to determine the prevalence of pica and its various forms among pregnant women in Kumasi, Ghana, and the effects of education and place of residence (rural and urban) on pica practice. A random sample of pregnant women (n = 400) in rural and urban areas of Kumasi were interviewed using a questionnaire-based survey in 2008 and repeated in 2009. The results showed 47.0% of the pregnant women practising pica. Pagophagia accounted for 41.0%, followed by geophagia (29.8%), amylophagia (7.4%), plumbophagia (6.4%), and trichophagia (3.7%). Among the rural dwellers, 47.7% of the pregnant women practised pica during their pregnancies while 46.4% of the urban pregnant women engaged in the practice. Age and level of education did not significantly affect the practice of pica (P = 0.053 and P = 0.142 respectively). Also, 17.4% of the respondents identified a family member practising pica. Pica is therefore highly prevalent in pregnant women in Kumasi, with pagophagia and geophagia being the predominant types of pica.