Gabriel Kigen

A study of the medicinal plants used by the Marakwet Community in Kenya

BackgroundThe medicinal plants used by herbalists in Kenya have not been well documented, despite their widespread use. The threat of complete disappearance of the knowledge on herbal medicine from factors such as deforestation, lack of proper regulation, overexploitation and sociocultural issues warrants an urgent need to document the information. The purpose of the study was to document information on medicinal plants used by herbalists in Marakwet District towards the utilization of indigenous ethnobotanical knowledge for the advancement of biomedical research and development.MethodsSemi- structured oral interviews were conducted with 112 practicing herbalists. The types of plants used were identified and the conditions treated recorded.ResultsHerbal practice is still common in the district, and 111 plants were identified to have medicinal or related uses. Different herbal preparations including fruits and healing vegetables are employed in the treatment of various medical conditions. Veterinary uses and pesticides were also recorded.ConclusionThe study provides comprehensive ethnobotanical information about herbal medicine and healing methods among the Marakwet community. The identification of the active ingredients of the plants used by the herbalists may provide some useful leads for the development of new drugs.

A Review of the Ingredients Contained in Over the Counter (OTC) Cough Syrup Formulations in Kenya. Are They Harmful to Infants

Background Cough syrups are widely used in the developing world, but safety of their use in infants and children less than two years has not been well documented. Some syrups contain multiple combinations of such drugs as promethazine, diphenhydramine and ephedrine; which are individually now contraindicated in children less than two years. Despite this, the syrups are available as over the counter drugs and may be dispensed to mothers who are unaware of the potentially hazardous effects to their infants. A descriptive cross-sectional study was used to investigate suitability of cough syrups sold within Eldoret municipality for use in children less than two years of age based on their formulations and available literature. Methods Two semi-structured questionnaires were administered to pharmacy attendants and mothers attending sick child clinic at a referral hospital to establish whether cough syrups containing more than one active ingredient of compounds, now contraindicated in children are administered to infants, and awareness of potential serious adverse effects. Data from labeled contents of cough syrups from retail pharmacies was recorded and corroborated with information from literature to determine those deemed to contain the ingredients. The second questionnaire was administered to mothers with children less than two years to ascertain whether they had used the identified syrups. A total of 260 mothers and 55 pharmacy attendants were interviewed. Results There was widespread use of the syrups in children, including infants, with 192 (74%) of the respondents having used identified syrups and over 90% of these on children less than 2 years including those less than three months.146 (76%) mothers had administered the syrup at double the recommended dose. Conclusion The regulatory authorities should make concerted efforts to discourage use of cough syrups containing ingredients that pose adverse events to infants, including campaigns to educate pharmacy workers and mothers.

Screening by Clinical Breast Examination in Western Kenya: Who Comes?

Purpose More than 80% of women with breast cancer in Kenya present to medical care with established late-stage disease. We sought to understand why women might not participate in breast cancer screening when it is offered by comparing the views of a cohort of those who attended a screening special event with those of community controls who did not attend. Methods All residents living close to three health centers in western Kenya were invited to participate in screening. Participants (attendees) underwent clinical breast examination by trained physician oncologists. In addition, women who consented were interviewed by using a modified Breast Cancer Awareness Module questionnaire. Nonattendees were interviewed in their homes the following day. Results A total of 1,511 attendees (1,238 women and 273 men) and 467 nonattendee women participated in the study. Compared with nonattendees, the women attendees were older, more often employed, knew that breast cancer presented as a lump, and were more likely to have previously felt a lump in a breast. In addition, they were more likely to report previously participating in screening activities, were more likely to have performed breast self-examination, and were less concerned about wasting a doctor’s time. Almost all those surveyed (attendees and nonattendees) expressed interest in future breast cancer screening opportunities. Conclusion The women who volunteer for breast cancer screening in western Kenya are more aware of breast cancer than those who do not volunteer. Screening recruitment should seek to close these knowledge gaps to increase participation.

Palmar-plantar erythrodysesthesia associated with capecitabine chemotherapy: a case report.

We report a case of a 62 year-old patient who developed Palmar-plantar erythrodysesthesia upon receiving four cycles of capacitabine-based chemotherapy. She was on post surgical adjuvant treatment for invasive well differentiated adenocarcinoma of the colon. The clinical and therapeutic aspects of this chemotherapeutic adverse effect are discussed.

Collateral benefits arising from mass administration of azithromycin in the control of active trachoma in resource limited settings.

Introduction The benefits of the use of antibiotics in the mass treatment for active trachoma and other diseases have been documented, but the secondary effects arising from such a programme have not been fully elucidated. The purpose of this study was to investigate the potential secondary benefits arising from the use of azithromycin in mass treatment of active trachoma in an economically challenged Kenyan nomadic community. Methods Health information reports for January 2005 to December 2010 were reviewed to determine the annual trends of infectious diseases in the two districts, Narok and Transmara. The year 2007 was considered as the baseline for mass drug administration (MDA). Odds ratios (OR) were used to describe the association. Results The mass distribution coverage in Narok was 83% in 2008, 74% in 2009 and 63% in 2010. The odds for malaria (OR = 1.13; 95% CI 1.12-1.14), diarrhoeal diseases (OR = 1.04; 95% CI 1.01-1.06), urinary tract infections (UTIs) (OR = 1.21; 95% CI 1.17-1.26), intestinal worms (OR, 4.98; 95% CI 4.68-5.3), and respiratory diseases other than pneumonia (OR, 1.15; 95% CI 1.13-1.16) were higher after three rounds of mass treatment, indicating a better outcome. Before the intervention, there was a reducing trend in the odds for respiratory diseases. In Transmara (control), there was an increase in odds for malaria, respiratory infections, UTIs and intestinal worms. The odds for diarrhoeal diseases, skin diseases and pneumonia decreased throughout the study period. Conclusion Mass distribution of azithromycin may have contributed to the decrease in the prevalence of the respiratory infections in Narok District.

Ethnomedicinal Plants Traditionally Used by the Keiyo Community in Elgeyo Marakwet County, Kenya

Objective:Traditional medicinal plants have long been used to treat various ailments in Keiyo district. However to date there are no records on medicinal plants used by the Keiyo despite threats of rapid disappearance of indigenous knowledge from deforestation, overexploitation among other factors. The purpose of the study was to document medicinal plants used by the Keiyo community in order to preserve traditional medical knowledge for future research and potential development of new drugs. Methods:The research team comprised of professionals from the fields of medicine and botany. Local leaders, community elders, church leaders and other stakeholders were used to identify herbalists and convince them to provide information. Semi structured interviews, group discussions and observations were used to collect information on traditional knowledge from herbalists. Details of the medical conditions treated, herbal preparations used, treatment methods, local plant names and methods of collection of herbs were recorded. Results:A total of 73 medicinal plant species belonging to 33 families were identified, used to treat 46 common human and three veterinary diseases. Leucas calostachys was the most widely used (17 medicinal uses) followed by Vachelia xanthophloea (10), Carissa edulis (9), Trimeria grandifolia (8), Terminalia brownii (7) and Rhamnus prinoides (6). Heartburn was treated using the largest number of plants (17) followed by cancer (9). Eight plants were used to either treat infertility in women or arthritis, whereas peptic ulcers, hypertension, headache, chest congestion and colic pains were each treated using seven plants. Conclusions:The study provides information on medicinal and healing methods used by the Keiyo community. It also revealed that traditional medicines are still widely used in Keiyo district. Some of the identified plants have been demonstrated to possess pharmacological activities related to those mentioned by the herbalists.

Randomized Phase IIA Trial of Gemcitabine Compared With Bleomycin Plus Vincristine for Treatment of Kaposi’s Sarcoma in Patients on Combination Antiretroviral Therapy in Western Kenya

Purpose Kaposi’s sarcoma (KS) is a spindle cell tumor resulting from growth dysregulation in the setting of infection with human herpes virus-8 (also called KS herpes virus). Advanced KS is characterized by poor responses to antiretroviral therapy and some of the chemotherapy readily accessible to patients in low-resource areas. Gemcitabine induced partial and complete regression of AIDS-associated KS (AIDS-KS) in 11 of 24 patients in a pilot study. The current study compares the antimetabolite gemcitabine with the standard care bleomycin and vincristine (BV) in the treatment of chemotherapy-naïve patients with AIDS-KS in a resource-limited setting. Patients and Methods Patients with persistent or progressive KS despite treatment with combined antiretroviral therapy were randomly assigned to receive gemcitabine 1,000 mg/m2 or bleomycin 15 IU/ m2 and vincristine 1.4 mg/m2 given twice weekly. The main end point was objective response by bidirectional measurement, adverse events, and quality of life after three cycles of chemotherapy. Results Of 70 participants enrolled, 36 received gemcitabine and 34 received BV. Complete response was achieved in 12 patients (33.3%) in the gemcitabine arm and six (17.6%) in the BV arm (P = .175). The partial response rate was 52.8% (n = 19) in the gemcitabine arm and 58.8% (n = 20) in the BV arm. Both study arms reported similar neurologic and hematologic adverse events; there was statistically significant baseline to post-treatment improvement in health-related quality-of-life scores. Conclusion The results of this randomized, phase IIA trial demonstrate gemcitabine activity in chemotherapy-naïve patients with AIDS-KS, on the basis of response rates, adverse events, and health-related quality-of-life scores.

Reversal of tenofovir induced nephrotoxicity: case reports of two patients

The use of the antiretroviral drug tenofovir has been associated with nephrotoxicity. However, the overall impact of this adverse effect has not comprehensively evaluated. Some researchers have reported that it is quite severe to warrant monitoring for renal toxicity, while others have concluded that the magnitude may not be that significant. We report two clinical cases seen in our renal clinic with high creatinine levels suggestive of nephrotoxicity who reverted back to normality upon withdrawal of tenofovir.

Medicinal plants used by traditional healers in Sangurur, Elgeyo Marakwet County, Kenya

Background: Although herbal medical products are still widely used in Kenya, many of the medicinal plants used by traditional medical practitioners (TMPs) have not been documented, despite several challenges that are now threatening the sustainability of the practice. Objective: To document the medicinal plants and healing methods used by TMPs in a region of Kenya with several recognized herbalists for potential research. Materials and Methods: Semi-structured interviews, group discussions, and direct observations were used to collect ethnopharmacological information. The participants bio-data, clinical conditions treated, methods of treatment, medicinal plants used, methods of preparation and administration, and dosage forms were recorded. Results: A total of 99 medicinal plants and 12 complementary preparations employed in the treatment of 64 medical conditions were identified. The most widely used plant was Rotala tenella which was used to treat nine medicinal conditions; seven each for Aloe tweediae and Dovyalis abyssinica; and six each for Basella alba and Euclea divinorum. The plants belonged to 55 families with Fabaceae family being the most frequently used (10), followed by Apocynaceae and Solanaceae, each with six species, respectively. We identified plants used to determine the sex of an unborn baby and those used to treat several conditions including anthrax and cerebral malaria and herbs used to detoxify meat from an animal that has died from anthrax. Of special interest was R. tenella which is used to prevent muscle injury. Conclusions: We have documented several plants with potential therapeutic effects. Further research may be conducted to determine their efficacy. Abbreviations Used: Fic: Informant consensus factor, Nur: Number of use reports in each category, Ns: Number of reported species, TMPs: Traditional medical practitioners.

Early neurosyphilis presenting with facial palsy and an oral ulcer in a patient who is human immunodeficiency virus positive: a case report

BackgroundNeurosyphilis is the tertiary stage of Treponema pallidum infection that involves the central nervous system, which occurs within days or weeks after an initial syphilis infection, especially in immunocompromised patients. The diagnosis of neurosyphilis is quite challenging as it is uncommon and often presents with obscure symptoms since any organ system may be involved.Case presentationWe describe a case of a 40-year-old African man who is human immunodeficiency virus positive with early neurosyphilis who presented with a stiff neck, headache, confusion, restlessness, and a left-sided chest pain; he did not respond to an empiric treatment of ceftriaxone and fluconazole for meningitis, and tramadol for headache. Ten days after admission, he developed generalized tonic–clonic convulsions; on examination he had ipsilateral facial nerve palsy and an oral ulcer, and responded well to benzathine penicillin treatment.ConclusionsLaboratory diagnosis of neurosyphilis is challenging because to date there is no single laboratory test which is considered sensitive enough for diagnosis of the disease, especially in resource-limited settings. Clinical judgment is still an important part of diagnosis; and neurosyphilis should be considered a diagnostic differential in patients with Human Immunodeficiency Virus presenting with central nervous system involvement and in other high-risk patients.