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Reported symptoms, treatment regimens and sources of antibiotics and herbal medications. (A) Duration of reported symptoms of fever, aching limbs, stomach cramps, dysentery, diarrhoea, rash, and vomiting. (B) Treatment
Source publication
Acute gastroenteritis (AGE) is the highest cause of mortality worldwide in children under the age of 5 years, with the highest mortalities occurring in low-to-middle income countries. Treatment can involve use of unregulated herbal medication and antibiotics. A cross sectional study was carried out to investigate the use of antibiotics and traditio...
Contexts in source publication
Context 1
... plant leaves, stem or root prescriptions reported by the respondents for management of AGE were re-confirmed by traditional herbalists and locally sourced in Kwara, Nigeria (S1 Table and S1 Fig) between October and December 2020. Plants were taxonomically confirmed and identified at the Plant Biology Herbarium, University of Ilorin, Ilorin, Nigeria. ...
Context 2
... of gastroenteritis such as diarrhoea (17%), dysentery (10.8%), vomiting (9.6%), fever (19.1%) and stomach cramps (18.1%) as well as non-specific symptoms such as joint aches (18.2%) were reported in over 90% of respondents that participated in this study, and these symptoms lasted a range of durations of 1-31 days ( Fig 1A). To investigate the management of AGE within the community, we assessed the treatment regimens reported by the respondents (Fig 1B and Table 1). ...
Context 3
... investigate the management of AGE within the community, we assessed the treatment regimens reported by the respondents (Fig 1B and Table 1). Overall, a greater proportion of respondents (54.6%) took antibiotics, while 42.5% took herbal medication ( Fig 1B). Furthermore, approximately 19% of the respondents combined the use of antibiotics and herbal medication and 23% used no medication. ...
Context 4
... the respondents who used antibiotics in the treatment of the symptoms of gastroenteritis reported, self-prescription of antibiotics (21.7%) was significantly higher than prescriptions given by pharmacists (15.2%) or undisclosed sources (9.7%) ( Fig 1C). Our data further showed that, as the age of respondents increased, there was a decrease in reliance on prescription of antibiotics by a doctor. ...
Context 5
... data further showed that, as the age of respondents increased, there was a decrease in reliance on prescription of antibiotics by a doctor. Consistent with this, of the respondents who used herbal medicines in the treatment of the reported symptoms of gastroenteritis, self-prescription tended to increase with age but this was not statistically significant ( Fig 1D). Formulation of traditional and herbal medicine is often undertaken by herbalists and the use of such remedies often relies on self-prescription. ...
Context 6
... 13.8%), healthcare workers (~1%), and undisclosed sources (i.e. no response, 21.2%; Fig 1E and Table 1). Furthermore, our data also showed that as the age of respondents increased, there was an increase in self-prescription and decrease in dependence on family and friends (i.e. ...
Context 7
... our data also showed that as the age of respondents increased, there was an increase in self-prescription and decrease in dependence on family and friends (i.e. others) for prescription among respondents ( Fig 1F). ...
Context 8
... this report, we sought to investigate the impact of the unregulated use of herbal plants on AGE using in vitro assays to assess the antibacterial effects of ethanolic extracts of some of the reported plants. These were sourced from local traditional herbalists and taxonomically identified (S1 Table and S1 Fig). Gram positive (S. ...
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Citations
... The NTS typically presents as an acute onset of fever, abdominal pain, diarrhoea, nausea and sometimes vomiting, while the illness may last for 2-7 days [2]. In response to such acute self-limiting gastrointestinal illnesses, the households, particularly the poor in the rural and peri-urban households, and where healthcare services are hard to reach, primarily resort to habitual use of antibiotics and herbal medication, with high levels of self-prescription compared to antibiotic prescriptions that originate through the pharmacists [39]. In particular, metronidazole, tetracycline, amoxicillin, ampicillin or the Amplicox (a combination of ampicillin and cloxacillin) have been reported to be regularly abused [39]. ...
... In response to such acute self-limiting gastrointestinal illnesses, the households, particularly the poor in the rural and peri-urban households, and where healthcare services are hard to reach, primarily resort to habitual use of antibiotics and herbal medication, with high levels of self-prescription compared to antibiotic prescriptions that originate through the pharmacists [39]. In particular, metronidazole, tetracycline, amoxicillin, ampicillin or the Amplicox (a combination of ampicillin and cloxacillin) have been reported to be regularly abused [39]. In view of these observation, cases of NTS at the healthcare facilities may have been grossly underreported as only more serious cases may get to the hospital. ...
... It should be understood that most of these category of farmers reside in the rural and peri-urban often unplanned areas, and public health facilities may be inadequate or hard to access, there are imbalanced ratio of health workers to patients at such facilities, and the direct and indirect costs to patients may be relatively higher [43]. These may be directly linked to findings in the study of Adeyemi et al. [39] where households regularly self-medicate using antibiotics and herbal medication, based on options of patients and household to adopt alternative cheaper healthcare measures due to impoverishment, with consequent contribution to underreporting and underestimation of cases of NTS in Nigeria [13,43]. Secondly, although NTS is perceived as a disease of livestock, especially poultry, in view of the different serotypes of Salmonella enterica subsp. ...
Background:
The non-typhoidal salmonellosis (NTS) is a pathogenic bacterial zoonosis with substantial but often under-appreciated public health impacts. The NTS is prevalent in poultry and humans in Nigeria, yet its economic and social burden have not been determined through any empirical study. To bridge the gap, we evaluated the impact of NTS in social and economic terms.
Methods:
Relevant population, economic and epidemiological data were retrieved from peer-reviewed publications, open sources and relevant authorities. Additional data were obtained through experts' opinions and field surveys. Using a customized and validated Microsoft Excel® tool, economic analysis was conducted.
Results:
Using the year 2020 reference point, the burden of NTS was 325,731 cases and a total of 1043 human deaths, at a disability-adjusted life year (DALYs) of 37,321. The cost associated with infection in humans was US$ 473,982,068. A total loss of US$ 456,905,311 was estimated in poultry including the direct value of animal loss, US$ 224,236,769, loss from salvage slaughter and culling, US$ 220,386,556, and value of foregone production, US$ 12,281,987.
Interpretation:
The outcomes of this important work provide empirical evidence to support informed decisions and investments in the control and eradication of human and poultry salmonellosis (NTS) in Nigeria.
... In Africa, some commonly used herbs for the treatment of acute gastroenteritis include extracts of the neem tree (A. indica) and E. africana (Adeyemi et al., 2021). A commonly used herbal treatment in China is the Gengen Huangqin Huanglian Decoction (GHHD) (Wu et al., 2020). ...
Infants, children, and adolescents are at risk of experiencing a multitude of gastrointestinal disorders (GID). These disorders can adversely affect the quality of life or be life-threatening. Various interventions that span the conventional and complementary therapeutic categories have been developed. Nowadays, parents increasingly seek complementary options for their children to use concurrently with conventional therapies. Due to the high prevalence and morbidity of diarrhea, constipation, and irritable bowel syndrome (IBS) in children, in this review, we decided to focus on the current state of the evidence for conventional and complementary therapies used for the treatment of these diseases in children. Diarrhea treatment focuses on the identification of the cause and fluid management. Oral rehydration with supplementation of deficient micronutrients, especially zinc, is well established and recommended. Some probiotic strains have shown promise in reducing the duration of diarrhea. For the management of constipation, available clinical trials are insufficient for conclusive recommendations of dietary modifications, including increased use of fruit juice, fiber, and fluid. However, the role of laxatives as conventional treatment is becoming more established. Polyethylene glycol is the most studied, with lactulose, milk of magnesia, mineral oil, bisacodyl, and senna presenting as viable alternatives. Conventional treatments of the abdominal pain associated with IBS are poorly studied in children. Available studies investigating the effectiveness of antidepressants on abdominal pain in children with IBS were inconclusive. At the same time, probiotics and peppermint oil have a fair record of benefits and safety. The overall body of evidence indicates that a careful balance of conventional and complementary treatment strategies may be required to manage gastrointestinal conditions in children.
... Some herbal medicines that were sold in Ilorin, Kwara State and Lagos State were reported to be contaminated with heavy metals and bacteria of public health concern [10,11]. The toxicity of herbal medicines has been a major concern that necessitates their toxicological evaluation alongside the scientific establishment or confirmation of their therapeutic potency [12]. Therefore, this investigation was aimed at the safety evaluation of a formulation of anti-haemorrhoid herbal recipe containing the bark of Alstonia boonei and dried seeds of cloves -Syzygium aromaticum for toxicity to somatic and reproductive cells in albino rats. ...
... AGE is an acute inflammatory disease caused by a bacterial or viral infection of the gastrointestinal mucosa, usually accompanied by acute diarrhea, abdominal pain, nausea, vomiting and fever (1)(2)(3). AGE is the highest cause of under-five mortality worldwide, especially in low-and middle-income countries (4). At present, the clinical treatment of AGE is the main symptomatic treatment of antibacterial and anti-inflammatory, which can improve the clinical symptoms of patients to a certain extent, but the efficacy of long-term use is poor, and it is easy to bring more adverse reactions. ...
This study was carried out to investigate the clinical efficacy of Gegen Qinlian Decoction combined with a Chinese herbal hot package in the treatment of acute gastroenteritis (AGE), and to analyze the effects on serum PCT, CRP and IL-6 levels. For this purpose, 100 patients with AGE admitted to the hospital from January 2019 to January 2022 were selected for the study and randomly divided into observation and control groups, with 50 cases in each group. Patients in the control group were given conventional Western medical treatment, while patients in the observation group were treated with Gegen Qinlian Decoction combined with a Chinese herbal hot package on this basis. The clinical efficacy, symptom relief time, main symptom scores and serum PCT, CRP and IL-6 levels before and after treatment were compared between the two groups. Results showed that the total effective rate of patients in the observation group was significantly higher than that in the control group (P<0.05). After treatment, the disappearance time of diarrhea, abdominal pain, fever and vomiting was significantly shorter in the observation group than in the control group (P<0.05). After treatment, the stool properties, number of stools and abdominal pain symptom scores of patients in both groups were lower than those before treatment, and the symptom scores of patients in the observation group were lower than those in the control group (P<0.05). The PCT, CRP and IL-6 levels of patients in both groups were significantly lower after treatment than before treatment, and the PCT, CRP and IL-6 levels of patients in the observation group were significantly lower than those in the control group (P<0.05). It was concluded that the clinical efficacy of Gegen Qinlian Decoction combined with Chinese herbal hot package in the treatment of AGE is remarkable, which can effectively improve the clinical symptoms and reduce the inflammatory reaction of patients and is worthy of clinical promotion.
Background
In this study, an anti-haemorrhoid herbal recipe containing bark of Alstonia boonei and dried cloves - Syzygium aromaticum was investigated for cytogenotoxicity, mutagenicity and histopathological effects following the micronucleus and sperm morphology assays using Swiss albino rats. The rats were administered anti-haemorrhoid herbal recipe at 25.0%, 50.0% and 100.0%, while distilled water and 0.05% sodium azide were the negative and positive controls, respectively. Phytochemicals in the herbal recipe were elucidated using the Fourier Transform Infrared (FTIR) and Gas Chromatography Flame Ionization Detection (GC-FID) techniques.
Results
In the treated rats, there was increase in body weight, cells division inhibition, micronucleated erythrocytes (MNPCEs & MNNCEs) and abnormal sperm cells were significantly induced at 100.0% (P < 0.05), whereas 25.0% promoted cell division. The herbal recipe at 50.0% and 100.0% did not cause any histopathological damages on the liver, kidney and testis except 25.0%. Polyphenolics, terpenoids and alkaloids were detected in the anti-haemorrhoid herbal recipe which could be cytotoxic, clastogenic and spermatotoxic at a high concentration (100.0%).
Conclusion
These results necessitate regulation and control of consumption of this anti-haemorrhoid herbal recipe by people through the authorized government agencies in Nigeria.
Background
Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries.
Methods
A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage.
Results
In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40–50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49–62%) than those studies with community surveys (40%; 95% CI: 34–46%) (P = 0.001). It was also varied by the recall period of antibiotics use—56% (95% CI: 50–62%) for instantly observed practice, 36% (95% CI: 22–50%) for within two week recall, 35% (95% CI: 26–45%) for 1–6 months recall, and 46% (95% CI: 37–54%) for more than six months recall ( P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets.
Conclusions
We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries.
Trial registration number: CRD42021288971 (PROSPERO). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .
