Prevalence and dynamics of clinically significant bacterial contaminants in herbal medicines sold in East Africa from 2000 to 2020: a systematic review and meta-analysis

Tropical Medicine and Health - Tập 49 - Trang 1-14 - 2021
Abdul Walusansa1,2,3, Savina Asiimwe1, Hussein. M. Kafeero3, Iramiot. J. Stanley2, Jamilu. E. Ssenku1, Jesca. L. Nakavuma4, Esezah. K. Kakudidi1
1Department of Plant Sciences, Microbiology and Biotechnology, School of Biosciences, Makerere University, Kampala, Uganda
2Department of Medical Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
3Department of Microbiology and Immunology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, Kampala, Uganda
4Department of Biomolecular and Biolaboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda

Tóm tắt

Infectious diseases remain a leading cause of mortality and morbidity around the world, and those caused by bacteria are common in the East African region. In this region, trade and consumption of herbal medicine has been expanding in the recent decades. Herbal medicines may be contaminated with pathogenic bacteria; however, there is limited information due to fragmented studies in East Africa. In this meta-analysis, we critically analyzed original research related to the incidence of pathogenic bacterial contaminants of HM in the East African region since 2000. The aim was to create a comprehensive understanding of the extent and dynamics of bacterial contamination in HM, to guide future research and concerted public health protection in the region. The study was conducted according to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched and evaluated published articles from eleven electronic databases (Google Scholar, PubMed, HerbMed, MEDLINE, Science Direct, Scifinder Scholar, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, Biological Abstracts and Commonwealth Agricultural Bureau Abstracts). Prevalences of different bacterial species, Cochran’s Q test, and the I2 statistic for heterogeneity were evaluated using a software called MedCalcs. Random and fixed effects models were used to determine the pooled prevalence of clinically significant bacteria from studies which were included in this meta-analysis. The potential sources of heterogeneity were examined through sensitivity analysis, sub-group analysis, and meta-regression at 95% level of significance. Fourteen studies met our inclusion criteria. Overall, the studies were highly heterogeneous (I2 = 98.48%) and there was no evidence of publication bias. Escherichia coli was the most prevalent contaminant. Salmonella spp. and Shigella spp. were the most frequently reported primary pathogens with pooled prevalence of 10.4% and 6.3%, respectively. Our findings are in tandem with recent systematic reviews conducted in Europe and Asia, but are in discrepancy with the reviews recently conducted in southern Africa. The East African herbal medicine industry poses considerable health risks to communities through dissemination of clinically significant bacteria. Presence of enteric bacterial contaminants indicates possible fecal pollution of herbal medicine region-wide. Adequate research pertaining to microbial safety of herbal medicine in the East African countries remains highly desired. The latter will enable establishment of strong, region-wide herbal safety mechanisms in order to support comprehensive public health protection in East Africa.

Tài liệu tham khảo

Hunt K, Ernst E. Patients’ use of CAM: results from the Health Survey for England 2005. Focus Altern Complement Ther. 2010;15(2):101–3.

Market Research Report. Herbal medicine market size and forecast, by product (tablets & capsules, powders, extracts), by indication (digestive disorders, respiratory disorders, blood disorders), and trend analysis, 2014 - 2024 [Internet]. 2017. Available from: https://www.hexaresearch.com/research-report/global-herbal-medicine-market/.

Kaadaaga HF, Ajeani J, Ononge S, Alele PE, Nakasujja N, Manabe YC, et al. Prevalence and factors associated with use of herbal medicine among women attending an infertility clinic in Uganda. BMC Complement Altern Med. 2014;14(1):27.

Lubinga SJ, Kintu A, Atuhaire J, Asiimwe S. Concomitant herbal medicine and antiretroviral therapy (ART) use among HIV patients in Western Uganda: a cross-sectional analysis of magnitude and patterns of use, associated factors and impact on ART adherence. AIDS Care. 2012;24(11):1375–83.

Stanifer JW, Lunyera J, Boyd D, Karia F, Maro V, Omolo J, et al. Traditional medicine practices among community members with chronic kidney disease in northern Tanzania: an ethnomedical survey. BMC Nephrol. 2015;16(1):170.

Okot DF, Anywar G, Namukobe J, Byamukama R. Medicinal plants species used by herbalists in the treatment of snakebite envenomation in Uganda. Trop Med Health. 2020;48:1–14.

Ochwang’i DO, Kimwele CN, Oduma JA, Gathumbi PK, Mbaria JM, Kiama SG. Medicinal plants used in treatment and management of cancer in Kakamega County. Kenya J Ethnopharmacol. 2014;151(3):1040–55.

Onyambu MO. Identification and characterization of the microbial contaminants of herbal medicines in Kenya (Doctoral dissertation, University of Nairobi). 2011. p. 1. Available online; erepository.uonbi.ac.ke.

Rakholiya KD, Kaneria MJ, Chanda SV. Medicinal plants as alternative sources of therapeutics against multidrug-resistant pathogenic microorganisms: Elsevier; 2013. p. 165–79. Available from: https://scholar.google.com/scholar?cluster=3956378780302722609&hl=en&as_sdt=0,5.

World Health Organization (WHO). Infectious diseases dominate WHO’s list of 2019 health threats [Internet]. 2019. Available from: https://www.contagionlive.com/news/infectious-diseases-dominate-whos-list-of-2019-health-threats.

Basch E, Ulbricht C, Harrison M, Sollars D, Smith M, Dennehy C, et al. Alfalfa (Medicago sativa L.) A clinical decision support tool. J Herb Pharmacother. 2003;3(2):69–90.

Kaume L, Foote JC, Gbur EE. Microbial contamination of herbs marketed to HIV-infected people in Nairobi (Kenya). S Afr J Sci. 2012;108(9–10):1–4.

Niyonshima D. “Staphylococcus aureus” contamination levels in selected local herbal medicines sold in Kampala. Uganda: GRIN Verlag; 2018.

Posadzki P, Watson L, Ernst E. Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. Eur J Clin Pharmacol. 2013;69(3):295–307.

Ulbricht C, Conquer J, Costa D, Hollands W, Iannuzzi C, Isaac R, et al. An evidence-based systematic review of saffron (Crocus sativus) by the Natural Standard Research Collaboration. J Diet Suppl. 2011;8(1):58–114.

Govender S, Du Plessis-Stoman D, Downing TG, Van de Venter M. Traditional herbal medicines: microbial contamination, consumer safety and the need for standards. S Afr J Sci. 2006;102(5–6):253–5.

Verhaeghe E, Mathieson C. Understanding the East African Community and its transport agenda. 2017; Available from: https://scholar.google.com/scholar?cluster=3956378780302722609&hl=en&as_sdt=0,5.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

Neyeloff JL, Fuchs SC, Moreira LB. Meta-analyses and Forest plots using a Microsoft Excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes. 2012;5(1):1–6.

Nanyanzi J. Evaluation of bacterial contamination and label information of oral-liquid herbal medicinal products for cough in Makindye Division, Kampala District; 2009.

Gonsha Rehema. An assessment of bacterial contamination of locally prepared herbal/traditional oral liquid medicines sold in Owino market. 2012; Available from: https://wfpha.confex.com/wfpha/2012/webprogram/Paper8962.html.

Ngari FW, Gikonyo NK, Wanjau RN, Njagi ENM. Investigation of selected pathogenic microorganisms and toxic elements in herbal materials used in management of oral health in Nairobi County, Kenya. J Appl Environ Biol Sci. 2013;3(12):1–7.

Mukundi JW. Bacteria, Aflatoxins and fluoride levels in locally processed herbal medicines from Nairobi County. Kenya: University of Nairobi; 2015.

HASSAN KM. Evaluation of heavy metals and microbial contamination in herbal medicines used for chronic illnesses Nairobi Metropolis (Doctoral dissertation, University of Nairobi). University of Nairobi; 2019. Available online; erepository.uonbi.ac.ke.

Keter L, Too R, Mwikwabe N, Ndwigah S, Orwa J, Mwamburi E, et al. Bacteria contaminants and their antibiotic sensitivity from selected herbal medicinal products from Eldoret and Mombasa. Kenya Am J Microbiol. 2016;7(1):18–28.

Korir R. Microbial and heavy metal contaminations in selected herbal medicinal products sold in Nairobi, Kenya [Internet]: University of Nairobi; 2017. Available from: http://erepository.uonbi.ac.ke/handle/11295/101393.

Walther C, Marwa KJ, Seni J, Hamis P, Silago V, Mshana SE, et al. Microbial contamination of traditional liquid herbal medicinal products marketed in Mwanza city: magnitude and risk factors. Pan Afr Med J. 2016;23(1).

Kira JD. Prevalence and antimicrobial susceptibility of bacteria isolated from herbal medicines vended in Morogoro municipality, Tanzania [Internet]: Sokoine University of Agriculture; 2015. Available from: www.scielo.org.co/pdf/rcien/v21n2/0121-1935-rcien-21-02-00085.pdf.

Musoke W. Microbial and heavy metal contamination in herbal medicines in Uganda. (Doctoral dissertation, Kyambogo). Available on https:kyuir.kyu.ac.ug/handle/20.500.12504/330.

Gonsha R. An assessment of bacterial contamination of locally prepared herbal/traditional oral liquid medicines sold in Owino market. wfpha; 2012.

Rodrigo-Troyano A, Sibila O. The respiratory threat posed by multidrug resistant G ram-negative bacteria. Respirology. 2017;22(7):1288–99.

Korir R, Anzala O, Jaoko W, Bii C, Ketera L. Multidrug-resistant bacterial isolates recovered from herbal medicinal products sold in Nairobi, Kenya. Heal Res J. 2017;1(1):40–6. Available online; https://eahrj.eahealth.org/index.php/eah/article/download/EAHRJ-D-17-00027/544.

Walters MS, Routh J, Mikoleit M, Kadivane S, Ouma C, Mubiru D, et al. Shifts in geographic distribution and antimicrobial resistance during a prolonged typhoid fever outbreak — Bundibugyo and Kasese Districts, Uganda, 2009–2011. Ryan ET, editor. PLoS Negl Trop Dis. 2014;8(3):e2726.

World Health Organization (WHO). WHO guidelines for assessing quality of herbal medicines with reference to contaminants and residues [Internet]: World Health Organization; 2007. Available from: https://apps.who.int/iris/handle/10665/43510.

World Health Organization (WHO). Guidelines for assessing quality of herbal medicines with reference to contaminants and residues. Geneva: World Health Organization; 2007. p. 2007.

Cosano I, Pintado C, Acevedo O, fNovella JL, Alonso GL, Carmona M, et al. Microbiological quality of saffron from the main producer countries. J Food Prot. 2009;72(10):2217–20.

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Tropical Medicine and Health

Tập 49

1-14

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