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Potential activities to improve primary care prescribing of antibiotics across Africa
(Frontiers in Tropical Diseases, 2025-08-25) Massele,Amos
There are considerable concerns with antimicrobial resistance (AMR) across Africa, enhanced by the inappropriate prescribing of antibiotics in ambulatory care. This includes prescribing for self-limiting conditions and Watch antibiotics. Inappropriate prescribing is enhanced by concerns with ambulatory care prescribers’ knowledge of antibiotics, including their perceived effectiveness for self-limiting conditions, AMR, and antimicrobial stewardship programs (ASPs). Appropriate education of prescribers, including surrounding the AWaRe (Access, Watch, and Reserve) system and guidance, which recommends the prescribing of antibiotics with less resistance potential, alongside introducing ASPs in ambulatory care, can help address these concerns. This will increasingly include instigating agreed quality indicators, and their monitoring, surrounding the AWaRe system and guidance. Improved surveillance of local resistance patterns can help with appropriately updating antibiotic prescribing guidance, including revising the AWaRe guidance based on local resistance patterns. Additional financing is also needed to help attain national goals.
Evaluating infection prevention and control programs in Zambian hospitals using the WHO infection prevention and control assessment framework (IPCAF) tool.
(Frontiers in Public Health, 2025-08-26) Massele,Amos Y
Background: Infection Prevention and Control (IPC) is key to preventing healthcare-associated infections (HAIs) and the spread of antimicrobial resistance (AMR). This study evaluated the implementation of IPC in Zambian hospitals.Materials and methods: We conducted a multicentric cross-sectional study in nine hospitals across Zambia using the WHO IPCAF tool. Data were collected from September 1 to 30, 2024 and analyzed using the self-scoring Excel and IBM SPSS version 25.0.Results: Out of the nine hospitals assessed, four were tertiary-level hospitals while the rest were secondary-level hospitals. Overall, the implementation of IPC core components was intermediate (IPCAF Score of 594 out of 800). Four hospitals had IPCAF scores between 401 and 600, indicating an intermediate level of IPC implementation. Five hospitals scored between 601 and 800, indicating an advanced implementation of IPC in these hospitals. Three tertiary hospitals scored between 601 and 800, demonstrating their advanced implementation of IPC core components.Conclusion: This study found that the overall implementation of IPC in the surveyed hospitals was intermediate, indicating that further improvements were needed. There is a need to provide peer-learning support and strengthen IPC implementation to respond to new or re-emerging infections and AMR in the country and beyond.
Mutation Rates and Fitness Genes in Staphylococcus aureus Treated with the Medicinal Plant Synadenium glaucescens
(Applied Sciences, 2025-08-07) Mafuru,Magesa
Extracts, fractions and the pure compound epifriedelanol of the medicinal plant Synadenium glaucescens have antibacterial properties. Herbal products are generally considered less prone to resistance development than conventional antimicrobials, as they contain multiple compounds, which makes bacteria less likely to develop resistance. However, data supporting this notion are lacking. This study evaluated the development of resistance in Staphylococcus aureus subjected to extract, fractions and epifriedelanol of S. glaucescens. It also identified S. aureus fitness genes contributing to intrinsic resistance to extract of S. glaucescens. Fluctuation and gradient concentration assays were used to determine mutation rates and growth adaptation, respectively, which were lower following exposure to growth in crude extract than the pure compound epifriedelanol. By subjecting 1920 single gene mutants from the Nebraska Transposon Mutant Library to growth in the presence of extract of S. glaucescens, 12 genes were identified as important for natural resistance in S. aureus JE2; however, only mutation in the hemB gene decreased the minimum inhibitory concentration by greater than 4-fold (64-fold). In conclusion, purifying active antimicrobial compounds from S. glaucescens and using them as antibacterial substances as an alternative to crude extract increased the risk of resistance development. Further, the gene hemB appears to have a significant role in the natural resistance to the extracts obtained from S. glaucescens in this study. Keywords: intrinsic resistance; mutation rate; fluctuation assay; gradient concentration; Staphylococcus aureus; Synadenium glaucescens; antimicrobials; antimicrobial resistance
Current access, availability and use of antibiotics in primary care among key low- and middle-income countries and the policy implications
(Expert review of anti-infective therapy, 2025-03-20) Massele,Amos Y
Introduction Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antimicrobial stewardship (AMS). There is a need to review current evidence on antibiotic use, access, and AMR, in primary care across key countries. Areas covered This narrative review analyzes publications from 2018 to 2024 regarding access, availability, and use of appropriate antibiotics. Expert opinion There were very few studies focussing on a lack of access to antibiotics in primary care. However, there was considerable evidence of high rates of inappropriate antibiotic use, including Watch antibiotics, typically for minor infections, across studied countries exacerbated by patient demand. The high costs of antibiotics in a number of LMICs impact on their use, resulting in short courses and sharing of antibiotics. This can contribute to AMR alongside the use of substandard and falsified antibiotics. Overall, limited implementation of national action plans, insufficient resources, and knowledge gaps affects sustainable development goals to provide routine access to safe, effective, and appropriate antibiotics. Conclusions There is a clear need to focus health policy on the optimal use of essential AWaRe antibiotics in primary care settings to reduce AMR in LMICs.
Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance and stewardship among low- and middle-income countries
(JAC-Antimicrobial Resistance, 2026-05-20) Amos Massele, Y
Background: There are concerns globally with rising rates of antimicrobial resistance (AMR), particularly in lowand middle-income countries (LMICs). AMR is driven by high rates of inappropriate prescribing and dispensing of antibiotics, particularly Watch antibiotics. To develop future interventions, it is important to document current knowledge, attitudes and practices (KAP) among key stakeholder groups in LMICs. Methods: We undertook a narrative review of published papers among four WHO Regions including African and Asian countries. Relevant papers were sourced from 2018 to 2024 and synthesized by key stakeholder group, country, WHO Region, income level and year. The findings were summarized to identify pertinent future activities for all key stakeholder groups. Results: We sourced 459 papers, with a large number coming from Africa (42.7%). An appreciable number dealt with patients’ KAP (33.1%), reflecting their influence on the prescribing and dispensing of antibiotics. There was marked consistency of findings among key stakeholder groups across the four WHO Regions, all showing concerns with high rates of prescribing of antibiotics for viral infections despite professed knowledge of antibiotics and AMR. There were similar issues among dispensers. Patients’ beliefs regarding the effectiveness of antibiotics for self-limiting infectious diseases were a major challenge, although educational programmes did improve knowledge. The development of the AWaRe (Access, Watch and Reserve) system, including practical prescribing guidance, provides a future opportunity for the standardization of educational inputs. Conclusions: Similar KAP regarding the prescribing and dispensing of antibiotics across LMICs and stakeholder groups presents clear opportunities for standardization of educational input and practical training programmes based on the AWaRe system.
Point prevalence survey of antibiotic Use in Level 1 hospitals in Zambia: future prospects for antimicrobial stewardship programs
(Infection and Drug Resistance, 2025-02-16) Massele, Amos Y.
Introduction The inappropriate prescribing and use of antibiotics have contributed to the emergence and spread of antimicrobial resistance (AMR). In Zambia, there is a paucity of information on the prescribing patterns and use of antibiotics among hospitalized patients in level 1 hospitals. This study investigated antibiotic use in five level 1 hospitals in Lusaka, Zambia. Methods This cross-sectional study utilized the World Health Organization (WHO) Point Prevalence Survey (PPS) methodology among in-patients admitted in level 1 hospitals before 08:00 a.m. on the survey day in August 2024. Data were analysed using IBM SPSS version 23.0. Results The prevalence of antibiotic use among inpatients was 59.0%, with ceftriaxone being the most prescribed. Antibiotics were prescribed mainly for paediatrics and male inpatients. This study found that 53.0% of prescribed antibiotics were from the Access group while 38.2% were from the Watch group of the World Health Organization Access, Watch, and Reserve (AWaRe) classification. Adherence to national treatment guidelines was 36.0%, with most antibiotics prescribed empirically without evidence of culture and sensitivity tests. Conclusion This study found a high use of antibiotics and low adherence to treatment guidelines in level 1 hospitals in Lusaka, Zambia. The findings of this study demonstrate the need to establish and strengthen antimicrobial stewardship programs and strengthen laboratory capacity to aid clinicians in diagnosing, treating, and managing patients across level 1 hospitals in Zambia.
Is harmonisation of curriculum enough to ensure clinical competencies of graduates? Experience of faculty and students from two health training institutions in Tanzania: a qualitative study
(BMJ open, 2025-11-11) Moshi, Mainen J.
Objective The growing complexity of global health issues underscores the need for a skilled workforce, achievable through competency-based training (competency-based curricula, CBC) that integrates knowledge and practice. Starting from 2022, medical and nursing CBC were harmonised across universities in Tanzania to ensure all graduates attain nationally defined core competencies. The reform aligned programme structure, learning outcomes and assessment methods to promote consistency and interprofessional collaboration. However, questions remain about whether harmonisation alone can ensure the development of practical clinical competencies among students. This study explored the experiences of medical and nursing faculty and students in implementing clinical training as a component of CBC in two health training institutions in Tanzania. Design An exploratory qualitative case study was conducted with 67 participants, using 8 in-depth interviews with administrators and 8 focus group discussions with faculty and students. Data were analysed using Braun and Clarke’s thematic approach. Setting Two private, faith-based medical universities in the United Republic of Tanzania. Participants The study purposefully recruited a total of 67 participants. The participants included university administrators (including Deputy Vice Chancellors for Academics, quality assurance officers and deans), medical and nursing faculty and students (fourth-year medical and third-year nursing students). Results Two main themes emerged: challenges in implementing clinical training and strategies used to enforce clinical training. Key challenges included curriculum design gaps, inadequate faculty and clinical instructors, a large number of students and a shortage of hospital staff. Strategies used were utilisation of clinical skills and simulation laboratories, involvement of non-academic clinical specialists’ staff, use of student-centred learning methodologies and leveraging regional, district and specialised private hospitals for clinical teaching. Conclusions Despite notable challenges in clinical training, the institutions in this study have implemented proactive strategies to support clinical training. Based on the findings, stakeholders should invest in increasing faculty and clinical instructors and expanding clinical placements to regional, district and private hospitals
A simple and rapid external standard calibration HPLC methodfor determination of lumefantrine in dried blood spot samplesfrom malaria patients in Botswana
(Biomedical Chromatography, 2024-01) Massele, Amos Y.
Abstract A simple external calibration liquid chromatography-diode array detector method was developed, validated, and applied for the determination of lumefantrine (Lum) in dried blood spot (DBS) samples collected from malaria patients in Botswana. The samples were validated in accordance with the United States Food and Drug Administration guidelines for bioanalytical methods after sample preparation using solid-liquid extraction. Separation was achieved using an XTerra C18 column (50 × 4.6 mm, 5 μm), and a binary solvent system of acetonitrile and water adjusted to pH 2.3 was used as the mobile phase. The validated method was applied for the determination of Lum in DBS samples collected from malaria patients infected with Plasmodium falciparum in Botswana. The calibration curve was linear between 0.5 and 12 μg/mL with a coefficient of determination (R2 ) of 0.9996. The limit of detection and the lower limit of quantification were 0.5 and 1.4 μg/mL, respectively. The efficiency of extraction measured as percentage recovery ranged between 84.2% and 107.8% at the three quality control (QC) levels, that is, low QC, mid QC, and high QC. In conclusion, data suggest that the method is suitable for the determination of trace Lum in biofluids and can also be used for therapeutic drug monitoring and pharmacokinetic profiling. Keywords: HPLC; LLOQ; dried blood spot; lumefantrine; malaria.
Epifriedelanol is the key compound to antibacterial effects of extracts of Synadenium glaucescens (Pax) against medically important bacteria
(Frontiers in Tropical Diseases, 2023-01-19) Mafuru, Magesa
Introduction: Synadenium glaucescens has been used for the treatment of bacterial infections in many parts of the world. We investigated the antibacterial and cytotoxicity activities of secondary metabolites of this plant. Methods: Hexane, dichloromethane, methanol, and water were used as extraction solvents. The extract of the root bark was fractionated with ethyl acetate and methanol. The isolation of compounds from root barks, leaves and stem wood extracts were carried out using column chromatography. Antibacterial activities were characterized based on growth curves, killing curves and MIC determinations. Haemolytic effect towards sheep red blood cells (RBCs) was analysed with spectrophotometer at the wavelength of 540nm. Results and Discussion: Extracts from whole root and root bark showed strong activity against Staphylococcus aureus, and Streptococci and Enterococci species, and moderate to weak activity against Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella species, Shigella sonnei and Yersinia enterocolitica. Staphylococcus aureus was the most susceptible, and E. coli and Klebsiella pneumonia were the least susceptible ones. Likewise, extracts, fractions, sub-fractions and epifriedelanol demonstrated bacteriostatic activity against S. aureus. The haemolytic activity of the extracts, fractions, sub-fractions and epifriedelanol was significantly low compared to the positive control, hydrogen peroxide. But extract from leaves showed high haemolytic effects at the concentrations of 500 μg/mL and 1000 μg/mL. Thus, extracts of S. glaucescens have antibacterial activity against several Gram-positive bacteria including Methicillin Resistant S. aureus with low haemolytic activity. At high concentrations, the extracts from leaves have toxicity risk. More studies for the active compounds are required for biological testing.
Antimycobacterial activity and brine shrimp toxicity of wild mushrooms used by communities in southern Tanzania
(Research Journal of Pharmacognosy, 2024-03-12) Moshi, Mainen J.
Background and objectives: Several wild mushroom species occur in southern Tanzania and are used as food by the local tribes. Experience shows that some of them could contain phytochemical compounds with therapeutic potential for treating various diseases. This study aimed to evaluate wild mushrooms used by indigenous communities living near the Selous- Niassa corridor in Namtumbo district, in Southern Tanzania for safety and antimycobacterial activity. Methods: Wild mushroom samples were collected randomly during the wet season and extracted by cold maceration. Dried extracts were evaluated for safety using the brine shrimp lethality test and for antimycobacterial activity using a twofold microdilution method against non-pathogenic Mycobacterium madagascariense, Mycobacterium indicus pranii, and Mycobacterium aurum. Results: The mushroom extracts exhibited a good safety profile against brine shrimp larvae with LC50 values ranging from 20.28 µg/mL (moderately toxic) to 465.97 µg/mL (nontoxic). The extracts exhibited variable antimycobacterial activity against M. madagascariense, M. indicus pranii, and M. aurum with minimum inhibitory concentrations (MIC) between 0.78 and 12.5 mg/mL against M. madagascariense, 0.098 and 6.25 mg/mL against M. indicus pranii and 1.25 and 2.5 mg/mL against and M. aurum. Nineteen wild mushroom species (59.4%, n = 32) exhibited antimycobacterial activity against all three mycobacterial species used. Conclusion: Preliminary investigation has provided evidence that some of the mushrooms locally available are not toxic. Some of these mushrooms have the potential to yield antimicobacterial active compounds. Further studies to determine the therapeutic and nutritional value of these mushrooms are needed. Keywords: anti-mycobacterial; brine shrimp lethality test; therapeutic potential; wild mushrooms
A simple and rapid external standard calibration HPLC method for determination of lumefantrine in dried blood spot samples from malaria patients in Botswana.
(2023-10-16) Massele, Amos Y.
A simple external calibration liquid chromatography-diode array detector methodwas developed, validated, and applied for the determination of lumefantrine (Lum) indried blood spot (DBS) samples collected from malaria patients in Botswana. Thesamples were validated in accordance with the United States Food and DrugAdministration guidelines for bioanalytical methods after sample preparation usingsolid–liquid extraction. Separation was achieved using an XTerra C18 column(50 4.6 mm, 5μm), and a binary solvent system of acetonitrile and water adjustedto pH 2.3 was used as the mobile phase. The validated method was applied for thedetermination of Lum in DBS samples collected from malaria patients infected withPlasmodium falciparumin Botswana. The calibration curve was linear between 0.5and 12μg/mL with a coefficient of determination (R2) of 0.9996. The limit of detec-tion and the lower limit of quantification were 0.5 and 1.4μg/mL, respectively. Theefficiency of extraction measured as percentage recovery ranged between 84.2%and 107.8% at the three quality control (QC) levels, that is, low QC, mid QC, and highQC. In conclusion, data suggest that the method is suitable for the determination oftrace Lum in biofluids and can also be used for therapeutic drug monitoring and phar-macokinetic profiling
A narrative review of recent antibiotic prescribing practices in ambulatory care in Tanzania: findings and implications
(Medicina, 2023-12-18) Massele, Amos Y.; Rogers, Anastasia M.; Gabriel, Deogratius R.; Mayanda, Ashura.
Background and objectives: There are concerns with the current prescribing practices of antibiotics in ambulatory care in Tanzania, including both the public and private sectors. These concerns need to be addressed as part of the national action plan (NAP) of Tanzania to reduce rising antimicrobial resistance (AMR) rates. Issues and concerns include high rates of prescribing of antibiotics for essentially self-limiting conditions. Consequently, there is a need to address this. As a result, the aims of this narrative review were to comprehensively summarize antibiotic utilization patterns particularly in ambulatory care and their rationale in Tanzania and to suggest ways forward to improve future prescribing practices. Materials and Methods: We undertook a narrative review of recently published studies and subsequently documented potential activities to improve future prescribing practices. Potential activities included instigating quality indicators and antimicrobial stewardship programs (ASPs). Results: Published studies have shown that antibiotics are being excessively prescribed in ambulatory care in Tanzania, in up to 95% to 96.3% of presenting cases depending on the sector. This is despite concerns with their appropriateness. High rates of antibiotic prescribing are not helped by variable adherence to current treatment guidelines. There have also been concerns with extensive prescribing of ‘Watch’ antibiotics in the private sector. Overall, the majority of antibiotics prescribed across the sectors, albeit inappropriately, were typically from the ‘Access’ group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than ‘Watch’ antibiotics to limit AMR. The inappropriate prescribing of antibiotics in ambulatory care is linked to current knowledge regarding antibiotics, AMR, and ASPs among both prescribers and patients. Recommended activities for the future include improved education for all groups, the instigation of updated quality indicators, and the regular monitoring of prescribing practices against agreed-upon guidelines and indicators. Education for healthcare professionals on ASPs should start at undergraduate level and continue post qualification. Community advocacy on the rational use of antibiotics should also include social media activities to dispel misinformation. Conclusion: The quality of current prescribing practices of antibiotics in ambulatory care is sub-optimal in Tanzania. This needs to be urgently addressed.
Current rates of purchasing of antibiotics without a prescription across sub-saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance
(Expert Review of Anti-infective Therapy, 2023-10-20) Massele, Amos Y.
Introduction Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. Areas covered A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing without a prescription). However, considerable variation with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. Expert Opinion ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists’ activities to reduce inappropriate dispensing. Such activities, alongside educating patients and HCPs, should enhance appropriate dispensing of antibiotics and reduce AMR.
Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania
(BMC oral health, 2006) Moshi, Mainen J.
Background: The aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+ cell count. Methods: Participants were 532 HIV infected patients, 51 children and 481 adults, 165 males and 367 females. Children were aged 2–17 years and adults 18 and 67 years. Participants were recruited consecutively at the Muhimbili National Hospital (MNH) HIV clinic from October 2004 to September 2005. Investigations included; interviews, physical examinations, HIV testing and enumeration of CD4+ T cells. Results: A total of 237 HIV-associated oral lesions were observed in 210 (39.5%) patients. Oral candidiasis was the commonest (23.5%), followed by mucosal hyperpigmentation (4.7%). There was a significant difference in the occurrence of oral candidiasis (χ2 = 4.31; df = 1; p = 0.03) and parotid enlargement (χ2 = 36.5; df = 1; p = 0.04) between children and adults. Adult patients who were on HAART had a significantly lower risk of; oral lesions (OR = 0.32; 95% CI = 0.22 – 0.47; p = 0.005), oral candidiasis (OR = 0.28; 95% CI = 0.18 – 0.44; p = 0.003) and oral hairy leukoplakia (OR = 0.18; 95% CI = 0.04 – 0.85; p = 0.03). There was no significant reduction in occurrence of oral lesions in children on HAART (OR = 0.35; 95% CI = 0.11–1.14; p = 0.15). There was also a significant association between the presence of oral lesions and CD4+ cell count < 200 cell/mm 3 (χ2 = 52.4; df = 2; p = 0.006) and with WHO clinical stage (χ2 = 121; df = 3; p = 0.008). Oral lesions were also associated with tobacco smoking (χ2 = 8.17; df = 2; p = 0.04). Conclusion: Adult patients receiving HAART had a significantly lower prevalence of oral lesions, particularly oral candidiasis and oral hairy leukoplakia. There was no significant change in occurrence of oral lesions in children receiving
Antimicrobial and brine shrimp lethality of extracts of Terminalia mollis Laws
(African Journal of Traditional, Complementary and Alternative Medicines, 2006) Moshi, Mainen J.
Using the disc diffusion method it was demonstrated that extracts of the leaves, stem and roots of Terminalia mollis Laws (Combretaceae) have antibacterial activity against Staphylococcus aureus (NCTC 6571), Escherichia coli (NCTC 10418), Pseudomonas aeruginosa (NCTC 10662), Klebsiella pneumoniae (NCTC 9633), Salmonella typhi (NCTC 8385), and Bacillus anthracis (NCTC 10073) and antifungal activity against Candida albicans (Strain HG 392), and local strains of Aspergillus flavus and Cryptococcus neoformans. The root extracts were the most active followed by the stem, and leaf extracts. Extracts of the three parts also exhibited cytotoxicity to brine shrimp larvae with LC50 values ranging from 26.3 to 58.1, l0.4 to 69.5, and 42.9‐ 101.3μg/ml, for the root, stem, and leaf extracts, respectively. The results support the traditional uses of extracts of this plant for the management of bacterial and fungal infections. Key words: Terminalia mollis, Antimicrobial activity, Traditional medicine.
Legislation on medicinal plants in Africa
(Medicinal Plant Research in Africa, 2013) Moshi, Mainen J.
Africa is endowed with rich and high endemicity of plant biological diversity, and a number of species are used as traditional medicines. Many African countries, working within the guidelines of the Convention for Biological Diversity and the Global Strategy for Plants Conservation, have developed legislation for the management of plant biodiversity, covering forestry, environment, food, agriculture, access and benefit sharing, intellectual property rights, registration of herbal medicines, and other areas. Many countries have signed the Convention on Biological Diversity, though some have not. However, enforcement of these laws in almost all countries is very weak; there is a lack of harmonization at the national level, coupled with high border porosity, which leaves openings for biopiracy. The Kyoto Protocol 2010 provides a good opportunity for African countries to harmonize legislation governing the exploitation of medicinal plant biodiversity in a manner that is beneficial to their countries. This chapter reviews the status of some of the legislation in African countries, highlighting some specific country plant biodiversity situations; for each of the countries mentioned an attempt has been made to give information on the available capabilities for the evaluation of the safety, efficacy, and quality of herbal medicines and regulations on registration of herbal and traditional medicines. It is recommended that African countries continue to strengthen legislation related to medicinal plants; strengthen their capacity for safety, efficacy, and quality evaluation; and embark on commercial cultivation of medicinal plants to benefit from the expanding global market of herbal medicines.
A survey of plants used by traditional healers in the management of non-insulin dependent diabetes mellitus
(The East and Central African Journal of Pharmaceutical Sciences, 2000) Moshi, Mainen J.
A survey to evaluate the knowledge and ability of traditional healers to recognise and manage patients with non-insulin dependent diabetes mellitus was done in Handeni district Tanga region, Tanzania. Among 169 traditional healers interviewed 53.2% were treating one or more symptoms related to diabetes. Only 3% understood what diabetes mellitus is, but did not know plants used to treat any of the symptoms. Overall, 66 plant specimen, representing 31 families, 54 genera and 61 species were collected. Among these 26% are reported in literature as being used for the treatment of symptoms such as impotence or as aphrodisiacs and one is reported to have hypocholesterolemic activity. Only 2, Securinega virosa and Phyllanthus amarus, out of the 27 plants tested, improved glucose tolerance. They both lowered area under the oral glucose tolerance curve dose-dependently at doses between 0.1 - 1.0 g/kg body wt. Four plants, Croton macrostachys, Maytenus putterlickioides, Albizia versicolor and Lannea stuhlmannii worsened glucose tolerance. Further studies are required to determine other properties of these plants that may be useful in the management of diabetes mellitus.
Zebrafish bioassay-guided microfractionation combined with CapNMR a comprehensive approach for the identification of anti-inflammatory and anti-angiogenic constituents of rhynchosia viscosa
(Planta Medica, 2010) Moshi, Mainen J.
Zebrafish have recently emerged as an attractive in vivo system for functional genomics and drug discovery [1]. Because of their small size, rapid development, optical transparency, and high genetic, physiologic, and pharmacologic similarity with humans, zebrafish embryos and larvae are also an ideal model for natural product discovery. As zebrafish bioassays require only microgram amounts of crude extracts, chromatographic fractions, and pure compounds, we are developing a zebrafish-based natural product discovery platform that takes advantage of modern techniques for the isolation and structural elucidation of natural products, such as UHPLC-TOF-MS profiling, LC-MS microfractionation and subsequent capillary NMR characterization [2]. An in vivo, zebrafish-based anti-inflammatory screen of methanolic extracts of East African medicinal plants resulted in the identification of R. viscosa, which revealed potent inhibition of leukocyte migration after larval tail transection in the presence of bacterial lipopolysaccharides. This extract also displayed anti-angiogenic activity in transgenic zebrafish with vasculature-specific expression of GFP. Intriguingly, R. viscosa is used by traditional healers in Tanzania for the treatment of inflammatory skin disorders and insect bites, corroborating our findings in zebrafish. Microfractionation of the crude methanolic extract was performed, and individual fractions tested for bioactivity in zebrafish. One highly active fraction was subjected to HR-ESI-MS and CapNMR analysis, resulting in the identification of genistein – a known inhibitor of inflammation and angiogenesis. These results indicate the potential of zebrafish bioassay-guided microfractionation, in combination with sub-milligram NMR techniques, to rapidly identify bioactive natural products.
In vivo Anti-plasmodial Activity of Crude Extracts of Three Medicinal Plants Used Traditionally for Malaria Treatment in Kenya
(European J Med Plants, 2018-08-01) Moshi, Mainen J.
The aim of the study was to determine the in vivo anti-plasmodial activity of three plants Rhamnus prinoides, Rubus keniensis and Garcinia buchananii which are used for malaria treatment by indigenous communities in Kenya. This work was done at the Department of Biological and Preclinical studies, Institute of Traditional Medicine, Muhimbili University of Health & Allied Sciences in October 2016 to August 2017. Male and female albino mice were infected with Plasmodium berghei (ANKA) in the Peter’s four day suppression test. Five groups of mice; Group 1 (solvent 5 mL/kg body weight of 1% carboxymethyl cellulose), Group 5 (10 mg/kg body weight chloroquine), Groups 2, 3 and 4 were given 200, 400 and 800 mg/kg body weight of plant extracts. The results showed that 5% aqueous methanol extracts of R. prinoides, G. buchananii and R. keniensis exhibited higher anti-plasmodial activity than the 11 dichloromethane methanol extracts in the preliminary testing. The doses showing 50% parasite suppression (EC50) were 139.2, 169.4 and 245.1 mg/kg body weight for R. prinoides, G. buchananii and R. keniensis, respectively. In vivo anti-plasmodial activity of the three plants has supported the traditional use of extracts of Rhamnus prinoides, Rubus keniensis and Garcinia buchananii for treatment of malaria. Isolation of compounds from these plants is in progress.
Promotion of Community based cultivation of Hibiscus sabdariffa, Moringa oleifera, Adansonia digitata and Aloe vera for use as herbal nutritional supplements for people living with HIV/AIDS
(Core, 2007) Moshi, Mainen J.
Introduction The devastation resulting from immunodeficiency in HIV/AIDS patients predisposes patients to a multitude of opportunistic infections, ranging from bacterial, fungal, viral, and protozoa infections and malignancies such as Kaposi’s sarcoma and non-Hodgikin’s lymphomas. The availability of antiretroviral drugs (ARVs), which reduce viral load and help to restore the immune system, has given hope to those who can afford them. However, for the majority of people the availability of ARVs is a luxury that they cannot afford. The only available option is to curb emerging opportunistic infections so as to reduce illness episodes. The availability of easily accessible and cheap drugs for the treatment of opportunistic infections would be of great relief to patients. The use of products from these 3 specific medicinal plants could contribute significantly towards the treatment of opportunistic infections in addition to supplying nutritional supplements to cope with the devastation of immunodeficiency. Nutritional supplementation could also be pivotal in dealing with the nutritional needs of pregnant women and undernourished children. Herbal nutritional supplements are likely to play an important role in improving the health of a large percentage of the population, especially in the rural areas, either directly through use or by generating income which will allow them to afford other types of foods.

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