Fakes and chemicals: indigenous medicine in contemporary Kenya and implications for health equity

Design, delivery and effectiveness of health practitioner regulation systems: an integrative review

BACKGROUND

Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions.

METHODS

We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework.

FINDINGS

This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners.

CONCLUSION

We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.

A tale of two rivers: development, destruction, and despair in Ongata Rongai, Kenya

Introduction

Ongata Rongai is a rapidly growing peri-urban space in Nairobi Metropolitan, Kenya. The last 10 years have seen exponential population growth and building development leading to overcrowding and pressure on water and environmental resources. This original research sheds light on interactions among humans, animals, and this rapidly changing urban environment. It is therefore a quintessentially One Health study.

Methods

Qualitative and ethnographically informed methods are employed to better understand the impact of rapid growth on the riparian environment and the effect of this on those who depend on it. The reflexive use of archival material and a historical ethnographic approach enabled in-depth narratives to address these issues within a longitudinal context, and the use of deliberate walking alongside visual methodologies and more traditional anthropological methods make this study novel both in terms of methodological approach and findings.

Results

This study finds that people cite high levels of pollution from solid waste and sewage have made the rivers almost unusable and a hazardous place for both humans and animals. Yet, in the past, these rivers played key roles in daily life. There is frustration with structural-level actors' moribund attitude to the environment. The poor health of the rivers and riparian environment leads to human and animal health challenges, increased pressure on water resources, and economic pressure due to a loss of livelihoods.

Discussion

The study contributes to what is currently a fairly small literature on urban riparian spaces globally, but one which is of growing and vital importance given the rapidly increasing percentage of humans who now reside in urban spaces. It contributes to WASH and urban clean water knowledge as well as One Health, public health, and urban growth narratives, and directly addresses challenges faced by SDG 6.

Medication nonadherence: health impact, prevalence, correlates and interventions

Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of motivation and ability. Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the opportunity to adhere as well as triggers or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere.

The Assessment of Morphological Diversity of Colchicum luteum L., an Economically Important Threatened Medicinal Plant of Kashmir Himalaya

Colchicum luteum L. is an economically important and endangered medicinal plant of the Kashmir Himalaya. The corm extract is used for the treatment of rheumatism, gout, Behcet’s syndrome, and Alzheimer disease. It is also used extensively in plant breeding programs for the doubling of chromosomes. The present study was carried out for two years (2017–2019) to study the genetic diversity of C. luteum, an economically important and endangered medicinal plant of Kashmir Himalaya. The mapping of genetic diversity of C. luteum was estimated using Mahalanobis D2 analysis in the Aharbal (Kulgam), Dhara (Theed), and Baera Baal Hills (Harwan) of Kashmir Valley. The results showed the presence of 5 clusters for 30 populations. There were 17 populations in cluster-1, 1 in cluster-2, 2 in cluster-3, 3 in cluster-4, and 7 in cluster-5. The majority of the population was a group in cluster-1 followed by cluster-5. The maximum intracluster distance (D2 values) was observed in cluster-5 (46.55588) followed by cluster-3 (41.61871), and the maximum inter-cluster distance (D2 values) was observed in cluster-3 (46.55588) followed by cluster-5 (41.61871). Our study revealed that plant species possessed sufficient genetic diversity among the populations. Cluster-5 showed superiority in plant−1 respect of the maximum mean plant height (28.46 cm), leaf area (47.0 cm2), number of seeds plant−1 (26.85), corm length (5.15 cm), corm width (3.17 cm), fresh weight of corm plant (6.87 g), and dry weight of corm plant (4.81 g) as compared to other clusters. Out of five clusters, cluster-5 is a promising one for better yield and yield attributing traits. The present study revealed that plant species possessed sufficient genetic diversity among the populations as 30 populations were arranged into 5 clusters. Therefore, cluster-5, consisting of seven populations from the undisturbed area of Harwan, and consequently the populations from the same cluster can be multiplied for initiating a conservation and breeding program and can serve as a tool for the scientific community to evolve better contemporary varieties of C. luteum with profitable characters such as more yield of corms, etc. This will assist farmers, particularly the marginal farmers, to alleviate their income.

An exploratory focus group study on experiences with snakebites: health-seeking behaviour and challenges in rural communities of Kenya

BACKGROUND

Snakebite envenoming is a long-hidden public health threat in the rural communities of Kenya. This study aimed to shed light on the health-seeking behaviour of people bitten by snakes, views on prevention measures and community needs and the consequences for snakebite patients in these areas.

METHODS

Six focus group interviews were conducted in communities in the Kajiado (n=3) and Kilifi (n=3) counties.

RESULTS

Traditional first-aid practices such as the use of a tourniquet and/or cutting the wound, use of a black stone and a variety of other traditional remedies were common. Challenges with transportation to health facilities and inadequately resourced facilities complicated accessing medical care. Community members voiced a need to improve access to trained healthcare workers and snakebite treatments at health facilities.

CONCLUSION

While communities had high trust in evidence-based medical care, traditional treatment was often sought, causing delays in timely medical attention. Traditional practices were often used in the home environment and these were not usually administered by a traditional healer. The findings illustrate the need to combine improving the availability of effective snakebite treatment and healthcare worker training on snakebite with community education to reduce the impact of snakebite.