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Opuni KF, Kretchy JP, Agyabeng K, Boadu JA, Adanu T, Ankamah S, Appiah A, Amoah GB, Baidoo M, Kretchy IA. Contamination of herbal medicinal products in low-and-middle-income countries: A systematic review. Heliyon 2023; 9:e19370. [PMID: 37674839 PMCID: PMC10477504 DOI: 10.1016/j.heliyon.2023.e19370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
The use of herbal medicinal products (HMPs) has grown significantly across low-and-middle-income countries (LMICs). Consequently, the safety of these products due to contamination is a significant public health concern. This systematic review aimed to determine the prevalence, types, and levels of contaminants in HMPs from LMICs. A search was performed in seven online databases, i.e., Africa journal online (AJOL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Directory of Open Access Journals (DOAJ), Health Inter-Network Access to Research Initiative (HINARI), World Health Organization Global Index Medicus (WHO GIM), Scopus, and PubMed using appropriate search queries and reported as per the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Ninety-one peer-reviewed articles published from 1982 to 2021 from 28 different countries across four continents were included in the study. Although metals, microbial, mycotoxins, pesticides, and residual solvents were the reported contaminants in the 91 articles, metals (56.0%, 51/91), microbial (27.5%, 25/91), and mycotoxins (18.7%, 17/91) were the most predominant. About 16.4% (1236/7518) of the samples had their contaminant levels above the regulatory limits. Samples tested for microbial contaminants had the highest proportion (46.4%, 482/1039) of contaminants exceeding the regulatory limit, followed by mycotoxins (25.8%, 109/423) and metals (14.3%, 591/4128). The proportion of samples that had their average non-essential metal contaminant levels above the regulatory limit was (57.6%, 377/655), 18.3% (88/480), 10.7% (24/225), and 11.3% (29/257) for Pb, Cd, Hg, and As, respectively. The commonest bacteria species found were Escherichia coli (52.3%, 10/19) and Salmonella species (42.1%, 8/19). This review reported that almost 90% of Candida albicans and more than 80% of moulds exceeded the required regulatory limits. HMP consumption poses profound health implications to consumers and patients. Therefore, designing and/or implementing policies that effectively regulate HMPs to minimize the health hazards related to their consumption while improving the quality of life of persons living in LMICs are urgently needed.
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Affiliation(s)
- Kwabena F.M. Opuni
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - James-Paul Kretchy
- Department of Public Health, School of Medicine and Health Sciences, Central University, P. O. Box 2305, Miotso, Accra, Ghana
| | - Kofi Agyabeng
- Department of Biostatistics, School of Public Health, University of Ghana, P. O. Box LG13, Legon, Accra, Ghana
| | - Joseph A. Boadu
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Theodosia Adanu
- Balme Library, University of Ghana, P.O. Box LG24, Legon, Accra, Ghana
| | - Samuel Ankamah
- Balme Library, University of Ghana, P.O. Box LG24, Legon, Accra, Ghana
| | - Alexander Appiah
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Geralda B. Amoah
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Mariam Baidoo
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
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Ampomah IG, Malau-Aduli BS, Seidu AA, Malau-Aduli AEO, Emeto TI. The practice of integrated healthcare and the experiences of people in Ghana's Ashanti region. BMC Health Serv Res 2022; 22:32. [PMID: 34986828 PMCID: PMC8734307 DOI: 10.1186/s12913-021-07340-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background The Ghanaian government has implemented interventions that integrate traditional medicine (TM) into its national health system in response to the high prevalence of TM use. However, empirical evidence of the experiences of service users and the practice of integrated health in Ghana is scanty. Therefore, this study explored the experiences of people with TM integration into the formal health system in Ashanti region using an adapted TM integration framework. Methods A sequential explanatory mixed methods study design comprising survey administration and in-depth interviews for data collection was utilised to address the research objective. Framework analysis was used in analysing the qualitative data and for triangulation of results. Results Participants were aware of licensing and training of TM practitioners in a science-based university in Ghana. However, knowledge of the existence of TM units in selected hospitals in the region was minimal. Integration knowledge was largely influenced by sex, marital status, household size and residential status, where males and urban dwellers were more familiar with the process than females and rural dwellers. Low patronage of integrated health services in the region was attributable to weak cross referrals. However, service users who had engaged with the integrated system recounted a satisfactory outcome. Conclusion Service users’ unfamiliarity with the presence of integrated facilities in Ghana could be an impediment to the practice of integrated healthcare. Sensitisation of the public about the practice of an integrated system could refine the Ghanaian integrated system. Regular evaluation of patient satisfaction and outcome measures might also serve as an effective strategy for improving health services delivery since evaluation is becoming an important component of health service design and implementation. There is the need for future studies to focus on exploring the perceptions and experiences of health practitioners and hospital administrators regarding the practice of integrated health in Ghana. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07340-0.
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Affiliation(s)
- Irene G Ampomah
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia.,Department of Population and Health, University of Cape Coast, Cape Coast, Post Office Box UC 182, Ghana
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townville, QLD, 4811, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia.,Department of Population and Health, University of Cape Coast, Cape Coast, Post Office Box UC 182, Ghana
| | - Aduli E O Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Theophilus I Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia. .,World Health Organization Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, QLD, 4811, Australia.
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Olusola JA, Akintan OB, Erhenhi HA, Osanyinlusi OO. Heavy Metals and Health Risks Associated with Consumption of Herbal Plants Sold in a Major Urban Market in Southwest, Nigeria. J Health Pollut 2021; 11:210915. [PMID: 34434607 PMCID: PMC8383799 DOI: 10.5696/2156-9614-11.31.210915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although herbal medicines play an important role as a source of medicine, concerns have been raised about the risks posed by consumption of these plants, especially if consumed above permissible levels. OBJECTIVES This study was undertaken to assess the level of exposure, toxicity and health risk associated with the consumption of herbal plants in Ado Ekiti urban market, Nigeria. METHODS Ten commonly consumed herbal plants sold in Ado Ekiti urban market were subjected to heavy metal analysis. Health risk assessment was carried out to determine the estimated daily intake (EDI) of heavy metals, health risk index (HRI), target hazard quotient for non-carcinogenic risk and estimation of cancer risk (ECR). RESULTS The EDIs for lead (Pb), nickel (Ni), chromium (Cr), copper (Cu) and magnesium (Mn) were above the upper tolerable daily intake reference for all studied plant species in both children and adults, an indication that herbal use poses a short-term to long-term health risk to consumers of these herbal products. The EDI for children was significantly lower compared to that of adults, indicating higher risks for adult consumers of these herbal products. The HRI in children for Pb (Alstonia congensis, Terminalia avicennioides, Aframomum melegueta, Cymbopogon citratus and Napoleona vogelii) were greater than 1; HRI in Cu and Mn also showed an unusually high concentration, an indication that long term exposure to the consumption of these herbal plants poses a serious health risk. The HRI in children and adults follows the order Mn > Cu > Ni > Pb > Cr; cadmium (Cd) was not detected in any of the herbal plants. The ECR for Pb, Ni and Cr present in the herbal plants for children ranged between 10-6 (low) to 10-3 (high), while the ECR for Pb, Ni and Cr for herbal plants for adults ranged between 10-5 (acceptable) to 10-2 (unacceptable). For both children and adults, there is a call for concern due to ECRs above the acceptable range; the consumption of these herbal plants poses a long-term cancer risk. CONCLUSIONS In both children and adults, ECRs for some of the herbal plants in the present study above the acceptable range present a risk to human health. The consumption of such herbal plants poses a long-term cancer risk. COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Johnson A. Olusola
- Institute of Ecology and Environmental Studies, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Oluwakemi B. Akintan
- Department of Geography and Planning Science, Ekiti State University, Ado Ekiti, Nigeria
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Bolan S, Kunhikrishnan A, Seshadri B, Choppala G, Naidu R, Bolan NS, Ok YS, Zhang M, Li CG, Li F, Noller B, Kirkham MB. Sources, distribution, bioavailability, toxicity, and risk assessment of heavy metal(loid)s in complementary medicines. ENVIRONMENT INTERNATIONAL 2017; 108:103-118. [PMID: 28843139 DOI: 10.1016/j.envint.2017.08.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 08/05/2017] [Accepted: 08/09/2017] [Indexed: 05/27/2023]
Abstract
The last few decades have seen the rise of alternative medical approaches including the use of herbal supplements, natural products, and traditional medicines, which are collectively known as 'Complementary medicines'. However, there are increasing concerns on the safety and health benefits of these medicines. One of the main hazards with the use of complementary medicines is the presence of heavy metal(loid)s such as arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg). This review deals with the characteristics of complementary medicines in terms of heavy metal(loid)s sources, distribution, bioavailability, toxicity, and human risk assessment. The heavy metal(loid)s in these medicines are derived from uptake by medicinal plants, cross-contamination during processing, and therapeutic input of metal(loid)s. This paper discusses the distribution of heavy metal(loid)s in these medicines, in terms of their nature, concentration, and speciation. The importance of determining bioavailability towards human health risk assessment was emphasized by the need to estimate daily intake of heavy metal(loid)s in complementary medicines. The review ends with selected case studies of heavy metal(loid) toxicity from complementary medicines with specific reference to As, Cd, Pb, and Hg. The future research opportunities mentioned in the conclusion of review will help researchers to explore new avenues, methodologies, and approaches to the issue of heavy metal(loid)s in complementary medicines, thereby generating new regulations and proposing fresh approach towards safe use of these medicines.
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Affiliation(s)
- Shiv Bolan
- Global Centre for Environmental Remediation, ATC Building, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Anitha Kunhikrishnan
- Department of Agro-Food Safety, National Institute of Agricultural Science, Wanju, Jeollabuk-do 55365, Republic of Korea
| | - Balaji Seshadri
- Global Centre for Environmental Remediation, ATC Building, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Girish Choppala
- Southern Cross GeoScience, Southern Cross University, Lismore, New South Wales 2480, Australia
| | - Ravi Naidu
- Global Centre for Environmental Remediation, ATC Building, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Nanthi S Bolan
- Global Centre for Environmental Remediation, ATC Building, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Yong Sik Ok
- O-Jeong Eco-Resilience Institute (OJERI) & Division of Environmental Science and Ecological Engineering, Korea University, Seoul, Republic of Korea
| | - Ming Zhang
- Department of Environmental Engineering, China Jiliang University, Hangzhou, China
| | - Chun-Guang Li
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Feng Li
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Barry Noller
- Sustainable Minerals Institute, University of Queensland, Brisbane, Australia
| | - Mary Beth Kirkham
- Department of Agronomy, Throckmorton Plant Sciences Center, Kansas State University, Manhattan, KS, USA
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Asuzu CC, Elumelu-Kupoluyi T, Asuzu MC, Campbell OB, Akin-Odanye EO, Lounsbury D. A pilot study of cancer patients' use of traditional healers in the Radiotherapy Department, University College Hospital, Ibadan, Nigeria. Psychooncology 2015; 26:369-376. [PMID: 26577066 DOI: 10.1002/pon.4033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 09/10/2015] [Accepted: 10/16/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This descriptive cross-sectional study assessed cancer patients' use of traditional healers, the association between delay in coming to this clinic and patients' use of traditional healers, reasons cancer patients use western medicine after trying traditional treatment and the cost of obtaining traditional treatment. METHODS Participants were made of 400 consecutive and consenting new patients in the Department of Radiotherapy, University College Hospital (UCH), Ibadan. A validated interviewer-administered semi-structured questionnaire was used for data collection. Data was analyzed using descriptive and inferential statistics. Focus group discussions were held with some of the clients as well as the traditional healers. RESULTS It showed that 34.5% of the patients patronized traditional healers, while 65.5% used only hospitals. The most common reason given among patients who patronized traditional healers for doing so was their desire to be healed and to be rid of pains (45.9%), while the most common reason they opt for western medicine afterwards was lack of improvement in their health condition (70.1%). The cost of traditional treatment for cancer ranged between no cost to N5,000 (that is approximately $31.25 @ $1 = N160) to be treated. The cost of orthodox care would range from a minimum of N40,000 to several millions of naira. CONCLUSIONS Patients patronize traditional healers to be rid of pains; hence physicians should endeavor to control cancer-related symptoms, especially pains as the patients await diagnosis. Also, the low cost of obtaining traditional treatment, regular assurance of cure and other assistances given to them, could be an enticing factor in its use. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- C C Asuzu
- Department of Guidance & Counselling, University of Ibadan, Ibadan, Nigeria.,Department of Radiotherapy, University of Ibadan, Ibadan, Nigeria
| | | | - M C Asuzu
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | - O B Campbell
- Department of Radiotherapy, University of Ibadan, Ibadan, Nigeria
| | - E O Akin-Odanye
- Department of Radiotherapy, University of Ibadan, Ibadan, Nigeria
| | - D Lounsbury
- Department of Population Science, Albert Einstein College of Medicine, New York, USA
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Borowska S, Brzóska MM. Metals in cosmetics: implications for human health. J Appl Toxicol 2015; 35:551-72. [DOI: 10.1002/jat.3129] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Sylwia Borowska
- Department of Toxicology; Medical University of Bialystok; Adama Mickiewicza 2C Street 15-222 Bialystok Poland
| | - Malgorzata M. Brzóska
- Department of Toxicology; Medical University of Bialystok; Adama Mickiewicza 2C Street 15-222 Bialystok Poland
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Oreagba IA, Oshikoya KA, Amachree M. Herbal medicine use among urban residents in Lagos, Nigeria. Altern Ther Health Med 2011; 11:117. [PMID: 22117933 PMCID: PMC3252251 DOI: 10.1186/1472-6882-11-117] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 11/25/2011] [Indexed: 11/11/2022]
Abstract
Background Over three-quarter of the world's population is using herbal medicines with an increasing trend globally. Herbal medicines may be beneficial but are not completely harmless. This study aimed to assess the extent of use and the general knowledge of the benefits and safety of herbal medicines among urban residents in Lagos, Nigeria. Methods The study involved 388 participants recruited by cluster and random sampling techniques. Participants were interviewed with a structured open- and close-ended questionnaire. The information obtained comprises the demography and types of herbal medicines used by the respondents; indications for their use; the sources, benefits and adverse effects of the herbal medicines they used. Results A total of 12 herbal medicines (crude or refined) were used by the respondents, either alone or in combination with other herbal medicines. Herbal medicines were reportedly used by 259 (66.8%) respondents. 'Agbo jedi-jedi' (35%) was the most frequently used herbal medicine preparation, followed by 'agbo-iba' (27.5%) and Oroki herbal mixture® (9%). Family and friends had a marked influence on 78.4% of the respondents who used herbal medicine preparations. Herbal medicines were considered safe by half of the respondents despite 20.8% of those who experienced mild to moderate adverse effects. Conclusions Herbal medicine is popular among the respondents but they appear to be ignorant of its potential toxicities. It may be necessary to evaluate the safety, efficacy and quality of herbal medicines and their products through randomised clinical trial studies. Public enlightenment programme about safe use of herbal medicines may be necessary as a means of minimizing the potential adverse effects.
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Princewill IL, Ogbonna PC. Heavy Metal Content in Soil and Medicinal Plants in High Traffic Urban Area. ACTA ACUST UNITED AC 2011. [DOI: 10.3923/pjn.2011.618.624] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Oshikoya KA, Senbanjo IO, Njokanma OF, Soipe A. Use of complementary and alternative medicines for children with chronic health conditions in Lagos, Nigeria. Altern Ther Health Med 2008; 8:66. [PMID: 19113999 PMCID: PMC2628640 DOI: 10.1186/1472-6882-8-66] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 12/29/2008] [Indexed: 11/23/2022]
Abstract
Background The use of complementary and alternative medicine (CAM) is on the increase globally with a high prevalence in children and adults with chronic illnesses. Many studies have evaluated the epidemiology of medicine use for children in developing countries but none has evaluated the use of CAM for children with chronic illnesses. The aim of this study was therefore to determine the prevalence, pattern of use, parental sources of information, perceived benefits, cost, and adverse effects of CAM in children with epilepsy, sickle cell anaemia and asthma in Lagos, Nigeria. Methods Parents of children with epilepsy (122), asthma (78) or sickle cell anaemia (118) who presented consecutively to the paediatric neurology, respiratory and haematology clinics of the Lagos State University Teaching Hospital (LASUTH), Ikeja were interviewed with a structured open- and close-ended questionnaire. The information obtained comprised the demography of both the patients and their parents; past and present treatments received by the patients; the type of CAM, if any, used by the patients; and the sources, cost, benefits and adverse effects of the CAM used. Results A total of 303 CAMs were used by the patients, either alone or in combination witother CAM. CAM was reportedly used by 99 (31%) patients (epilepsy -38%, sickle cell anaemia – 36% and asthma – 25%). The majority (84%) of these patients were currently using CAM. The use of CAM was stopped six months prior to the study by 16 patients (16%). Biological products were the most frequently used CAMs (58%), followed by alternative medical systems (27%) and mind-body interventions (14%). Relations, friends and neighbours had a marked influence on 76% of the parents who used CAM for their children. Eighty-five (86%) parents were willing to discuss the use of CAM with their doctors but were not asked. CAM use was associated with adverse reactions in 7.1% of the patients. Conclusion Parental use of CAMs to treat their children with epilepsy, asthma and sickle cell anaemia is common in Nigeria. Efforts should be made by doctors taking care of these patients to identify those CAM therapies that are beneficial, harmless and cheap for possible integration with conventional therapy.
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