Potential of Malawi's medicinal plants in Covid-19 disease management: A review

Consumption and adverse reaction reporting of herbal medicines among people living with HIV at University teaching hospitals in Blantyre, Malawi and Ibadan, Nigeria

Background

Consumption of herbal medicines among people living with HIV is a common practice in Sub-Saharan Africa. The utilization of herbal medicines was at 17.5% and 67.9% in Malawi and Nigeria, respectively. There is inadequate data on use and adverse reactions (ADRs) reporting of herbal medicines among people living with HIV (PLWHIV). This study was designed to investigate use and ADRs reporting of herbal medicines among PLWHIV at the University Teaching Hospitals in Blantyre, Malawi and Ibadan, Nigeria.

Methodology

A cross-sectional study was conducted among PLWHIV attending Antiretroviral Therapy (ART) clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi and University College Hospital, Ibadan, Nigeria. A structured questionnaire was administered to 360 and 370 participants in Blantyre and Ibadan respectively, through face-to-face interviews after obtaining their informed consent.

Results

The prevalence of herbal medicines use among PLWHIV in Malawi and Nigeria was at 80.6% and 55.7% (p<0.001), respectively. The most frequently used herbal medicines in Malawi were Aloe vera (14.0%), Moringa oleifera (14.0%), Zingiber officinale (13.0%) and Allium sativum (7.0%). Likewise, in Nigeria, the most commonly used herbal medicines were Zingiber officinale (15.0%), Vernonia amygdalina (14.0%), Moringa oleifera (9.0%), and Allium sativum (11.0%). The major reason for herbal medicines' use in Malawi was ready availability (42.1%) and perception that it boosts immunity (44.6%) in Nigeria. The PLWHIV reported experiencing suspected herbal medicine ADRs in Malawi (3.9%) and in Nigeria (8.0%).

Conclusion

A higher percentage of people living with HIV are using herbal medicines in Malawi as well as in Nigeria. In both countries, a few participants reported experiencing suspected ADRs related to herbal medicines.

GC-MS analysis, molecular docking, and pharmacokinetic studies of Multidentia crassa extracts' compounds for analgesic and anti-inflammatory activities in dentistry

Plant extracts have been useful for oral health or dentistry. However, only a few evidence-based justifications exist. This study evaluated Multidentia crassa (Hiern) Bridson & Verdc, one of the oral health-used plants in Malawi. Gas chromatography-mass spectrometry (GC-MS) and Fourier transform infrared (FT-IR) identified the extracts' compounds. The pharmacokinetics of the identified compounds were studied using pkCSM and SwissADME, and molecular docking studies were used to identify potential drug candidates for oral health by predicting the binding affinity of the compounds to cyclooxygenases, interleukin-1 beta receptors, odontoblast cold sensor proteins, and purinergic receptor P2X3. FT-IR analysis showed characteristic peaks of phenols, carboxylic acids, alkenes, alkyl halides, amines, esters, ethers, aromatics, and lipids. GC-MS results showed the presence of 58 bioactive phytocompounds, some of which have various pharmacological activities relevant to oral health. Molecular docking further validated stigmastan-3,5-diene's potency for analgesic and anti-inflammatory purposes. Based on a literature review, this is the first report on the bioactive compounds of M. crassa extracts showing analgesic and anti-inflammatory effects. This study's results can lead to new herbal and conventional medicines. Therefore, we recommend in vivo and in vitro studies to elucidate the pharmacological effects of the plant extracts.

Unlocking the anti-diabetic potential of Gymnema sylvestre, Trigonella foenum-graecum, and their combination thereof: An in-vivo evaluation

The current study aimed to explore the anti-diabetic effect of aqueous extracts of Gymnema sylvestre, Trigonella foenum-graecum and mixture of both the plants in alloxan-induced diabetic rabbits. A total of 30 rabbits were grouped into six equal groups as: normal control, diabetic control, diabetic treated with 300 mg/kg body weight (bw) G. sylvestre, diabetic treated with 300 mg/kg bw T. foenum-graecum, diabetic treated with 300 mg/kg bw mixture of both the plants and diabetic treated with 500 mg/kg bw metformin for 4 weeks. Diabetes was induced to all the study group animals except normal control by intravenous administration of alloxan monohydrate (80 mg/kg bw). Blood glucose was measured by glucometer and other biochemical parameters were determined through various kit methods. Serum insulin was measured through ELISA kit method. Results showed that both the plants and metformin significantly (p < .05) decreased the fasting blood glucose. Hypoglycemic activity of aqueous extract of G. sylvestre and metformin was found slightly higher than aqueous extract of T. foenum-graecum and the mixture of both the plants. However, a significant (p < .05) rise in insulin secretion was observed in studied plants extract treated rabbits. Serum urea, creatinine, and liver enzymes were found reduced significantly (p < .05) in treated rabbits whereas packed cell volume was also returned to normal in treated animals as compared to control group. The study concluded that G. sylvestre and T. foenum-graecum extracts have comparable effects with metformin in normalizing the blood glucose level and have more pronounced effect than metformin in restoring the serum biochemical parameters to normal levels. Hence, these plants may be the good alternative medicine in managing the diabetes mellitus.

Potential pharmacokinetic interactions with concurrent use of herbal medicines and a ritonavir-boosted COVID-19 protease inhibitor in low and middle-income countries

The COVID-19 pandemic sparked the development of novel anti-viral drugs that have shown to be effective in reducing both fatality and hospitalization rates in patients with elevated risk for COVID-19 related morbidity or mortality. Currently, nirmatrelvir/ritonavir (Paxlovid™) fixed-dose combination is recommended by the World Health Organization for treatment of COVID-19. The ritonavir component is an inhibitor of cytochrome P450 (CYP) 3A, which is used in this combination to achieve needed therapeutic concentrations of nirmatrelvir. Because of the critical pharmacokinetic effect of this mechanism of action for Paxlovid™, co-administration with needed medications that inhibit or induce CYP3A is contraindicated, reflecting concern for interactions with the potential to alter the efficacy or safety of co-administered drugs that are also metabolized by CYP3A. Some herbal medicines are known to interact with drug metabolizing enzymes and transporters, including but not limited to inhibition or induction of CYP3A and P-glycoprotein. As access to these COVID-19 medications has increased in low- and middle-income countries (LMICs), understanding the potential for herb-drug interactions within these regions is important. Many studies have evaluated the utility of herbal medicines for COVID-19 treatments, yet information on potential herb-drug interactions involving Paxlovid™, specifically with herbal medicines commonly used in LMICs, is lacking. This review presents data on regionally-relevant herbal medicine use (particularly those promoted as treatments for COVID-19) and mechanism of action data on herbal medicines to highlight the potential for herbal medicine interaction Herb-drug interaction mediated by ritonavir-boosted antiviral protease inhibitors This work highlights potential areas for future experimental studies and data collection, identifies herbal medicines for inclusion in future listings of regionally diverse potential HDIs and underscores areas for LMIC-focused provider-patient communication. This overview is presented to support governments and health protection entities as they prepare for an increase of availability and use of Paxlovid™.

Medicinal Uses of the Fabaceae Family in Zimbabwe: A Review

The current study is aimed at providing a systematic review of the ethnomedicinal, phytochemical and pharmacological properties of Fabaceae species used as sources of traditional medicinies in Zimbabwe. Fabaceae is one of the well-known plant families of ethnopharmacological importance. Of the approximately 665 species of the Fabaceae family occurring in Zimbabwe, about 101 are used for medicinal purposes. Many communities in the country, mainly in peri-urban, rural and marginalized areas with limited access to healthcare facilities, rely on traditional medicines as their primary healthcare. The study reviewed research studies undertaken on Zimbabwe's Fabaceae species during 1959 to 2022. Information was gathered from literature sourced from Google Scholar, Science Direct, Scopus, PubMed, books, dissertations, theses and scientific reports. This study showed that 101 species are traditionally used to manage human and animal diseases in Zimbabwe. The genera with the highest number of medicinal uses are Indigofera, Senna, Albizia, Rhynchosia and Vachellia. Species of these genera are used as traditional medicines against 134 medical conditions, mainly gastrointestinal conditions, female reproductive conditions, respiratory conditions and sexually transmitted infections. Shrubs (39.0%), trees (37.0%) and herbs (18.0%) are the primary sources of traditional medicines, while roots (80.2%), leaves (36.6%), bark (27.7%) and fruits (8.9%) are the most widely used plant parts. Many of Zimbabwe's Fabaceae species used as sources of traditional medicines have been assessed for their phytochemical and pharmacological properties, corroborating their medicinal uses. However, there is a need to unravel the therapeutic potential of the family through further ethnopharmacological research focusing on toxicological studies, in vitro and in vivo models, biochemical assays and pharmacokinetic studies.

Herbal Supplements as Treatment Options for COVID-19: A call for Clinical Development of Herbal Supplements for Emerging and Re-Emerging Viral Threats in Sub-Saharan Africa

The advent of Corona virus Disease 2019 (COVID-19) distorted health systems of many countries. Efforts have been made to either develop new treatment solutions such as vaccines or repurpose previously adopted drugs. Challenges in accessing available treatment, inadequate, non-existent, or overstretched healthcare facilities, long COVID disease, cultural practices and beliefs about vaccination, vaccine hesitancy, availability, accessibility and perceived safety of herbal supplements seem to be major factors propelling individuals to use herbal supplements. Published reports advocating for clinical development of herbal supplements for COVID-19 and other emerging and re-emerging viral diseases are sparse. This paper aims to review the pathogenesis of COVID-19, use of herbal products during the pandemic and make case for clinical development of herbal supplements through the adoption of modern and acceptable technologies and research processes.

This was a scoping review. Database searches of Google Scholar, PubMed and ResearchGate among others were performed using related keywords to identify relevant journals and lists of primary articles. Clinical trial databases:-Clinicaltrial.gov, Pan African Clinical Trial Registry (PACTR) and WHO international clinical trial registry (ICTRP) were reviewed to extract data.

The use of herbal supplements during COVID-19 was not only peculiar to individuals living in Sub-Saharan Africa, but a global practice. Herbal supplements recommended to manage COVID-19 have not been validated using clinical trials. Available data showed that the number of herbal supplements undergoing clinical trial for COVID-19 indication in Africa was low.

The availability of medicinal plants in Sub-Saharan Africa if well explored has great potentials to address various emerging and re-emerging viral diseases confronting the region. The economic potential of clinically validated herbal supplements are huge, and tapping into this opportunity created by preference of population to herbal supplement could increase export of herbal supplement and gross domestic product (GDP) of respective countries in Africa.

Ethnobotanical Study of Traditional Medicinal Plants Used for the Treatment of Infectious Diseases by Local Communities in Traditional Authority (T/A) Mbelwa, Mzimba District, Northern Region, Malawi

Local communities in Mzimba District, Malawi, have limited access to healthcare services and often rely on traditional medical practice and medicinal plants (MPs) for most of their medical care. However, phytomedicines’ use has not been well documented. This study aimed to identify and document medicinal plants and the associated ethnobotanical knowledge. Ethnobotanical data were collected in seven localities (19 villages) in the T/A Mbelwa, Mzimba, from May to June 2021. Forty traditional healers, herbalists, and farmers selected purposively and by snowball sampling were interviewed through semi-structured interviews, field observations, group discussions, and guided field walks. Quantitative indices, viz. relative frequency of citation (RFC), use value (UV), relative importance (RI) values, informant consensus factors (ICFs), and fidelity levels (FLs), were used to analyze the data. Eighty MPs belonging to 43 families and 77 genera were recorded. The Leguminosae family showed the highest number of species (16), followed by Solanaceae, Rubiaceae, and Phyllanthaceae. Trees (35 species) and roots (62%) accounted for the most significant habit and part, respectively. Washing (29%) was the most common preparation method. The most cited plant was Zanthoxylum chalybeum (RFC = 0.80, UV = 0.28, RI = 1.66), followed by Cassia abbreviata (RFC = 0.68, UV = 0.35, RI = 1.50). Respiratory disorders showed the highest ICF (0.53), followed by general and unspecified disorders (0.31). Z. chalybeum, C. abbreviata, and Oldfieldia dactylophylla showed maximum FLs (100%) for treating malaria and dysentery. Phytochemical, bioassay, toxicity, and conservation studies are needed to assess medicinal plants’ safety, efficacy, and quality as steps toward discovering new promising therapeutic leads without neglecting conservation programs for their sustainable utilization.

Role of ethno-phytomedicine knowledge in healthcare of COVID-19: advances in traditional phytomedicine perspective

Background

Since the outbreak of the COVID-19 virus, ethnomedicinal plants have been used in diverse geographical locations for their purported prophylactic and pharmacological effects. Medicinal plants have been relied on by people around the globe for centuries, as 80% of the world’s population rely on herbal medicines for some aspect of their primary health care needs, according to the World Health Organization.

Main body

This review portrays advances in traditional phytomedicine by bridging the knowledge of ethno-phytomedicine and COVID-19 healthcare. Ethnomedicinal plants have been used for symptoms related to COVID-19 as antiviral, anti-infective, anti-inflammatory, anti-oxidant, antipyretic, and lung–gut immune boosters. Traditionally used medicinal plants have the ability to inhibit virus entry and viral assembly, bind to spike proteins, membrane proteins, and block viral replications and enzymes. The efficacy of traditional medicinal plants in the terms of COVID-19 management can be evaluated by in vitro, in vivo as well as different in silico techniques (molecular docking, molecular dynamics simulations, machine learning, etc.) which have been applied extensively to the quest and design of effective biotherapeutics rapidly. Other advances in traditional phytomedicines against COVID-19 are controlled clinical trials, and notably the roles in the gut microbiome. Targeting the gut microbiome via medicinal plants as prebiotics is also found to be an alternative and potential strategy in the search for a COVID-19 combat strategy.

Conclusions

Since medicinal plants are the sources of modern biotherapeutics development, it is essential to build collaborations among ethnobotanists, scientists, and technologists toward developing the most efficient and the safest adjuvant therapeutics against the pandemic of the twenty-first century, COVID-19.

COVID-19, the environment and animal life in Malawi compared to other countries: A brief scooping review for a research agenda in the developing countries

The impact of COVID-19 on the human population in Malawi has been documented. However, its impact on the animal population and the environment has not been thoroughly researched. Because of the well-known inter-relationship between human and animal populations and the environment, a study based on a brief scooping review of previous related studies, media and survey reports, was conducted. The findings reveal that except for a few selected studies, the research gap on COVID-19's impact on the environment and animals in Malawi is wide compared to other countries. Nonetheless, from the few identified related studies, this study has revealed that as the restriction of movement and closure of borders disrupted the supply chain of forest resources in the country, the COVID-19 pandemic has led to increased pressure on forests as a coping strategy due to significant loss of jobs in the informal sector. Although the quality of water and air improved in most parts of the globe due to reduced human activity, there is no substantial literature on the same in Malawi partly due to ineffective monitoring systems. However, COVID-19 has exposed the deficiencies in water security in Malawi, thereby creating opportunities to address them. Conversely, increased demand for water at household levels due to restricted movements contributed to environmental pollution at suburb levels. In particular, the less developed and overpopulated countries suffered from land pollution due to poor disposal of plastic generated from hospitals and personal protection equipment. Elsewhere, studies show that minimal human interference with animals outside homes resulted in an increase of fish and bird biomasses. But, unemployment rates caused by the pandemic have seriously contributed to illegal poaching in developing countries. Therefore, a rapid assessment of the impact of the pandemic on environment in Malawi, to generate the evidence needed for policy makers to use in support of the affected and also plan for the recovery and sustainability of wildlife, is recommended.