Physiological Sciences

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    Assessment of Level of Knowledge of Management of Acne vulgaris among Community Pharmacists and Prescribers in Lusaka Urban
    (Asian Online Journals, 2015-12) Prashar, Lavina; Kachipond, Fredrick; Nagalamika, Owen
    Acne is a common skin condition affecting almost 85% of the population. Everyone has the risk of developing acne at certain stages of life. The management of acne in early stages is important for disease prognosis. Patients with acne usually present at community pharmacies and clinics during the early stages of their disease. Assessment of knowledge and practice of community pharmacists and prescribers in treating these patients is required. The aim of this study was to assess the levels of knowledge in acne management among community pharmacists and prescribers in Lusaka urban. The study was designed as a cross-sectional survey and was conducted on 89 community pharmacists and prescribers working in Lusaka, Zambia. Participants were asked to answer a self administered questionnaire on the management of acne vulgaris that comprised questions evaluating the knowledge on disease causes, aggravating or relieving factors, treatment practices and use of reference materials. The study revealed that Pharmacists and prescribers had inadequate levels of knowledge on disease management; 21% had low levels of knowledge where as only 6% had high levels of knowledge. By category, 36% of the prescribers had low levels and 10% had high levels of knowledge. 8% of the pharmacists had low levels of knowledge and only 2% had high levels. Lack of knowledge was reflected in their treatment practices, 62.9% never classified acne when initiating treatment and less than a quarter managed acne cases independently. This study showed no association of levels of knowledge to referral of patients with severe acne (p>0.05). It was concluded from the study that pharmacists and prescribers have inadequate knowledge and practice for management of acne. Steps should be taken to update and improve their dermatological knowledge.
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    A Comparative Study for the Efficacy and Tolerability of Fluvoxamine and Venlafaxine in patients with Obsessive Compulsive Disorder
    (RA Publications, 2015-09-20) Prashar, Lavina; Paul, Ravi
    To compare the efficacy and tolerability of Fluvoxamine and Venlafaxine in patients with Obsessive Compulsive Disorder (OCD). A total of 50 newly diagnosed patients with OCD were randomly assigned 25 each to receive either fluvoxamine (Selective serotonin reuptake inhibitor) or venlafaxine (selective serotonin norepinephrine reuptake inhibitor). Primary efficacy was assessed by the change from baseline on the Yale Brown Obsessive Compulsive Scale (Y-BOCS). The Clinical Global Impression Improvement Scale (CGI-S) was used to measure symptom improvement. Each patient was followed as a single visit in a week wise manner following the order; Week0, Week 1, Week 2, Week 4, Week 6, Week 8, Week 12 and Week 16. At each visit if any adverse reaction to either of the drugs experienced by the patient were noted. Treatment group comparison of patients, demographic characteristics and baseline severity measurements were done using a Chi square test and the student t-test. Statistical significance was defined as a 2-sided p value ≤ 0.05. Both drugs showed significant reduction in the OCD symptoms as measured on the Y-BOC Scale over the 16-week follow up. When compared fluvoxamine showed statistically significant reduction in overall YBOC score and Obsessive mean score. The difference in compulsive mean score was not significant in the two treatment groups. Fluvoxamine is more efficacious than Venlafaxine in the treatment of OCD.
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    The Effect of Kigelia africana Fruit Extract on Blood Glucose in Diabetes Induced Mice
    (RA Publications, 2015-09-20) Prashar, Lavina; Muyenga, Tumelo; Bwalya, Angela Gono; Muungo, L.T.M
    To determine the effect Kigelia africana fruit extract has on blood glucose levels of diabetes mice and its phytochemical profile Mice were induced with diabetes using Alloxan monohydrate 90mg/kg. Blood glucose was checked before induction and 72 hours after induction to confirm diabetes. Treatment involved using oral administration of Kigelia fruit extract 1000mg/kg, Kigelia fruit extract 500mg/kg, Glibenclamide 0.25 mg/kg, Kigelia fruit extract 500mg/kg and Glibenclamide 0.25mg/kg and Normal Saline.The results showed a greater reduction in blood glucose of mice after treatment with Kigelia extract 1000mg/kg compared to Kigelia 500mg/kg [(5.3 +/- 0.5mmol/l) vs (6.3+/- 0.6mmol/l), (p= 0.005)]. Further, Glibenclamide 0.25mg/kg showed less reduction in blood glucose than Kigelia 1000mg/kg [(7.4+/-0.9mmol/l) vs (5.3 +/- 0.5), (p= 0.00)]. The mean blood glucose levels were lower in mice that received Kigelia extract than those that received both Kigelia extract and Glibenclamide [(5.3 +/- 0.5mmol/l) vs (7.8 +/- 0.6 mmol/l), (p=0.00)]. The fruit extract tested positive for Tannins, Saponins, Flavanoids, Alkaloids, Glycosides and Steroids. Findings of this study indicate that Kigelia africana fruit extract causes reduction in blood glucose of diabetes induced mice and gives better results when used alone than in concomitant use with Glibenclamide. The study also indicates that the fruit extract has alkaloids, saponins, steroids, glycosides, tannins and flavonoids. To determine the effect Kigelia africana fruit extract has on blood glucose levels of diabetes mice and its phytochemical profile Mice were induced with diabetes using Alloxan monohydrate 90mg/kg. Blood glucose was checked before induction and 72 hours after induction to confirm diabetes. Treatment involved using oral administration of Kigelia fruit extract 1000mg/kg, Kigelia fruit extract 500mg/kg, Glibenclamide 0.25 mg/kg, Kigelia fruit extract 500mg/kg and Glibenclamide 0.25mg/kg and Normal Saline. The results showed a greater reduction in blood glucose of mice after treatment with Kigelia extract 1000mg/kg compared to Kigelia 500mg/kg [(5.3 +/- 0.5mmol/l) vs (6.3+/- 0.6mmol/l), (p= 0.005)]. Further, Glibenclamide 0.25mg/kg showed less reduction in blood glucose than Kigelia 1000mg/kg [(7.4+/-0.9mmol/l) vs (5.3 +/- 0.5), (p= 0.00)]. The mean blood glucose levels were lower in mice that received Kigelia extract than those that received both Kigelia extract and Glibenclamide [(5.3 +/- 0.5mmol/l) vs (7.8 +/- 0.6 mmol/l), (p=0.00)]. The fruit extract tested positive for Tannins, Saponins, Flavanoids, Alkaloids, Glycosides and Steroids. Findings of this study indicate that Kigelia africana fruit extract causes reduction in blood glucose of diabetes induced mice and gives better results when used alone than in concomitant use with Glibenclamide. The study also indicates that the fruit extract has alkaloids, saponins, steroids, glycosides, tannins and flavonoids
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    Extraction and Demonstration of Uterotonic Activity from the Root of Steganotaenia araliacea Hochst.
    (Zambian Medical Association, 2017-09-14) Prashar, Lavina; Goma, Fastone; Ezeala, Christian; Nyirenda, James; Chuba, David; Simfukwe, Newton; Lengwe, Chilufya
    The root of Steganotaenia araliacea is used for assisting labour in folk medicine. Recent reports indicate that the root could possess uterotonic substances.The study aimed to evaluate three methods for the extraction of uterotonic principles from the root of S. araliacea growing in Zambia. Roots of the plant were collected from Chongwe District of Zambia. The air-dried roots were size-reduced, and the powdered material extracted with hot ethanol, hot distilled water, and cold distilled water. The solvent extracts were concentrated and dried at 110 0C. Solutions of the hot aqueous and cold aqueous extracts were prepared in distilled water and used for organ bath experiments to demonstrate uterotonic activities using strips of pregnant rat uterus. The frequencies and amplitude of contractile forces were recorded. The amplitudes were plotted against log concentration of extract with GraphPad Prism software, and the EC50 values determined. The percentage yields were 31.3 % for the hot aqueous extract, 8.15 % for the ethanolic extract, and 3.27 % for the cold aqueous extract. The cold aqueous extract showed higher potency (EC50 of 0.54 mg/ml) compared to the hot aqueous extract (EC50 of 2.09 mg/ml). Root extracts of S. araliacea possess demonstrable uterotonic effects. Extraction of the roots for this purpose could benefit from preliminary defatting with organic solvents, followed by successive extraction with hot and cold water.
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    Indigenous Knowledge Systems for the Treatment of Hypertension in Lusaka, Zambia: Perceptions, Knowledge and Practice.
    (Zambian Medical Association, 2016-01) Prashar, Lavina; Goma, Fastone; Kalungia, Chichony Aubrey; Bwalya, Angela Gono; Hamachila, Audrey; Mutati, Ronald Kampamba; Zingani, Ellah; Mwila, Chiluba; Musoke, Pamela
    Indigenous knowledge systems and traditional technologies have made and can continue to make a significant contribution to modern medicines with discovery of novel molecules in the treatment of various conditions. The traditional knowledge in our communities is passed on from generation to generation. Scientific evaluation of these compounds from traditional medicines can lead to discovery drugs with better efficacy and novel mechanism. The study aimed at determining the indigenous knowledge based preparations used for hypertension in Lusaka, Zambia. The specific objectives were: a). To determine the knowledge and practice of Traditional Health Practitioners in the management of HTN, b). To identify the parts of the plants utilized in the preparation of the IKS-based preparation used in the management of hypertension. c). To determine the procedure employed in preparing the IKS-based preparations used in the management of hypertension. d). To recommend for further elucidation of the possible active compounds in the indigenous based preparations and postulate possible pharmacological mechanisms of actions. The study adopted structured interviews complemented by non-participatory observations. Samples used by traditional healers were collected for identification and characterization A total of twelve (12) traditional healers registered with Traditional Health Practitioners of Zambia who manage hypertension were interviewed. The traditional healers interviewed had knowledge of causes of hypertension, only three (3) indicated bewitchment as one of the causes. spiritual method constituted an important method of diagnosis. The beliefs of Traditional Healers with regard to hypertension indicates their alignment to agreeing the scientific understanding of hypertension in terms of its causes, risk factors and complications. Traditional Healers in Zambia believe hypertension can be managed by some mode of action of the herbs. Common themes that emerged to determine the effectiveness of the herbs used included; patient feedback, physical appearance, confirmation at local clinic and increased urine output. Majority (5/12) felt that there herbs take atleast 7-14 before the effects are seen. All the traditional healers indicated using atleast two (2) types of herbal preparations to manage hypertension. Of the preparations mentioned three (3) were not of plant origin. These include; crocodile fat, pebble and honey. This study observed that the traditional healers of Zambia knowledge of causes and complications of hypertension are alligned to the scientific knowledge. Divination is however still the most important (50%) method used for diagnosis and witchcraft/ spiritual method forms an important method for some for diagnosis of hypertension. It is noteworthy that traditional healers in Zambia believe hypertension can be managed by some mode of action of the herbs a belief shared by the conventional management.
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    Opuntia stricta cladode Extract reduces blood glucose levels in Alloxan-induced diabetic mice.
    (Scientific and Academic Publishing, 2018-07) Prashar, Lavina; Kalungia, Chichony Aubrey; Mataka, Mary; Kaonga, Patrick; Bwalya, Angela Gono; Munkombwe, Derrick
    Opuntia stricta (commonly called prickly pear cactus) is a natural plant that grows in some parts of Zambia where its fruits and cladodes are commonly consumed for nutritional and medicinal purposes, including glycaemic control among some patients with diabetes mellitus (DM). There is insufficient evidence whether Opuntia stricta indigenously growing in Zambia possess antidiabetic effects.To assess in vivo antidiabetic effects of the aqueous extract of Opuntia stricta cladodes in alloxan-induced diabetic mice. A laboratory-based experimental study was conducted involving 20 adult Swiss albino mice (Mus musculus) weighing 18-30 g. DM was induced using a single intraperitoneal dose of alloxan monohydrate 90 mg/kg. Opuntia stricta aqueous extract was administered orally and blood glucose levels (in mmol/L) monitored daily for 10 days. Alloxan induced a 4- to 5-fold sustained increase in blood glucose levels at 72 hours after administration in mice. Within a 10-day experimental period, Opuntia stricta cladode aqueous extract (1 mg/kg) significantly reduced blood glucose levels in vivo (from 16.6 ± 1.4 mmol/L, 95% CI: 14.9-18.3 at baseline to 7.5 ± 1.0 mmol/L, 95% CI: 6.2-8.9 at endpoint, p < 0.001, n = 5). Similarly, at a dose of 2 mg/kg, the extract significantly reduced blood glucose levels (from 18.7 ± 4.6 mmol/L, 95% CI: 13.0-24.4 at baseline to 6.9 ± 1.7 mmol/L, 95% CI: 4.7-9.0 at endpoint, p = 0.001, n = 5). Opuntia stricta cladode aqueous extract attained a greater reduction in blood glucose levels compared to Glibenclamide 0.25 mg/kg. Opuntia stricta cladode aqueous extract demonstrated a presence of alkaloids, flavonoids, saponins, sterols, carbohydrates, phenols and tannins. Opuntia stricta cladode from Zambia demonstrates antidiabetic effects to reduce blood glucose levels in vivo.
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    Physiological response of uterine muscle to Steganoteania araliacea in rat models
    (RA Publications, 2015-01) Prashar, Lavina; Lukubi, Lwindi; Goma, Fastone; Mushabati, Festus; Choongo, Kennedy
    The bark root of Steganotaenia araliacea Hochst (Umbelliferae) nicknamed “herbal pitocin” is used in the traditional circles in Zambia to induce and/or enhance labour. This work was aimed at investigating the contractile stimulatory effects of the aqueous extracts of Steganotaenia araliacea (SAEª) on isolated smooth muscle preparations of the rat uterus. Objectives: To determine the physiological effect of SAEª on isolated pregnant and non-pregnant uterine muscle. Methods: A gravid/non-gravid rat was sacrificed by cervical dislocation (decapitation) method and the abdomen opened to expose the internal organs. The two uterine horns were identified, dissected out and transferred to a dish containing De Jalon’s physiological solution. Acetylcholine (Ach) and Oxytocin (OT) were used as reference agonist with their corresponding antagonists; atropine (AT), and indomethacin and salbutamol (SBM) respectively. The effect of these reference agonists with their corresponding antagonist and that of aqueous extract of SAE on non-pregnant rat uterus pre-treated with 1 mg/kg stilboesterol for 24 h and on the pregnant rat uterus were investigated. Results: In vitro studies of SAEª on uterine tissue showed contractile (uterotonic) activity on both isolated gravid and estrogenized non-gravid rat uterus at the concentration shown in this study. SAE ª significantly increased the amplitude(from baseline value of 0.1471mN to 0.3003mN) and frequency of spontaneous uterine contractions. However, SBM significantly inhibited (p < 0.05) the frequency and amplitude of spontaneous uterine contractions on the isolated pregnant and non – pregnant rat uterus preparations but atropine and indomethacin could not modify the contractions produced by SAEª, hence indicating a non-muscarinic and non-prostaglandin biosynthesis dependant respectively. Conclusion: The inhibition of contractile effect of the crude aqueous extract of SAEª shown by Salbutamol (p < 0.05) suggests the probable stimulation of the Oxytocinergic receptors of the uterus by the extract. These physiological finding justify the traditional use of the plant for its uterotonic properties.
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    A Preliminary Study of Knowledge, Attitude and Practice of Adverse Drug Reaction Reporting in a Teaching Hospital in Lusaka, Zambia
    (Zambian Medical Association, 2014-12) Prashar, Lavina; Musoke, Pamela
    Objectives of the Study: The study was aimed at examining ADR reporting practices and barriers among medical doctors, pharmacists, nurses, clinical officers, and medical residents at the University Teaching Hospital, Lusaka, Zambia. The specific objectives were: a) to assess the knowledge of ADR reporting among health professionals, b) to assess attitudes of health professionals towards ADR reporting, and c) to assess the practice of ADR reporting among health professionals. Materials and Methods: The study adopted a questionnaire-based cross-sectional method. One hundred and forty questionnaires were administered to health professionals working at the University Teaching Hospital, Lusaka. Statistical Analysis Used: The Statistical Package for the Social Sciences (SPSS) version 20 was used to run various descriptive statistics and to draw charts. Pearson's Chi-square test was used to observe the association of knowledge and attitude with experience and position, at significance level of 0.05. Results: One hundred and twenty-eight questionnaires were successfully filled in and returned, giving a response rate of 91.4%. Knowledge of ADR reporting among the professionals was extremely very low. Only one respondent obtained 50% of the total scores, i.e. 19 marks out of 34 marks; and no respondent got above 50%. The minimum score obtained was 0, the maximum score was 19, and the average score was 12.6 with a standard deviation of 3.555. There was no association between knowledge level of ADR reporting and age of the respondent (r=0.003 (n=123); p=0.973). Furthermore, there was no association between knowledge levels of ADR reporting and length of respondents' practice at UTH (r=0.013 [n=120]; p=0.886). Low knowledge levels of ADR reporting were attributed to lack of training. Only 17.7% of respondents had been trained in ADR reporting. The major factors that encouraged ADR reporting included: if the reaction was serious (84.7%); if the reaction was unusual (77.4%); if the reaction was to a new product (73.4%); if the reaction was well recognized for a particular drug (60.5%); and confidence in diagnosis of an ADR (46.0%). Factors that discouraged ADR reporting included: lack of feedback (73.5%); the level of clinical knowledge to decide whether an ADR had occurred (49.0%); lack of time to actively look for ADRs (46.9%); the information reported may be wrong (37.8%); lack of time to fill in a report (36.7%); and lack of need to report a recognized ADR because it will make little difference to knowledge (30.6%). Very few (12.7%) respondents had reported an ADR case. The major factors found to be responsible for under reporting of ADR include ignorant of reporting procedures (52.0%), lack of reporting forms (31.8%), and lack of appreciation of the importance of ADR reporting. Conclusion: This study observed that knowledge of ADR reporting was very low among health professionals at UTH. These deficiencies in knowledge and attitudes require urgent attention not only to improve the rate of ADR reporting, but also in order to improve the safety of the patients. Furthermore, the hospital management should improve awareness and training on ADR reporting
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    Tafenoquine: A New 8- Aminoquinoline
    (Zambian Medical Association, 2009) Prashar, Lavina; Paul, Ravi
    Malaria remains one of the major health hazards, with high associated morbidity and mortality in addition to having a crippling effect on the economy. Worldwide, malaria is the cause of morbidity in 300- 500 million people annually, out of whom, 2-3 1 million die . The disease is endemic within most tropical and subtropical regions of the world but 90% of all malaria deaths currently occur in Sub-Saharan Africa. In Africa, official figures show that a child dies of malaria every 45 seconds and the disease is 2 responsible for 20% of all childhood deaths . In Zambia, an estimated 3 million cases are said to occur every year and in the year 2006, the estimated 3 number of deaths because of the disease was 6,484 .The parasites responsible for malaria include P. falciparum, P. vivax, P. ovale and P. malariae. P. vivax and P. ovale exhibit the exoerythrocytic stage responsible for relapses, but of critical importance in Sub-Saharan region is P falciparum.
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    Zambia abortion survey report : incidence and determinants of abortion in Zambia.
    (Golden Touch Graphical Printers, 2009) Likwa, Rosemary Ndonyo
    Abortion remains the major risk factor to maternal morbidity and mortality in many parts of Africa and more so in the Zambian situation, even though the level of its incidence is still uncertain. Despite Zambia having the most favourable and liberal abortion law in Africa, morbidity and mortality that have accounted for unsafe abortion remain a major reproductive health challenge, demonstrating gaps in application of abortion law compounded by institutional and socio-cultural barriers, as social norms of Zambian societies. The purpose of a national abortion survey in Zambia was to estimate abortion incidence ratio rate and examine its determinants in order to better understand the magnitude of unsafe abortion and seek further approaches for improving safe abortion services and other related reproductive health services in the country. Specifically, it involved collecting annual abortion data, from June 2008 to May 2009 in major referral hospitals, alongside determining abortion complications by demographic characteristics in relation to age, education, occupation, marital status, religion, parity and method used for abortion over a period of six months. The other objective was to examine the mode of abortion practice and its occurrence by type of abortion complications, as whether legal, unsafe (illegal practice), or spontaneous abortion prevalent at the health facilities. Aretrospective cross sectional hospital-based survey was conducted to review 4174 abortion case records over a period of six months, January to June 2009, in four major hospitals of Kitwe Central, Ndola Central, University Teaching Hospital (UTH) and Kabwe General Hospital in three provinces of Lusaka, Copperbelt and Central. These study sites were selected purposively on the basis of population concentration and serving as major referral hospitals in the country. A ratio estimation of abortion incidence rate was applied to the annual abortion data for June 2008 to May 2009 estimated on the basis of annual expected pregnancies for 2009. Other measures included demographic characteristics and abortion status in relation to its classification as, legal termination of pregnancy (TOP), unsafe abortion (Illegally induced), or spontaneous, method used for abortion and parity as main variables. A record review checklist was used to collect all abortion data. Data were analyzed by SPSS statistical package for descriptive statistics and statistical tests for associations in the occurrence of abortion and its characteristics, method used and parity. The findings show the abortion incidence ratio rate of 12.3 percent per 100 live births of expected annual number of pregnancies for 2009 for the three provinces. There are greater significant associations in the prevalence of abortion with education, marital status, occupation, religion, parity, methods used for abortion and type of health facility (pvalue< 0.000- 0.001), which determines the extent to which abortion affects women in Zambia. Age was not found significantly statistical difference in its association with the prevalence of abortion (pvalue > 0.558). However, abortion affected all age-groups of women in the age range from 10 to 49 years, with a mean of 26.29 years, even though there were some variations in the distribution of abortion incidences according to their age-groups. Significant differences were also observed in the practice of legal abortions (2.5 percent) and those presenting with complications of unsafe abortion and spontaneous abortions as incomplete abortion accounting for 92.4 percent (pvalue < 0.000). Mortality is highest in Ndola Central (45.5 percent) followed by Kitwe Central (27.3 percent) than UTH and Kabwe General Hospital with limited figures, giving the overall percent of 0.3 percent of all abortion deaths. More women are surviving from the risk of abortion morbidity in Zambia. Use of MVA is found highly significant in reducing abortion mortality at health facilities. The findings suggest greater unmet needs for family planning and safe abortion services directing to improvement in family planning programme, policies and future innovation research approaches including the effective process of monitoring and evaluating abortion trend and strategies alongside strengthened health information system are imperative. Abortion is a highly risk factor to morbidity more than mortality which directs to better effective preventive measures of unwanted pregnancies than reliance on case management strategies of abortion care.