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Background: Availability and accessibility of anti-cancer medicines is the pillar of cancer management, and it is one of the main concerns in low-income countries including Rwanda. The objective of this study was to assess the availability and affordability of anticancer medicines at cancer-treating hospitals in Rwanda. Methodology: A descriptive cross-sectional study was conducted at 5 cancer-treating hospitals in Rwanda. Quantitative data were collected from stock cards and software that manage medicines and included the availability of anti-cancer medicines at the time of data collection, their stock status within the last two years, and the selling price. Results: The study found the availability of anti-cancer medicines at 41% in public hospitals at the time of data collection, and 45% within the last two years. We found the availability of anti-cancer medicines at 45% in private hospitals at the time of data collection, and 61% within the last two years. 80% of anti-cancer medicines in private hospitals were unaffordable while 20% were affordable. The public hospital that had most of the anti-cancer medicines in the public sector provided free services to the patients, and no cost was applied to the anti-cancer medicines. Conclusion: The availability of anti-cancer medicines in cancer-treating hospitals is low in Rwanda, and most of them are unaffordable. There is a need to design strategies that can increase the availability and affordability of anti-cancer medicines, for the patients to get recommended cancer treatment options.

Background A strong health system cannot function without a well-designed, well-operated, and well-maintained supply chain management system. Temperature-sensitive products within the supply chain are products that encompass pharmaceutical goods or products, which, when not stored or transported within predefined environmental conditions and/or within predefined time limits, are degraded and rendered not fully effective. The objective of this study was to evaluate the compliance to the good distribution practices of temperature-sensitive products in Rwanda. Methods A cross-sectional study was conducted at a medical supply company in Rwanda and involved 30 staff members managing temperature-sensitive products. The staff came from the Quality Assurance and quality control unit, Warehouse and logistics unit, Sales and marketing unit, Distribution unit, as well as some branch directors. Interviews were conducted and historical data on recorded temperature and humidity levels in storerooms and refrigerators/freezers as well as transit temperature data from representative district branches were collected for a period of three years (2017–2019). All data were analyzed using SPSS version 25. For compliance, temperature and relative humidity were compared with international standards. Results It was found that the Standard Operating Procedures were available but not updated to ensure compliance. The scarcity of trained staff was found to be the main factor hindering adherence to standards, hence monitoring of temperature and relative humidity sometimes had loopholes that need to be addressed. This study also discovered that adherence to recommended temperature ranges for the products was compromised by inconsistency in recording and reporting temperature and humidity, and a lack of temperature monitoring tools and qualified equipment. Conclusions The study revealed the weaknesses that exist in the process of distribution of temperature-sensitive products at the medical supply company, which mainly, are attributed to paucity of trained staff. Strategic planning for short, medium, and long-term remedies will require that all parties involved in the management of these products work together towards upholding the standard.

Substance use among adolescents is a growing problem of public health importance and research suggests that substance use behaviors are on the rise.1,2 In their examination of contributors to the global burden of disease, Rehm et al. (2006) documented that substance use behaviors accounted for approximately 4% of the disability adjusted life years.3 Substance use differs by age and gender. 4,5 Substance use behaviors among adolescents have been found to be associated with unintentional injuries, violent behavior, weapon carrying, sexual risk taking, drink-driving, overdose, self-harm, toxicity and death.6-10 Furthermore, it has also been associated with socioeconomic status, suicidal ideation, truancy, depression and having poor relationships with parents in several studies.11-14 Adolescence is a transition period to adulthood and substance use during this important phase could potentially lead to dependence depending on access and availability of illicit drugs thus preventive measures are important where deemed necessary.15 Regrettably, most research on substance use patterns, utilizes data derived from mainly high-income country settings. Thus the literature remains silent on the extent to which harmful substance use patterns have been examined in low- and middle-income country settings. Furthermore, in low- and middle-income settings which do report on substance use patterns among their populations, few if any provide data that has been disaggregated by age13 (Peden et al., 2008). In Tanzania, substance use is on the rise and has been associated with the spread of HIV especially through sharing injections especially in the densely populated cities like Dar es Salaam. A study found cannabis use estimated at 0.8%, more so among younger people in 2003 in Dar es Salaam.16 Within specific populations, a psychiatric patient population had a prevalence of 29% cannabis use in Mwanza.17 In another study conducted in Mwanza in 2014, shared housing and cohabiting was found to be associated with injection drug use among drug users.18 The aim of the present study was to explore the sociodemographic factors associated with substance use in a low-income urban sub-Saharan setting.

Chocolate vine (Akebia quinata) is consumed as a fruit and is also used in traditional medicine. In order to identify the bioactive components of A. quinata, a phytosterol glucoside stigmasterol-3-O-&beta, d-glucoside (1), three triterpenoids maslinic acid (2), scutellaric acid (3), and hederagenin (4), and three triterpenoidal saponins akebia saponin PA (5), hederacoside C (6), and hederacolchiside F (7) were isolated from a 70% EtOH extract of the fruits of A. quinata (AKQU). The chemical structures of isolates 1&ndash, 7 were determined by analyzing the 1D and 2D nuclear magnetic resonance (NMR) spectroscopic data. Here, we evaluated the effects of AKQU and compounds 1&ndash, 7 on insulin secretion using the INS-1 rat pancreatic &beta, cell line. Glucose-stimulated insulin secretion (GSIS) was evaluated in INS-1 cells using the GSIS assay. The expression levels of the proteins related to pancreatic &beta, cell function were detected by Western blotting. Among the isolates, stigmasterol-3-O-&beta, d-glucoside (1) exhibited strong GSIS activity and triggered the overexpression of pancreas/duodenum homeobox protein-1 (PDX-1), which is implicated in the regulation of pancreatic &beta, cell survival and function. Moreover, isolate 1 markedly induced the expression of extracellular signal-regulated protein kinases 1 and 2 (ERK1/2), insulin receptor substrate-2 (IRS-2), phosphoinositide 3-kinase (PI3K), and Akt, which regulate the transcription of PDX-1. The results of our experimental studies indicated that stigmasterol-3-O-&beta, d-glucoside (1) isolated from the fruits of A. quinata can potentially enhance insulin secretion, and might alleviate the reduction in GSIS during the development of T2DM.

Repeated chromatography of the EtOAc-soluble fraction from the 70% EtOH extract of the flower buds of Syzygium aromaticum (clove) led to the isolation and characterization of four new flavonol glucuronides, rhamnetin-3-O-β-d-glucuronide (1), rhamnazin-3-O-β-d-glucuronide (2), rhamnazin-3-O-β-d-glucuronide-6″-methyl ester (3), and rhamnocitrin-3-O-β-d-glucuronide-6″-methyl ester (4), together with 15 flavonoids (5-19) having previously known chemical structures. The structures of the new compounds 1-4 were determined by interpretation of spectroscopic data, particularly by 1D- and 2D-NMR studies. Six flavonoids (6, 7, 9, 14, 18, and 19) were isolated from the flower buds of S. aromaticum for the first time in this study. The flavonoids were examined for their cytotoxicity against human ovarian cancer cells (A2780) using MTT assays. Among the isolates, pachypodol (19) showed the most potent cytotoxicity on A2780 cells with an IC50 value of 8.02 μM.

The present investigation of the chemical constituents of the stem barks of Ailanthus altissima has resulted in the isolation of six canthinone-type alkaloids, including a new compound, (R)-5-(1-hydroxyethyl)-canthine-6-one (1), and five known compounds (2-6). Moreover, four phenyl propanoids (7-10), two lignans (11 and 12), two triterpenoids (13 and 14) and a fatty acid (15) having previously known chemical structures were isolated during the same course of this study. The structure of the new compound was elucidated by physical (m.p., [α]D) and spectroscopic data (¹H-NMR, (13)C-NMR, 2D NMR, and HR-DART-MS) interpretation and its absolute configuration was determined by electronic circular dichroism (ECD) data and quantum chemical calculations. The inflammatory activities of the isolates were screened on lipopolysaccharide (LPS)-induced nitric oxide (NO), a proinflammatory mediator, in RAW 264.7 cells. Among these isolated compounds, six compounds exhibited significant inhibition of NO production, with IC50 values in the range of 5.92 ± 0.9 to 15.09 ± 1.8 μM.