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Three decoctions, namely Emelia M (EMB), Mshikazi and Delosma H are used by traditional health practitioners in KwaZulu-Natal, South Africa to treat and manage leukaemia and related conditions.This study evaluated the in vitro antioxidant activity and phytochemical profile of the aqueous extracts of Emelia M (EMB), Mshikazi and Delosma H decoctions.Antioxidant activity of the extracts was evaluated using1-diphenyl-2-picrylhydrazyl (DPPH), glutathione (GSH), phosphomolybdate and thiobarbituric acid reactive substance (TBARS) assays. Phytochemical screening was used to determine the presence of compounds.The DPPH radical scavenging activity was similar to ascorbic acid for EMB and Delosma H, but not for Mshikazi. At 24 h, EMB increased GSH in both THP-1 and Jurkat cells similar to Delosma H while Mshikazi demonstrated the lowest activity. At 48 h, EMB and Delosma H revealed increased GSH in THP-1 cells with no significant decrease in GSH levels in Jurkat cells. However, EMB showed the lowest lipid peroxidation activity compared to Delosma H and Mshikazi after 24 h treatment of both cells. Phenols, flavonoids, terpenoids, saponins were present in all extracts.Extracts of the three decoctions possess both antioxidant and prooxidant properties through high scavenging activity and increased in lipid peroxidation.

MSI2 is a homolog 2 of the Musashi RNA binding proteins (MSI) and is known to contribute to acute myeloid leukaemia (AML) and expressed up to 70% in AML patients. High expression of MSI2 has been found to lead to the lower overall survival of patients with AML. This study proposed the potential antagonists of MSI2 RNA-recognition motifs (MSI2 RRM1) derived from the LC-MS analysis of three traditional herbal samples. The LC-MS analysis of the three traditional herbs concoctions yields a total of 271 unique molecules of which 262 were screened against MSI2 RRM1 protein. After the dynamic study of the selected 8 top molecules from the virtual screening, the five most promising ligands emerged as potential MSI2 antagonists compare to the reference experimental molecule. The results show that the dynamic of MSI2 RRM1 protein is accompanied by a rare even of protein chain dissociation and re-association as evident in both the bound and unbound state of the protein. The unbound protein experience earlier chain dissociation compare to ligand-bound protein indicating that ligand binding to the protein slows down the dissociation time but thereafter increases the frequency of alternation between the protein chain association and dissociation after the first experience. Interestingly, the re-association of the protein chain is also accompanied by full restoration of the ligands to the binding site. The drug candidate Methotrexate (M3) and rescinnamine (M9) are listed among the promising antagonist of MSI2 with unique properties compared to a less promising molecule Ergotamine (M6).Communicated by Ramaswamy H. Sarma.

Background: Three decoctions, namely Emelia M (EMB), Mshikazi and Delosma H are used by traditional health practitioners in KwaZulu-Natal, South Africa to treat and manage leukaemia and related conditionsObjectives: This study evaluated the in vitro antioxidant activity and phytochemical profile of the aqueous extracts of Emelia M (EMB), Mshikazi and Delosma H decoctions.Methods: Antioxidant activity of the extracts was evaluated using1-diphenyl-2-picrylhydrazyl (DPPH), glutathione (GSH), phosphomolybdate and thiobarbituric acid reactive substance (TBARS) assays. Phytochemical screening was used to determinethe presence of compounds.Results: The DPPH radical scavenging activity was similar to ascorbic acid for EMB and Delosma H, but not for Mshikazi. At 24 h, EMB increased GSH in both THP-1 and Jurkat cells similar to Delosma H while Mshikazi demonstrated the lowest activity. At 48 h, EMB and Delosma H revealed increased GSH in THP-1 cells with no significant decrease in GSH levels in Jurkat cells. However, EMB showed the lowest lipid peroxidation activity compared to Delosma H and Mshikazi after 24 h treatment of both cells. Phenols, flavonoids, terpenoids, saponins were present in all extracts.Conclusion: Extracts of the three decoctions possess both antioxidant and prooxidant properties through high scavenging activity and increased in lipid peroxidation. Keywords: Antioxidants; herbal medicines; Emelia M; Mshikazi; Delosma H.

Background: Documentation of patient health information in the form of patient medical records (PMRs) is an essential, ethical and regulatory requirement in any healthcare system. African traditional medicine (ATM) exists parallel to biomedicine and continues to play a significant role in primary healthcare of the majority of South Africans. The World Health Organization (WHO) has promoted the integration of ATM into the national health system of South Africa. Patient health information documentation can facilitate this integration, and PMRs promote communication between the two health systems through referrals. Documentation in biomedicine is a clear, compulsory, routine activity, but does not occur regularly or routinely in ATM. Objective: To examine the attitudes and perceptions of traditional health practitioners (THPs) towards documentation of patient health information in their practice. Methods: This quantitative cross-sectional survey involved snowball sampling to recruit THPs in Umlazi Township and rural parts surrounding the township, in Durban, South Africa. A semi-structured questionnaire was used. Quantitative data were analysed using SPSS 25 and the Relative Importance Index (RII) and qualitative data were analysed using Excel for themes. Results: Sampling resulted in 248 THPs of whom 178 (72%) were females. The RII ranked the factors that negatively influenced the participants’ attitudes towards documentation of patient health information. Of the 178 females who participated in the study, 129 (72.5%) showed their willingness to introduce documentation in their practice. Of the 127 participants with less than 10 years of practice experience, 126 (99.2%) agreed to the importance of introducing PMRs in their practice. The majority of participants perceived documentation of patient health information as vital to improve their practice. A prominent theme was that the THPs regarded documenting patient health information as important and effective in their practice. Conclusion: More than half of participants showed positive attitudes and perceptions towards documenting of patient health information in ATM. The majority of the participants in this study acknowledged the importance of introducing documentation of patient health information in their practice even though they lacked experience and more knowledge. This reflects a need for essential intervention in developing specialised tools to begin promoting documentation of patient health information in ATM.

Introduction: Despite the recognition of Traditional Medicine systems as a critical component of health care by the WHO and the African Union, its integration into the health care mainstream remains very subdued in South Africa. This is partly due to the lack of empirical data pertinent to traditional healer training that could inform the accreditation process. Objective: To determine core competencies acquired by Traditional Health Practitioners (THP) of KwaZulu-Natal Province, South Africa during their apprenticeship. Materials and methods: Purposeful, convenient and snowballing sampling and the sequential data collection methods of questionnaires, journaling and focus groups was used to collect data from the THP tutors and their trainees in rural, peri-urban and urban areas of eThekwini and uThungulu Districts of Kwa Zulu Natal (KZN). Results: Eleven core competencies were identified: consultation, diagnoses, holistic patient care and treatment, integrative and holistic healing, application of healing procedures and cultural rituals, spiritual development, ethical competencies, problem solving, herbalism, ancestral knowledge and end of life care. Conclusion: The apprenticeship of THPs in KZN is based on eleven core competencies. These competencies are fundamental pillars for critical health care provided by THPs and are crucial for setting standards for the accreditation of traditional training in South Africa if the THP Act 22 of 2007 is to achieve its purpose of providing for the management of and control over the registration, training and conduct of the practitioners. Hence, the appointed interim THP Council should include the identified competencies when articulating bases for accreditation of the training and assessments. Keywords: Indigenous training, traditional health practitioners, Kwazulu-Natal.

Background: Documentation of patient health information (PHI) is a regulatory requirement and hence a standard procedure in allopathic healthcare practice. The opposite is true for African traditional medicine (ATM) in most African countries, including South Africa, despite legal and policy frameworks that recognise and mandate the institutionalisation of ATM. Developing good practice standards for PHI documentation is an essential step in the institutionalisation of ATM. Objective: This study examined the knowledge and practices of documentation of PHI by traditional health practitioners (THPs) in Durban, eThekwini Municipality, KwaZulu-Natal Province, South Africa. Methods: In this quantitative cross-sectional study, snowball sampling was used to identify and recruit THPs. An interviewer-administered questionnaire was used to gather data. Chi-square tests and logistic regression were used to assess associations of knowledge and practice of documentation of PHI with potential predictors; age, gender, education, type of practitioner, experience, number of patients seen per day and location of the practice. Results: Of the 248 THPs who participated, 71.8% were female. Mean (SD) age was 47.4 (14.2), ranging 18–81 years. The majority (65.7%) were Izangoma (diviners). Overall, 42.9% of the THPs reported knowledge of patient medical records (PMRs). In logistic regression, only number of patients seen per day remained a significant predictor of knowledge about PMR. THPs who reported seeing 6–10 patients were five times more likely (Odds Ratio (OR): 5.164, 95% Confidence Interval (CI): 1.270–20.996; p = 0.022) to report knowledge of PMR than those seeing Conclusion: Knowledge of PMR is low, and the practice of documenting PHI is even lower among THPs in eThekwini. That knowledge of PMR was a strong predictor of documentation practice, and the most common reason for not documenting was lack of knowledge about what and how to document suggests that training could improve PHI documentation in traditional medicine practice.

South Africa is currently experiencing an increase in the number of traditional medicine preparations which purport to have immune boosting effects. This is largely related to the high prevalence of HIV infections. This study therefore aimed to evaluate the possible immunomodulatory mechanisms of uMakhonya ® , one of the widely used commercial immune boosters, using THP-1 monocyte cells. Endotoxin-free doses of uMakhonya ® ranging from 1000 μg/mL to 10 μg/mL were used to evaluate the cytotoxic effects, cell migration, secretion of twelve different chemokines and possible modulation of nuclear factor kappa Beta (NF-κβ) transcriptional activity. This commercial traditional medicine product was shown to induce dose dependent cytotoxicity with high doses significantly ( p 50 of 100.08 and 107.68 μg/mL for normal and LPS stimulated THP-1 cells respectively) when compared to untreated cells. The lower doses were shown to have no significant ( p > 0.05) chemo-attractant effects in the cell migration assay. UMakhonya ® at these lower and less cytotoxic doses induced a significant ( p uMakhonya ® increased transcriptional activity of NF-κβ which may explain the increase in chemokines secretion. Therefore this in vitro study showed that uMakhonya ® is cytotoxic at high doses, did not show any chemo-attractant effects and induced significant increases in chemokines secretion. Increased transcriptional activity of NF-κβ in treated cells may contribute to increased chemokines secretion. This study on uMakhonya ® should form the benchmark for the research of the high number of related products that are sold commercially in South Africa.

Background With the burden of HIV and AIDS still very high, South Africa has seen an increase in commercial traditional medicines claiming to have immune-enhancing effects. Because of lack of regulation of the traditional medicine sector, these products have proliferated. This study aimed to evaluate the immunomodulatory effects of uMakhonya®, a commercial traditional immune booster, using various models of normal human peripheral blood mononuclear cells (PBMCs). Methods Immunosuppressed, mitogen-, and peptidoglycan (PG)-stimulated PBMCs were treated with various doses of uMakhonya® and incubated for 24 h. The treated and control samples were analyzed for cytotoxicity, secretion of 12 different inflammatory cytokines, soluble interleukin-2 receptor (sIL-2R) levels, and nitric oxide (NO) secretion. Results In cytotoxicity assays, uMakhonya® induced dose-dependent cytotoxic effects in all three models, with IC50 values of 512.08, 500, and 487.91 μg/mL for immunosuppressed, phytohaemagglutinin (PHA)-, and PG from Staphylococcus. aureus (PG-S. aureus)-stimulated PBMCs, respectively. UMakhonya® at 100 and 10 μg/mL induced a significant (p 0.05) decreased NO levels in PBMCs after PG-S. aureus stimulation. Conclusions These results showed that uMakhonya® can induce both pro-inflammatory and anti-inflammatory effects depending on the initial stimuli applied to immune cells.

Introduction: Developed from centuries of oral knowledge passed from generation to generation, African traditional medicines (ATM) are at a crossroads. In order for these ATMs to evolve with time similarly to modern medical sciences, there is an urgent need to scientifically evaluate their mechanism of action, safety and efficacy. Case report: In this short commentary we report on the progress we have made in scientifically evaluating traditional herbal immune boosters at a period where the African continent finds itself ravaged by a plethora of infectious diseases. Discussion: While the South African government has gone a long way in building an effective modern health system, many people still use ATMs such as immune boosters for a variety of infectious diseases and general wellbeing. The high prevalence of HIV infections is one of the reasons that have led to an increase in the use of ATMs which purport to have immune boosting capabilities. In our laboratory we have developed various models and carried out extensive in vitro and in vivo biochemical and molecular experiments on the immunomodulatory effects of these immune boosters and have shown that these products can modulate the expression and secretion of both cytokines and chemokines. Therefore the potential uses of immune boosters in clinical medicine does not only apply in treating immunodeficiency caused by HIV but can be useful in managing tuberculosis (TB), various forms of cancer and various other diseases that can be managed by modulating the immune response. Such research studies are very promising and present opportunities for further clinical studies to develop unique ATMs. Conclusion: As medicines meant to stimulate the body’s immune system to defend itself, immune boosters can be useful alone or as immune adjuvants along with pharmaceutical drugs. Therefore further studies on the effectiveness of these immune boosters are justified along with those that will ensure that there are no drug interactions with other pharmaceutical products.

Sutherlandia frutescens (SF), a popular traditional medicinal plant found in various parts of southern Africa, is used for treatment or management of HIV/AIDS and other diseases including cancer. However, its toxicity profile has not been fully established. The aims of this study were to examine the effects of 70% ethanol (SFE) and deionised water (SFW) extracts on normal isolated human T cells. An experimental study on normal human lymphocytes treated with doses SF extract doses ranging from 0.25 to 2.5 mg/ml. Untreated, vehicle-treated (Ethanol) and camptothecin (CPT) treated normal T cells were used as controls. Induction of cell death, changes in intracellular ATP, caspase-3/-7 activity and nuclear changes were analysed using flow cytometry, luminometry and nuclear staining (Hoechst) respectively. The highest concentration (2.5 mg/ml) of SFE extract induced significant necrosis (95%), depletion of ATP (76%), and inhibition of caspase-3/-7 activity (11%) following a 24 hour incubation period (p< 0.001). The 2.5 mg/ml concentration of SFW showed the same trend but were less effective (necrosis- 26%, ATP- 91%, & caspase-3/-7- 15%). These effects showed a time-dependence over 48 hours of incubation, with high doses of SFE extracts eliminating viable cells by necrosis, depleting ATP levels and decreasing caspase-3/-7 activity (p< 0.001). The activity of SFE extract was independent of ethanol. The SFW extract dilutions were less toxic than the SFE extracts. Significant DNA fragmentation as demonstrated by Hoechst staining was also seen over 48-hour incubation for high doses of both types of SF extracts. These results showed that although high concentrations of SF extracts can be toxic to normal T cells in vitro, SFW fractions were relatively safe for use.

Background: Regulation and standardization of African traditional medicines (ATM) prescribed by traditional healers in South Africa is still far from being implemented. This is despite the fact that more people are using ATM products than ever. In an effort to demonstrate that collaboration with traditional health practitioners (THPs) can yield standardized TM products, this study aimed to evaluate the immunomodulatory effects of an herbal immune booster formulated by traditional healers from the Vaal Region, South Africa. Materials and Methods: Using normal and lipopolysaccharide (LPS) stimulated human peripheral blood mononuclear cells (PBMCs) models, doses of the immune booster ranging from 1000 to 10 μg/mL were evaluated for their cytotoxicity, inflammatory cytokines and chemokines secretion, nitric oxide (NO) secretion, malondialdehyde (MDA) assay, and 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay. Results: The immune booster induced a dose dependent cytotoxic effect on both normal and LPS stimulated PBMCs with higher doses showing cytotoxicity while lower dose from 100μg/mL did not show any cytotoxicity. When re-dissolved in aqueous PBS immune booster doses up to 100 μg/mL showed better DPPH radical inhibition (41%) than ascorbic acid at 40μg/mL (33%). The immune booster also decreased lipid peroxides significantly (p< 0.05) and this was comparable to ascorbic acid. There was also a significant (p< 0.05) increase in nitrite (NO) after treatment of LPS stimulated PBMCs with immune booster doses when compared to untreated samples. The immune booster stimulated inflammatory cytokines secretion in normal PBMCs (IL 1α, IL 1β, IL 6, IL 10 and TNFα while showing a decrease in IFNγ at the higher dose) while in LPS stimulated PBMCs some cytokines were decreased (IL 1α, IL 17α and at lower doses IL 10 and TNFα) and others were increased (IFNγ, TNFα and GM-CSF) depending on the dose used. In both normal and LPS stimulated PBMCs the immune booster significantly (p< 0.05) increased (MIP 1α) while causing significant (p< 0.05) decreases in IP 10 (high dose), I-TAC and MIG secretion. Conclusions: This immune booster showed potential immunostimulatory effects by increasing nitric oxide, inflammatory cytokines and chemokines secretion in both normal and LPS stimulated PBMCs. This TM also showed promising antioxidant potential in the MDA and DPPH assays. Further in vitro and animal studies are warranted.

The traditional medicines sector in South Africa is still largely unregulated despite legislation aimed at regulating the practice being in place. The HIV and AIDS epidemic has fuelled demand for traditional medicines, with many patients consulting traditional health practitioners who offer different treatments, including herbal immune boosters. This study investigated the mutagenic and antioxidant effects of the widely sold herbal immune booster, uMakhonya®. The Ames test was used for analysis of the genototoxic effects while the adenosine triphosphate (ATP) assay was used to evaluate cell cytotoxicity in peripheral blood mononuclear cells (PBMCs) and THP-1 monocytes. To evaluate the antioxidant effects the malondialdehyde (MDA) quantification, the nitric oxide and 1,1-diphenyl-2-picryl-hydrazyl (DPPH) assays were used. UMakhonya® doses of up to 5000 μg/mL were not genotoxic in the Ames test. UMakhonya® was shown to induce dose-dependent cytotoxicity in both PBMCs and THP-1 cells with doses ranging from 500 μg/ mL to 1000 μg/mL, showing significant (p

Sutherlandia frutescens (SF) is one of the medicinal plants used as an immune booster in the treatment of chronic ailments such as HIV/AIDS and cancer. Limited data suggest that its efficacy is based on its regulatory effect on cytokines, the critical components of the immune response. In this study, we investigated the in vitro immunomodulatory effects of SF extracts on normal human peripheral blood mononuclear cells (PBMCs). An ELISA-based assay was used to assess the levels of expression of 12 cytokines in treated cells. An adenosine triphosphate (ATP) assay was used to assess cell viability in relation to cytokine secretion. SF ethanol extracts induced changes in cytokine secretion relative to the dose of the extract. Generally cytokine expression and secretion was low in concentration because were not stimulated with any endotoxin. The high SFE dose (2.5 mg/ml) significantly (p

African Traditional Medicines (ATMs) serve as a major source of primary healthcare for African people. The reasons for their use range from easy access, affordability, beliefs in traditional systems and long term safety. ATMs have been used to treat individuals infected with HIV and therefore need scientific validation; a view supported by Traditional Health Practitioners (THPs). This study aimed to evaluate the in vitro cytotoxicity, immune modulatory and anti-HIV activities of traditional multiple herbal preparations from local THPs. Ugambu, Ihashi, Product Nene, Product Blue, SPNa and SDKc ATM were supplied by local THPs. Changes in adenosine triphosphate (ATP) & glutathione (GSH) over 24 hours were measured using luminometry. Changes in 12 cytokines were assayed using an ELISA-based absorbance assay. Protective effects against HIV killing of MT-4 cells were tested using the XTT assay and antiviral activity was measured using an HIV-1 viral load assay. Cyclosporine and AZT were used as positive controls. Ugambu, Ihashi, Product Nene and SDKc induced a dose dependent toxicity on treated PBMCs by reducing ATP and GSH at high doses (p< 0.001). These medicinal preparations, along with SPNa, showed immunomodulatory activity by significantly (p< 0.001) changing the secretion of pro-inflammatory cytokines. Product Blue stimulated the levels of ATP and GSH in treated PBMCs at all doses however this product did not show any immunomodulatory activity on cytokine secretion when compared to control cells. Ugambu, Ihashi, Product Nene showed promising anti-HIV activity relative to AZT (p< 0.01). This study has shown that some of these traditional medicinal preparations have at least one or all the properties of immunostimulation, immunomodulation or antiretroviral effects. The mechanism of action of the shown activities should further be investigated.

The regulation and registration of traditional medicines (TM) continues to present challenges to many countries regardless of the fact that an increased number of the population utilises TM for their health care needs. There have been improvements in the legal and policy framework of South Africa based on the WHO guidelines. However, there are currently no guidelines or framework for the registration of TM in South Africa. This article reviews literature and existing guidelines of specific countries and regions and makes recommendations for South African guidelines.Keywords: Regulation, Registration, Traditional Medicines, South Africa

Sutherlandia frutescens (SF), a popular traditional medicinal plant found in various parts of southern Africa, is used for treatment or management of HIV/AIDS and other diseases including cancer. However, its toxicity profile has not been fully established. The aims of this study were to examine the effects of 70% ethanol (SFE) and deionised water (SFW) extracts on normal isolated human T cells. An experimental study on normal human lymphocytes treated with doses SF extract doses ranging from 0.25 to 2.5 mg/ml. Untreated, vehicle-treated (Ethanol) and camptothecin (CPT) treated normal T cells were used as controls. Induction of cell death, changes in intracellular ATP, caspase-3/-7 activity and nuclear changes were analysed using flow cytometry, luminometry and nuclear staining (Hoechst) respectively. The highest concentration (2.5 mg/ml) of SFE extract induced significant necrosis (95%), depletion of ATP (76%), and inhibition of caspase-3/-7 activity (11%) following a 24 hour incubation period (p< 0.001). The 2.5 mg/ml concentration of SFW showed the same trend but were less effective (necrosis- 26%, ATP- 91%, & caspase-3/-7- 15%). These effects showed a time-dependence over 48 hours of incubation, with high doses of SFE extracts eliminating viable cells by necrosis, depleting ATP levels and decreasing caspase-3/-7 activity (p< 0.001). The activity of SFE extract was independent of ethanol. The SFW extract dilutions were less toxic than the SFE extracts. Significant DNA fragmentation as demonstrated by Hoechst staining was also seen over 48-hour incubation for high doses of both types of SF extracts. These results showed that although high concentrations of SF extracts can be toxic to normal T cells in vitro, SFW fractions were relatively safe for use.

Traditional health practitioners (THPs) play a significant role the delayed establishment of the Interim THP Council, does not in South African healthcare. However, the Basic Conditions of relieve the employer's burden of 'illegitimate' medical certificates Employment Act (BCEA) does not consider sick notes issued by issued by THPs. While seen as a dilemma for some employers, THPs to be valid. This creates a dilemma for employees, whose others have accommodated African cultural beliefs and accept right to consult a practitioner of their choice is protected by the THP-issued sick notes. Finalising the Interim THP Council will Constitution. We assessed the current legislation and highlight the allow THP registration and oblige employers to honour sick notes challenges that employees face in selecting a healthcare system of issued by THPs. The empowerment of THPs to play a meaningful their choice. The services of THPs represent an untapped capacity role in healthcare delivery is of national importance. that can complement and strengthen healthcare services, especially in the workforce. The BCEA legislative technicality, coupled with the delayed establishment of the Interim THP Council, does not relieve the employer's burden of 'illegitimate' medical certificates issued by THPs. While seen as a dilemma for some employers, others have accommodated African cultural beliefs and accept THP-issued sick notes. Finalising the Interim THP Council will allow THP registration and oblige employers to honour sick notes issued by THPs. The empowerment of THPs to play a meaningful role in healthcare delivery is of national importance.