New Study Confirms Herbal Medicines in Kampala are Contaminated

Kampala, Uganda – In a comprehensive study spanning two decades, alarming findings have confirmed the presence of fecal contamination in locally made herbal medicines across East Africa.

The study, “Prevalence and dynamics of clinically significant bacterial contaminants in herbal medicines sold in East Africa from 2000 to 2020: a systematic review and meta-analysis,” was published in the prestigious Journal of Tropical Medicine and Health in 2021.

The study which used a systematic review method (a synthesis of different studies), was conducted by Ugandan scientists who are Abdul Walusansa, Savina Asiimwe, Hussein. M. Kafeero, Iramiot. J. Stanley, Jamilu. E. Ssenku, Jesca. L. Nakavuma and Esezah. K. Kakudidi. It has resulted in a public Doctoral defense for the principal investigator Mr. Abdul Walusansa at Makerere University College of Natural Sciences on Tuesday, July 08, 2023. Titled: “Drug resistance & Microbial safety of herbal medicines in Kampala” the defense shall be accessible to members of the public via the link https://tinyurl.com/y4vxb9ac; ID: 928 5713 9580 and Code: 276123.

The study: 

The study, conducted from the year 2000 to 2020, revealed that a staggering 62.948% of herbal medicines sampled contained dangerous microbes, posing significant health risks to communities in the region.

It was mined from databases such as Google Scholar, PubMed, HerbMed, MEDLINE, Science Direct, SciFinder Scholar, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, Commonwealth Agricultural Bureau Abstracts, and Biological Abstracts. It used key search terms such as; Herbal medicine, Indigenous traditional medicine, Microbial contamination, Bacteria, Herbal medicine safety, Herbal medicine risks, East Africa, Uganda, Tanzania, Kenya, Rwanda, Burundi, and Southern Sudan.

The researchers observed that infectious diseases caused by bacteria continue to be a major health concern in East Africa, and their review uncovered a troubling trend – herbal medicines in the region may be contaminated with pathogenic bacteria.

“The trade and consumption of herbal medicine have been steadily increasing, but fragmented studies have limited our understanding of the extent and dynamics of bacterial contamination in these products.”

The researchers scoured eleven electronic databases for published articles, critically analyzing fourteen studies that met their inclusion criteria. The results were alarming:

“Herbal medicines were highly heterogeneous in terms of bacterial contaminants, with Escherichia coli being the most prevalent. Even more concerning were the high prevalence rates of Salmonella spp. and Shigella spp., both primary pathogens responsible for dangerous outbreaks of diarrheal diseases like typhoid fever in the region,” the researchers write.

The researchers targeted three East African countries: Kenya, Uganda, and Tanzania. Through meticulous research and data collection, they sought to uncover the presence of harmful bacteria in these widely used traditional remedies.

Surprisingly, no eligible studies were found in Rwanda, Burundi, and South Sudan, highlighting the need for more comprehensive research on this subject in those regions. The absence of data from these areas underscored the urgency in understanding the safety concerns linked to herbal medicines across East Africa and beyond.

Findings:

Among the findings from the selected studies, the researchers analyzed a total sample size of 1350 herbal medicine products. Shockingly, 57% of these samples tested positive for bacterial contamination, revealing the alarming prevalence of potential health hazards in commercial herbal medicines.

The studies’ heterogeneity posed challenges, but the researchers successfully reduced heterogeneity for specific bacterial isolates, including Shigella, Proteus, and Serratia. The absence of demonstrable evidence for publication bias validated the credibility of the research.

“The overall pooled prevalence of all bacterial species was 62.948%, indicating a significant presence of potentially harmful contaminants in herbal medicines,” they wrote.

The researchers added that Escherichia coli emerged as the most prevalent contaminant, comprising 23% of the cases. Meanwhile, Salmonella spp. and Shigella spp. were the most frequently reported primary pathogens, with pooled prevalence of 10.4% and 6.3%, respectively.

Accordingly, the high prevalence of Escherichia coli pointed to grossly deprived environmental hygiene in the East African region, possibly leading to fecal contamination of water, plants, and other resources consumed by humans.

The presence of primary pathogens like Salmonella spp. and Shigella spp. posed severe clinical implications, as they have been associated with deadly outbreaks of diarrheal diseases, including typhoid fever, in the East African region.

According to the World Health Organization, herbal medicines should have zero presence of such microbes, indicating a serious health concern in the herbal medicine industry in East Africa. The results of these studies are a wake-up call for the herbal medicine industry in East Africa.

Recommendations:

The researchers recommend that the Efforts to improve safety mechanisms, adopt molecular approaches for bacterial characterization, and enhance hygiene standards are urgently needed to protect the health of the public and restore trust in traditional herbal medicines.

“As the region strives for safer herbal remedies, the findings from this research serve as a crucial foundation for the future of herbal medicine in East Africa,” the researchers write.

The researchers further call for adequate research and measures to ensure the microbial safety of herbal medicines in East African Community member countries.

For example they suggest that establishing strong and concerted herbal safety mechanisms in Eastern Africa is now a priority to protect public health and improve the well-being of the population.

“As the public becomes aware of these findings, consumers are urged to exercise caution when using herbal medicines and to seek guidance from qualified healthcare professionals before usage. By addressing these issues and implementing appropriate safety measures, the region can ensure that traditional herbal medicines remain a safe and effective option for healthcare while safeguarding the health of its people.”

The further propose that urgent action is needed to address this growing concern, as the industry expands and the potential dangers to public health continue to mount.

“Comprehensive research on microbial safety of herbal medicines is essential to establish strong and region-wide herbal safety mechanisms that can safeguard public health in East Africa. With this newfound understanding, concerted efforts must be made to protect consumers and promote safer herbal medicine practices in the region,” they conclude.

What is Escherichia coli?

Often abbreviated as E. coli, this is a type of bacteria that is commonly found in the intestines of humans and animals. While most strains of E. coli are harmless and even beneficial, some can cause illness and infections. The bacteria are part of the normal gut flora and play a role in digestion and the production of certain vitamins. However, there are pathogenic strains of E. coli that can lead to various infections, particularly in the gastrointestinal tract. These pathogenic strains produce toxins that can cause symptoms such as diarrhea, abdominal cramps, and vomiting. In some severe cases, particularly in vulnerable individuals or when specific dangerous strains are involved, E. coli infections can lead to more serious health issues, including kidney failure.

What is Salmonella spp

This is a group of bacteria that can cause foodborne illness in humans and animals. There are numerous serotypes of Salmonella, with the two most common ones being Salmonella enterica and Salmonella bongori. Among these serotypes, Salmonella enterica is the most significant cause of human infections.

Salmonella bacteria are commonly found in the intestines of animals, birds, and reptiles. They can contaminate various types of food, especially raw or undercooked meat, poultry, eggs, and unpasteurized dairy products. Fruits, vegetables, and other foods can also become contaminated through contact with animal feces or contaminated water sources during cultivation or processing.

When humans consume food or water contaminated with Salmonella, they can develop salmonellosis, which is the infection caused by these bacteria. Symptoms of salmonellosis typically include diarrhea, abdominal cramps, fever, and sometimes vomiting. The illness usually lasts for several days and resolves on its own without specific treatment.

What is Shigella spp?

These are a group of bacteria that can cause gastrointestinal infections in humans. The most common species of Shigella that cause illness in humans are Shigella sonnei, Shigella flexneri, Shigella boydii, and Shigella dysenteriae. These bacteria are highly contagious and can spread easily from person to person, particularly in environments with poor hygiene practices.

Shigella infections typically lead to a condition known as shigellosis or bacillary dysentery. The bacteria are transmitted through the fecal-oral route, often due to the consumption of contaminated food or water. The infection can also spread from person to person, especially in crowded settings or through contact with infected individuals.

Symptoms of shigellosis usually appear within a few days after exposure and include diarrhea (which may be bloody), abdominal cramps, fever, and sometimes nausea and vomiting. In some severe cases, shigellosis can cause dysentery, which is characterized by severe diarrhea with mucus and blood, along with a high fever.

Shigella infections are more common in developing countries and in areas with poor sanitation and limited access to clean water. Young children, the elderly, and individuals with weakened immune systems are particularly vulnerable to severe shigellosis.

For more on this study, please visit: https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-020-00295-8#:~:text=The%20pooled%20prevalence%20of%20potentially,Salmonella%20spp

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