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Increasing numbers of medicines are being used by pregnant South African women in the public sector during pregnancy, for the treatment of different biomedical and supernatural disease states and conditions. The motivation for the research is to support the development of more local pregnancy registries in order to strengthen evidence for the safety and efficacy of medicines used in pregnancy. A mixed methods approach was used. Women in their ninth month of pregnancy in a public sector setting, and four community pharmacists were identified. The women who met the inclusion criteria were recruited. One in-depth semi-structured interview was conducted with each woman before giving birth and data on their pregnancy outcomes were collected after labour. Coincidentally, the mother of one of the participants was found to be a traditional healer. She was also interviewed on the topic. A structured questionnaire was administered to the pharmacists. Ten pregnant women between the ages of 19 to 39 who had used or were using a traditional medicine during the pregnancy were recruited. All the participants had had at least one antenatal check up during their pregnancy with one having attended five times. No abnormal results were reported from any of the check ups or tests done during the visits. All of them had been to school and had at least Standard 8/Grade 10 education. Ten babies were seen between one and four days postpartum and no birth defects were obvious or were reported for any of them. The traditional healer did not provide additional information to what the women had said and confirmed that some of the practices the women reported were known to her as traditional medicine practices. All four pharmacists indicated that they considered complementary and alternative medicines (CAMs) to be “somewhat effective” and sold them at their pharmacies although none of them were aware of whether or not they were registered with the MCC. None of the pharmacists appeared to have an in-depth knowledge of traditional, complementary and alternative medicines (TCAMs). All four pharmacists said that it is important to have a basic understanding of TCAMs before using them, although they did not agree on the reasons for this. All of them felt that pharmacists have a professional responsibility to provide information on TCAMs (especially herbal preparations) and two felt that providing this information is part of a medical doctors’ responsibility. No harm from taking TCAMs could be shown. However herbal medicines have numerous ingredients some of which are unknown and taking these medicines is risky. The pharmacists in this sample were unsure whether they were accessing unreliable CAM information. Reliable sources of information and reference materials on CAMs to assist pharmacists and other healthcare professionals are needed. The apparent widespread use of TCAM in pregnancy indicates a need for documentation about its efficacy and safety. The establishing of TCAM pregnancy registries should seriously be considered. Due to the increase in CAM use, CAM education during pharmacists’ training as well as continuing professional development (CPD) in CAM for pharmacists in practice should be encouraged.

The major socio-economic development challenges facing most African countries include economic diversification, poverty, unemployment, diseases and the unsustainable use of natural resources. The challenge of quality healthcare provisioning is compounded by the HIV/AIDS pandemic in Sub Saharan Africa. However, there is a great potential in using electronic healthcare (e-health) as one of the supportive systems within the healthcare sector to address these pressing challenges facing healthcare systems in developing countries, including solving inequalities in healthcare delivery between rural and urban hospitals/clinics. The purpose of this study was to compile a Provincial E-health Framework (PEHF) based on the feedback from electronic healthcare readiness assessments conducted in selected rural and urban hospitals/clinics in the North West Province in South Africa. The e-healthcare readiness assessment was conducted in the light of effective use of ICT in patient healthcare record system, consultation among healthcare professionals, prescription of medication, referral of patients and training of healthcare professionals in ICT usage. The study was divided into two phases which were phases 1 and 2 and a qualitative design supported by a case study approach was used. Data were collected using different techniques to enhance triangulation of data. The techniques included group interviews, qualitative questionnaires, photographs, document analysis and expert opinions. The outcome of the assessment led to the compilation of the PEHF which was based on Service Oriented Architecture (SOA). SOA was chosen to integrate the hospitals/clinics‟ ICT infrastructure yet allowing each hospital/clinic the autonomy to control its own ICT environment. To assist hospitals/clinics integrate their ICT resources, this research study proposed an Infrastructure Network Architecture which clustered hospitals/clinics to share common ICT infrastructure instead of duplicating these resources. Furthermore, processes of the e-health services (e-patient health IV record system, e-consultation system, e-prescription system, e-referral system and e-training system) were provided to assist in the implementation of the PEHF. Finally, a set of guidelines were provided by the research study to aid the implementation of the PEHF.

PhD (Chemistry) / Department of Chemistry / Terminalia sericea Burch. ex. DC (Combretaceae) is one of the 50 most popular medicinal plants in Africa. The fruit, leaves, stems and roots are commonly used for the treatment of cough, skin infections, diabetes, diarrhoea, venereal diseases and tuberculosis. However, the roots are most commonly used in the preparation of traditional medicines. Pharmacological studies have revealed that the crude root extracts display antibacterial activity against several Gram-positive and Gram-negative bacteria. Anolignan b, termilignan b and arjunic acid are reported to be the major antibacterial constituents present in the roots. Other compounds isolated from the roots include resveratrol-3-rutinoside, sericic acid, sericoside and arjunglucoside I. Authorities worldwide, including the Medicines Control Council of South Africa, have begun to regulate herbal drugs sold in the form of commercial formulations. Quality control of herbal drugs is challenging, since the chemical profiles of the raw materials may vary, depending on the origin of the plant material and the way that it was handled and processed. The chemistry, in turn, impacts on the safety and efficacy of the plant material. To date, there are no available data on parameters that can be used to standardise the quality of T. sericea raw materials. The aim of this study was therefore to provide information on the variation of the chemical constituents that contribute to the biological effects of the roots of T. sericea and also establish its safety. Since the compounds previously isolated from the roots were not commercially available, isolation of the major constituents of the roots was undertaken to obtain analytical standards. A crude dichloromethane:methanol (1:1) extract was initially fractionated using silica gel column chromatography, where after, some of the fractions were further purified using silica gel and Sephadex LH-20 column chromatography. Final purification of the enriched fractions was achieved using preparative high performance liquid chromatography coupled with mass spectrometry (prep-HPLC-MS). The structures of these compounds were subsequently elucidated using one- and two- dimensional nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry and identified as sericic acid (340 g), sericoside (500 g), resveratrol-3-rutinoside (240 mg) and arjunglucoside I (74 mg). The chemical variation within the crude root extracts of samples (n = 42) from ten populations in the Limpopo Province of South Africa, was determined using ultra performance liquid chromatography-mass spectrometry (UPLC-MS). A method was developed for the simultaneous determination of sericic acid, resveratrol-3-rutinoside, sericoside and arjungluicoside I in the extracts using UPLC with photodiode array detection (PDA). The method was validated according to the guidelines of the International Council for Harmonisation (ICH). A regression coefficient (R2) of 0.998 was obtained for sericic acid, resveratrol-3- rutinoside and arjunglucoside I, while the R2 value for sericoside was 0.999, indicating a linear relationship between the concentration and the detector response. Satisfactory limits of detection for sericic acid (25.2 ng/mL), sericoside (11.6 ng/mL), resveratrol-3-rutinoside (23.3 ng/mL) and arjunglucoside I (8.81 ng/mL) were determined. Recoveries of 98 % and 80% were obtained for samples spiked with 12.5 μg/mL and 25 μg/mL of resveratrol-3-rutinoside, respectively, indicating that the method is accurate. The intra- and inter-day variation in resveratrol-3-rutinoside concentration, measured over three days, indicated excellent analytical precision, since all the relative standard deviations were below 0.70 %. The quantitative data revealed that sericic acid (1.59 to 8.45 mg/g), sericoside (2.07 to 20.17 mg/g), resveratrol-3-rutinoside (0.65 to 29.82 mg/g) and arjunglucoside I (0.86 to 8.44 mg/g dry weight) were the major constituents of the root samples, but their concentrations were highly variable. Chemometric analysis of the aligned UPLC-MS data was used to investigate similarities and differences in the chemical profiles of the samples using an untargeted approach. A principal component analysis (PCA) model was constructed and subsequently hierarchical cluster analysis (HCA) indicated the presence of two main groups, which were found to be independent of the populations to which the samples belong. Classes, based on the HCA class identifiers, were subsequently assigned to the samples, and an orthogonal projection to latent structures-discriminant analysis (OPLS-DA) model was then constructed, (R2 cum = 0.996 and Q2 cum = 0.967). The corresponding loadings plot allowed sericic acid, sericoside and resveratrol-3-rutinoside to be identified as biomarkers associated with the first group. Quantitative, rather than qualitative differences were responsible for the observed clustering pattern. Techniques that could be applied in quality control protocols for T. sericea root were investigated. High performance thin layer chromatography (HPTLC) analysis of the root extracts was optimised by testing different developing solvents and visualization reagents. The presence of the sericic acid (Rf = 0.80), sericoside (Rf = 0.49) and resveratrol-3-rutinoside (Rf = 0.36) were clearly visible on the plates. There were visible variations in the concentrations of resveratrol-3-rutinoside in representative samples from the 10 populations, corresponding to the UPLC results. The powdered samples were then analysed by mid-(MIR) infrared spectroscopy. Chemometric analysis of the data revealed no definitive clustering pattern. Partial least squares-discriminant analysis (PLS-DA) calibration models were established from the MIR spectral data combined with the accurate UPLC-values, for the prediction of the sericoside (R2Y = 0.848, Q2 = 0.757, RMSEP = 2.70 mg/g) and resveratrol-3-rutinoside (R2Y = 0.794, Q2 = 0.695, RMSEP = 4.37 mg/g) concentrations in powdered root samples. The antibacterial activities of the root extracts, column fractions and isolated compounds were determined using three Gram-positive and five Gram-negative bacteria, all selected due to their ability to cause intestinal and skin disorders. Extracts and fractions containing high concentrations of sericic acid exhibited the highest activities against Klebsiella pneumoniae (ATCC 13883), Pseudomonas aeruginosa (ATCC 27858), Salmonella typhimurium (ATCC 14028), Staphylococcus aureus (ATCC 25923), Staphylococcus epidermidis (ATCC 12223) and Shigella sonnei (ATCC 9292). The pure compound (sericic acid) was highly active against S. sonnei (MIC 0.078 μg/mL), a Gram- negative bacterium. There were no variations in the activity of the crude extracts against B. cereus and P. aeruginosa, while the MIC values obtained against S. typhi were variable and ranged from 0.25 to 1.0 mg/mL. Sericoside and resveratrol-3-rutinoside did not display any activity. The anti-oxidant activities were evaluated using DPPH (2,2-diphenyl-1-picrylhydrazyl) and reducing power assays. The anti-oxidant assays revealed that resveratrol-3- rutinoside exhibited lower activity (DPPH = 186 μg/mL; RP = 184 μg/mL) compared to the crude extract (DPPH = 22.3 μg/mL; RP = 24.4 μg/mL) and ascorbic acid (DPPH = 11.3 μg/mL, RP = 145 μg/mL). Sericic acid and sericoside did not display any anti- oxidant activities. The variation in the anti-oxidant activities (4.58 to 26.0 μg/mL) of the samples from different populations was an indication of chemical variability. A toxicity study of the raw powdered plant material was conducted using vervet monkeys (Chlorocebus pygerythrus). Biochemical analysis (liver function tests, kidney function tests and hematology), physical and physiological examinations were conducted. The subjects were fed a normal diet supplemented with T. sericea root powder (2.14 g/kg per day) for 120 days, where after the diet was returned to normal (washout) for another 30 days. The treatment groups presented with elevated serum enzymes at Week 4, followed by the reduction of the elevated serum enzymes levels at Week 12. These results indicate short-term hepatotoxic effects, followed by hepatoprotective activity. Reduction of the serum glucose at Week 4 suggests hypoglycemic potential. However, elevated serum creatinine levels indicated possible nephrotoxicity. In conclusion, this study has indicated the variability in the chemical constituents of the roots of T. sericea, which affects the antibacterial and anti-oxidant activities. Sericic acid, resveratrol-3-rutinoside, and sericoside were, for the first time, identified as biomarkers that can be used for the quality control of raw root material to be used in herbal products. Sericic acid was also found to be the main antibacterial constituent of the roots. The hepatoprotective, nephrotoxic and hematotoxic effects observed in monkeys to which the root powder had been administered is cause for concern. / NRF

Thesis (D. Tech. (Biomedical Technology)) -- Central University of Technology, Free State, 2014 / Medicinal plants are part of indigenous people‟s cultural heritage, thus since ancient times treatment of various diseases using medicinal plants has been part of human culture. The value of medicinal plants to mankind has been very well proven. It is estimated that 70% to 80% of people worldwide rely mainly on traditional health care systems, especially on herbal medicines (Stanley and Luz, 2003). In many societies the medicinal properties of plants were discovered mostly through trial and error, but use was also influenced by the belief systems of the people involved and often became entangled with religious and mythical practices (Mathias et al., 1996). Besides that, medicinal plants are proving to be rich resources of constituents that can be used in drug development and synthesis. Medicinal plants have been a source of a wide variety of biologically active compounds for many centuries and have been used extensively as crude material or as pure compounds for treating various disease conditions. Between 1% and 10% of plants out of an estimated 250 000 to 500 000 species of plants on earth are used by humans (Boris, 1996). 2 Plants used for medicinal purposes contribute significantly to the development of major medical drugs that are used today. Most common medicines have compounds extracted from plants as their primary active ingredients and many have provided blueprints for synthetic or partially synthesized drugs (Simpson and Ogorzaly, 2001). There has been a major resurgence of interest in traditionally used medicinal plants, with a number of international and local initiatives actively exploring the botanical resources of southern Africa with the intention to screen indigenous plants for pharmacologically active compounds (Gurib-Fakim et al., 2010; Rybicki et al., 2012). South Africa is considered a “hot spot” for biodiversity and more than 22 000 plant species occur within its boundaries. This represents 10% of the world‟s species, although the land surface of South Africa is less than 1% of the earth‟s surface (Coetzee et al., 1999). Plants have also been used by man for various purposes, among others as arrow and dart poisons for hunting, poisons for murder, hallucinogens used for ritualistic purposes, stimulants for endurance and hunger suppression, as well as medicine (Duke et al., 2008; Cragg and Newman, 2005). A derivative of the polyhydroxy diterpenoid ingenol isolated from the sap of Euphorbia peplus (known as “petty spurge” in England or “radium weed” in Australia), which is a potential chemotherapeutic agent for skin cancer, is currently under clinical development by Peplin Biotech for the topical treatment of certain skin cancers (Kedei et al., 2004; Ogbourne et al., 2004). Combretastatin A-4 phosphate, 3 a stilbene derivative from the South African bush willow, Combretum caffrum, acts as an anti-angiogenic agent causing vascular shutdowns in tumors (Newman et al., 2005; Holwell et al., 2002). Further reliance on plants for drug development is demonstrated by the use of galantamine hydrobromide, an alkaloid obtained from the plant Galanthus nivalis used traditionally in Turkey and Bulgaria for the treatment of Alzheimer‟s disease (Howes et al., 2003; Heinrich and Teoh, 2004). The plant chemicals used for the above-mentioned purposes are secondary metabolites, which are derived biosynthetically from plant primary metabolites (e.g. carbohydrates, amino acids and lipids). Secondary metabolites are organic compounds that are exclusively produced by plants and that are not directly involved in the normal growth, development and reproduction of a plant (Firn and Jones, 2003). Yet, they have many functions that are important for the plant‟s long-term health and appearance. Plants, being stationary, have to cope with a number of challenges, including engineering their own pollination and seed dispersal, local variation in the supply of the simple nutrients that they require to synthesize their food and the coexistence of herbivores and pathogens in their immediate environment. Plants have therefore evolved secondary biochemical pathways that allow them to synthesize a spectrum of organic molecules, often in response to specific environmental stimuli, such as herbivore-induced damage, pathogen attacks, or nutrient deprivation (Reymond et al., 2000; Hermsmeier et al., 2001). 4 The biosynthesis of secondary metabolites is derived from the fundamental processes of photosynthesis, glycolysis and the Krebs cycle to afford biosynthetic intermediates which, ultimately, result in the formation of secondary metabolites also known as natural products (Dewick, 2002). It is hypothesized that secondary metabolism utilizes amino acids and the acetate and shikimate pathways to produce “shunt metabolites” (intermediates) that have adopted an alternate biosynthetic route, leading to the biosynthesis of secondary metabolites (Sarker et al., 2006). Modifications in the biosynthetic pathways that produce secondary metabolites are probably due to natural causes (e.g. viruses or environmental changes) or unnatural causes (e.g. chemical or radiation processes) in an effort to adapt or provide longevity for the plant (Sarker et al., 2006). Plants‟ secondary metabolites can be classified into several groups according to their chemical classes, such alkaloids, terpenoids and phenolics (Harbone, 1984; Wink, 2003).

For centuries Traditional Health Practitioners (THPs) used their indigenous knowledge (IK) in conserving medicinal plants and environments to maintain sustainability. With the rapid environmental, social, economic and political changes occurring in many areas inhabited by rural people exist the danger that the loss of biodiversity from habitat destruction and unsustainable harvesting practices will result in some species becoming extinct. The main aim of the study was to determine the natural habitat of extinction-prone traditional medicinal plants combining the insight of THPs with an ultimate goal of guiding research for the conservation, propagation and cultivation of traditional medicinal plants. Despite problems, opportunities and challenges expressed and identified by THPs, the analysis of data from interview schedule and personal observations, show that the THPs' practices are shaped by historical processes and local cultural values, social norms and their management strategies that are influenced by a broad range of factors. / Agriculture, Animal Health & Human Ecology / M.A. (Human Ecology)

Dissertation submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, 2011. / The purpose of this study was to investigate the relationship between the understanding and utilization of Strychnos henningsii (umqalothi, Red bitterberry) by Zulu traditional healers and the signs and symptoms induced by the thirtieth centesimal potency (30CH) homoeopathic dilution of the crude substance in a previously conducted triple-blind placebo-controlled homoeopathic proving. Methodology The study was carried out in four dispersed areas of KZN (Harding, Durban, Weenen and Melmoth). From each area one isangoma and one inyanga were interviewed, resulting in eight interviews. All visits were conducted by the researcher, who acted as principal communicator and translator, and his supervisor, who assisted him by doing live video recording of all interviews. The methodology employed was that of qualitative interviewing using semi-structured interviews. Each video was transcribed into Zulu text and subsequently translated to English text by the researcher and his supervisor. The data obtained from the interviews was then compared to data obtained from the previously conducted homoeopathic proving of Strychnos henningsii 30CH in order to evaluate the overlap between the traditional and the homoeopathic approach to utilisation of the plant. Results After comparison, it was found that there was an overlap in the gastro-intestinal system, cardio-vascular system, respiratory system and female/male genito-urinary system and in some mental symptoms. v However, there were no overlaps found in traditional usage of the plant as an antisnake venom, and in the proving symptoms related to scalp, hair, eyes, ear, nose, face, mouth, teeth and throat. Conclusion After comparison between the understanding and utilization of Strychnos henningsii by Zulu traditional healers and the signs and symptoms induced by the proving of Strychnos henningssi 30CH, it was concluded that while there are certain overlaps, the homoeopathic proving produced a wider range of symptoms which may either serve to extend the traditional use, or overlap with existing traditional use not exposed within the scope of this study. Interviews with a greater number of traditional healers in a wider geographic area may reveal a closer correlation between homoeopathic proving symptoms and patterns of use by traditional healers.

Submitted in partial fulfilment of the requirements for the degree of Masters in Business Administration (MBA), Business Studies Unit, Durban University of Technology, 2008 / The pharmaceutical industry is in the midst of a fundamental transformation. Time and cost constraints are forcing marketers to search for new ways to maintain and grow brand awareness. The amount of time that doctors allow for representatives to market their products is becoming less and less and as a result products are not getting the exposure they used to. Organisations that find innovative ways to maintain exposure of their products may gain a competitive advantage over those organisations that rely on traditional marketing methods. The prolific increase in the use of the internet may provide pharmaceutical organisations with a complementary channel to market their products. The objective of this study is to determine the levels of internet technology adoption among general practitioners. The Technology Acceptance Model (TAM) is one of the most influential research models in studies of the determinants of information systems/ information technology (IS/IT) acceptance. In TAM, perceived usefulness and perceived ease of use are hypothesised and empirically supported as fundamental determinants of user acceptance of a given IS/IT. Using TAM, this study sets out to determine general practitioners’ intention to use the internet as a source of pharmaceutical information. The literature review provides an extensive evaluation on the development of TAM and its application in different technologies. Based on these findings, the researcher developed this study to investigate internet technology acceptance in the pharmaceutical industry. Use is made of the descriptive survey method and data is retrieved from a sample of 105 general practitioners in Kwazulu-Natal. The observation is made via the benefit of a questionnaire. The process of sampling is that of convenient sampling. The analysis is quantitative and makes use of statistical analysis appropriate for the data. Analysis of the survey results produces useful insights into the factors influencing internet technology adoption by general practitioners. When analysing the independent variables, respondents were not in strong agreement about the perceived usefulness nor the perceived ease of use of internet technology as a source of pharmaceutical information. However, positive results from the relationships between the independent (perceived usefulness and perceived ease of use) and dependent variables (attitude and intention to use) provide valuable data with which organisations may develop internet-based marketing strategies. Based on the survey findings, recommendations using the Beynon-Davies (2004) Internet Adoption Model are suggested.

The aim of this study is to isolate and evaluate the anticonvulsant components from the leaves of Leonotis leonorus (L) R.aR. and to see if there is any change in activity with the origin of the plant material and I or the season in which plant material is collected. Therefore, in this study, two sites were chosen for collection of plant material and the collection was made in summer and in winter. Chemical, physical and pharmacological methods were used to isolate, identify and to evaluate compounds isolated from the leaves of Leonotis leonorus for anticonvulsant activity.

Research report submitted to the School of Economic and Business Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Commerce (Information Systems) by coursework and research, 2 November 2017 / Mobile health applications are fast becoming an influential source of information for pregnant women. Studies have shown that pregnant women download 3 such apps on average on their cellphones. These mobile technologies have been shown to help women monitor their progress during their pregnancy and personalise healthcare to suit their needs. To date, llimited research has been directed towards understanding usage behaviours with these apps. Various authors have argued that there is a need to expand the scope of research from simple usage behaviour to deeper levels as technology becomes more sophisticated and easily available. M-health technologies are increasingly becoming more varied and sophisticated and as such this study aims to explore post-adoption usage specifically of mobile health pregnancy applications in the South African context. This study specifically looked at post adoption usage behaviours and used Hsieh and Zmud’s (2006) framework as a basis of understanding these behaviours. The potential influences on these behaviours were sourced from various studies done on pregnant women usage of ICT in general. These influences were then investigated to see whether they were relevant in the context of m-health pregnancy support applications. The primary method of data collection was open ended semi structured interviews with twelve pregnant women. Data analysis was done using the iterative model for qualitative data analysis proposed by Miles and Huberman (1994). The findings revealed that pregnant women displayed post adoption usage behaviours of routine use and IS continuance. With regards to the infusion stage, the study found that pregnant women engaged in the first set of post adoption usage behaviours i.e. extended usage and deep usage. They did not engage in second stage behaviours namely emergent use, feature extension or intention to explore behaviours. The influences identified in the literature were found to be relevant in the context of m-health applications and additional influences such as cost of seeing gynaecologist, number of features on the app and social structures were found to have an influence on usage of the apps. This study provides unique insights into the views of pregnant women’s experiences with m-health apps. Specifically, by using interpretive research it uncovers the subjective meanings around post adoption usage behaviours, understanding how pregnant women engage in these behaviours and subsequently how these behaviours are sustained during their pregnancy. The study recognises m-health pregnancy support apps as important tools in the pregnancy journey. It highlights how pregnant women value these apps and view them as huge information sources, reassurance and comfort during their pregnancy. It is argued that medical professionals cannot distance themselves away from these apps and need to work in conjunction with them to provide robust maternity care to their patients. 5 Theoretically, this study adds to our understanding of post adoption usage behaviours specifically in the context of m-health pregnancy apps. Limited studies have been done in this field specifically in the South African context and the study provides a foundation for further research. Further research can be done to understand how these apps are changing the relationship between pregnant women and medical professionals and furthermore, whether the information received from these apps is reliable and credible. / GR2018