title: Herbal medicine use and linked suspected adverse drug reactions in a prospective cohort of Ugandan inpatients.
abstract: BACKGROUND
  Clinical history-taking can be employed as a standardized approach to elucidate the use of herbal medicines and their linked suspected adverse drug reactions (ADRs) among hospitalized patients. We sought to identify herbal medicines nominated by Ugandan inpatients; compare nomination rates by ward and gender; confirm the herbs' known pharmacological properties from published literature; and identify ADRs linked to pre-admission use of herbal medicines.
  
  
  METHODS
  Prospective cohort of consented adult inpatients designed to assess medication use and ADRs on one gynaecological and three medical wards of 1790-bed Mulago National Referral Hospital. Baseline and follow-up data were obtained on patients' characteristics, including pre-admission use of herbal medicines.
  
  
  RESULTS
  Fourteen percent (26/191) of females in Gynaecology nominated at least one specific herbal medicine compared with 20 % (114/571) of inpatients on medical wards [20 % (69/343) of females; 20 % (45/228) of males]. Frequent nominations were Persea americana (30), Mumbwa/multiple-herb clay rods (23), Aloe barbadensis (22), Beta vulgaris (12), Vernonia amygdalina (11), Commelina africana (7), Bidens pilosa (7), Hoslundia opposita (6), Mangifera indica (4), and Dicliptera laxata (4). Four inpatients experienced 10 suspected ADRs linked to pre-admission herbal medicine use including Commelina africana (4), multiple-herb-mumbwa (1), or unspecified local-herbs (5): three ADR-cases were abortion-related and one kidney-related.
  
  
  CONCLUSIONS
  The named herbal medicines and their nomination rates generally differed by specialized ward, probably guided by local folklore knowledge of their use. Clinical elicitation from inpatients can generate valuable safety data on herbal medicine use. However, larger routine studies might increase the utility of our method to assess herbal medicine use and detect herb-linked ADRs. Future studies should take testable samples of ADR-implicated herbal medicines for further analysis.
authors.affiliation: Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda. kiguba@gmail.com.
authors.forename: Ronald
authors.initials: R
authors.lastname: Kiguba
authors.affiliation: Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda.|Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Sam
authors.initials: S
authors.lastname: Ononge
authors.affiliation: Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Charles
authors.initials: C
authors.lastname: Karamagi
authors.affiliation: Medical Research Council Biostatistics Unit, Cambridge, UK.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Bird
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D029001:Herbal Medicine; D006757:Hospital Units; D006801:Humans; D007297:Inpatients; D010946:Plants, Medicinal / Q000009:adverse effects*; D011247:Pregnancy; D011446:Prospective Studies; D014454:Uganda
keywords: Adverse drug reactions; Alternative medicines; Herbal medicines; Suspected adverse drug reactions; Uganda