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"Staphylococcus aureus" contamination levels in selected local herbal medicines sold in Kampala, Uganda

Bachelor Thesis 2016 53 Pages

Medicine - Public Health

Excerpt

TABLE OF CONTENTS

DEDICATION

ACKNOWLEDGEMENT

ABBREVIATIONS

LIST OF TABLES

ABSTRACT

CHAPTER ONE: INTRODUCTION
1.1 Background
1.2 Problem statement
1.3 Justification
1.4 Study objectives
1.4.1 General objective
1.4.2 Specific objectives
1.5 Research questions

CHAPTER TWO: LITERATURE REVIEW
2.1 Herbal medicine
2.1.1 Classification of herbal medicine
2.1.2 Uses of herbal medicine
2.2 Bacterial quality of herbal medicines
2.2.1 Public health complications of contaminated herbal medicine
2.3 Biology of Staphylococcus aureus
2.3.1 Transmission of Staphylococcal infections
2.3.2 Diseases caused by Staphylococcus aureus
2.4 Antibacterial resistance
2.4.1 Antibacterial resistance mechanisms of Staphylococcus aureus

CHAPTER THREE: MATERIALS AND METHODS
3.1 Study area
3.2 Study design
3.3 Data collection
3.3.1 Qualitative data collection
3.3.2 Quantitative data collection
3.4 Sample size
3.5 Sampling strategy
3.6 Sample selection criteria
3.6.1 Inclusion criteria
3.6.2 Exclusion criteria
3.7 Staphylococcus aureus culture
3.7.1 Labelling test tubes and culture plates in the laboratory
3.7.2 Processing of samples
3.7.3 Preparation of media
3.7.4 Culture of samples
3.7.5 Plate reading bacterial identification and colony plate count
3.8 Antibacterial susceptibility testing
3.9 Quality control and quality assurance
3.10 Data analysis
3.11 Study limitation and mitigation

CHAPTER FOUR: PRESENTATION AND INTERPRETATION OF RESULTS
4.1 Local herbal medicines sold in Kampala, Uganda
4.2 Level of contamination of herbal medicine with Staphylococcus aureus
4.2.1 Growth patterns of Staphylococcus aureus
4.2.2 Colony forming units of Staphylococcus aureus
4.3: Antibacterial susceptibility patterns of Staphylococcus aureus

CHAPTER FIVE: DISCUSSION OF RESULTS
5.1 Local herbal medicines sold in Kampala, Uganda
5.2 Level of contamination of herbal medicine with Staphylococcus aureus
5.3 Antibacterial susceptibility patterns of Staphylococcus aureus

CHAPTER SIX: CONCLUSION AND RECOMMENDATION
6.1 Conclusion
6.2 Recommendation

REFERENCES

APPENDICES
Appendix 1: Coagulase test
Appendix 2: labelling, counting and isolating colonies in pictures
Appendix 3: Map of Kampala city, Uganda
Appendix 4: Questionnaire
Appendix 5: List of local herbal medicines sold in Kampala and the conditions they treat

DEDICATION

I dedicate this special project report to my dear parents, brothers and sisters

ACKNOWLEDGEMENT

I am everlastingly thankful to the almighty god for the gift of knowledge, wisdom and good health.

Secondly, I acknowledge the work of my parents Mr. and Mrs. Ilimaso K. Denis to put me in school and support me up to this level.

Thirdly, I am thankful to my lecturers especially my supervisor Dr. Muzoora Saphan.

ABBREVIATIONS

Abbildung in dieser Leseprobe nicht enthalten

LIST OF TABLES

Table 1: Mechanism of Staphylococcus aureus resistance to antibacterials

Table 2: Categories, formulations and common indications of local herbal medicines sold in Kampala, Uganda (n=170)

Table 3: Growth patterns of Staphylococcus aureus

Table 4: Colony forming units of Staphylococcus aureus in different samples (n=30)

Table 5: Staphylococcus aureus susceptibility (n=7)

ABSTRACT

Herbal medicine use in Uganda and the world at large is at its peak because of the documented efficacy, effectiveness, cheap cost and less side effects. The estimates of herbal medicine users in the world is 80% and 60% in Uganda, yet with all this demand, less effort has been put to ensure that they are free from bacterial contamination. The study therefore aimed at determining Staphylococcus aureus contamination of selected liquid herbal medicines sold in Kampala, Uganda with the following specific objectives; (i) to provide an update on the different local herbal medicines sold in Kampala, Uganda and the conditions they treat; (ii) to determine Staphylococcus aureus contamination levels of selected liquid local herbal medicines sold in Kampala, Uganda; and (iii) to establish the antibacterial susceptibility patterns of isolated Staphylococcus aureus. A questionnaire was used to collect data on the different local herbal medicines sold in Kampala, Uganda. To determine levels of Staphylococcus aureus contamination, microbial culture was performed on 30 selected liquid herbal medicine samples. In addition Staphylococcus aureus susceptibility patterns were determined by subjecting isolated Staphylococcus aureus species to gentamicin 10pg, chloramphenicol 30 30pg ampicillin 10pg, penicillin 10U and tetracycline 30pg. A total of one hundred and seventy (170) local herbal medicines were identified and classified into twenty five (25) categories basing on conditions they treat (Table 2). From the microbial culture, seven samples (23.3%) showed growth ranging from 0.05x10 cfu/ml to 3.175x10[5]cfu/ml. These were all above established limit for Staphylococcus aureus contamination (EOCD, 2012). Isolated Staphylococcus aureus was sensitive to gentamicin, tetracycline, ampicillin, chloramphenicol and resistant penicillin. I therefore recommend that herbal medicines should be tested for bacterial quality by regulatory bodies before being sold to patients to avoid Staphylococcus aureus infection hence avoiding treatment costs. In addition, herbal medicine practitioners should embark on good manufacturing practices to avoid contamination of herbal medicines.

CHAPTER ONE: INTRODUCTION

1.1 Background

The use of herbal medicine has gained popularity because of its efficacy and safety (Aschwanden, 2001). According to world health organisation (WHO) statistics, 80% of the world’s population relies on herbal medicine for primary health care (Lutoti et al., 2013; Noor et al., 2014). Global sales of herbal medicine have been estimated to be US dollars $60billion in 2000, and in 2008, the worldwide market for herbal products was estimated to be Us dollar $83 billion. As years pass on, there has been a steady growth rate of herbal medicine use ranging from 3-12% per year globally (Zhang et al., 2012). Ministry of health in Uganda Statistics indicate that about 60% of the Ugandan population seeks medical care from herbal medicine practitioners (Lutoti et al., 2013).

Herbal medicine has gained popularity because; it is considered to be safer (more natural) than pharmaceuticals (Calixto, 2000; Aschwanden, 2001; Ola et al., 2013; Noor et al., 2014) hence harmless to the human population (Kosalec et al, 2009). In addition, synthetic medicine is costly compared to traditional medicine (Lutoti et al., 2013; Noor et al., 2014). For example, studies show that 70% of the world’s population are too poor to buy modern cancer medicine and therefore resort to cheap herbal cancer medicines (Wislow et al., 1998). Besides, beliefs of society that everything that was put on earth has to be used and is therefore safe have promoted herbal medicine use (Kosalec et al., 2009; Ndhlala et al., 2012). There are also high numbers of herbal medicine practitioners, frequent advertisements on radios and televisions, and door to door vendors all which act together to inform the consumer about the products and bring them closer to him/her (Lutoti et al., 2013). Furthermore, herbal medicines cure diseases which synthetic drugs have failed to cure for example the use of Zemaphyte a Chinese traditional medicine to cure atopic eczema (Ting et al., 2013). Herbal medicines are also prescribed by doctors for example in Japan, 85% of the doctors prescribe a traditional herbal medicine called kampo (Aschwanden, 2001), and other physicians recommend them as being safe as far as adverse effects are concerned (Wislow et al., 1998; Babu et al., 2009; Seyyednejad et al., 2010).Considering the documentations made, adverse effects of synthetic medicine are common in press than reports of herbal adverse effects (Wislow et al., 1998). The major reason for all this is because “synthetic medicine” is always inspected as regards microbial safety, toxicity, clinical trials performed and findings documented. For instance in Uganda, regulatory bodies such as National Drug Authority (NDA) regulates critically synthetic medicines compared to natural herbal products. The authority only encourages safe preparation of herbal medicine but doesn’t go ahead to check if implementation has been done (Lutoti et al., 2013; URN, 2013).

Of great concern, some local herbal medicine in Uganda is always sold packaged in recycled plastic and metallic materials for example used plastic soda bottles. These materials are just washed, sun-dried and used for packing without subjecting them to effective sterilisation methods. This is probably because the producers do not have enough money to make good, better quality and bacteria free packaging materials. Furthermore, any extra cost incurred would be recovered by the consumer which would make the medicine expensive (Ndhlala et al., 2012). In addition, local herbal medicine producers use local methods of extracting the medicine using local processing equipment like mortar and pestle among others. Packaging containers also do not contain labels for example of preservatives used (Ndhlala et al., 2012). This leads to suspicion that either no preservative is used or incompatible preservative is used that cannot be revealed to the public. Thus, local herbal medicine could be acting as media for some pathogenic bacteria like Staphylococcus aureus, salmonella species, Klebsiella pneumonae and Enterobacter among others. In addition, during transport for sell, local herbal medicine is packed in boxes and baskets exposed to environmental factors such as strong sunlight hence high temperatures which favour bacterial multiplication.

Herbal medicine may be contaminated with bacteria under the following circumstances; if the areas where they were got were contaminated with faeces; processing of the medicine from unclean utensils; contaminated water and with Staphylococcus aureus in particular if unclean hands were used (Kosalec et al., 2009). Additionally, the containers used for packaging the finished herbal medicine product may be contaminated with bacteria (Kosalec et al., 2009). Bacterial contamination poses a potential health risk, particularly with strains resistant to known antibacterials for example Bacillus species, Staphylococcus species and Enterobacter cloacae (Brown and Jiang, 2008). The study therefore the aims at assessing if local herbal medicines sold around Kampala are free from Staphylococcus aureus which is among the leading causes of bacterial infections (Nantanda et al., 2008)

Albeit a toxicological study was done on some herbal medicine sold in Uganda like cough products and sex enhancement products, focussing on some of their toxic constituents (Lutoti et al., 2013), their microbial safety has not been studied in Uganda. Globally, the safety of some herbal medicines has not been reported (WHO, 1993). Therefore to fully protect the public, bacterial safety of the herbal medicines needs to be assessed (Lowy, 1998).

1.2 Problem statement

In Uganda, 60% of the population seeks medical attention from herbal medicine practitioners (Lutoti et al., 2013). This is mainly because herbal medicines are considered to be efficacious, natural and safer than synthetic medicines (Calixto, 2000; Ashwadan 2001). In Uganda, most local herbal medicine producers use manual methods of harvesting and processing the herbal medicine that are capable of introducing bacterial contaminants (Bukuluki et al., 2014).Besides, regulatory bodies do not strongly regulate herbal medicine like it does for artificial / synthetic medicine as regards bacterial contamination yet herbal medicines are now highly used for treatment (Lutoti et al., 2013). Several studies have been done to assess the bacterial safety of liquid herbal medicines and have found bacterial contamination. For instance, Yesuf et al (2016) found liquid herbal medicines contaminated with both Gram positive (Staphylococcus species) and Gram negative bacteria. However, there paucity information on the bacterial safety of liquid herbal medicines sold in Uganda. Therefore, the study proposes to determine Staphylococcus aureus contamination of liquid herbal medicine sold in Kampala, Uganda. This is because Staphylococcus aureus is one of the microorganisms that cause both minor and life threatening infections (Lowy, 2003).These range from minor skin infections to bacteraemia, abscess, endocarditis and toxic shock syndrome (Lowy, 1998) yet Staphylococcus aureus is resistant to cheap common antibiotics (Adeleye, 2005; Esimone et al., 2007).

1.3 Justification

Regulatory bodies (National Drug Authority, NDA and Food and agricultural organisation, FAO) do not emphasize bacterial safety of local herbal medicine like they put on imported medicine. More so, local herbal medicine containers do not have information like preservatives and bactericides used. Therefore the herbal medicine may contain bacteria that could pose health risk to the users. For that matter, if bacterial quality is not ascertained, herbal medicine consumers might get diseases from pathogens resistant to known antibacterials. Furthermore depending on results herbal medicine practitioners will be promoted or stringent rules put on them to ensure that they supply bacterial free herbal medicine.

1.4 Study objectives

1.4.1 General objective

To determine Staphylococcus aureus contamination of selected liquid local herbal medicines sold in Kampala, Uganda.

1.4.2 Specific objectives

I. To provide an update on the different local herbal medicine sold in Kampala city and conditions they treat.
II. To determine Staphylococcus aureus contamination levels of selected liquid local herbal medicines sold in Kampala, Uganda.
III. To establish the antibacterial susceptibility patterns of isolated Staphylococcus aureus.

1.5 Research questions

I. What are the different local herbal medicines sold in Kampala city, Uganda and what conditions do they treat?
II. What are the contamination levels of Staphylococcus aureus in selected local liquid herbal medicine sold in Kampala city, Uganda?
III. What are the antibacterial susceptibility patterns of isolated Staphylococcus aureus species?

CHAPTER TWO: LITERATURE REVIEW

2.1 Definition of herbal medicines

Herbal medicine is defined as a plant-derived material or preparation with therapeutic or other human health benefits which contains either raw or processed ingredients from one or more plants (Zhang et al., 2012). Lutoti et al (2013) also defines herbal medicine as herbs, herbal materials, herbal preparations and finished herbal products that contain parts of plants or other plant materials as active ingredients. It only encompasses raw or processed ingredients obtained from one or more plants as well as their parts. Herbal medicine does not involve preparations in which chemically defined active substances have been added. Herbal medicine in Uganda is presented in form of crude extracts, or finished formulations for example tablets and capsules. Examples of common herbal medicine used in Uganda include; cough products, sex enhancement products, septillion tablets, syrup for respiratory tract infections (Lutoti et al., 2013).

2.1.1 Classification of herbal medicines

According to Zhang et al., (2012), herbal medicines are classified into three groups namely;

i. Herbal materials (raw or processed herbal materials for example powder and slices).
ii. Traditional herbal products (decoctions, tablets, pills, or capsules containing crude herbal materials or crude extracts).
iii. Standardised herbal products(formulations containing standardised extracts or purified substances)

2.1.2 Uses of herbal medicines.

Worldwide use of herbal medicine is at its peak (Zhang et al., 2012). It is estimated that 80% of the population uses herbal medicine for primary health care (WHO, 1998; Lutoti et al., 2013). Herbal medicine is majorly used to treat chronic conditions. Such conditions include; diabetes mellitus (Umashanker & Shruti, 2011; Lutemberwa et al., 2013), HIV/AIDS (Namuddu et al., 2011), cancer and psychosocial reasons as breast enlargement, firming and weight gain (Orisatoki et al., 2010; Lutoti et al., 2013). For the case of HIV/ AIDS, it is estimated that 30-70% of HIV infected patients use herbal medicines (Kaume et al., 2012). Herbal medicine is usually used when ‘synthetic’ medicine has failed to cure some conditions and have spread widely from countries of origin to other countries for example Chinese local herbal medicine (Ting et al., 2013). Chinese herbal medicines have been used by countries dominated by Chinese communities with Singapore achieving a consumption rate of 89% in children within the first months of their life (Ting et al., 2013). Global sales of herbal medicine have been estimated to be US $60billion in 2000, and in 2008, the worldwide market for herbal products was estimated to be US $83 billion (Zhang et al., 2012). As years pass on, there has been a steady growth rate ranging from 3-12% per year (Zhang et al., 2012).

Herbal medicine use is popular in developing countries with world health organisation (WHO) estimates showing that up to 80% of Africans depend on herbal medicine (Aschwanden, 2001). Ghana, Mali and Zambia use herbal medicine as the 1st choice for treatment of high fever in nearly two thirds of children (Aschwanden, 2001). In addition, herbal medicine use in India accounts for about 65% of the population (Aschwanden, 2001) and in Uganda, 60% of its population depends on herbal medicine for primary health care (Lutoti et al., 2013).In developed countries, herbal medicine is also used with WHO estimates showing that 50% of people in Canada and 75% of people in France use herbal medicine (Aschwanden, 2001).

Herbal medicine has gained popularity because; it is considered to be safer (more natural) than pharmaceuticals (Aschwanden, 2001; Noor et al., 2014) hence harmless (Kosalec et al., 2009). Additionally, synthetic medicine is costly compared to traditional medicine (Lutoti et al., 2013). Beliefs of society that everything that was put on earth has to be used and is therefore safe have promoted herbal medicine use (Ndhlala et al., 2012). Furthermore herbal medicines cure diseases which synthetic drugs have failed to cure for example the use of Zemaphyte a Chinese traditional medicine to cure atopic eczema (Ting et al., 2013). Herbal medicines are also prescribed by doctors for example in Japan, 85% of the doctors prescribe a traditional herbal medicine called kampo (Aschwanden, 2001).

In Uganda there is a high number of herbal medicine practitioners, frequent advertisements on radios and televisions, and door to door vendors all which act together to inform the consumer about the products and bring them closer to him/her (Lutoti et al., 2013).

2.2 Bacterial quality of herbal medicines

Herbal medicine contamination with bacteria is a common problem (Raman et al., 2004). Studies have shown that herbal medicine may contain bacterial contaminants (Noor et al., 2014) with Staphylococcus aureus taking the lead (Esimone et al., 2007; Abba et al., 2009; Kaume et al., 2012; Yesuf et al., 2016). For example, in a study done on 46 ginseng sample supplements (Siberian ginseng root, Chinese ginseng herb and root, and American ginseng root and extract) in USA market indicated that; 100% of Siberian ginseng was contaminated with bacteria with aerobic plate counts (APCs) between 2.3x10[4] and 1x10[6] cfu/g. Eighty nine percent (89%) of Chinese ginseng herbs were contaminated with bacteria at levels ranging between <100 and1.2x10[6]cfu/g. in addition, 100% of Chinese ginseng root samples were contaminated with bacteria with APCs between 3.0x10 and 6.8x10 cfu/g and 30% of American ginseng samples contaminated with bacteria with APCs equivalent to <100- 4.5x104 cfu/g (Tournas et al., 2006).

Some bacterial species have been shown to grow on herbal medicine. Examples of such bacteria include; Enterobacter, enterococcus, shigella and streptococcus (Kosalec et al., 2009). Also a study by Brown and Jiang (2008) isolated antibiotic resistant bacteria, Bacillus spp, Staphylococcus spp, Erwiniaspp, Enterobacter cloacae and Sterophomonas maltophila in herbal supplements bought from local stores in USA. These were resistant to ampicillin, nalidixic acid, trimethoprim, ceftriaxone, and streptomycin (Kosalec et al., 2009).

Contamination can occur at any stage during production and marketing (Kosalec et al., 2009) and presence of bacteria in herbal products indicates lack of controlled environmental and hygienic conditions during processing and packaging (Tournas et al., 2006). Processing and storage conditions also determine the quality of final herbal products, problems being more common in tropical and subtropical regions because of high temperature and moisture contents conducive for toxin production (Zhang et al., 2012). Limits for assessment of bacterial quality have been set according to categories of herbal medicinal products; category A for medicinal products which contain herbal drugs with or without excipients and intended for preparation of infusions or decoctions with boiling water. It includes traditionally brewed tea. Category B, which includes extracts and or herbal drugs pre-treated to reduce microbial contamination and category C which does not meet category B criteria of decontamination (Kosalec et al., 2009).

2.2.1 Public health complications of contaminated herbal medicine

Herbal medicine however natural can cause serious illness. Blindness has been reported as an attribute to use of herbal medicine. For example, 255 of corneal ulcers in Tanzania were attributed to use of traditional eye medicines which are based on herb extracts (WHO, 2001). In a similar study 25% of the childhood blindness in Malawi was associated with herbal medicine use citation needed. Lack of proper sterilisation along with inclusion of urine, saliva, or breast milk in some of the herbal medicines, gives pathogens ample opportunity to thrive in eyes already hard hit by injury or infection (Aschwanden, 2001).

Herbal medicine contaminated with bacteria resistant to known antibacterials poses a health burden to the patients. Examples include Staphylococcus aureus, Bacillus spp, and Enterobacter (Kosalec et al., 2009). Opportunistic microbial spp (moulds and bacteria) can pause a threat to immunosuppressed patients especially those with HIV/AIDS (Kineman et at., 2002). In addition, herb processing plants may have bacteria species that produce endotoxins that put human health at a risk (Dutkiewicz et at., 2001) for example Alcaligenes feacalis.

2.3 Biology of Staphylococcus aureus.

Staphylococcus aureus belongs to micrococcacae family. It is among the most versatile organisms and known worldwide as a leading cause of disease.it is classified as an opportunistic organism with a diverse range of infections. It is a normal flora of the human skin and body entry portals for example ears, eyes and nasal passages. An estimated 20% of humans are carriers and any break in the human skin or colonisation of immune compromised patients can provide a chance to Staphylococcus bacteria to cause infection. Staphylococcus aureus is gram positive and under microscope appear as gram positive cocci in clusters. It is differentiated from other staphylococcal species based on gold-yellow pigmentation of colonies on mannitol salt agar (MSA), positive results of coagulase test, as well as deeoxyribonuclease tests (Lowy, 1998).

2.3.1 Transmission of Staphylococcal infections.

The reservoirs of Staphylococcus aureus are the humans with 30-50% of healthy adults colonised with both methicillin resistant and methicillin sensitive isolates of Staphylococcus aureus (Lowy, 2003; Chambers & Deleo, 2009)). Persons colonised with Staphylococcus aureus are at increased risk of subsequent infections. Rates of Staphylococcal infections are high among patients of type1 Diabetes Mellitus and intravenous drug users. Most Staphylococcal infection cases are acquired through exposure to contaminated hands of health care workers most especially after they have been colonised by Staphylococcus from their own reservoirs. Transmission is also as a result of contact with an infected patient as well as result of contact with contaminated materials. Outbreaks also result from exposure to single long term carrier or environmental sources.

2.3.2 Diseases caused by Staphylococcus aureus

Staphylococcus aureus is the leading cause of nosocomial infections and as more patients are treated outside the hospital setting, there is an increased concern in the community (Mylotte et al., 1987). It causes a wide range of infections ranging from minor to major diseases of public concern (Akanbi & Mbe, 2012). Staphylococcus aureus causes minor skin infections like pimples, impetigo, boils, cellulitis, folliculitis, carbuncles, scalded skin syndrome and abscesses. Life threatening diseases of Staphylococcus aureus include; pneumonia, meningitis, osteomyelitis, endocarditis, toxic shock syndrome, bacteraemia and sepsis (Lowy, 2003; Akanbi & Mbe, 2012).

2.3.2.1 Staphylococcal bacteraemia

Bacteraemia is the presence of bacteria in blood. Without antibiotic treatment, bacteraemia has a worldwide case fatality rate around 80%(Tong et al., 2015) whereas with antibiotic treatment, case fatality rate ranges from 15% to 60% depending on the age and health of the patient in addition to the antibiotic resistance of Staphylococcus aureus (Tong et al., 2015). Infection is mostly associated with breakages in the skin or mucosal membranes due to surgery, injury or use of intravascular devises for example catheters, haemodialysis machines or injected drugs (Rasmussen et al,. 2011).

2.3.2.2 Toxic shock syndrome caused by Staphylococcus aureus.

Toxic shock syndrome is a potential fatal illness caused by a bacterial toxin. Staphylococcus aureus is one of the bacteria that cause toxic shock syndrome based on its ability to produce an enterotoxin type B. On average, its incidence is 3-4 people out of 100000 people who use tampons and 1- 17 of every 100000 menstruating people who use sanitary pads (Todd, 1988; McCormic et al., 2001).Toxic shock syndrome is mostly associated with menstruation accounting to 90% of the cases of toxic shock syndrome. Toxic shock syndrome develops from the site of colonisation rather than the site of infection (Lowy, 1998).

2.4 Antibacterial resistance.

Antibacterial resistance refers to a condition where drug targeting a given bacterium causing a certain infection fails to impart its antibacterial effects. This is due to the fact that bacteria have developed mechanisms to overcome the effects of the target drugs. Most of the common drug resistant bacteria include Staphylococci, Pneumococci, Gonococci, Meningococci Enterococci and Gram negative bacteria for example Salmonella, Shigella, Klebsiella, and Pseudomonas. The mechanisms for antibacterial resistance include production of enzymes which inactivate or modify antibacterials. These mechanisms lead to a change in the bacterial cell membrane-preventing uptake of the antibacterial drug and modification of drug target site. As a result the drug can no longer interact with the bacteria. In addition, the bacteria develop metabolic pathways which enable the site of antibacterial action not to be recognised by the drug (Cheesbrough, 2006).

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Details

Pages
53
Year
2016
ISBN (eBook)
9783668719149
ISBN (Book)
9783668719156
File size
769 KB
Language
English
Catalog Number
v427756
Institution / College
Makerere University
Grade
75.0
Tags
Herbal Medicine Staphylococcus aureus Contamination Kampala City Uganda

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Title: "Staphylococcus aureus" contamination levels in selected local herbal medicines sold in Kampala, Uganda