‘Herbal remedy, oral iron therapy safe for treating anaemia in pregnancy’

Medical doctors at three teaching hospitals in Nigeria have confirmed the efficacy and safety of herbal remedy, Mojeaga, in combination with conventional oral iron therapy for treating blood shortage in pregnancy.

The teaching hospitals include: Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra State; Chukwuemeka Odumegwu University Teaching Hospital (COUTH) Awka, Anambra State and Enugu State University Teaching Hospital (ESUTH) Parklane, Enugu, Enugu State.

The study titled “Efficacy and safety of Mojeaga remedy in combination with conventional oral iron therapy for correcting anaemia in the obstetric population: A phase II randomised pilot clinical trial” was published in the August 2023 edition of the journal PLOS ONE.

The researchers, mostly obstetrics and gynaecologists, are led by Associate Professor of Obstetrics and Gynaecology at NAUTH, Prof. George Uchenna Eleje. Others include: Ifeanyichukwu Uzoma Ezebialu, Joseph Tochukwu Enebe, Nnanyelugo Chima Ezeora, Emmanuel Onyebuchi Ugwu, Iffiyeosuo Dennis Ake, and Joseph Ifeanyichukwu Ikechebelu, among others.

According to the researchers, until now there is no prior randomised trial on the efficacy of Mojeaga remedy (a special blend of Alchornea cordifolia, Pennisetum glaucum and Sorghum bicolor extracts) when co-administered with standard-of-care for correction of anaemia in obstetrics practice. This study determined the efficacy, safety and tolerability of Mojeaga as adjunct to conventional oral iron therapy for correction of anemia in the obstetric population.

The researchers adopted a pilot open-label randomised clinical trial. Participants with confirmed diagnosis of anaemia in three tertiary hospitals in Nigeria were studied. Eligible participants were randomised 1:1 to either Mojeaga syrups 50 mls (200mg/50mls) administered three times daily in conjunction with conventional iron therapy (Mojeaga group) for two weeks or conventional iron therapy alone without Mojeaga (standard-of-care group) for two weeks. Repeat hematocrit levels were done two weeks post-initial therapy. Primary outcome measures were changes in hematocrit level and median hematocrit level at two weeks post therapy. Maternal adverse events and neonatal outcomes (birth anomalies, low birthweight, preterm rupture of membranes and preterm labour) were considered the safety outcome measures. Analysis was by intention-to-treat.

Results of the study showed ninety-five participants were enrolled and randomly assigned to the Mojeaga group (n = 48) or standard-of-care group (n = 47). The baseline socio-demographic and clinical characteristics of the study participants were similar. At two weeks follow-up the median rise in hematocrit values from baseline and median hematocrit values were significantly higher in the Mojeaga group. There were no treatment-related serious adverse events, congenital anomalies or deaths in the Mojeaga group and incidence of other neonatal outcomes were similar.

The researchers concluded: “Mojeaga represents a new adjuvant for standard-of-care option for patients with anaemia. Mojeaga remedy is safe for treating anaemia during pregnancy and puerperium without increasing the incidence of congenital anomalies, or adverse neonatal outcomes.”

According to the World Health Organisation (WHO), anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. Haemoglobin is needed to carry oxygen and if one has too few or abnormal red blood cells, or not enough haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues. This results in symptoms such as fatigue, weakness, dizziness and shortness of breath, among others. The optimal haemoglobin concentration required to meet physiological needs varies by age, sex, elevation of residence, smoking habits and pregnancy status.  Anaemia may be caused by several factors: nutrient deficiencies through inadequate diets or inadequate absorption of nutrients, infections (example malaria, parasitic infections, tuberculosis, Human Immuno-deficiency Virus/HIV), inflammation, chronic diseases, gynaecological and obstetric conditions, and inherited red blood cell disorders. The most common nutritional cause of anaemia is iron deficiency, although deficiencies in folate, vitamins B12 and A are also important causes.

The WHO said anaemia is a serious global public health problem that particularly affects young children, menstruating adolescent girls and women, and pregnant and postpartum women. WHO estimates that 40 per cent of children six–59 months of age, 37 per cent of pregnant women, and 30 per cent of women 15–49 years of age worldwide are anaemic.

Meanwhile, Nigerian researchers had in earlier studies demonstrated that a combination of three local herbs, Mojeaga herbal remedy, could be used to boost the immune system, red blood cells and prevent development of degenerative diseases such as diabetes and cancer.

The researchers investigated the phytochemicals contents, antioxidant property and haematinic potential of Mojeaga herbal remedy (Alchornea cordifolia, Sorghum bicolor, Pennisetum glaucum) leaf preparation in animal models.

The researchers concluded: “It is significant to consider this research study, which elicited essential preclinical information progressing to anti-anemic herbal remedy development in the country. Therefore, possible isolation and features of bioactive components should be accounted for with diverse pharmacological properties of Mojeaga herbal remedy in accordance with determining its bioactive guide to assay.”

The researchers were led by a Professor of Phytomedicine at Department of Plant Biology and Biotechnology, University of Benin, MacDonald Idu; Managing Director of Mojeaga International Ventures Limited, Benin City, Mr. Monday Ojeaga Alugeh; Director of Mojeaga, Mr. Micheal Ojeaga Alugeh; and a researcher at Department of Plant Biology and Biotechnology, University of Benin Dr. Benjamin Ogunma Gabriel.

Alchornea cordifolia is called oje in Ebira-Etuno; uwonmwe in Edo; mbom in Efik; tahi in Gwari; bambani or bombana in Hausa; ubebe or ububo in Igbo; ipain in Ijaw; ukpaoromi in Yekhee; and epa or ipan-esin in Yoruba. Alchornea cordifolia is a perennial evergreen shrub that belongs to the family Euphorbiaceae. It is known as Dove wood in English. Studies have validated its ethno-pharmacological uses with characterised pharmacologically active molecules. Infusion of the leaves is used in the treatment of respiratory problems such as sore throat, cough, bronchitis and intestinal problems such as gastric ulcers, diarrhea, amoebic dysentery and worms. Poultice of the leaves is also used to treat wounds. Application of the leaves and root bark of Alchornea cordifolia is used in treatment of leprosy and as antidote for snakebite. Alchornea cordifolia root and bark are used to increase sexual performances among the people of Congo in Africa sub-region. In Nigeria, it is used to treat gonorrhoea, yaws, rheumatic pain and cough.

Sorghum bicolor belongs to the plant family Poaceae. It makes a refreshing non-alcoholic beverage, kunu-zaki (in Hausa), and tasty pap, akamu (in Ibo), and thick porridge, tuwo dawa (in Hausa). It is fermented to make sorghum beer called burkutu or pito, or made into flour and mixed with bean flour then fried to make dawaki. Sorghum bicolor leaves are typically green, glasslike and flat and not as broad as maize leaves. It belongs to the grass family Poaceae. Sorghum bicolor is locally known as oka pupa in the Southern part of Nigeria. Sorghum bicolor grain is higher in protein and lower in fat content than corn and this is partly responsible for its haemopoietic ability.

It has been reported that sorghum can be used as anti-abortive, cyanogenetic, demulcent, diuretic, emollient, in toxicant and poison. Sorghum is a folk remedy for cancer, epilepsy, flux, stomachache, diarrhoea, and treatment of tubercular swellings. Recent focus has been on the leaf sheath of S. bicolor used as herbal remedy for anemia and boosting effect on blood concentration haematinic potentials, which serves as blood tonics.

Pennisetum glaucum is commonly called pearl millet, which belongs to a section of the Paniceae family known as Poaceae. It is called mawi in Gwari; damróó in Hausa; adlă in Idoma; ókōdú in Igala; ọkà mịlètì in Igbo; zumya in Jukun; and ẹmẹyẹ̀ in Yoruba. It helps to increase haemoglobin (Hb), high iron content (8 mg/100 g) and high zinc content (3.1 mg/100 g). Hb is the main component of red blood cells and serves as the transporter for oxygen and carbon dioxide in the blood. Pearl millet is effective in the management of constipation by dealing with constipation with high fibre (1.2 g/100 g).

It combated cancer, promoting anti-cancer properties via inhibition of tumour development. Also, it helps in regulating diabetes by dealing with low glycemic index. It is also useful for anti-allergic gluten-free, diarrhoea via probiotic treatment of lactic acid bacteria. It promotes nutriceutical content of flavonoids, phenolics, and omega-3 fatty acids. Pearl millet has a large amount of phosphorus.