There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing... more There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable e...
The introduction of effective vaccines in December 2020 marked a significant step forward in the ... more The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), ...
Globally, the COVID-19 pandemic has aggravated inequalities in access to quality pharmacy educati... more Globally, the COVID-19 pandemic has aggravated inequalities in access to quality pharmacy education, particularly in resource-limited settings in Africa (Engle, 2020; Fuller et al., 2020). This is a serious concern for Africa especially, given that sub-Saharan Africa ranks lowest on the global pharmaceutical workforce index and has a disproportionately high burden of infectious and non-communicable diseases, combined with weak health systems (World Health Organisation [WHO], 2013; Bates et al., 2018).
Journal of Pharmaceutical Health Services Research
Objectives Standard treatment guidelines improve patient care outcomes. Few studies assess the im... more Objectives Standard treatment guidelines improve patient care outcomes. Few studies assess the impact of standard treatment guidelines on population-level medicine use indicators in resource limited settings in sub-Saharan Africa, where the burden of disease is greatest. The objective of this study was to determine the immediate and long-term impact of the national standard treatment guidelines on medicine use indicators at the population-level in Namibia. Methods An interrupted time-series modeling of the impact of national standard treatment guidelines implemented in Namibia in 2011, on population-level medicine use indicators. Antibiotic, generic and polypharmacy prescribing indicators were abstracted from the national Pharmaceutical Information System, over an eight-year period, 2007– 2015. This generated 15-quarterly time points. The impact was estimated by changes in trends of the indicators, immediately and after the intervention using R-software. The immediate impact was ref...
Background: Prevalence rates of diabetes mellitus are growing across Africa with an appreciable n... more Background: Prevalence rates of diabetes mellitus are growing across Africa with an appreciable number likely to be on insulin to manage their condition. This has significant implications on future morbidity and mortality exacerbated by high complication rates. Complication rates in patients requiring insulins are enhanced by hypoglycaemia. Long acting insulin analogues were developed to reduce hypoglycaemia and improve patient compliance. However, they are typically appreciably more expensive than human and other insulins in Africa, and continuing controversies surrounding their benefits limits their listing on national Essential Medicine Lists (EMLs). Biosimilars can reduce the prices long-acting insulin analogues. This needs assessing. Methods: Mixed methods approach including documentation of insulin utilisation patterns and prices among a range of African countries. In addition, input from senior level government, academic, and healthcare professionals from across Africa on the...
Background: Health research is critical to the institutional mission of the Makerere College of H... more Background: Health research is critical to the institutional mission of the Makerere College of Health Sciences (MakCHS). Optimizing the alignment of health research capacity at MakCHS with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP), is a deliberate priority, a responsibility, and a significant opportunity for research. To guide this strategic direction, an assessment of MakCHS’s research grants and publication portfolio was conducted. Methods: A survey of all new and ongoing grants, as well as all publications, between January 2005 and December 2009 was conducted. Research, training, and education grants awarded to MakCHS ’ constituent faculties and departments, were looked for through financial records at the college or by contact with funding organizations. Published manuscripts registered with PubMed, that included MakCHS faculty authors, were also analyzed. Results: A total of 58 active grants were identified, of ...
Journal of Toxicology and Environmental Health Sciences, 2015
The indiscriminate use of pesticides in developing countries has impacted negatively on the envir... more The indiscriminate use of pesticides in developing countries has impacted negatively on the environment and public health. Despite that informal households in Uganda carry a high pest burden, the safe use and disposal of pesticides is poorly studied. We determined the prevalence and pesticide use practices among the informal households in Mulago, a suburb of Kampala city. A cross-sectional survey was conducted among heads of informal households in Mulago II parish, using a semi-structured interview questionnaire. Out of the 56 households in the parish, twenty 20 household met the inclusion criterion for an informal household. Household heads were interviewed on the pest burden and the practices on safe use and disposal of pesticides. Data was analyzed using SPSSv21 software; the chi-square test was used for Univariate analysis. The mean pest burden per household was 4 ± 0.7 pests: mosquitoes 20 (100%), bedbugs 18 (90%; p < 0.001), rats and houseflies 16 (80%; p = 0.007), and cock...
International Journal of Pharmaceutical Sciences and Research, 2018
Introduction and aims: Combination antiretroviral therapy (cART) has improved morbidity and morta... more Introduction and aims: Combination antiretroviral therapy (cART) has improved morbidity and mortality in patients with HIV across countries including countries in sub-Sahara Africa. However, cART is associated with renal impairment. The lack of pre-cART data in a recently published study limited the discussion on renal-based treatment outcomes with cART, which could have important clinical implications. Consequently, the aim of this paper is to correct this. Methods: Longitudinal retrospective study, with renal function assessed pre-cART and at various time points on cART using the Cockcroft-Gault method. The data source was the patients’ care booklets. Results: 71 patients were included. The majority were adults and female. Before cART initiation, 70.4% and 29.6% had abnormal and normal CrCl, respectively. CrCl was normalised in 24% of patients, while abnormal in the remainder. The mean (median) time to normalisation was 47.4(33.7) months, observed more in paediatric than adult pat...
The control of blood glucose is critical in prevention of complication of diabetes and to improve... more The control of blood glucose is critical in prevention of complication of diabetes and to improve the quality of life of these patients. However in a setting of patients attending care from a private setting, the access to inexpensive care may be a critical control of diabetes, a lifelong chronic illness that requires optimal adherence to nutritional and medication. Such practices may ultimately heighten the financial burden associate with management of diabetes of complications such as hypertension and diabetic foot. In spite of this, the Glycaemic control practices in private health care settings in Uganda have not been well described and thus may negatively impact on the health outcomes. The study aimed to describe the practices among diabetic patients attending the Rubaga hospital, determine the level of Glycaemic control and identify the factors associated with diabetics&#39; patients monitoring indicators (Hb1Ac levels, blood glucose levels). This is a Cross-sectional analytical study. Patients were randomly selected during the period of April and May 2012. The laboratory determination of the blood glucose levels (RBG) and Glycosylated hemoglobin (HB1AC) was done using the COBAS 6000 clinical chemistry analyser. Analysis was done using the student T-test and Chi-square test with a level of significance of 0.05. There was a significant statistical relationship between fasting plasma glucose and HbA1c (p-value = 0.000). Factors influencing high HBA1C levels in diabetic patients at Rubaga hospital were high cost of diabetes mellitus treatment (p-value = 0.019), duration the study participant had had the disease (P = 0.003) and having another chronic illness alongside diabetes mellitus (p-value = 0.045). The Republic of Uganda should make treatment of diabetes mellitus universally accessible and free. It should also put sensitization measures in place geared towards minimizing occurrence of some chronic disease conditions like hypertension which lead to co-treatment that lowers drug compliance.
Introduction and aims: Considerable differences in prevalence and mortality rates from COVID-19, ... more Introduction and aims: Considerable differences in prevalence and mortality rates from COVID-19, with higher rates among European countries and Iran versus African and Asian countries in part due to early and extensive prevention measures. There has been considerable controversy surrounding hydroxychloroquine, with resultant misinformation increasing prices and suicides. Growing concerns also with unintended consequences of lockdown and other measures. Consequently, a need to investigate changes in utilisation and prices of relevant medicines during the pandemic in Namibia with its proactive approach to guide future decision making. Community pharmacists play a key role in this respect. Methods: Questionnaire survey among 55 pharmacists from March to end June 2020. Results: Proactivity among some pharmacists to plan for the pandemic with increased stocks. Limited increases in utilisation of antimalarials and antibiotics in Namibia versus other countries enhanced by restrictions on s...
There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing... more There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable e...
The introduction of effective vaccines in December 2020 marked a significant step forward in the ... more The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), ...
Globally, the COVID-19 pandemic has aggravated inequalities in access to quality pharmacy educati... more Globally, the COVID-19 pandemic has aggravated inequalities in access to quality pharmacy education, particularly in resource-limited settings in Africa (Engle, 2020; Fuller et al., 2020). This is a serious concern for Africa especially, given that sub-Saharan Africa ranks lowest on the global pharmaceutical workforce index and has a disproportionately high burden of infectious and non-communicable diseases, combined with weak health systems (World Health Organisation [WHO], 2013; Bates et al., 2018).
Journal of Pharmaceutical Health Services Research
Objectives Standard treatment guidelines improve patient care outcomes. Few studies assess the im... more Objectives Standard treatment guidelines improve patient care outcomes. Few studies assess the impact of standard treatment guidelines on population-level medicine use indicators in resource limited settings in sub-Saharan Africa, where the burden of disease is greatest. The objective of this study was to determine the immediate and long-term impact of the national standard treatment guidelines on medicine use indicators at the population-level in Namibia. Methods An interrupted time-series modeling of the impact of national standard treatment guidelines implemented in Namibia in 2011, on population-level medicine use indicators. Antibiotic, generic and polypharmacy prescribing indicators were abstracted from the national Pharmaceutical Information System, over an eight-year period, 2007– 2015. This generated 15-quarterly time points. The impact was estimated by changes in trends of the indicators, immediately and after the intervention using R-software. The immediate impact was ref...
Background: Prevalence rates of diabetes mellitus are growing across Africa with an appreciable n... more Background: Prevalence rates of diabetes mellitus are growing across Africa with an appreciable number likely to be on insulin to manage their condition. This has significant implications on future morbidity and mortality exacerbated by high complication rates. Complication rates in patients requiring insulins are enhanced by hypoglycaemia. Long acting insulin analogues were developed to reduce hypoglycaemia and improve patient compliance. However, they are typically appreciably more expensive than human and other insulins in Africa, and continuing controversies surrounding their benefits limits their listing on national Essential Medicine Lists (EMLs). Biosimilars can reduce the prices long-acting insulin analogues. This needs assessing. Methods: Mixed methods approach including documentation of insulin utilisation patterns and prices among a range of African countries. In addition, input from senior level government, academic, and healthcare professionals from across Africa on the...
Background: Health research is critical to the institutional mission of the Makerere College of H... more Background: Health research is critical to the institutional mission of the Makerere College of Health Sciences (MakCHS). Optimizing the alignment of health research capacity at MakCHS with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP), is a deliberate priority, a responsibility, and a significant opportunity for research. To guide this strategic direction, an assessment of MakCHS’s research grants and publication portfolio was conducted. Methods: A survey of all new and ongoing grants, as well as all publications, between January 2005 and December 2009 was conducted. Research, training, and education grants awarded to MakCHS ’ constituent faculties and departments, were looked for through financial records at the college or by contact with funding organizations. Published manuscripts registered with PubMed, that included MakCHS faculty authors, were also analyzed. Results: A total of 58 active grants were identified, of ...
Journal of Toxicology and Environmental Health Sciences, 2015
The indiscriminate use of pesticides in developing countries has impacted negatively on the envir... more The indiscriminate use of pesticides in developing countries has impacted negatively on the environment and public health. Despite that informal households in Uganda carry a high pest burden, the safe use and disposal of pesticides is poorly studied. We determined the prevalence and pesticide use practices among the informal households in Mulago, a suburb of Kampala city. A cross-sectional survey was conducted among heads of informal households in Mulago II parish, using a semi-structured interview questionnaire. Out of the 56 households in the parish, twenty 20 household met the inclusion criterion for an informal household. Household heads were interviewed on the pest burden and the practices on safe use and disposal of pesticides. Data was analyzed using SPSSv21 software; the chi-square test was used for Univariate analysis. The mean pest burden per household was 4 ± 0.7 pests: mosquitoes 20 (100%), bedbugs 18 (90%; p < 0.001), rats and houseflies 16 (80%; p = 0.007), and cock...
International Journal of Pharmaceutical Sciences and Research, 2018
Introduction and aims: Combination antiretroviral therapy (cART) has improved morbidity and morta... more Introduction and aims: Combination antiretroviral therapy (cART) has improved morbidity and mortality in patients with HIV across countries including countries in sub-Sahara Africa. However, cART is associated with renal impairment. The lack of pre-cART data in a recently published study limited the discussion on renal-based treatment outcomes with cART, which could have important clinical implications. Consequently, the aim of this paper is to correct this. Methods: Longitudinal retrospective study, with renal function assessed pre-cART and at various time points on cART using the Cockcroft-Gault method. The data source was the patients’ care booklets. Results: 71 patients were included. The majority were adults and female. Before cART initiation, 70.4% and 29.6% had abnormal and normal CrCl, respectively. CrCl was normalised in 24% of patients, while abnormal in the remainder. The mean (median) time to normalisation was 47.4(33.7) months, observed more in paediatric than adult pat...
The control of blood glucose is critical in prevention of complication of diabetes and to improve... more The control of blood glucose is critical in prevention of complication of diabetes and to improve the quality of life of these patients. However in a setting of patients attending care from a private setting, the access to inexpensive care may be a critical control of diabetes, a lifelong chronic illness that requires optimal adherence to nutritional and medication. Such practices may ultimately heighten the financial burden associate with management of diabetes of complications such as hypertension and diabetic foot. In spite of this, the Glycaemic control practices in private health care settings in Uganda have not been well described and thus may negatively impact on the health outcomes. The study aimed to describe the practices among diabetic patients attending the Rubaga hospital, determine the level of Glycaemic control and identify the factors associated with diabetics&#39; patients monitoring indicators (Hb1Ac levels, blood glucose levels). This is a Cross-sectional analytical study. Patients were randomly selected during the period of April and May 2012. The laboratory determination of the blood glucose levels (RBG) and Glycosylated hemoglobin (HB1AC) was done using the COBAS 6000 clinical chemistry analyser. Analysis was done using the student T-test and Chi-square test with a level of significance of 0.05. There was a significant statistical relationship between fasting plasma glucose and HbA1c (p-value = 0.000). Factors influencing high HBA1C levels in diabetic patients at Rubaga hospital were high cost of diabetes mellitus treatment (p-value = 0.019), duration the study participant had had the disease (P = 0.003) and having another chronic illness alongside diabetes mellitus (p-value = 0.045). The Republic of Uganda should make treatment of diabetes mellitus universally accessible and free. It should also put sensitization measures in place geared towards minimizing occurrence of some chronic disease conditions like hypertension which lead to co-treatment that lowers drug compliance.
Introduction and aims: Considerable differences in prevalence and mortality rates from COVID-19, ... more Introduction and aims: Considerable differences in prevalence and mortality rates from COVID-19, with higher rates among European countries and Iran versus African and Asian countries in part due to early and extensive prevention measures. There has been considerable controversy surrounding hydroxychloroquine, with resultant misinformation increasing prices and suicides. Growing concerns also with unintended consequences of lockdown and other measures. Consequently, a need to investigate changes in utilisation and prices of relevant medicines during the pandemic in Namibia with its proactive approach to guide future decision making. Community pharmacists play a key role in this respect. Methods: Questionnaire survey among 55 pharmacists from March to end June 2020. Results: Proactivity among some pharmacists to plan for the pandemic with increased stocks. Limited increases in utilisation of antimalarials and antibiotics in Namibia versus other countries enhanced by restrictions on s...
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