Browsing by Author "Kalemeera, Francis"

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    Fixed dose drug combinations – are they pharmacoeconomically sound?:
    (Informa UK Limited, 2020) Godmana, Brian; McCabee, Holly; Leong, Trudy D.; Mueller, Debjani; Martini, Antony P.; Hoxhak, Iris; Mwital, Julius C.; Mutashambara Rwegereram, Godfrey; Masselen, Amos; Costao, Juliana de Oliveira; Rezende Macedo do Nascimentoa, Renata Cristina; Pires de Lemoso, Livia Lovato; Tachkovs, Konstantin; Milushewas, Petya; Patrickt, Okwen; Lum Nibat, Loveline; Laiusw, Ott; Sefah, Israel; Abdulsalimy, Suhaj; Soleymaniz, Fatemeh; Guantai, Anastasia N; Achieng, Loice; Oluka, Margaret; Jakupi, Arianit; Logviss, Konstantīns; Hassali, Mohamed Azmi; Kibuule, Dan; Kalemeera, Francis; Mubita, Mwangana; Fadaregg, Joseph; Ogunleye, Olayinka O.; Saleem, Zikria; Hussain, Shazhad; Bochenek, Tomasz; Mardare, Ileana; Alrasheedy, Alian A.; Furst, Jurij; Tomek, Dominik; Markovic-Pekovic, Vanda; Rampamba, Enos M.; Alfadl, Abubakr; Amu, Adefolarin A.; Matsebula, Zinhle; Thi Phuong, Thuy Nguyen; Thanh, Binh Nguyen; Kalungia, Aubrey Chichonyi; Zaranyika, Trust; Masuka, Nyasha; Olarua, Ioana D.; Wale, Janney; Hill, Ruaraidh; Kurdia, Amanj; Timoneya, Angela; Campbell, Stephen; Meyer, Johanna C.
    Introduction: There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower- and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability. Areas covered: Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value. Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country’s essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed. KEYWORDS: Fixed dose combinations; pharmacoeconomics; adherence; medicines; noncommunicable diseases; infectious diseases; lower and middle income countries
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    Migration to online pharmacy education in Namibia:
    (PKP Publishing services, 2021) Kibuule, Dan; Lates, Jennie; Ishola, Anthony; Hango, Ester; Kalemeera, Francis; Knott, Michael; Mavu, Daniel; Singu, Bonifasius; Rennie, Timothy; Brinkmann, Irene; Mubita, Mwangana
    Background: COVID-19, a global pandemic, has disrupted pharmacy education in Africa, due to unpreparedness to migrate to online Learning. Aim: To assess outcomes and challenges facing migration to online pharmacy education. Methods: An evaluation of implementation of online learning in the Bachelor of Pharmacy programme in Namibia using key informant feedback. The outcomes were outputs and challenges facing migration to online learning, and its impact on pass rates and scores. Results: The pooled mean score was higher in 2020 (66.2%), compared to 2019 (63.4%) and 2018 (62.1%), (p=0.076). A variety of platforms were used as alternatives or supplements to Moodle. The main challenges included inequalities in internet connectivity, monitoring and quality assurance, implementation of experiential learning, and reliability of online assessment. Conclusions: Whilst migration to online learning did not impact on pass rates, there is need for policies and systems to address programmatic challenges to eliminate inequalities in online pharmacy education.
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    Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future
    (Taylor & Francis, 2020) Godman, Brian; Basu, Debashis; Pillay, Yogan; Almeida, Paulo H. R. F.; Mwita, Julius C.; Rwegerera, Godfrey Mutashambara; Paramadhas, Bene D Anand; Tiroyakgosi, Celda; Okwen, Patrick; Niba, Loveline Lum; Sefah, Israel; Oluka, Margaret; Guantai, Anastasia N; Kibuule, Dan; Kalemeera, Francis; Mubita, Mwangana; Fadare, Joseph; Ogunleye, Olayinka O.; Rampamba, Enos M; Wing, Jeffrey; Mueller, Debjani; Alfadl, Abubakr; Amu, Adefolarin A; Matsebula, Zinhle; Kalungia, Aubrey; Zaranyika, Trust; Masuka, Nyasha; Wale, Janney; Hill, Ruaraidh; Kurdi, Amanj; Timoney, Angela; Campbell, Stephen; Meyer, Johanna C
    Background Currently about 19 million people in Africa are known to be living with diabetes, mainly Type 2 diabetes (T2DM) (95%), estimated to grow to 47 million people by 2045. However, there are concerns with early diagnosis of patients with Type 1 diabetes (T1DM) as often patients present late with complications. There are also challenges with access and affordability of insulin, monitoring equipment and test strips with typically high patient co-payments, which can be catastrophic for families. These challenges negatively impact on the quality of care of patients with T1DM increasing morbidity and mortality. There are also issues of patient education and psychosocial support adversely affecting patients’ quality of life. These challenges need to be debated and potential future activities discussed to improve the future care of patients with T1DM across Africa. Methodology Documentation of the current situation across Africa for patients with T1DM including the epidemiology, economics, and available treatments within public healthcare systems as well as ongoing activities to improve their future care. Subsequently, provide guidance to all key stakeholder groups going forward utilizing input from senior-level government, academic and other professionals from across Africa. Results Whilst prevalence rates for T1DM are considerably lower than T2DM, there are concerns with late diagnosis as well as the routine provision of insulin and monitoring equipment across Africa. High patient co-payments exacerbate the situation. However, there are ongoing developments to address the multiple challenges including the instigation of universal health care and partnerships with non-governmental organizations, patient organizations, and pharmaceutical companies. Their impact though remains to be seen. In the meantime, a range of activities has been documented for all key stakeholder groups to improve future care. Conclusion There are concerns with the management of patients with T1DM across Africa. A number of activities has been suggested to address this and will be monitored. KEYWORDS: Type 1 diabetes healthcare, policies-insulin primary, healthcare glucose, monitoring patient, co-paymentsAfrica
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    Pharmacotherapeutic interventions for bipolar disorder type II:
    (Taylor & Francis, 2019) Godman, Brian; Grobler, Christoffel; Van-De-Lisleh, Marianne; Walei, Janney; Barbosa, Wallace Breno; Masselek, Amos; Opondo, Philip; Petrova, Guenka; Tachkov, Konstantin; Sefah, Israel; Abdulsalimo, Suhaj; Alrasheedy, Alian A.; Unnikrishnanp, Mazhuvancherry Kesavan; Garuoliene, Kristina; Bamitaler, Kayode; Kibuule, Dan; Kalemeera, Francis; Fadare, Joseph; Khan, Tanveer Ahmed; Hussain, Shahzad; Bochenek, Tomasz; Kalungia, Aubrey Chichonyi; Mwanza, James; Martin, Antony P; Hill, Ruaraidh; Barbui, Corrado
    Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middleincome countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed. Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments. Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients’ rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up. KEYWORDS: Bipolar disorders; bipolar disorder type II; lower and middle-income countries; health policies; treatment; pharmaceuticals; differential diagnosis
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    Renal function outcomes in patients receiving TDF-containing antiretroviral therapy:
    (International Journal of Pharmaceutical Sciences and Research, 2018) Kalemeera, Francis; Oberholster, Carla; Segamwenge, Innocent; Kibuule, Dan; Naikaku, Ester; Mwangana, M.; Godman, Brian
    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 patients (p = 0.014). However, in paediatric patients, normalisation took longer than in adult patients. The reduction in CrCl, was observed at variable time points. 9/16 patients experienced a decline during first-line cART and 7 of these were receiving TDF. 7/16 experienced this during second-line cART and 6 were receiving TDF. Conclusion: HIV is typically the cause of renal impairment prior to cART, with TDF likely to be the cause of renal impairment during cART. Consequently, co-administration of TDF with other nephrotoxic drugs should be undertaken with caution if unavoidable. Overall, improvement in renal impairment was faster in adults.
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    Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa:
    (2020) Ogunleye, Olayinka O.; Basu, Debashis; Debjani Mueller; Sneddon, Jacqueline; Seaton, R. Andrew; Yinka-Ogunleye, Adesola F.; JWamboga, oshua; Miljković, Nenad; Mwita, Julius C.; Rwegerera, Godfrey Mutashambara; Rwegerera, Godfrey Mutashambara; Okwen, Patrick; Niba, Loveline Lum; Nsaikila, Melaine; Rashed, Wafaa M.; Hussein, Mohamed Ali; Hegazy, Rehab; Amu, Adefolarin A.; Boahen-Boaten, Baffour Boaten; Matsebula, Zinhle; Gwebu, Prudence; Chirigo, Bongani; Mkhabela, Nongabisa; Dlamini, Tenelisiwe; Sithole, Siphiwe; Malaza, Sandile; Dlamini, Sikhumbuzo; Afriyie, Daniel; Asare, George Awuku; Amponsah, Seth Kwabena; Sefah, Israel; Oluka, Margaret; Guantai, Anastasia N.; Opanga, Sylvia A.; Sarele, Tebello Violet; Mafisa, Refeletse Keabetsoe; Chikowe, Ibrahim; Khuluza, Felix; Kibuule, Dan; Kalemeera, Francis; Mubita, Mwangana; Fadare, Joseph; Sibomana, Laurien; Ramokgopa, Gwendoline Malegwale; Whyte, Carmen; Maimela, Tshegofatso; Hugo, Johannes; Meyer, Johanna C.; Schellack, Natalie; Rampamba, Enos M.; Visser, Adel; Alfadl, Abubakr; Malik, Elfatih M.; Malande, Oliver Ombeva; Kalungia, Aubrey C.; Mwila, Chiluba; Zaranyika, Trust; Chaibva, Blessmore Vimbai; Olaru, Ioana D.; Masuka, Nyasha; Wale, Janney; Hwenda, Lenias; Kamoga, Regina; Hill, Ruaraidh; Barbui, Corrado; Bochenek, Tomasz; Kurdi, Amanj; Campbell, Stephen; Martin, Antony P.; Thi Phuong, Thuy Nguyen; Thanh, Binh Nguyen; Godman, Brian
    Background: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of otherinfectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. Objective: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. Our Approach: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. Ongoing Activities: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. Conclusion: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.
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    Review of ongoing Aoactivities and challenges to improve the care of patients with type 2 diabetes across Africa and the implications for the future
    (Frontiers in pharmacology, 2020) Godman, Brian; Basu, Debashis; Pillay, Yogan; Mwita, Julius C.; Tiroyakgosi, Celda; Rwegerera, Godfrey Mutashambara; Okwen, Patrick Mbah; Niba, Loveline Lum; Nonvignon, Justice; Sefah, Israel; Oluka, Margaret; Guantai, Anastasia N.; Kibuule, Dan; Kalemeera, Francis; Mubita, Mwangana; Fadare, Joseph; Ogunleye, Olayinka O.; Distiller, Larry A.; Rampamba, Enos M.; Wing, Jeffrey; Mueller, Debjani; Alfadl, Abubakr; Amu, Adefolarin A.; Matsebula, Zinhle; Kalungia, Aubrey; Zaranyika, Trust; Masuka, Nyasha; Wale, Janney; Hill, Ruaraidh; Kurdi, Amanj; Timoney, Angela; Campbell, Stephen; Meyer, Johanna C.
    Background: There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective: Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach: Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities: A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities, Conclusion: There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care. Keywords: Type 2 diabetes, Africa, national initiatives, diagnosis, medicines, adherence, patient groups
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    Utility of medicines information leaflets in hypertensive care in a setting with low health literacy:
    (SAGE Publications, 2020) Kudzinesta, Mtungwazi; Mubita, Mwangana; Kalemeera, Francis; Godman, Brian; Hango, Ester; Kibuule, Dan
    Introduction:Higher levels of health literacy improve utilization of health information, medication adherence and outcomes. Few studies evaluate the utility of medicines information in hypertensive care in settings with low health literacy. Aim:To determine the level of health literacy and utility of medicines information leaflets (MILs) among hypertensive patients in public health care in Namibia. Methods:A hospital-based survey among hypertensive patients receiving care at a referral hospital in Namibia from the 8 June 2018 to 29 June 2018. Patient’s health literacy and utility of MIL were assessed using three literacy tools and a survey questionnaire. Quantitative data were analysed using descriptive statistics and qualitative thematic content analysis for factors associate with the utility of the MIL. Results:Of the 139 patients, 63% were female and the mean age was 45.7 (range: 19.0–84.0) years. Over 85.6% had of low literacy skills (Rapid Estimate of Literacy in Medicine (REALM) score <44, that is, unable to read simple health materials), 38.8% had positive Single Item Literacy Screener (SILS) scores (⩾2, require help to read medicines information) and 66.9% had inadequate skills for comprehension, appraisal and decision-making with regard to health information (Health Literacy Skills Instrument-Short Form (HLSI-SF) score <70%). The level of access to and utility of MIL were low, 32.4% and 34.6%, respectively. The main factors associated with poor utility of the MIL were low patient health literacy, lack of guidelines on the use of MIL and MIL written in non-native languages. Conclusion:Low rates of health literacy and utility of MIL were observed among hypertensive patients in Namibia. The integration of health literacy programmes, and MIL guidelines are needed to promote utility of medicine information and improve medication adherence. Keywords Access, health literacy, medicine information leaflets, Namibia, utility