Browsing by Author "Mubita, Mwangana"

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    COVID-19 resilient pharmacy education:
    (FIP, 2020) Mavu, Daniel; Lates, Jennie; Hango, Ester; Rennie, Timothy; Lusepani, Monde; Kibuule, Dan; Mubita, Mwangana
    Background: The COVID-19 pandemic has led to suspension of pharmacy education in resource-limited settings, negatively impacting pharmaceutical workforce outputs. Aims: To identify the elements of a COVID-19 resilient pharmacy education programme in Namibiaand its grassroots impact on the pharmaceutical workforce and systems strengthening. Methods: An evaluation of COVID-19 resilience of the Diploma in Pharmacy programme in Namibia. Data on elements for resilience and outcomes were collected; qualitative and quantitative data were analysed descriptively. Results: The evaluation identified ten key elements for successful implementation of a COVID-19 resilient pharmacy education programme. The integration of quality improvement projects in the workplace strengthened pharmaceutical systems and workforce capacity in areas of rational medicine use and supply management of medicines. Conclusions: Whilst the COVID-19 pandemic has disrupted pharmacy education, this paper presents ten elements that, when implemented, may improve the resilience and minimise unforeseen academic interruptions during pandemics. Keywords: COVID-19, Namibia, Pharmacy Education, Work Integrated, Workforce
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    Creating clinical pharmacy capacity in Namibia:
    (Springer, 2020) Corkhill, Nicola L.; Lates, Jennie; Mubita, Mwangana; Kibuule, Dan; Jonkman, Lauren J.; Hachey, David; Hunter, Christian John; Bates, Ian; Rennie, Timothy W.
    Namibia has previously relied on external training of pharmacists but began in-country training in 2011. In response to an identifed need for postgraduate clinical pharmacy development and training in the country, a Master’s degree was set up at the University of Namibia in 2016. The country has a considerable health burden of HIV and TB as well as a shortage of healthcare professionals. A UK clinical diploma model was adapted to meet the specifc needs of the country and wider region, ensuring students could access the course over a sparsely populated, but large geographical spread, in addition to providing work-based learning, embedding research skills for future development, and focusing on the health needs of Namibia. The course uses online learning platforms and contact sessions to cover both knowledge and skill acquisition throughout the 3 years of the course. UK and US clinical pharmacists are utilised to provide specialist input, both remotely and within student workplaces, and further support has come from collaborations, including cross-site visits, with the UK-based pharmacy school whose diploma model was adapted. Challenges have included a shortage of clinical mentors, also compounding the students’ difculty in visualising their future roles, as well as lone practitioners fnding it hard to attend all contact sessions. The initial dropout rates of earlier cohorts have since reduced with greater understanding of the programme, and enthusiasm for the course remains high. The aim for the Master’s is to train students to become competent clinical pharmacists, thus having the knowledge and skills to mentor future cohorts of the course, as well as expanding the specialty within the country. Keywords Africa · Clinical pharmacy · Namibia · Postgraduate
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    Current and former students’ views on two different methods of classroom-based teaching in pharmaceutical care:
    (FIP, 2016) Kalemeera, Francis; Naikaku, Ester; Mubita, Mwangana; Kibuule, Dan
    Background: Namibia is divided into 34 districts, each with a public hospital supplemented by a number of primary health care facilities. These hospitals shoulder the responsibility of ordering and distributing pharmaceuticals for the district as a whole. As the number of pharmacists in the public sector is quite low, staff often get engrossed in supply chain issues on the expense of pharmaceutical care. Namibia, cognisant of this challenge, established the School of Pharmacy, with one of the goals being to equip the students with knowledge and skills in the area of pharmaceutical care. So far two groups have gone through pharmaceutical care training: the 2014 and 2015 BPharm IVs. The 2014 group received classroom-based training through conventional didactic sessions, while the 2015 group was trained via case-discussions. The two groups were asked to comment on which of the two training methods was better for pharmaceutical care training. Methods: We summarised the methods of classroom-based training as implemented in 2014 and 2015. We used a Focus Group Discussion with the 2015 group and telephonic discussion with individuals of the 2014 group. Individuals from both groups were asked if they would pursue a career in hospital-based clinical pharmacy. We used the Student’s T test to compare the proportions of students who reported wanting to pursue a career in clinical pharmacy, with the confidence level set at 95%, and the significance observed at a p-value ≤ 0.05. Results: Summaries of the two methods were generated and used to explain the two methods to the respondents. All the respondents (n=9, 2015 group; n=10, 2014 group) said that the case discussion method was better than the conventional didactic sessions. The majority of the respondents (n=8, 89%) from the 2015 group said they would pursue a career in clinical pharmacy. Conclusion: The case-discussions seem to be a better method for classroom-based training, when compared with the conventional didactic sessions. Even though the proportion of students considering building a career in clinical pharmacy was greater in the Class of 2015 than that in Class of 2014, we cannot conclude that the new method of training was the reason that underscored the difference. A more in-depth assessment is required to provide clarity on the relationship between the module delivery method and pursuing a career in clinical pharmacy. Keywords: Clinical Pharmacy, Pharmaceutical Care, Case-Discussions, Didactic Sessions
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    Emergency compounding of COVID-19 medicines:
    (2020) Mavu, Daniel; Mubita, Mwangana; Niaz, Qamar; Lusepani, Monde; Enkara, Tonata; Philomien, Aiases; Pick, Riana; Kibuule, Dan
    Background: The COVID-19 pandemic has exacerbated inequitable access to medicines in sub-Saharan Africa, mainly due to limited capabilities for local manufacture. Aim: To describe priority medicine lists and critical skill sets required for an emergency compounding of COVID-19 medicines training programme. Methods: An evaluation of the COVID-19 emergency compounding readiness programme for the University of Namibia pharmacy graduates. The main outcomes were enhanced skill sets in compounding, quality control, and regulation of priority COVID-19 medicines. Data on outcomes were thematically analysed. Results: Fifty-eight pharmacy graduates demonstrated competence in emergency compounding, quality control, regulation, and provision of therapeutic information of COVID-19 medicines. A priority list and a skills set for emergency compounding of COVID-19 medicines were developed. Conclusions: The upskilling of pharmacy graduates on emergency compounding of COVID-19 medicines has the potential to address inequalities in the rapid response and control of epidemics.
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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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    Predictors of loss to follow-up of tuberculosis cases under the DOTS programme in Namibia
    (ERJ, 2020) Kibuule, Dan; Aiases, Philomein; Ruswa, Nunurai; Rennie, Timothy William; Verbeeck, Roger K.; Godman, Brian; Mubita, Mwangana
    Background: In Namibia, one out of every 25 cases of tuberculosis (TB) is “lost to follow-up” (LTFU). This has impacted negatively on national efforts to end the disease by 2035. The aim of this study was to determine the trends and predictors of LTFU under the directly observed treatment short-course (DOTS) programme in Namibia. Methods: The study involved a retrospective longitudinal analysis of a nationwide cohort of TB cases registered under the DOTS programme in Namibia from 2006 to 2015. The trends and predictors of LTFU among cases in the National Electronic TB Register of the National TB and Leprosy Program were respectively determined by interrupted time series and multivariate logistic regression analyses using R-Studio software. Results: Out of 104 203 TB cases, 3775 (3.6%) were LTFU. A quarter (26%) of cases with poor outcomes were due to LTFU. The annual decline in cases of LTFU was significant between the first (2005–2010) and second (2010–2015) medium-term plan period for TB programme implementation ( p=0.002). The independent predictors of LTFU were male sex ( p=0.004), 15–24 years age group ( p=0.03), provider of treatment ( p<0.001), intensive phase ( p=0.047) and living in border/transit regions ( p<0.001). HIV co-infection and TB regimen were not significant predictors of LTFU. Conclusions: There were declining trends in LTFU in Namibia. DOTS programmes should integrate socioeconomic interventions for young and middle-aged adult male TB cases to reduce LTFU.
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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