Department of Clinical Phamacology

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Awareness of, responsiveness to and practice of patients’ rights at Uganda’s national referral hospital
(Sabinet, 2013) Kagoya, Harriet Rachel; Kibuule, Dan; Mitonga-Kabwebwe, Honoré; Ekirapa-Kiracho, Elizabeth; Ssempebwa, John C.
Background: The realisation of patients’ rights in resource-constrained and patient-burdened public health care settings in Uganda remains an obstacle towards quality health care delivery, health careseeking behaviour and health outcomes. Although the Uganda Patients’ Charter of 2009 empowers patients to demand quality care, inequitable access and abuse remain common. Aim: The study aimed to assess level of awareness of, responsiveness to and practice of patients’ rights amongst patients and health workers (HWs) at Uganda’s national referral hospital, Mulago Hospital in Kampala. Methods: A three-phase cross-sectional questionnaire-based descriptive survey was conducted amongst 211 patients, 98 HWs and 16 key informants using qualitative and quantitative data collection methods. The study was conducted in May–June 2012, 2.5 years after the launch of the Uganda Patients’ Charter. Results: At least 36.5% of patients faced a challenge regarding their rights whilst seeking health care. Most of the patients (79%) who met a challenge never attempted to demand their rights. Most patients (81.5%) and HWs (69.4%) had never heard of the Uganda Patients’ Charter. Awareness of patients’ rights was significantly higher amongst HWs (70%) than patients (40%) (p < 0.01). Patients’ awareness was associated with education level (c2 = 42.4, p < 0.001), employment status (c2 = 33.6, p < 0.001) and hospital visits (c2 = 3.9, p = 0.048). For HWs it was associated with education level (c2 = 155.6, p < 0.001) and length of service (c2 = 154.5, p <0.001). Patients feel powerless to negotiate for their rights and fear being discriminated against based on their ability to bribe HWs with money to access care, and political, socio-economic and tribal status. Conclusion and recommendations: Awareness of, responsiveness to and practice of patients’ rights remains limited at Mulago Hospital. There is a need for urgent implementation of an integrated multilevel, multichannel, patient-centred approach that incorporates social services and addresses intrinsic patient, HW and health system factors to strengthen patients’ rights issues at the hospital.
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
Compliance to guidelines for the prescribing of antibiotics in acute infections at Namibia’s national referral hospital:
(Taylor & Francis, 2017) Nakwatumbah, S.; Kibuule, D.; Godman, B.; Haakuria, V.; Kalemeera, F.; Baker, A.; Mwangana, M.
Background: Sub-optimal antibiotic prescribing remains a public health concern in Namibia. The objective is to determine the level and predictors of compliance to guidelines in the prescribing of antibiotics in acute infections at a national referral hospital in Namibia to improve future prescribing. Methods: Descriptive observational cross-sectional study. The clinical records of patients receiving care were reviewed. Prescribing practices were assessed using a self- administered questionnaire with reference to Namibia Standard Treatment Guidelines (NSTG). Results: The majority of prescriptions (62%) complied with the NSTGs; however, lower than national targets (95%). Most prescriptions were empiric and prescribers typically made reference to the NSTG (58%). Diagnosed infections were principally respiratory infections (58%) and penicillins were the most used antibiotics. Good concurrence between signs and symptoms with the diagnosis; diagnosis of upper respiratory tract, oral-dental and urogenital infections with prescribing of penicillins. Combination antibiotics and amphenicols were independent predictors of compliance to the NSTGs. The main behaviours associated with antibiotic prescribing were patient influences, clinical state, and access to guidelines. Conclusions: Compliance to NSTGs is suboptimal. Prescribing of combination antibiotics, penicillins and diagnosis of oral dental, genitourinary and ear, nose and throat infections were important predictors for NSTG compliance. There is a need to implement antibiotic indicators and stewardship programmes, and ensure access to NSTGs, to improve future antibiotic prescribing in Namibia.
Initiatives to increase the prescribing of low cost generics :
(KEIJournals, 2017) Godman, Brian; Baker, Amanj; Leporowski, Axel; Morton, Alec; Baumgärte, Christoph; Bochenek, Tomasz; Fadare, Joseph; Finlayson, Alexander; Hussain, Shazhad; Khan, Babar; Kalaba, Marija; Kibuule, Dan; Kwon, Hye-Young; Melien, Oyvind; Nascimento, Renata CRM; Salem, Ahmed; Schiffers, Krijn; Truter, Ilse; Voncina, Luka; Hassali, Mohamed Azmi
Getting the most out of the pharmaceutical budget is critical across all countries as the financial pressures on healthcare systems intensify. In this paper, we review global practice on encouraging the use of low costs generics versus branded pharmaceuticals, including patented products in the same class where care is not compromised, across countries to guide future practice. Our review ranges widely across European countries as well as other high income countries, including Abu Dhabi, Japan and the USA, and other low and middle income countries. There is a particular focus on Scotland, building on previous publications. We conclude based on multiple publications, including several case studies, that achieving efficiency in pharmaceutical spending is possible in virtually all environments, although there are examples of technologies where generic or therapeutic substitution should not be encouraged. However, there is no magic bullet to achieving full and appropriate use of generics. Countries have to be prepared to use a number of different education, economic, engineering and enforcement methods including prescribing restrictions to achieve success. Similarly, different approaches to achieve low prices for good quality generics given the considerable price differences that currently exist. The combination of low prices and increased use of generics will help achieve or attain universal healthcare, benefiting all key stakeholder groups. We conclude with a call for greater cross-country learning in pursuit of what should be a common goal for all health systems. Keywords: Co-payments, compulsory substitution, generics, prescribing restrictions, prices, reforms, Scotland
The pharmaceutical society of Uganda (PSU)
(Daily Monitor, 2017-10-02) Kyama, Eric
Pharmacists in Uganda have called for more support towards pharmaceutical service delivery as key stakeholders in the country's health sector. Under their umbrella body: pharmaceutical society of Uganda (PSU) the pharmacists said that many health facilities I both the private and public sector do not sufficient employ pharmacists,
Uganda's pharmaceutical sector growing steadily.
(Daily Monitor, 2017-10-02) Nasasira, Roland D
Pharmacists in Uganda have appealed to the government to invest in research if the country's pharmaceutical sector is to register remarkable growth. Mr. Samuel Opio, the secretary of (PSU), says in the past 10 years, PSU has experienced an increase in numbers of pharmacies from 450 to more than 1,000 pharmacies national wide.
How to start uo a pharmacy.
(Daily Monitor, 2017-10-02) Nasasira, Roland
About seven years ago, Mr. Benard Ainebyoona, a telecommunication engineer established a drug shop in Sonde, Mukono district. After realising that there was no pharmacy in the area, he upgraded his drug shop into a pharmacy and equipped it with a blood testing laboratory to increase on health services offered to his customers.
Quality assurance of health management information system in Kayunga district, Uganda
(Sabinet, 2018) Kagoya, Harriet R.; Kibuule, Dan
Background: An efficient health management information system (HMIS) improves health care delivery and outcomes. However, in most rural settings in Uganda, paper-based HMIS are widely used to monitor public health care services. Moreover, there are limited capabilities and capacity for quality HMIS in remote settings such as Kayunga district. Objectives: The quality assurance practices of HMIS in health centres (HCs) in Kayunga district were evaluated. Method: A cross-sectional descriptive study design was used to assess the quality of HMIS at 21 HCs in Kayunga district. Data were collected through in-depth interviews of HMIS focal persons as well as document analysis of HMIS records and guidelines between 15 June 2010 and 15 July 2010. The main outcomes were quality assurance practices, the HMIS programmatic challenges and opportunities. The practice of HMIS was assessed against a scale for good quality assurance practices. Qualitative data were coded and thematically analysed, whereas quantitative data were analysed by descriptive statistics using SPSS v22 software. Results: All the 21 HCs had manual paper-based HMIS. Less than 25% of HCs practised quality assurance measures during collection, compilation, analysis and dissemination of HMIS data. More than 50% of HCs were not practising any type of quality assurance during analysis and dissemination of data. The main challenges of the HMIS were the laborious and tedious manual system, the difficulty to archive and retrieve records, insufficient HMIS forms and difficulty in delivering hard copies of reports to relevant stakeholders influenced quality of data. Human resource challenges included understaffing where 43% of participating HCs did not have a designated HMIS staff. Conclusion: The HMIS quality assurance practices in Kayunga were suboptimal. Training and support supervision of HMIS focal persons is required to strengthen quality assurance of HMIS. Implementation of electronic HMIS dashboards with data quality checks should be integrated alongside the manual system
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.
Drug shops to be phased out.
(New Vision, 2018-01-11) Amamukirori, Betty
Drug shops located in the city , municipalities and town councils have been given one year to either transform into pharmacies or shut down, Donna Kusemerewa, the executive director of National Drug Authority(NDA) has said. She said pharmacies are stocked with all types of drugs and can sufficiently serve the population.
Pharmacies stopped from running retail, wholesale at a go.
(New Vision, 2018-01-12) Kitubi, Martin
The National Drug Authority (NDA) has stopped issuing licences to pharacies offering both wholesale and retail services due to compromising patients' privacy. Donna Kusemererwa, the executive director of NDA, revealed to New Vision that the new rule will affect new pharmacies, but those in existence will be given time to separate retail from wholesale business.
NDA is wrong on drug shops ban.
(New Vision, 2018-01-18) Birungi, John Peter
Recently the National Drug Authority issued a directive that drug shops are to be phased out in municipalities and the city. The reason given was that drug shops must be transformed into pharmacist. The reason given appears to be weak.
Government to buy new drug for sickle cell anaemia
(Daily Monitor, 2018-03-01) Ainebyoona, Emmanuel
The Minister of Health Dr. Ruth Aceng, has directed the National Drug Authority to register hydroxyurea as a treatment for sickle cell anaemia in a move to increase the drug's availability and accessibility
Pharmacists petition government over delayed registration
(Daily Monitor, 2018-03-01) Namagembe, Lilian
Pharmacist graduates have petitioned the Ministry of Health over delayed issuance their practicing licences after finishing internship last year.
Pharmacists petition govt over delayed registration
(Daily Monitor., 2018-03-01) Namagembe, Lilian
Pharmacist graduates have petitioned the ministry of health over the delayed issuance of their practising licences after finishing internship last year. In a February 27 petition signed by 56 of affected 100 phyarmacists, the graduates demand that they be registered and issused with certificates of registration within seven days
Children diagnosed with diabetes
(New Vision, 2018-04-16) Magezi, N Lilian
Recently, a donation of half a million syringes for children with diabetes type type 1, was made through Sonia Nabela Foundation - an organisation that raises awareness about the disease in Uganda.
Wandegeya Pharmacy closed
(Sunday Vision, 2018-04-22) Kasujja, Carol; Ssejjoba, Eddie
The National Drug Authority has halted operations of Friecca Pharmacy in Wandegeya, a city suburb, saying it has been operating without a licence.
Pharmacy students ask govt to increase health budget
(New Vision, 2018-04-25) Ssengendo, Abdulkarim
Pharmacy students in Uganda have urged the Government to increase the health budget and number of pharmacists being trained in the country every year.
Vaccine against malaria on test trial
(New Vision, 2018-04-25) Basudde, Elvis
The vaccines against malaria have been the object of constant endeavor by the scientific community and pharmaceutical industries for over three decades, with little success so far. Even doctors from the National Malaria Control Programme, at the ministry of Health, have expressed pessimism, saying currently the scientific team in Uganda is not having any success story in terms of developing an in country malaria vaccine.
How to fight malaria drug resistance
(New Vision, 2018-04-25) Amongin, Faith
Uganda is still stuck at the control phase despite the various interventions by government and other stake holders to reduce the prevalence like the ongoing distribution of Insecticide mosquito Treated Nets (ITN) and Indoor Residual Spraying (IRS) in mainly areas where prevalence is highest. However, one of the major complications in the fight against malaria is the issue of drug resistance; that is the reduction in the effectiveness of a medication that is used repeatedly.

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