Faculty of Health Sciences
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Item 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.Item 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, DanBackground: 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 SessionsItem 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.Item 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 AzmiGetting 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, ScotlandItem Death from poisoning(Daily Monitor, 2017-03-01) Onzivua, SylvesterAt 9:21 PM on the night of November 22, 2006, Alexander Litvinenko died at the University college hospital in central London when his heart failed. He was a former officer of the Russian security services who had been given political asylum in the United Kingdom after fleeing his native country, Russia.Item Dirty water puts 7,800 lives at risk(Daily monitor, 2018) Felix AinebyoonaMost residents use dirty water for domestic purposes, Exposing them to water borne diseases such as dysentery, diarrhea, typhoid and bilharzia among othersItem Quality assurance of health management information system in Kayunga district, Uganda(Sabinet, 2018) Kagoya, Harriet R.; Kibuule, DanBackground: 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 systemItem Male, Female patients share ward in Busia Health Centre(Monitor, 2018) David OworiThe facility has one room which serves as an outpatient department, maternity wing and a children's ward.Item 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, BrianIntroduction 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.Item Senior doctor wants medics to teach health to learners(Daily Monitor, 2018-02-06) Tajuba, PaulA medical consultant has proposed that government starts a special programme under which health workers will help teachers to teach reproductive and general health knowledge to learners, a move he said will reduce the cost if health care in the country.Item Lack of drugs affecting mental health treatment(Daily Monitor, 2018-02-06) Wafula, Philip; Edema, DenisMental health patients at Jinja Regional Referral Hospital have started shunning treatment and routine check up due to persistent lack of drugs at the facility. The patients also decry the high costs of transport involved while seeking treatment.Item Busolwe General Hospital operating in dire condition(Daily Monitor, 2018-02-06) Kitunzi, YahuduThe facility has not got any major repair since it's establishment in 1970. What welcomes you upon arrival at the facility are rotten beds, dilapidated buildings and poor hygiene.Item It's time to rethink quality emergency care(Daily Monitor, 2018-02-07) Mugisha, IvanMowzey Radio sustained a serious traumatic brain injury, with bystanders reporting, " i heard his head crack and saw his eyes in a coma."Item Kadaga launches five-year campaign against child marriages(Daily Monitor, 2018-02-07) Kato, JosephThe speaker of parliament, Ms. Rebecca Kadaga has a launched a five year campaign against child marriages and teenage pregnancies in Uganda.Item Shs500b earmarked for maternal health(Daily Monitor, 2018-02-07) Namagembe, LilianMinistry of Health has secured a lump sum $140m (about shs513b) loan for maternal health to stop the high death of women during pregnancy and child birth. Maternal and child mortality rates account for more than 60 per cent of the lives lost in Uganda.Item Mengo Hospital cleared over patients deaths(Daily Monitor, 2018-02-08) Namagembe, LilianThe investigations followed media reports that circulated indicating that at least 13 patients operated on during the one-week long neurosurgical camp at the hospital, including former Kyadondo South MP Issa Kikungwe passed on. The reports also indicated that the doctors were not qualified.Item Nodding syndrome children die as care centre remains closed(Daily Monitor, 2018-02-09) Ocungi, JuliusTwo children who were suffering from nodding syndrome just a month after a care centre in Omoro district that catered for them was closed due to shortage of funds.Item Abortion adverts have an impact on maternal health(Daily Monitor, 2018-02-10) Jjuuko, DennisThe city is awash with adverts for legal abortion without a clear indication of what is legal and what is not. This may have harmful impact on girls and women that need this service in unregulated environment, thereby ruining Uganda's maternal health, sexual and reproductive health record, together with the gender agenda.Item Postmortem clears mysteries(Saturday Monitor, 2018-02-10) Onzivua, SylvesterDeath is a mysterious and anything to do with it is viewed with apprehension, not least of all the postmortem examination. Most people dread this examination performed on a relative and it is abhorred by some religions. The value of the examination is questioned by many as it may not be if any value to the deceased. What is sometimes even worrying to some relatives is that some parts (tissues) of thee dead body are removed by the doctors, which parts the deceased is buried without.Item I was infected with HIV but living on(Daily Monitor, 2018-03-01) Nakibuuka, BeatriceAt 14, Grace Kyolaba, the first born and only girl in her family was defiled by a man whose face she says cannot recall clearly. One evening after school in November 2015, the primary seven pupil went to the market. That journey changed her life.