Faculty of Health Sciences

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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.
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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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    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
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    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.
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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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    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
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    Prevalence of self-medication for acute respiratory infections in young children in Namibia:
    (Core, 2019) Kamati, Monika; Godman, Brian; Kibuule, Dan
    Background: Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among under-fives. However, self-medication and “self-care” care practices remain common especially among informal settlements in Namibia. Consequently, we sought to ascertain the rationale for this to guide future activities. Method: Mixed method approach among residents in an informal settlement in Namibia to determine the extent of health seeking behaviors and the rationale for any self-medication. Results: Of the 100 informal households surveyed, 60% used self-medication for ARIs including cold/flu medication, paracetamol and decongestants. There was no self-purchasing of antibiotics. The main drivers of self-medication were a perceived diagnosis of ARI as “minor or mild” as well as long waiting times and queues to receive care at public health facilities. Conclusion: The majority of households in this settlement self-medicate for ARIs. There is need for outreach primary health care services in the future in townships to screen and appropriately manage ARI to address concerns. This can include increasing pharmacy services. Key words: self-medication; prevalence; ARIs; Namibia
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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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    Optimizing spontaneous adverse drug reaction reporting in public healthcare setting in Namibia
    (Nordic Association, 2019) Adenuga, Babafunso A.; Kibuule, Dan; Rennie, Timothy W.
    Despite the universal scale-up of pharmacovigilance systems globally, adverse drug reaction (ADR) reporting remains suboptimal among resource-limited countries. Few studies in sub-Saharan Africa evaluate the effectiveness of adverse drug reaction (ADR) reporting programmes. A cross-sectional survey using a self-administered questionnaire to assess ADR reporting knowledge, attitude and practices among healthcare workers in Namibia's public sector was conducted between September and December 2018. The primary outcome were practices, knowledge and attitude of the respondents towards ADR reporting. Quantitative and qualitative data were analysed using descriptive statistics and thematic analysis, respectively. Of the 197 healthcare workers surveyed, 43.1% were nurses, 63.4% of the respondents knew about the ADR reporting system in Namibia, 76.7% knew the pharmacovigilance/ADR reporting centre in Namibia, while 37.3% had reported an ADR before. Nurses were less likely to be knowledgeable and report ADRs. The independent predictor of ADR reporting was the nursing cadre; adjusted odds ratio (aOR) = 0.17 (95% CI: 0.07, 0.401, P < .01). Pre- and in-service trainings including introduction of electronic reporting platforms were some of the identified ways of optimizing the pharmacovigilance and ADR reporting systems by the respondents. As pharmacovigilance in Namibia relies on spontaneous reporting of ADRs, there is a need for advocacy and workforce strengthening for ADR reporting in the public health sector.
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    Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries:
    (Taylor & Francis, 2019) Godman, Brian; Haque, Mainul; McKimm, Judy; Bakar, Muhamad Abu; Sneddon, Jacqueline; Wale, Janney; Campbell, Stephen; Martin, Antony P; Hoxha, Iris; Abilova, Vafa; Paramadhas, Bene D Anand; Mpinda-Joseph, Pinkie; Matome, Matshediso; Pires de Lemos, Livia Lovato; Sefah, Israel; Kurdi, Amanj; Opanga, Sylvia; Jakupi, Arianit; Saleem, Zikria; Hassali, Mohamed Azmi; Kibuule, Dan; Fadare, Joseph; Bochenek, Tomasz; Rothe, Celia; Furst, Jurij; Markovic-Pekovic, Vanda; Bojanić, Ljubica; Schellack, Natalie; Meyer, Johanna C; Matsebula, Zinhle; Thi Phuong, Thuy Nguyen; Jan, Saira; Kalungia, Aubrey; Mtapuri-Zinyowera, Sekesai; Sartelli, Massimo; Hill, Ruaraidh
    Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use.Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known.Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals.Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.
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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
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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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    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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    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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    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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    Effective stakeholder analysis and engagement:
    (Iberoamerican Journal of Medicine, 2020) Adenugaa, Babafunso A.; Aluvilua, Anastasia; Olafusi, Oluwaseun O.; Kibuule, Dan
    Stakeholder analysis involves the efficient gathering and analyzing of qualitative information by engaging identified players in a specific sector, in this case, the healthcare sector of Namibia, to determine whose interests should be considered when developing a policy or program and/or in the post/pre-implementation phase of a policy or program [1]. This approach also assists in identifying gaps that might exist within the sector under examination.
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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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    Does pharmaceutical information systems data inform decision-making in public healthcare? Utility of a national system in a limited resource setting
    (Elsevier, 2020) Kagoya, H. R.; Rennie, T. W.; Kibuule, Dan; Mitonga, H. K.
    Background: Globally, weak pharmaceutical information systems (PIS) negatively affect universal health coverage and outcomes. Few studies in sub-Saharan Africa qualitatively and quantitatively assess drivers and utility of data from PIS in public healthcare. Methods: A nationwide cross-sectional descriptive study interviewed PIS focal persons in all 14 regions of Namibia. The primary outcome was extent and predictors of utility of PIS data. The extent of utility of PIS data was determined using descriptive statistics and predictors by logistic regression in SPSSv24 or thematic analysis for qualitative data. Results: The study recruited 58 key informants at facility-based 56 (96.6%) and national 2 (3.4%) levels. Of the 56 facility-based respondents, 29 (51.8%) were female and 27 (48.2%) pharmacists. The mean age and PIS work experience were 33.5 7.6years and 4.5 3.3years respectively. The utility level of PIS data was 34 (60.7%) (target >80%). A total of 103 uses of PIS data were cited; of which 38 (36.9%) were informing decisions on rational medicine use, 27 (26.2%) on pharmaceutical stock management and 24 (23.3%) on strengthening pharmacy workforce. The utility of PIS data significantly decreased with lack of systems on routine reporting by health facility in-charge (cOR ¼ 0.25, 95%CI: 0.06,0.90, p ¼ 0.035). Longer work experience (cOR ¼ 1.05, 95% CI: 0.88,1.25, p ¼ 0.58), formal consultations (cOR ¼ 1.29, 95%CI: 0.14,11.54, p ¼ 0.82), and availability of feedback systems (cOR ¼ 1.08, 95%CI: 0.33,3.56, p ¼ 0.89) appeared to increase utility of PIS data. Two thematic drivers of utility of PIS data were programmatic “feedback and action on PIS; structures, technical support for PIS discussion”; technical “training/technical capacity of staff; tools and resources for data collection and utilization”; and human-resource “staff availability and workload; attitude and commitment”. Conclusion: The nationwide study shows sub-optimal utility of PIS data in public healthcare in Namibia, which negatively affects delivery of pharmaceutical services. This calls for action to enhance capabilities for utilization of automated real-time pharmaceutical information decision support systems to enhance real-time analysis and feedback on medicines data in resource-limited settings. Keywords: Health information system, Medicines management information system, Namibia, Utility
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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