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A model to strengthen utility of quality pharmaceutical health systems data in resource-limited settings
(SAGE Publications, 2020) Kagoya, Harriet Rachel; Kibuule, Dan; Rennie, Timothy William; Mitonga, Honoré Kabwebwe
Background: Limited utility of quality health data undermines efforts to strengthen healthcare delivery, particularly in resource-limited settings. Few studies model the effective utility of quality pharmaceutical information system (PIS) data in sub-Saharan Africa, typified with weak health systems. Aim: To develop a model and guidelines for strengthening utility of quality PIS data in public healthcare in Namibia, a resource-limited setting. Methods: A qualitative model based on Dickoff et al. practice-oriented theory, Chinn and Jacobs’ systematic approach to theory, and applied consensus techniques. Data from nationwide studies on quality and utility of PIS data in public healthcare conducted between 2018 and March 2020 informed the development of the model concepts. Pharmaceutical and public health systems experts validated the final model. Results: Overall, four preliminary national studies that recruited 58 PIS focal persons at 38 public health facilities and national level informed the development of four model concepts. The model describes concepts on access, management, dissemination, and utility of quality PIS data. Activities to implement the model in practice include grass-root integration of real-time automated pharmaceutical intelligence systems to collect, consolidate, monitor, and report PIS data. Strengthening coordination, human resources, and technical capacity through support supervisory systems at grass-root facilities are key activities. PIS focal persons at health facility and national level are agents to implement these activities among recipients, that is, healthcare professionals at points of care. Guidelines for implementation of the model at point of care are included. Experts described the model as clear, simple, comprehensive, and integration of pharmaceutical intelligence systems at point of care as novel and of importance to enhance utility of quality PIS data in resource-limited settings. Conclusion: While utility of quality PIS data is limited in Namibia, advantages of the model are encouraging, toward building resilient pharmaceutical intelligence systems at grass roots in resource-limited countries, where there are not only weak health systems, but high burden of misuse of medicines. Keywords: Data, health, information systems, pharmaceutical, quality, utility
Activities in Namibia to limit the impact of COVID-19 versus Europe and Iran and the implications for the future
(2020) Kibuule, Dan; Nambahu, Lahya; Sefah, Israel Abebrese; Kurdi, Amanj; Thi Phuong, Thuy Nguyen; Kwon, Hye-Young; Godman, Brian
Introduction and aims: Considerable differences in prevalence and mortality rates from COVID-19, with higher rates among European countries and Iran versus African and Asian countries in part due to early and extensive prevention measures. There has been considerable controversy surrounding hydroxychloroquine, with resultant misinformation increasing prices and suicides. Growing concerns also with unintended consequences of lockdown and other measures. Consequently, a need to investigate changes in utilisation and prices of relevant medicines during the pandemic in Namibia with its proactive approach to guide future decision making. Community pharmacists play a key role in this respect. Methods: Questionnaire survey among 55 pharmacists from March to end June 2020. Results: Proactivity among some pharmacists to plan for the pandemic with increased stocks. Limited increases in utilisation of antimalarials and antibiotics in Namibia versus other countries enhanced by restrictions on self-purchasing in Namibia, reflected in limited price rises and shortages. Higher use of Vitamin C/ immune boosters in Ghana and Nigeria versus Namibia reflected in higher price rises, with increased utilisation and prices of PPE across all countries. Encouragingly lower increases in herbal medicines in Namibia versus Ghana. Concerns though with unintended consequences. Conclusion: Encouraging to see continued low prevalence and mortality rates from COVID-19 in Namibia and limited increase in utilisation of antimalarials and antibiotics with prescribing restrictions. Concerns with rising rates of malaria and other infectious diseases following lockdown need addressing. Pharmacists can help plan for the future, educate the public during pandemics, help with vaccinations and general medicines management.
Alignment of standard treatment guidelines with medicine use indicators in a limited-resource setting:
(JPHSR, 2020) Kagoya, Harriet Rachel; Rennie, Timothy William; Kibuule, Dan; Mitonga, Honore Kabwebwe
Background Standard treatment guidelines (STGs) are a critical public health tool for promoting rational use of medicines. No studies have evaluated alignment of STGs with medicine use indicators especially in low and-middle-income countries (LMICs) with disproportionate burden of disease and irrational medicine use. Objective To determine the level of alignment of Namibia’s STGs with WHO medicine use indicators. Methods A descriptive policy analysis of alignment of Namibia’s STGs and WHO medicine use indicators. Thirty-two conditions/diseases prevalent and managed at primary healthcare level were included in the study of alignment of the STGs with two WHO medicine use indicators in terms of average number of medicines/condition (polypharmacy, WHO target <2) and antibiotic prescribing (WHO target <30%) after adjusting for estimated encounters per condition. Data were analyzed using (SPSSv24 software, IBM Corporation, NY) to determine frequencies, percentages and means. Key findings Of the 32 conditions/diseases studied, 41% had three or more medicines per condition indicated in the STGs. The weighted minimum and maximum average number of medicines/condition/encounter in the STGs were 2.62 and 2.78 respectively. Antibiotics were indicated for 72% (weighted per encounter = 75%) of the 32 conditions. Conditions/diseases of the urogenital system had the highest antibiotics indicated in the STGs (100%); respiratory (80%); ENT (80%); gastrointestinal (33%) before weighting conditions for estimated patient encounters, while ENT conditions had the highest antibiotics (32%) after weighting. Conclusions Alignment of Namibia STGs and medicine use targets is sub-optimal. The STGs have a high indication of antibiotics and polypharmacy. Misalignment is the main contributor to sub-optimal medicine use indicators with respect to average number of medicines and antibiotics. Countries should review their STGs and align with medicine use indicators to enhance rational medicine use and fight antimicrobial resistance. This article provides guidance for aligning STGs with medicine use indicators. Keywords antimicrobial resistance; indicators; low-and-middle income countries; medicine use; standard treatment guidelines (STGs)
An analysis of hospital pharmacy practice in Namibia, based on FIP’s Basel Statements
(Oxford, 2021) Bare, Andrea; Ivey, Marianne; Kibuule, Dan; Stevenson, James G.
Background Sub-Saharan Africa, a region faced with a double challenge of infectious and noncommunicable diseases requires strengthening of hospital pharmacy practice to improve treatment outcomes and patient safety. Objectives The objectives of this study were to assess the current state of pharmacy practice in hospitals in Namibia and to identify opportunities for expanding pharmacists’ role in addressing public health challenges and improving medicines use outcomes. Methods A survey utilized FIP’s self-assessment tool to evaluate current hospital pharmacy practice in Namibia against best practices articulated in the Basel Statements. The study was conducted among hospital pharmacists across Namibia. Quantitative and qualitative data were analysed using descriptive statistics and thematic analysis. Key findings: The study was conducted in 24 hospital pharmacies across Namibia, the majority of which were public facilities (67%). Overall, current hospital pharmacy practice activities are focused on medicine procurement, preparation and distribution. The main barriers to optimal hospital pharmacy services are associated with limited human resources and collaboration across healthcare providers, as well as policy gaps. Conclusions There is a strong desire among hospital pharmacists to expand their contributions to improving medicines outcomes and solving public health problems. Namibia’s pharmacy educational system is a strength and should be utilized to continue advancing hospital pharmacy practice and medicines use. Therapeutics committees are usually part of each hospital’s structure and can be very effective for hospital-based policy change. The opportunity exists to optimize pharmacists’ contributions by utilizing the local therapeutics committees in combination with the educational system to advance hospital pharmacy practice in Namibia. Keywords: Namibia; hospital pharmacy; Basel Statements
Annona muricata silver nanoparticles exhibit strong anticancer activities against cervical and prostate adenocarcinomas through regulation of CASP9 and the CXCL1/CXCR2 genes axis
(IOS Press, 2021) Gavamukulya, Yahaya; Mainab, Esther N.; El-Shemy, Hany A.; Merokac, Amos M.; Kangogo, Geoffrey K.; Magomab, Gabriel; Wamunyokoli, Fred
BACKGROUND: Green synthesized nanoparticles have been earmarked for use in nanomedicine including for the development of better anticancer drugs. OBJECTIVE: The aim of this study was to undertake biochemical evaluation of anticancer activities of green synthesized silver nanoparticles (AgNPs) from ethanolic extracts of fruits (AgNPs-F) and leaves (AgNPs-L) of Annona muricata. METHODS: Previously synthesized silver nanoparticles were used for the study. The effects of the AgNPs and 5-Fluorouracil were studied on PC3, HeLa and PNT1A cells. The resazurin, migration and colonogenic assays as well as qRT-PCR were employed. RESULTS: The AgNPs-F displayed significant antiproliferative effects against HeLa cells with an IC50 of 38.58 g/ml and PC3 cells with an IC50 of 48.17 g/ml but selectively spared normal PNT1A cells (selectivity index of 7.8), in comparison with first line drug 5FU and AgNPs-L whose selectivity index were 3.56 and 2.26 respectively. The migration assay revealed potential inhibition of the metastatic activity of the cells by the AgNPs-F while the colonogenic assay indicated the permanent effect of the AgNPs-F on the cancer cells yet being reversible on the normal cells in contrast with 5FU and AgNPs-L. CASP9 was significantly over expressed in all HeLa cells treated with the AgNPs-F (1.53-fold), AgNPs-L (1.52-fold) and 5FU (4.30-fold). CXCL1 was under expressed in HeLa cells treated with AgNPs-F (0.69-fold) and AgNPs-L (0.58-fold) and over expressed in cells treated with 5FU (4.95-fold), but the difference was not statistically significant. CXCR2 was significantly over expressed in HeLa cells treated with 5FU (8.66-fold) and AgNPs-F (1.12-fold) but under expressed in cells treated with AgNPs-L (0.76-fold). CONCLUSIONS: Here we show that biosynthesized AgNPs especially AgNPs-F can be used in the development of novel and better anticancer drugs. The mechanism of action of the AgNPs involves activation of the intrinsic apoptosis pathway through upregulation of CASP9 and concerted down regulation of the CXCL1/ CXCR2 gene axis. Keywords: Silver nanoparticles, HeLa, PC3, PNT1A, CASP9, CXCL1/CXCR2
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.
Commentary on the Antidiabetic Activity of Kigelia Africana
(JPRM, 2021) Muyenga-Akapelwa, Tumelo; Ezaela, Christian E.; Mushabati, Festus; KayondeBamitale, Samuel Dominion; Kibuule, Dan
Kigelia Africana Lam (Benth) a plant of the Bignoniaceae family, is a medicinal plant with many medicinal properties [1]. Of interest to this paper are the highlighted blood-glucose-lowering activities of the plant, which have led to its use among traditional healers in Zambia [2] and other parts of Africa [3,4,5] Traditional healers in Zambia macerate the fruit using water as a solvent which is drunk as prescribed [6] Anecdotal evidence suggests that the patient takes the fruit maceration twice daily after meals.
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.
Compliance to prescribing guidelines among public health care facilities in Namibia:
(Springer, 2020) Niaz, Qamar; Godman, Brian; Campbell, Stephen; Kibuule, Dan
Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0±1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the fndings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare. Keywords Compliance · Namibia · Prescribing indicators · Prescribing patterns · Qualitative research · Standard treatment guidelines
Consumption of psychotropic medicines at a referral hospital in Namibia:
(2020) Kafula, Maria N.; Ugburo, Emmanuel; Kibuule, Dan
Setting: In Namibia, the burden of mental illnesses is estimated at 25.6% and is expected to double by 2025. Few studies in sub-Saharan Africa estimate the consumption rates of psychotropic medicines as a proxy of irrational use. Aim: The consumption rate of psychotropic medicines at a referral hospital was determined. Method: A hospital-based retrospective medicine utilization analysis of Facility Electronic Stock Card (FESC) psychotropic medication was conducted at Intermediate Hospital Katutura over a 7 year period, 2011-2017. Data on consumption and expenditure on psychotropic medicines were abstracted from FESC and analysed using descriptive statistics in SPSS v22. The main outcomes were consumption rates, daily Defined Dose, (DDD) and/or expenditure. Results: Of the 580 351,4 DDD of psychotropic medicines consumed, 84% were anti-psychotics, 9.2% anti-depressants and 6.8% anxiolytics. Anti-psychotics (48.8%) and anxiolytics (47.9%) had the highest consumption by cost relative to antidepressants (3.3%). The most consumed antidepressants were imipramine (62%) by DDD and fluoxetine (55.8%) by cost. The most consumed anti-psychotics were chlorpromazine (74.6%) by DDD and haloperidol (68.4%) by cost respectively. Diazepam (79.4%) and hydroxyzine (94.2%) were most consumed sedative-hypnotics by DDD and cost respectively. Conclusion: The consumption of new psychotropics contributes to higher costs. There is need for cost-effectiveness analysis of new versus conventional psychotropics to optimize treatment, outcomes and costs. Keywords: Pyschotropics, consumption rate, DDD, Namibia.
Continuum of maternity care in Zambia:
(BMC, 2021) Sserwanja, Quraish; Musaba, Milton W.; Mutisya, Linet M.; Olal, Emmanuel; Mukunya, David
Background: Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia. Methods: We used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. Complete continuum of care was considered when a woman had; at least four antenatal care (ANC) contacts, utilized a health facility for childbirth and had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25. Results: Of the 7,325 women, 38.0% (2787/7325) (95% confidence interval (CI): 36.9-39.1) had complete continuum of maternal healthcare. Women who had attained tertiary level of education (adjusted odds ratio (AOR): 1.93, 95% CI: 1.09-3.42) and whose partners had also attained tertiary level of education (AOR: 2.58, 95% CI: 1.54-4.32) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated ANC after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.27-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces. Conclusion: Level of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services. Keywords: Continuum of care, Antenatal care, Postnatal care, Childbirth, Utilization, Women and Zambia
Contraceptive uptake in eastern Uganda: was the 2020 target of 50% modern contraceptive rate achieved?
(BMC, 2021) Birungi, Julian Daisy; Tumukunde, Prossy; Nekaka, Rebecca; Nteziyaremye, Julius
Background: Contraception is a worthwhile and cost effective investment that has potential to spur national development. It is important in averting significant maternal and childhood morbidity and mortality. No wonder countries with low contraceptive prevalence rates (CPR) have poor maternal and childhood health indicators. Consequently, during the 2012 London conference Uganda set a target of improving modern CPR (mCPR) to 50% by 2020. We report how eastern Uganda is faring on this commitment and identify the factors associated with contraceptive uptake. Methods: Using a cross-sectional study design, we recruited 418 sexually active women aged 15-49 years who had come to nurse their sick ones in a tertiary hospital. We used systematic sampling to recruit participants. Data was collected using an interviewer administered pretested questionnaire, analyzed using STAT version 19. Results: Of the 418 women respondents, 15.6% were teens while 50% were aged 20-29 years. Significantly, 64.59% were married. The majority, 78.7% were informally employed, and more than 62% were Christians. Moreover, 97.8% were formal educated and 52.2% had 1-4 living children. The overall contraceptive prevalence was 33.7% while mCPR was 30.86%. Significantly whereas 36.6% had ever used contraception, 29.7% had never. The top contraceptives choices were injectables (56.7%), implants (27%), calendar method (6.4%) and abstinence (2.8%). Significantly, 99.8% were aware of contraception and, radio (91%) and health workers (82%) being major sources of information. Significant factors affecting uptake include age and marital status, youngest child’s age, decision when to have next child, history of sexually transmitted disease, partner’s age and support. Conclusion: The contraceptive prevalence rates are below the national average and the London target despite significant awareness among women. Efforts to increase uptake should include male involvement, continued dissemination of information and reinforcing sexual and reproductive health education in schools. This will help to demystify misconceptions, misapprehensions and myths about contraceptives. Keywords: Contraception, London 2012 summit, Male support, Uganda
Covariates of pica among pregnant women attending antenatal care at Kawempe hospital, Kampala, Uganda: a cross-sectional study
(The American Society of Tropical Medicine and Hygiene, 2021) Nakiyemba, Olivia; Obore, Susan; Musaba, Milton; Wandabwa, Julius; Kiondo, Paul
Pica is the craving and purposive eating of nonfood items. It is common worldwide and presents among vulnerable populations like children and pregnant women. Its etiology and health consequences are not well understood. The aim of this study was to determine the prevalence and covariates of pica among pregnant women attending antenatal clinic at Kawempe hospital in Uganda. We conducted a cross-sectional study from July 2019 to December 2019. Participants in this study were 307 pregnant women who had come to attend antenatal clinic at the hospital. The prevalence of pica was computed. Bivariate and multivariable analysis was done to establish the factors that were independently associated with pica. The prevalence of pica was 57%. The most common type of pica was geophagia (eating clay and sand) followed by pagophagia (eating ice). Of the women who practiced pica, half consumed the nonfood items daily. Factors independently associated with pica were being in the third trimester (adjusted OR [aOR]: 3.60; 95% CI: 1.36–9.48] and having nausea in pregnancy (aOR: 2.11; 95% CI: 1.20–3.70). At Kawempe hospital, pica is common among women who attend the antenatal clinic and is associated with having nausea in pregnancy and being in the third trimester. Health workers need to counsel pregnant women about the dangers of pica so as to reduce helminth infections and micronutrient deficiency associated with it.
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
Covid-19, healthcare and self-medication issues in resource limited-settings :
(Busitema University, 2021) Sefah, Israel Abebrese; Essah, Darius Obeng; Haque, Mainul; Opanga, Sylvia A; Kumar, Santosh; Chikowe, Ibrahim; Kibuule, Dan; Rampamba, Enos M; Kalungia, Aubrey C; Thi Phuong, Thuy Nguyen; Saleem, Zikria; Markovic‑Pekovic, Vanda; Kurdi, Amanj; Godman, Brian
Introduction and objectives: There have been concerns with the level of misinformation regarding COVID-19 and its treatment, drug shortages, as well as increased use and prices of antimalarials, antibiotics and hygiene products during the recent pandemic. Community pharmacists can play a significant role in disease prevention and treatment in the fight against COVID-19 including providing hygiene information and medicine availability across Africa and generally. Consequently, there is a need to review the role of community pharmacists in preventing unintended consequences during any pandemic as well as the impact of COVID-19 on the demand, availability and prices of suggested medicines for its management. Method: Multiple approach involving a qualitative review of the management of COVID-19 across countries coupled with a pilot study in Ghana among six purposely selected community pharmacists during the early stages of the pandemic assessing patterns of demand, availability and prices of medicines suggested for the management of COVID-19. Alongside this, pharmacists’ future role enhancing appropriate medicine use in Ghana and wider combined with the help of senior level co-authors. Results: The majority (five out of six) of pharmacists in Ghana reported increased demand for hydroxychloroquine, antibiotics and vitamins as immune boosters resulting in shortages with price increases particularly for antimalarials. Conclusion: The global lockdown had impacted on the supply and prices of medicines in Ghana similar to other countries. Community pharmacists can play a key role with encouraging safe medicine use, reducing self-purchasing of medicines and planning workflows during future pandemics including vaccinations. They can also help address potential misinformation and its consequences as well as the unintended consequences of pandemics including better management of non-communicable diseases. Keywords: Community pharmacists, COVID-19, Ghana, misinformation, self-medication, supply chain
COVID-19:
(PKP Publishing services, 2020) Lates, Jennie; Kibuule, Dan
Globally, the COVID-19 pandemic has aggravated inequalities in access to quality pharmacy education, particularly in resource-limited settings in Africa (Engle, 2020; Fuller et al., 2020). This is a serious concern for Africa especially, given that sub-Saharan Africa ranks lowest on the global pharmaceutical workforce index and has a disproportionately high burden of infectious and non-communicable diseases, combined with weak health systems (World Health Organisation [WHO], 2013; Bates et al., 2018).
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
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
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
Effect of pre-operative bicarbonate infusion on maternal and perinatal outcomes among women with obstructed labour in Mbale hospital: A double blind randomized controlled trial
(PLOS One, 2021) Musaba, Milton W.; Wandabwa, Julius N.; Ndeezi, Grace; Weeks, Andrew D.; Mukunya, David; Waako, Paul; Nankabirwa, Victoria; Tulyamuhika Mugabe, Kenneth; Semakula, Daniel; Tumwine, James K.; Barageine, Justus K.
Introduction Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labour (dystocia). Its effectiveness and safety among women with obstructed labour is not known. Objective To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labour (OL) in Mbale hospital. Methods We conducted a double blind, randomised controlled trial from July 2018 to September 2019. The participants were women with OL at term (>37 weeks’ gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements. Intervention A total of 477 women with OL were randomized to receive 50ml of 8.4% sodium bicarbonate (238 women) or 50 mL of 0.9% sodium chloride (239 women). In both the intervention and controls arms, each participant was preoperatively given a single dose intravenous bolus. Every participant received 1.5 L of normal saline in one hour as part of standard preoperative care. Outcome measures Our primary outcome was the mean difference in maternal venous blood lactate at one hour between the two arms. The secondary outcomes were umbilical cord blood lactate levels at birth, neonatal sepsis and early neonatal death upto 7 days postnatal, as well as the side effects of sodium bicarbonate, primary postpartum hemorrhage, maternal sepsis and mortality at 14 days postpartum. Results The median maternal venous lactate was 6.4 (IQR 3.3–12.3) in the intervention and 7.5 (IQR 4.0–15.8) in the control group, with a statistically non-significant median difference of 1.2 mmol/L; p-value = 0.087. Vargha and Delaney effect size was 0.46 (95% CI 0.40–0.51) implying very little if any effect at all. Conclusion The 4.2g of preoperative intravenous sodium bicarbonate was safe but made little or no difference on blood lactate levels.

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