Department of Clinical Phamacology

Permanent URI for this collection

https://bdears.busitema.ac.ug/handle/123456789/364

Browse

Now showing 1 - 20 of 37

Sub-Acute toxicity effects of methanolic stem bark extract of entada abyssinica on biochemical, haematological and histopathological parameters in wistar albino rats
(Frontiers in pharmacology, 2021) Obakiro, Samuel Baker; Kiprop, Ambrose; Kigondu, Elizabeth; K’owino, Isaac; Kiyimba, Kenedy; Kato, Charles Drago; Gavamukulya, Yahaya
Background: Whereas the efficacy of Entada abyssinica (fabaceae) extracts against various ailments has been scientifically validated, its safety has not been established. This study was undertaken to evaluate the toxicity effects of methanolic stem bark extract of E. abyssinica on biochemical, haematological and histological parameters of Wistar albino rats following repeated oral administration. Methods: Wistar albino rats of both sexes were randomized into groups and orally administered daily with determined doses (150, 300 and 600 mg/kg) of E. abyssinica methanolic extract using 1% tween 80 in distilled water as a control for 28 days. On the 29th day, all the animals were sacrificed and dissected to collect blood and selected organs. The serum and whole blood were assayed for biochemical and haematological parameters respectively while selected organs were examined for histopathological lesions. Numerical data was analyzed using graph pad prism and expressed as mean ± standard error of mean. The differences between the treatment and control groups were tested for statistical significance using one-way analysis of variance and/or Student’s t-test. Results: In repeated daily oral doses (150, 300 and 600 mg/kg), the methanolic stem bark extract of E. abyssinica did not cause significant alteration in majority of the biochemical and hematological indices. However, the extract significantly elevated the level of uric acid (all doses), aspartate aminotransferase (300 and 600 mg/kg), low density lipoproteins (150 mg/kg) and mean corpuscular heamoglobin concentration (all doses). On the other hand, the extracts reduced high density lipoproteins (150 and 300 mg/kg), mean corpuscular volume (all doses), haematocrit (150 and 600 mg/kg), mean platelet volume (150 and 600 mg/kg) and procalcitonin (150 mg/kg). In the vital organs, therewere no significant lesions observed except at the highest dose (600 mg/kg) where there was mild evidence of lymphocyte infiltration in the liver and focal interstitial nephritis. Conclusion: The methanolic stem bark extract of E. abyssinica is relatively safe in Wistar albino rats when repetitively administered orally in small doses for a prolonged period of time. We recommend more chronic toxicity studies and clinical trials on herbal remedies containing this plant to ensure that its use is free of potential toxicity to humans. Keywords: toxicity, fabaceae, traditional medicine, Entada abyssinica, biochemical, haematological, histopathalogical, wistar albina rats
Awareness of, responsiveness to and practice of patients’ rights at Uganda’s national referral hospital
(Sabinet, 2013) Kagoya, Harriet Rachel; Kibuule, Dan; Mitonga-Kabwebwe, Honoré; Ekirapa-Kiracho, Elizabeth; Ssempebwa, John C.
Background: The realisation of patients’ rights in resource-constrained and patient-burdened public health care settings in Uganda remains an obstacle towards quality health care delivery, health careseeking behaviour and health outcomes. Although the Uganda Patients’ Charter of 2009 empowers patients to demand quality care, inequitable access and abuse remain common. Aim: The study aimed to assess level of awareness of, responsiveness to and practice of patients’ rights amongst patients and health workers (HWs) at Uganda’s national referral hospital, Mulago Hospital in Kampala. Methods: A three-phase cross-sectional questionnaire-based descriptive survey was conducted amongst 211 patients, 98 HWs and 16 key informants using qualitative and quantitative data collection methods. The study was conducted in May–June 2012, 2.5 years after the launch of the Uganda Patients’ Charter. Results: At least 36.5% of patients faced a challenge regarding their rights whilst seeking health care. Most of the patients (79%) who met a challenge never attempted to demand their rights. Most patients (81.5%) and HWs (69.4%) had never heard of the Uganda Patients’ Charter. Awareness of patients’ rights was significantly higher amongst HWs (70%) than patients (40%) (p < 0.01). Patients’ awareness was associated with education level (c2 = 42.4, p < 0.001), employment status (c2 = 33.6, p < 0.001) and hospital visits (c2 = 3.9, p = 0.048). For HWs it was associated with education level (c2 = 155.6, p < 0.001) and length of service (c2 = 154.5, p <0.001). Patients feel powerless to negotiate for their rights and fear being discriminated against based on their ability to bribe HWs with money to access care, and political, socio-economic and tribal status. Conclusion and recommendations: Awareness of, responsiveness to and practice of patients’ rights remains limited at Mulago Hospital. There is a need for urgent implementation of an integrated multilevel, multichannel, patient-centred approach that incorporates social services and addresses intrinsic patient, HW and health system factors to strengthen patients’ rights issues at the hospital.
Current and former students’ views on two different methods of classroom-based teaching in pharmaceutical care:
(FIP, 2016) Kalemeera, Francis; Naikaku, Ester; Mubita, Mwangana; Kibuule, Dan
Background: Namibia is divided into 34 districts, each with a public hospital supplemented by a number of primary health care facilities. These hospitals shoulder the responsibility of ordering and distributing pharmaceuticals for the district as a whole. As the number of pharmacists in the public sector is quite low, staff often get engrossed in supply chain issues on the expense of pharmaceutical care. Namibia, cognisant of this challenge, established the School of Pharmacy, with one of the goals being to equip the students with knowledge and skills in the area of pharmaceutical care. So far two groups have gone through pharmaceutical care training: the 2014 and 2015 BPharm IVs. The 2014 group received classroom-based training through conventional didactic sessions, while the 2015 group was trained via case-discussions. The two groups were asked to comment on which of the two training methods was better for pharmaceutical care training. Methods: We summarised the methods of classroom-based training as implemented in 2014 and 2015. We used a Focus Group Discussion with the 2015 group and telephonic discussion with individuals of the 2014 group. Individuals from both groups were asked if they would pursue a career in hospital-based clinical pharmacy. We used the Student’s T test to compare the proportions of students who reported wanting to pursue a career in clinical pharmacy, with the confidence level set at 95%, and the significance observed at a p-value ≤ 0.05. Results: Summaries of the two methods were generated and used to explain the two methods to the respondents. All the respondents (n=9, 2015 group; n=10, 2014 group) said that the case discussion method was better than the conventional didactic sessions. The majority of the respondents (n=8, 89%) from the 2015 group said they would pursue a career in clinical pharmacy. Conclusion: The case-discussions seem to be a better method for classroom-based training, when compared with the conventional didactic sessions. Even though the proportion of students considering building a career in clinical pharmacy was greater in the Class of 2015 than that in Class of 2014, we cannot conclude that the new method of training was the reason that underscored the difference. A more in-depth assessment is required to provide clarity on the relationship between the module delivery method and pursuing a career in clinical pharmacy. Keywords: Clinical Pharmacy, Pharmaceutical Care, Case-Discussions, Didactic Sessions
Compliance to guidelines for the prescribing of antibiotics in acute infections at Namibia’s national referral hospital:
(Taylor & Francis, 2017) Nakwatumbah, S.; Kibuule, D.; Godman, B.; Haakuria, V.; Kalemeera, F.; Baker, A.; Mwangana, M.
Background: Sub-optimal antibiotic prescribing remains a public health concern in Namibia. The objective is to determine the level and predictors of compliance to guidelines in the prescribing of antibiotics in acute infections at a national referral hospital in Namibia to improve future prescribing. Methods: Descriptive observational cross-sectional study. The clinical records of patients receiving care were reviewed. Prescribing practices were assessed using a self- administered questionnaire with reference to Namibia Standard Treatment Guidelines (NSTG). Results: The majority of prescriptions (62%) complied with the NSTGs; however, lower than national targets (95%). Most prescriptions were empiric and prescribers typically made reference to the NSTG (58%). Diagnosed infections were principally respiratory infections (58%) and penicillins were the most used antibiotics. Good concurrence between signs and symptoms with the diagnosis; diagnosis of upper respiratory tract, oral-dental and urogenital infections with prescribing of penicillins. Combination antibiotics and amphenicols were independent predictors of compliance to the NSTGs. The main behaviours associated with antibiotic prescribing were patient influences, clinical state, and access to guidelines. Conclusions: Compliance to NSTGs is suboptimal. Prescribing of combination antibiotics, penicillins and diagnosis of oral dental, genitourinary and ear, nose and throat infections were important predictors for NSTG compliance. There is a need to implement antibiotic indicators and stewardship programmes, and ensure access to NSTGs, to improve future antibiotic prescribing in Namibia.
Initiatives to increase the prescribing of low cost generics :
(KEIJournals, 2017) Godman, Brian; Baker, Amanj; Leporowski, Axel; Morton, Alec; Baumgärte, Christoph; Bochenek, Tomasz; Fadare, Joseph; Finlayson, Alexander; Hussain, Shazhad; Khan, Babar; Kalaba, Marija; Kibuule, Dan; Kwon, Hye-Young; Melien, Oyvind; Nascimento, Renata CRM; Salem, Ahmed; Schiffers, Krijn; Truter, Ilse; Voncina, Luka; Hassali, Mohamed Azmi
Getting the most out of the pharmaceutical budget is critical across all countries as the financial pressures on healthcare systems intensify. In this paper, we review global practice on encouraging the use of low costs generics versus branded pharmaceuticals, including patented products in the same class where care is not compromised, across countries to guide future practice. Our review ranges widely across European countries as well as other high income countries, including Abu Dhabi, Japan and the USA, and other low and middle income countries. There is a particular focus on Scotland, building on previous publications. We conclude based on multiple publications, including several case studies, that achieving efficiency in pharmaceutical spending is possible in virtually all environments, although there are examples of technologies where generic or therapeutic substitution should not be encouraged. However, there is no magic bullet to achieving full and appropriate use of generics. Countries have to be prepared to use a number of different education, economic, engineering and enforcement methods including prescribing restrictions to achieve success. Similarly, different approaches to achieve low prices for good quality generics given the considerable price differences that currently exist. The combination of low prices and increased use of generics will help achieve or attain universal healthcare, benefiting all key stakeholder groups. We conclude with a call for greater cross-country learning in pursuit of what should be a common goal for all health systems. Keywords: Co-payments, compulsory substitution, generics, prescribing restrictions, prices, reforms, Scotland
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.
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
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.
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
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
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
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
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
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.
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
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)
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.
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.
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.

Browse

Recent Submissions