School of Health Sciences (Health-Sciences)

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    Exploring experiences and self efficacy of midwives in screening and managing gender based violence in pregnant women: A qualitative study in Antenatal Clinic of Mulago hospital.
    ( 2018-05) Gai, David
    Background: Gender-based violence among pregnant mothers remains a challenge in both developed and developing countries in the world today. Nations and stakeholders continue to involve themselves in the tackling of this vice. The involvement of midwives is very crucial during the prenatal care period as these are the professionals constantly in touch with them throughout pregnancy. Assessing the experiences and self-efficacy of midwives to understand their interaction with the pregnant mothers experiencing GBV is very paramount. Less is known about the experiences andself-efficacy of midwives during screening and managing gender-based violence in Uganda. This study aims at assessing the experiences and self-efficacy of midwives in screening and managing gender-based violence among pregnant mothers attending antenatal care services in Mulago hospital. Objective: To explore the experiences and self-efficacy of midwives in screening and managing gender-based violence. Methodology: This study used an explorative qualitative design using in-depth interviews to collect data from participants. The participants that were recruited in this study were midwives in Mulago hospital both enrolled and registered working in the antenatal clinic. Results: Midwives experience various challenges such as lack of facility support, lack of training on GBV, failure of clients to disclose abuse and knowledge related challenges among them. They report confidence in screening and managing GBV among pregnant mothers. Conclusion: Midwives do a screening of GBV according to the presentation of pregnant mothers at antenatal care clinic. In the process of screening and managing GBV, they face many challenges.
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    Prevalance and factors associated with uncorrected refractive errors among children of 13-17 years of age in Mayuge District, Uganda.
    (Makerere University, 2018-07-27) obbo, Martin
    Background: Uncorrected refractive errors (URE) are the leading cause of avoidable blindness among children worldwide, making the comparison of prevalence of uncorrected refractive errors among children in Uganda a topic of interest. This study aims to determine the prevalence of uncorrected refractive errors in children between 13-17 years of age. More information regarding the prevalence of URE is greatly needed in the country for sufficient planning by the Ministry of Health. Objective: To determine the prevalence of uncorrected refractive errors among children between 13-17 years of age in Mayuge district, Uganda. Methodology: A cross-sectional study design was used in which Bunya Secondary school was selected using random sampling method to represent Mayuge district. A total of 158 participants aged between 13-17 years of age were be enumerated in the study. Unaided visual acuity (VA) using a Snellen chart at a distance of 6 meters, near binocular visual acuity and direct ophthalmoscopy for all participants after obtaining an informed consent was employed. The VA was repeated using a pinhole for participants with VA ≤ 6/12. A non-cycloplegic refraction was done for those whose pinhole VA improved. Near vision refraction was assessed for each participant whose near vision was less than N8. Data was collected using the patient record cards and questionnaires then stored using Microsoft Access 2016. The results were analyzed using SPSS version 25. Results: The prevalence of uncorrected refractive errors in Mayuge district was 16.7%. This result is much lower than similar studies from the India subcontinent where rates varied between 30% to17.1% (Marmamula et al., 2011b, Nangia et al., 2013). Conclusion: The prevalence of uncorrected errors is 16.7% among children aged between 13-17 in Mayuge district. This is not very significant compared to previous studies done around the world. There is still room to address the prevalence of URE in the future. Recommendations: More research is needed in this country in the aspect of URE so as to echo out the urgency to combat the URE to prevent avoidable blindness and vision impairment. More resources are needed to inspire more research as well in this field.
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    Prevalence, management and outcomes of postpartum hemorrhage in women delivering in Arua Regional Referral Hospital
    (Makerere University, 2019) Nabuyondo, Zaharah
    Postpartum Hemorrhage (PPH) is commonly defined as a blood loss of 500 ml or more within 24 hours after birth(WHO, 2014). Globally, postpartum hemorrhage (PPH) is a leading cause of maternal mortality(Say et al., 2014). The global prevalence of PPH is 6 % (Oyelese&Ananth, 2010) and the highest burden is experienced in low-income countries (Sheldon et al., 2014). It is a major cause of maternal morbidity and mortality, accounting for about one-third of all pregnancy-related deaths in Africa and Asia(Lozano et al., 2012). The magnitude of PPH in sub-Saharan Africa is very high accounting for about 10.5 % the deliveries(Rath, 2011). In Uganda, PPH causes 25 % of all maternal deaths(Sheldon et al., 2014) .The severe morbidities associated with PPH include anemia, disseminated intravascular coagulation, blood transfusion, hysterectomy, and renal or liver failure(Callaghan, Kuklina, & Berg, 2010; Walsh, 2011).Uterine atony, or failure of the uterus to contract after delivery, is the most common cause of PPH(Viteri&Sibai, 2018). The prophylactic administration of a uterotonic has been shown to reduce the incidence of PPH through inducing uterine contractions(Dildy III, 2018). Oxytocin is considered the gold standard for prophylaxis, although ergometrine, methergyne, and misoprostol are also frequently used. When uterine atony occurs, the timely administration of a uterotonic drug is recommended(Dahlke et al., 2015). Uterotonic treatment can help prevent the need for more sophisticated interventions, such as the administration of intravenousfluids, additional drug therapy,bloodtransfusion,and surgical intervention. Other interventions in management of PPH include, normal saline/Ringer’s lactate infusion, clot removal, uterine massage, catheterization, vaginal packing, removal of retained placenta and suture compression. Although PPH occurs in all settings, the majority of maternal deaths as a result of PPH take place in developing countries, of which Uganda is included. This disparity has been attributed to differences in quality of care, including the availability of trained personnel attending deliveries, access to quality uterotonic drugs, and the timely receipt of needed interventions when obstetric emergencies arise(Stanton et al., 2012). In the World Health Organization (WHO) multicountry survey that documented the incidence of maternal morbidity and mortality at health facilities globally, PPH accounted for 27% of all deliveries (Souza et al., 2013). In Uganda specifically, majority of the studies focus on the risk factors associated with PPH(Ngwenya, 2016;Ononge, Mirembe, Wandabwa, & Campbell, 2016), and not much is documented regarding outcomes of PPH. This study therefore aims to determine the prevalence, management and outcomes of PPH in a regional referral hospital in Arua District.
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    In vitro asseement of the anti bacterial activity of ethanolic aeriel part extract of momordica foetida extract on the armpit flora
    (makerere, 2019-04-23) Kigenyi, Silagi ; Sida, Harrison
    ABSTRACT. Momordica foetida is a perennial herb with creamy flowers with reddish or orange center and having both female and male flowers on same plant. The fruit is bright orange with prickles on a beautiful plant but very unpleasant smell that belong to Cucurbitaceae family. The aerial parts of Momordica foetida was used, crushed and its contents extracted using, 9 8 % ethanol (alcohol). The antibacterial activity of the extract was tested on the axilla swab and. susceptible staphylococcus aureus A TCC 25953. The axilla swab from two patients who had experienced the bad odor were then cultured on the blood agar for 24hours at a temperature of 37.7°C. the grown microorganisms were exposed to the ethanolic extract of Momordica foetida and later also incubated at above stated conditions for the same period. The biggest zone of inhibition was seen with 200mg/ml concentration but the MIC was seen with 25mg/ml concentration of the ethanolic aerial extract of Momordica foetida. That was for both axilla swabs and also for staphylococcus aureus ATCC 25953.The graph pad prism 7 was run to compare the zones of inhibition between the negative control and the extract and p-value of 0.0001 was obtained indicating a high level of significance. There is significant antibacterial activity of the ethanolic aerial extract of Momorclica foeti cia on the staphylococcus aureus as shown by the p-value.Sorne bacteria in the armpit swab were susceptible and others were not susceptibale
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    Use of herbal medicine by caregivers in the management of children with sickle cell disease in Mulago National Referral Hospital - Uganda
    (Makerere University, 2019-05) Lubega, Martin
    ABSTRACT Introduction: Sickle Cell Disease (SCD) is an inherited chronic disease and remains a global public health threat. Studies have reported use of complementary and alternative medicines in chronic diseases such as sickle cell. However, in Uganda, the extent to which herbal medicines are used in management of children with sickle cell disease has not been documented. This study was conducted to determine the prevalence of herbal medicine (HM) use and associated factors among caregivers of children with SCD at Mulago National Referral Hospital. Methodology: A descriptive cross-sectional quantitative study was conducted in March 2019 at Mulago Sickle cell clinic. A sample of 384 caretakers was consecutively recruited and a structured interviewer administered questionnaire was used to collect data from the caretakers. Data was managed using SPSS version 23. Multivariate logistic regression was used to identify the factors associated with HM use. Factors with p-value <0.05 were regarded significant. Results: In this study, 298 of 384 (77.6%) caregivers used herbal medicine. Multivariate analysis of the various factors associated with HM use revealed that the odds of a caregiver who agreed that HM cures symptoms faster than conventional medicine (CM) using HM were 3 times those of caregivers who disagree with this statement (AOR =3.439, 95% CI: 1.447 - 8.176). The odds that a caregiver who agreed that HM has fewer side effects than CM were almost 4 times those of caregivers who disagree with this statement (AOR =3.528, 95% CI: 1.917 -6.494). The odds that a caregiver who agreed that marketing HM through televisions adverts encourages HM use were 4 times those of caregivers who disagree with this statement (AOR =4.185, 95% CI:2.036 - 8.603). Conclusion: This study reports a high prevalence of HM use among caregivers of children with SCD. The practice is significantly influenced by caretakers’ perception that HM cures symptoms faster than CM, HM has fewer side effects than CM and the use of television adverts in marketing HM. More effort is therefore needed to explore the various perceptions caretakers have about HM and assessment of the various television adverts on HM for their credibility and authenticity. There is also need for studies to identify the common HM used so that their efficacy and safety are well studied.
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    Prevalence of risky Sexual Behaviors and Associated Factors among HIV Positive Adults on ART at Wakiso Health Centre IV.
    (Makerere University, 2019-05) AMANYA, CHARLES
    Introduction Risky sexual behaviors among people living with HIV/AIDS is a public health concern because of risk of HIV transmission, acquiring resistant strains and STIs. The main objective of this study was to determine the prevalence of risky sexual behaviors and associated factors among HIV positive adults on ART at Wakiso Health Centre IV. Methods The study employed a descriptive cross sectional design. A pretested interviewer administered questionnaire was used to collect data. Systematic random sampling technique was used, 207 respondents participated in this study. The data were entered into SPSS version 20 and analyzed. Descriptive, bivariate and multivariate analysis were done. A P˂0.05 was considered to determine the statistical significance of the association between factors and risky sexual behaviors. Results A total of 207 respondents participated in this study. The prevalence of risky sexual behavior was 60.9%. The factors associated with risky sexual behaviors at multivariate analysis were, disclosure to close friends (AOR=2.113 P=0.015), social support (AOR=0.499 P=0.028) and people on ART not likely to use condoms (AOR=3.115 P=0.000). Conclusion: The prevalence of risky sexual behaviour among HIV positive adults who attended the HIV clinic at Wakiso Health Centre IV is 60.9%.Majority of the participants did not disclose to close friends, a quarter of the participants are still using alcohol and more than half reported no social support.
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    Prevalence and forms of work place abuse among nurses and midwives working within and around Kampala
    ( 2019-05) Mazzi, Ruth
    Introduction. Globally work place abuse has been documented among nurses and midwives and its associated with decrease in the quality of nursing care provided in hospitals. However, there is limited information and data about work place abuse in Uganda thus this study sought to document the prevalence and forms of work place abuse among nurses and midwives working within and around Kampala in Uganda. Methodology. A cross sectional study was conducted with 240 nurses and midwives. Participants were enrolled through peer referral from facilities within and around Kampala. We ascertained prevalence and forms of work place abuse through a self-administered questionnaire. We analyzed data descriptively and presented it in form of tables, pie charts and bar graphs. Results. Of the participants 98(40.8%) had observed work place abuse while on duty. Among those who reported experiencing work place abuse 31.5%had experienced it in the last 6-months and 23.3% in 12 months prior to the study. The commonest forms of work place abuse were verbal abuse (74.5%), physical abuse (6.1%), psychological abuse (18.4%) and sexual abuse(1%) . The frequently cited abusers were: nurse in charges (35.6%), doctors (21.9%), fellow nurses (20.5%) and patient relatives (5.5%). Conclusion. 3 in 10 nurses working within and around Kampala have experienced abuse in the last six months. The commonest forms are verbal and psychological mainly by the nurse in charges, doctors, senior nurses and administrators.
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    Assessment of medication errors at the in-patient wards of Arua Regional Referral Hospital, Arua District, Uganda
    (Makerere University, 2019-05) Mwawule Wadulo, Fredrick ; Bacia, Laura
    Background: A medication error is interpreted as an avoidable circumstance which may affect the drug end user while the medication is in his/her custody or even in the care of the healthcare professional. Medication error occurrences have been explored and documented in some parts of Uganda but not in ARRH. And since these errors pose a serious challenge to the health care system, it was worth assessing their occurrence in ARRH. Objectives: To establish the prevalence of different types of medication errors, drivers of medication errors and hindrances to medication error reporting at the in-patient wards of ARRH. Methods: It was a descriptive cross-sectional study employing mixed methods. The study was conducted at the in-patient department of ARRH amongst 309 patients and 59 HWs. Data was collected using a semi- structured questionnaire and key informant interview guides. Data was analyzed using the SPSS version 19.0 computer package. Data collected were presented in form of pie charts, frequency tables and bar graphs and summarized into percentages. Qualitative data was presented in form of detailed descriptions. Findings: Administration errors accounted for majority (57.2%) of the medication errors, followed by dispensing errors (53.1%) and lastly prescription errors (36%).The study results indicated that antibiotics were the category of medicines more prone to incorrect time of drug administration (76.4%) and incorrect frequency of drug administration (93.8%) with a statistical significance of p=0.00 in all scenarios. None of the 309 patient files completely had no medication errors. Drivers to medication errors reported were personal negligence, attitude of health workers, lack of enough reliable knowledge and desire to avoid mistrust significantly hindered medication error reporting with 43 HWs agreeing. Conclusion: Medication errors are common in ARRH and are most prevalent during drug administration. Negligence is the key factor implicated in medication error occurrence. Desire to avoid mistrust and fear of being rated incompetent amongst HWs has significantly hindered error reporting.
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    IUD contraceptive use among women of reproductive age: A qualitative study at the Family Planning Clinic of Nakaseke General Hospital
    (Makerere University, 2019-05) Nambalirwa, Teddy
    Uganda has a high Maternal Mortality Rate (MMR) of 343 per 100000 live births. This could be due to unwanted pregnancies thus leading to major complications such as abortions, hemorrhage. However, to reverse this high maternal death, long acting reversible contraceptives (LARC) which includes Intra Uterine Devices (IUD) had been proposed in the developing countries. Despite availing the necessary contraceptive, Uganda still has a very low uptake of (IUD) among women of reproductive age at 0.6 percent and their discontinuation rate in the first three months of use is also high
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    Invitro assessment of antibacterial activity of a combination of cloxacillin and an extract of tithonia diversifolia flowers against MRSA.
    (Makerere University, 2019-05-16) Oyuru, Amos ; Kibalya, Ronald Nditusawa
    ABSTRACT. Introduction. Staphylococcus aureus is a very common pathogen implicated in causing hospital acquired infections including skin, soft tissues, respiratory, bone, joint and cardiovascular diseases. The pathogen has exhibited resistance to a number of antibiotics; one of such resistant isolates is Methicillin resistant S. aureus. It is resistant to all currently available beta-lactam antibiotics. This leaves the only choice of treatment as second line agents for example Vancomycin and linezolid; these are expensive and very vulnerable to resistance. However, resistant species to vancomycin have also been isolated. Furthermore, the epidemiology of infections caused by MRSA are changing from being confined within the hospitals to being common within the community settings, and if the increasing antibiotic resistance is left un attended to, management of S. aureus infections may become too complex and no more effective antibiotics will be present for management of this infections in the near future. Therefore purpose of this study was to test for the activity of an essential oil extract from the flowers of T. diversifolia against MRSA and to further assess the antibacterial effect of combining its essential oil extract with cloxacillin against MRSA. Objectives. I. To assess the antibacterial activity of the essential oil extract from the flowers of T. diversifoliaagainst MRSA. II. To assess the antibacterial activity of the combination of essential oil extract from the flowers of T. diversifolia and cloxacillin against MRSA. Methodology The flowers were collected and the essential oil extracted by hydro distillation, its antimicrobial susceptibility against MRSA was tested, its MIC was also determined by MIC by agar well diffusion method. The MIC of cloxacillin was also determined. This was followed by determination of the FICI of the combination at different concentration ranges of the MICs of cloxacillin and the essential oil extract. Results. MIC of T. diversifolia flower’s essential oil and that of cloxacillin was determined to be 17mg/ml and 48µg/ml respectively. The FICI was 0.122.
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    Assessment of Knowledge, Attitudes and Practices of Patient Counseling for Diabetes Mellitus Patients by Dispensers in Community Pharmacies in Kampala
    (Makerere, 2019-05-22) Kisakye, Jackline Nsanze ; Mutabazi, Daisy
    ABSTRACT Background Diabetes is one of the leading causes of morbidity and mortality worldwide. Although medication counseling and interventions by dispensers have been found to support the management of diabetes mellitus, little is known about dispensers’ knowledge concerning patient counselling and regular practices and attitudes concerning medication counselling of diabetes patients in community pharmacies. Objectives The objective of this study was to assess the practices, knowledge and attitudes of dispensers towards counselling diabetic patients within community pharmacies in Kampala. Methods This was a cross sectional study with subjects as the pharmacy stuff involved in patient care in community pharmacies in Kampala district. Data was collected by the principal investigators and research assistants using two tools namely; a questionnaire and simulated client checklist. Data was doubly entered into Epi data and later exported to SPSS for statistical analysis in order to derive conclusions. Results: In the cross-sectional study, we had a 100% response rate. Using questionnaires, 82% of the respondents had good counselling practices. The information that was most frequently provided to patients was name, dose and dosing schedule of the drug which was supported by the simulated client study. 97% of the respondents knew how to update their knowledge on new and existing drugs, however only 27% of the respondents had good knowledge about Diabetes and its management. The most used sources of drug information were formularies and guidelines (60.5%) and the internet (57.5%). 97% of respondents strongly agreed/agreed that patient counselling is the responsibility of pharmacy professionals. Conclusion: The present study emphasizes the existing gap in self-reported and actual counseling practices by community pharmacist in Kampala, Uganda. Hence, the ministry of health, local health policy makers and other stakeholders should collaborate to design interventions to improve community pharmacists’ dispensing and counseling practice.
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    Assesment of knowledge, attitudes and practices on adverse drug reaction reporting in retail community pharmacies in kampala
    (Makerere University, 2019-05-22) Narika, Racheal Lodor ; Namaganda, Veronica
    ABSTRACT Background; Adverse Drug Reactions (ADRs) are scantly reported with poor contribution by healthcare professionals worldwide and in particular in developing countries. The aim of this study was to assess the knowledge, attitudes and practices of adverse drug reactions (ADRs) reporting in retail community pharmacies in Kampala. Methods; a cross sectional study was done in retail community pharmacies in Kampala. A self-administered questionnaire was adapted from similar studies that have been done and modified to our setting. Data was collected by the principal investigators and research assistants from dispensers in retail community pharmacies in Kampala. Completed questionnaires were collected and data were analyzed. Data were expressed in numbers as well as percentages. Results; 203 healthcare professionals responded including 13 pharmacists, 34 pharmacy technicians, 24 allied health professionals, 126 nurses. 95% knew what the term adverse drug reaction means, 93% were aware that ADRs should be reported. 68% of the respondents knew that Uganda has ADR reporting forms, and that Uganda has a national Pharmacovigilance Centre. Overall 97% of the respondents had good knowledge. All the respondents had good attitudes; all of them agreed that ADR reporting is important and necessary, and 71% thought that it should be voluntary. All participants were willing to take up a training on ADR reporting. In practices; 45% of the respondents had ever suspected an ADR however only 9% of these had ever reported to the NDA with a frequency of less than 10 times. Only 24% of the respondents were aware of the availability of ADR reporting forms at the facility. 56% of the facilities encouraged reporting especially through training (94%) and only 25% of the community pharmacies have SOPs for reporting ADRs. Conclusions; The study showed that the health care professionals had a good knowledge and attitude towards ADR reporting. However this was not reflected in the practices as most didn’t report ADRs despite suspecting their occurrence.
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    Assessment of inventory management in a public hospital and a private not for profit hospita in Uganda: A case of Kawolo Hospital and ST. Francis hospital Nsambya
    (Makerere, 2019-05-22) Kananura, Emmanuel ; Tumwebaze, Ambrose
    ABSTRACT Introduction. Proper inventory management is key to ensuring effective and sustainable health care provision through appropriate handling of medicines and health supplies. To ensure effective systems in Uganda, the ministry of health (MoH) has championed use of Essential Medicines and Health Supplies reporting and ordering system that enables local handling of medicines and health supplies at each hospital. However, proper use of this system remains a major bottleneck to the health sector in general which has resulted into frequently reported stock outs and expiries and variable performance amongst Public and Private Not for Profit (PNFP) hospitals. Objective. This study was aimed at assessing inventory management in a Public and PNFP hospital in Uganda, a case study of Kawolo hospital, Lugazi and St. Francis hospital, Nsambya. Methods. A cross sectional study was employed using a mixed methods approach to collect both qualitative and quantitative data. Qualitative data was collected using key informant interviews that included hospital pharmacists, dispensers and store keepers. Quantitative collected by documentary review of the selected tracer items at the selected hospitals. Results. Both hospitals had stock cards, for some selected tracer items, though not all. Kawolo hospital used all the inventory management tools of interest unlike Nsambya which only had stock cards. The median number of days out of stock was 6 days for Nsambya hospital versus 43 days for Kawolo hospital. The mean percentage days out of stock was 21.139% at Kawolo hospital and 5.393% at Nsambya hospital. The difference in mean percentage stock out days (16.7462%) was statistically significant, given the P-value 0.04. Of the selected items, Kawolo hospital had expiries worth 5.36M while Nsambya had no documented drug expiries. Perceived factors for inventory management included; limited funding by government, delays by suppliers, insufficient technical expertise and man power and lack of supervision. A better inventory management at Nsambya hospital was attributed to good management policies, sufficient funding and the technical team for doing the good work. Conclusion Kawolo, a government hospital had more tracer items and all the inventory management tools of interest unlike Nsambya hospital, a PNFP. Generally, inventory management at Nsambya hospitalperformed better than at Kawolo hospital though both had challenges. Limited funding, lack of supervision and delays in delivery should be addressed to improve the quality of health delivery in both public and PNFPs.
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    Development of a tlc method for control of tetracycline residues in milk sold for consumption in kawempe division
    (Makerere, 2019-05-23) Seguya, Joseph
    ABSTACT Background:The intensification of animal production has necessitated the raising levels of antimicrobial use in production, with consequent presence of residues in animal related products. The rising levels of tetracycline use especially in dairy animals for the treatment of mastitis warrant development of robust and rapid screening methods to control these residues and to protect the public against effects associated with tetracycline residues such as antimicrobial resistance and delayed hypersensitivity reactions. Objective: The general objective of this research wasto develop a TLC method for screening for tetracycline residues in milk sold for consumption in Kawempe division assess. Methods Method development involved selection of a mobile phase, extraction, plate development and visualization. All these parameters were optimized and validated on robustness, repeatability, specificity and limit of detection as per the ICH guidelines. During sample analysis, a total of 57 milk samples were collected and extracted as per the developed method, and analysis done as per the method. Visualization was under UV lamp at 366nm Results A TLC method for screening tetracycline residues in milk was developed and validated as per ICH guidelines. The method was developed using a mobile phase (methanol:citric acid:acetone, 10:5:5v/v/v) on TLC glass plates SIL-G F25 with saturation time of 30 minutes and UV detection at 366nm. The Rf values for doxycycline, oxytetracycline and tetracycline were 0.68, 0.59 and 0.6. The method was repeatable, robust with good specificity. All the 57 milk samples analyzed had no detectable levels of tetracyclines. Conclusion The developed TLC method is suitable for use as a preliminary screening tool, to supplement the quantitative methods currently being used. This will reduce on the sampling time and hasten the process of controlling drug residues.
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    Evaluation of anti bacterial activity of ethanolic crude leaf extracts of mangifera indica L AND biden pilosa against methicillin resistant staphylococcus aureus.
    (Makerere University, 2019-05-23) Odradria, Moses
    Background: 80% of the world population depended on natural herbal medicines for primary health care. In Uganda, the National Drug Authority and policy recognized medicinal herbs as being a vital component to saving human lives for their pharmacological activities since they supplemented synthetic medicines. Bidens pilosa and Mangifera indica are herbal plants known to be effective against staphylococcus species and other infectious diseases such as gastroenteritis, septicemia and wound infections. Methicillin resistant staphylococcus aureus (MRSA) a superbug in the healthcare system is known to cause nosocomial infections in hospitals as well as Nursing home care facilities such as pneumonia, bacteremia, septicemia, endocarditic and toxic shock syndrome. The activity of the combined ethanolic crude leaf extract of Mangifera indica and Bidens pilosa against these bacteria were determined in this study. Objectives: To evaluate the anti-bacterial activity of combined ethanolic crude leaf extracts of Bidens pilosa and Mangifera indica with the individual extracts against MRSA. Todetermine the MICs of individual ethanolic crude leaf extracts of Bidens pilosa and Mangifera indica collected from around Makerere University main campus against MRSA. To assess if the combined ethanoic crude leaf extracts of the Bidens pilosa and Mangifera indica had antibacterial activity against MRSA. To determine which ratio of the combination had the highest antibacterial activity against the MRSA. Method An experimental study design, Well-diffusion method on a resistant isolate. Conclusion: This study combined the effects of these two extracts with evidence that the combination was superior than the effects of individual extract.
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    Acceptance of antimicrobial stewardship programs in community pharmacies in kampala city.
    (makerere, 2019-05-23) Sekasi, Moses
    Background: Increasing Antimicrobial resistance (AMR) hastens a post-antibiotic era and so underscores the need for rational and judicious use of antibiotics. World Health organization (WHO) points out antimicrobial stewardship as one of the strategies to slow the development of resistance. Antimicrobial stewardship has been adopted in hospitals but to a small extent in community pharmacies. To implement Antimicrobial stewardship in community pharmacies requires people with the right knowledge, attitudes, right practices and willingness to take up Antimicrobial stewardship programs. Objective: To assess the acceptance of Antimicrobial Stewardship Programs (AMS) by health workers in community pharmacies in Kampala city. Materials and methods: A descriptive cross-sectional study was conducted among health workers in community pharmacies in Kampala, Uganda between April, 2019 and May 2019. Pre-tested, self-administered questionnaires were used for data collection. A simple random-sampling method was used to select community pharmacies to be included in the study. Independent-sample Mann–Whitney U tests, independent sample Kruskal–Wallis tests, and logistic regression analysis were performed with SPSS version 25.0 Results: Of the 275 health workers in community pharmacies, 203 responded to the survey (response rate 73.8%). The participants had good understanding of the drivers of antimicrobial resistance. They showed positive perceptions, but poor practices regarding AMS. All of the participants were of the view that AMS program could be beneficial for health care professionals for improvement of patient care, and 78% (n=159) of participants gave their opinion about incorporation of AMS programs in community pharmacies. Collaboration was never/rarely undertaken by health workers in community pharmacies with other health care professionals over the use of antibiotics (n=158, 77.8%), and a significant proportion of participants (n=178, 87.8%) never/rarely participated in AMS-awareness campaigns. Logistic regression analysis revealed that male sex (OR 0.204, 95% CI 0.104−0.4; P<0.001), age 20–29 years (OR 0.172, 95% CI 0.05−0.595; P=0.005), and <1 year of experience (OR 0.197, 95% CI 0.083−0.468; P<0.001) were the factors associated with poor practices regarding AMS. Conclusion: The present study concludes that health workers in community pharmacies have a good understanding of the drivers of antimicrobial résistance. Health workers in community pharmacies have positive perceptions regarding AMS programs in community pharmacies. In addition, the practices of health workers in community pharmacies regarding AMS were poor. Finally, health workers in community pharmacies were willing to integrate antimicrobial stewardship programs into their practice. We recommend incorporation of AMS programs in community settings, involving health workers in community pharmacies. Further studies should be carried out by researchers on a larger scale in order to evaluate the knowledge and perceptions of health workers in community pharmacies regarding AMR and AMS programs across Uganda.
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    Assessment of compliance to sterile parenteral chemotherapeutic drug reconstitution at Uganda Cancer Institute
    (Makerere University, 2019-05-23) Ngonzi, Simon
    Background: Cancer is one of the leading causes of death globally, with 32,617 new cancer cases and 21,829 cancer deaths that occurred in 2018 only in Uganda. To reduce this burden, UCI offers chemotherapeutic treatment. However other studies show that death has been associated with contaminations of the reconstituted chemotherapeutic drugs. Aim: We assessed the compliance to sterile parenteral chemotherapeutic drug reconstitution area of the pharmacy of UCI. Methods: Swabs were taken from the surfaces at the chemotherapeutic drug reconstitution area of the pharmacy of UCI. These swabs were serially diluted and cultured on media plates. Air was also sampled using settle plate technique. The colonies formed were expressed in Cfu/ml and the potential nosocomial pathogen(s) were isolated and confirmed using gram stain and biochemical tests. Thereafter, data was statistically analyzed using SPSS version 20.0. Results: The mean log bacterial load on work surfaces between 7:00am – 7:30 am and 12:30pm-1:00pm was 4.1172 and 3.2851 (CFUs/ml) respectively. Staphylococcus aereus (10%) and coliform (5%) were major nosocomial pathogens identified on work surfaces. 100% of the personnel observed did not fill hygiene and garbing competence forms, however, 82.3% of these personnel disinfected the surface of the ISO class 5 device with appropriate agent prior to reconstitution. The facilities were 40% compliant as compared with USP (general chapter 797, 2008 edition). Conclusion and recommendations: UCI drug reconstitution area is clean with respect to common nosocomial pathogens however there is bacterial contamination and this was high in the morning than afternoon, and work surfaces were more contaminated than air. General Personnel performance was above average, facilities were not compliant to the standards. This calls for more interventions for further improvement
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    Prevalence and predictors of adverse drug reactions to first line antiretroviral therapy among adolescents at ISS Clinic-Mbarara Regional Referral Hospital
    (Makerere University, 2019-05-24) Aepei, Gabriel
    Background: HIV/AIDs remains a major threat to the health sector impacting negatively on the social and economic development of the community. With the advent of HAART there has been a reduction on AIDS related mortality. However the ADRs from these drugs are limiting the success of HAART. Objective: To determine the prevalence and predictors of adverse drug reactions to first line HAART among adolescents at ISS clinic- MRRH Methodology: A retrospective cross-sectional study was conducted at ISS clinic-MRRH among adolescent (10-19years) patients taking first line HAART. A total of 196 patient files were reviewed to obtain ADR related information. Data was entered into and analyzed using SPSS version 23. Predictors of ADRs were assessed by bivariate analysis and those found significant were further subjected to multivariate logistic regression model and were considered significant if P<0.05. Results: Out of the 196 patients, 52% were female and the mean age was 14.7 SD ±2.455, average duration on HAART in years was 7.69 ±3.498. The clinical characteristics for most patients at HAART initiation were; CD4>500 (53.1%), VL>5000(64.3%), BMI<18.5(60.7%), WHO clinical stage 3 (53.1%). Most of the patients (56%) were on AZT/3TC/NVP and 8% were on TDF/3TC/EFV. ADRs were observed in 76.5% of the patients, with skin rash (34%) and CNS toxicities (29.6%) being the most prevalent. NVP and ABC based regimens had more incidences of skin rash 45% and 32.3% respectively. Predictors that were found to be significantly associated with ADRs were; BMI<18.5 AOR: 10.13, 95% C.I: 4.36-23.50; P=<0,001 and CD4>500 AOR: 0.254, 95% C.I: 0.18-0.593, P=0.02. Conclusion: There is a high prevalence of ADRs among adolescents at ISS clinic –MRRH and the predictors of ADRs among the adolescents were BMI<18.5 and CD4>500. Key terms: Prevalence, ADRs and adolescents.
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    Factors associated with HIV related stigma among adults from fishing communities around lake George, Kasese district
    (Makerere University, 2019-06) Tukamuhebwa, Susan
    HIV- related stigma has been identified as a key obstacle to diagnosis of HIV, linkage to care, retention in care, adherence to ART and achieving viral suppression, the UNAIDS 90-90-90 goals as well as ending the pandemic by 2030. Since stigma levels are high in most at risk populations, this study therefore aimed to assess the factors associated with HIV- related stigma among adults from fishing communities around lake George in Kasese district.
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    Effectiveness of community client-led art delivery on people living with HIV at Buwambo Health Centre IV Wakiso District.
    (Makerere University, 2019-06-17) Mugerwa, Brian ; Bwambale, Isaac
    ABSTRACT Background: There is a 21% and 26-30% Loss to follow up cases in the first 6 months and first two years of treatment respectively in Uganda, ultimately leading to low retention levels of HIV patients on treatment. The Uganda Ministry of Health started a program in 2016 called Community Client- led ART delivery model (CCLAD) as a model of drug delivery among People Living with IIIV and consists of stable art clients in the same community/locality where members take turn to pick ARVs and distribute them among other group members. AIM: This study was aimed at assessing the effectiveness of community client led ART delivery model on people living with HIV in Buwambo Health Centre IV Wakiso District. Methods: This was a descriptive cross sectional survey conducted iii Buwambo health center IV among CCLAD leaders. Semi-Structured questionnaires were administered to 18 CCLAD Leaders. The collected data was entered into Microsoft excel and descriptive analysis was done using SPSS version 20. Results: The study showed that 16.7% of the CCLAD leaders had very bad adherence, 27.8% bad adherence, 33.3% fair adherence and 22.2% good adherence before joining CCLAD, as compared to adherence after joining CCLAD where 5.6% had good adherence. 67% very good adherence and 27.8% had excellent adherence. This gave an average adherence score of 2.61 (SD=1.03) before CCLAD indicative of poor adherence and 5.22 (SD=2.61) after CCLAD indicative of very good adherence to ART drugs. The study also showed an increase in viral load suppression from 83.3% to 94.4% before and after joining CCLAD respectively. There was also a reduction in occurrence of opportunistic infection among CCLAD leaders from 27.8% to 5.6% before and after joining CCLAD 1 respectively. Conclusion: The study has confirmed a significant relationship between joining CCLAD and improvement of drug accessibility, adherence and treatment outcomes.