Browsing by Author "Kitutu, Freddy Eric"
Now showing 1 - 20 of 30
Results Per Page
Sort Options
Item Availability, prices and affordability of UN commissions life saving medicines for reproductive and maternal health in Uganda(Journal of Pharmaceutical Policy and Practice, 2017) Kibira, Denis; Kitutu, Freddy Eric; Merrett, Gemma Buckland; Mantel-Teeuwisse, Aukje K.Uganda was one of seven countries in which the United Nations Commission on Life Saving Commodities (UNCoLSC) initiative was implemented starting from 2013. A nationwide survey was conducted in 2015 to determine availability, prices and affordability of essential UNCoLSC maternal and reproductive health (MRH) commodities. The survey at health facilities in Uganda was conducted using an adapted version of the standardized methodology co-developed by World Health Organisation (WHO) and Health Action International (HAI). In this study, six maternal and reproductive health commodities, that were part of the UNCoLSC initiative, were studied in the public, private and mission health sectors. Median price ratios were calculated with Management Sciences for Health International Drug Price Indicator prices as reference. Maternal and reproductive health commodity stocks were reviewed from stock cards for their availability for a period of 6 months preceding the survey. Affordability was measured using wages of the lowest paid government worker.Item Blood Culture Testing Outcomes among Non-Malarial Febrile Children at Antimicrobial Resistance Surveillance Sites in Uganda, 2017–2018(Tropical medicine & infectious disease, 2018) Kisame, Rogers; Najjemba, Robinah; Griensven, Johan van; Kitutu, Freddy Eric; Takarinda, Kudakwashe; Thekkur, Pruthu; Delamou, Alexandre; Walwema, Richard; Kakooza, Francis; Mugerwa, Ibrahim; Sekamatte, Musa; Robert, Kimera; Katairo, Thomas; Opollo, Marc Sam; Otita, Morgan; Lamorde, MohammedBlood culture (BC) processes are critical to the utility of diagnostic testing, bloodstream infection (BSI) management, and antimicrobial resistance (AMR) surveillance. While Uganda has established BC guidelines, often laboratory practice does not meet the desired standards. This compromises pathogen recovery, reliability of antimicrobial susceptibility testing, and diagnostic test utility. This study assessed laboratory BC process outcomes among non-malarial febrile children below five years of age at five AMR surveillance sites in Uganda between 2017 and 2018. Secondary BC testing data was reviewed against established standards. Overall, 959 BC specimens were processed. Of these, 91% were from female patients, neonates, infants, and young children (1–48 months). A total of 37 AMR priority pathogens were identified; Staphylococcus aureus was predominant (54%), followed by Escherichia coli (19%). The diagnostic yield was low (4.9%). Only 6.3% of isolates were identified. AST was performed on 70% (18/26) of identified AMR priority isolates, and only 40% of these tests adhered to recommended standards. Interventions are needed to improve laboratory BC practices for effective patient management through targeted antimicrobial therapy and AMR surveillance in Uganda. Further research on process documentation, diagnostic yield, and a review of patient outcomes for all hospitalized febrile patients is needed.Item Can malaria rapid diagnostic tests by drug sellers under field conditions classify children 5 years old or less with or without Plasmodium falciparum malaria? Comparison with nested PCR analysis(Malaria journal, 2018) Kitutu, Freddy Eric; Wamani, Henry; Selling, Katarina Ekholm; Ashaba Katabazi, Fred; Bisaso Kuteesa, Ronald; Peterson, StefanMalaria rapid diagnostic tests (RDTs) available as dipsticks or strips, are simple to perform, easily interpretable and do not require electricity nor infrastructural investment. Correct interpretation of and compliance with the RDT results is a challenge to drug sellers. Thus, drug seller interpretation of RDT strips was compared with laboratory scientist re-reading, and PCR analysis of Plasmodium DNA extracted from RDT nitrocellulose strips and fast transient analysis (FTA) cards. Malaria RDT cassettes were also assessed as a potential source of Plasmodium DNA. Methods: A total of 212 children aged between 2 and 60 months, 199 of whom had complete records at two study drug shops in south western Uganda participated in the study. Duplicate 5 μL samples of capillary blood were picked from the 212 children, dispensed onto the sample well of the CareStart™ Pf-HRP2 RDT cassette and a FTA, Whatman™ 3MM filter paper in parallel. The RDT strip was interpreted by the drug seller within 15–20 min, visually re-read centrally by laboratory scientist and from it; Plasmodium DNA was recovered and detected by PCR, and compared with FTA recovered P. falciparum DNA PCR detection. Results: Malaria positive samples were 62/199 (31.2%, 95% CI 24.9, 38.3) by drug seller interpretation of RDT strip, 59/212 (27.8%, 95% CI 22.2, 34.3) by laboratory scientist, 55/212 (25.9%, 95% CI 20.0, 32.6) by RDT nitrocellulose strip PCR and 64/212 (30.2%, 95% CI 24.4, 37.7). The overall agreement between the drug seller interpretation and laboratory scientist re-reading of the RDT strip was 93.0% with kappa value of 0.84 (95% CI 0.75, 0.92). The drug seller compliance with the reported RDT results was 92.5%. The performance of the three diagnostic strategies compared with FTA-PCR as the gold standard had sensitivity between 76.6 and 86.9%, specificity above 90%, positive predictive values ranging from 79.0 to 89.8% and negative predictive values above 90%. Conclusion: Drug sellers can use RDTs in field conditions and achieve acceptable accuracy for malaria diagnosis, and they comply with the RDT results. Plasmodium DNA can be recovered from RDT nitrocellulose strips even in the context of drug shops. Future malaria surveillance and diagnostic quality control studies with RDT cassette as a source of Plasmodium DNA are recommended.Item Compliance of private pharmacies in Uganda with controlled prescription drugs regulations: a mixed-methods study(Substance abuse treatment, prevention, and policy, 2020) Kamba, Pakoyo Fadhiru; Mulangwa, John; Kaggwa, Bruhan; Kitutu, Freddy Eric; Kaulukusi Sewankambo, Nelson; Tebasoboke Katabira, Elly; Byakika-Kibwika, Pauline; Odoi Adome, Richard; Bollinger, Robert CyrilControlled prescription drug use disorders are a growing global health challenge in Sub-Saharan Africa. Effective supply chain regulations on dispensing and stock control are important for controlling this epidemic. Since compliance with these regulations in resource-limited countries is poor, there is need to understand its predictors in order to reduce the risk of prescription drug use disorders. Methods: A mixed-methods study utilizing a structured questionnaire and a simulated client guide was undertaken in Kampala and Mbale towns in Uganda. The questionnaire recorded self-reported dispensing and verified stock control practices and their covariates from 101 private pharmacies. The guide recorded actual dispensing practices from 27 pharmacies. Snowball sampling was done to enrich the sample with pharmacies that stock opioids. The mean compliance with good dispensing and stock control practices was calculated. Multivariate logistic regression analyses were applied to identify predictors of compliance.Item Cost-Effectiveness Analysis of Integrated Community Case Management Delivery Models Utilizing Drug Sellers and Community Health Workers for Treatment of Under-Five Febrile Cases of Malaria, Pneumonia, Diarrhea in Rural Uganda.(Research Square, 2021) Lubogo, Patrick; Lukyamuzi, John Edward; Kyambadde, Deo; Komakech, Alex Aboda; Kitutu, Freddy Eric; Mugema Mulogo, EdgarMalaria, pneumonia, and diarrhea continue to be the leading causes of death in children under the age of ve in Uganda. To combat the above-mentioned febrile illnesses, integrated community case management (iCCM) delivery models utilizing CHWs or drug sellers have been implemented. The purpose of this study is to compare the cost-effectiveness of delivering iCCM interventions via drug sellers versus community health workers in rural Uganda. This study was a cost-effectiveness analysis to compare the iCCM delivery model utilizing drug sellers against the model using CHWs. The effect measure was the number of appropriately treated U5 children, and data on effectiveness came from a quasi-experimental study in Southwestern Uganda and the inSCALE cross-sectional household survey in eight districts of mid-Western Uganda. The iCCM interventions were costed using the micro-costing (ingredients) approach, with costs expressed in US dollars. Cost and effect data were linked together using a decision tree model and analyzed using the Amua modeling software.Item Dolutegravir-Based ART: Exploring Patient Safety and Acceptability Following National Roll-Out in Uganda(Research Square, 2021) Zakumumpa, Henry; Kitutu, Freddy Eric; Ndagije, Helen Bomire; Nakitto-Kesi, Diana; Nambi Ssanyu, Jacquellyn; Kiguba, RonaldThe World Health Organization recommends dolutegravir (DTG) as the backbone for rst-line and secondline antiretroviral therapy (ART) worldwide. However, little is known about the acceptability and tolerability of DTG-based ART at routine points-of-care in Uganda. We set out to explore the perceptions of ART clinic managers regarding the acceptability and tolerability of DTG-based ART since national roll-out in March 2018 in Uganda. We adopted a qualitative descriptive design involving 49 ART clinic managers and clinicians. Between September 2020 and February 2021, we conducted 22 in-depth interviews with ART clinic managers and clinicians in 12 purposively selected health facilities across Uganda. The selection of study sites ensured diversity in facility ownership-type (public/private), level of service delivery (tertiary/secondary/primary) and the four major geographic sub-regions of Uganda. We conducted three focus group discussions with 27 ART clinicians in the participating facilities. Data were analyzed by thematic approach.Item Expiry of medicines in supply outlets in Uganda(Bulletin of the World Health Organization, 2010) Katabaazi Nakyanzi, Josephine; Kitutu, Freddy Eric; Oria, Hussein; Kamba, Pakoyo FadhiruIn developing countries, where budgets for medicines are often tight, the supply cycle needs to be well-managed to prevent all types of wastage, including pilferage, misuse and expiry. This wastage reduces the quantity of medicines available to patients and therefore the quality of health care they receive. At least US$550 000 worth of antiretrovirals and 10 million antimalarial doses recently expired in Uganda’s National Medical Stores (NMS).1,2 The Ugandan pharmaceutical supply system comprises three non-profit wholesalers (one government medical store and two private non-profit ventures) and several private for-profit wholesale pharmacies that supply medicines in bulk to retail units (private retail pharmacies, hospital pharmacies and drug shops). Drug shops are the smallest retail medicine outlets, are supervised by non-pharmacist health-care professionals, and are limited to handling small amounts of over the-counter medicines.Item Factors associated with health facility utilization during childbirth among 15 to 49-year-old women in Uganda: evidence from the Uganda demographic health survey 2016(BMC Health Services Research, 2021) Sserwanja, Quraish; Mukunya, David; Musaba, Milton W.; Kawuki, Joseph; Kitutu, Freddy EricAlmost all maternal deaths and related morbidities occur in low-income countries. Childbirth supervised by a skilled provider in a health facility is a key intervention to prevent maternal and perinatal morbidity and mortality. Our study aimed to establish the factors associated with health facility utilization during childbirth in Uganda. Methods: We used the Uganda Demographic and Health Survey 2016 data of 10,152 women aged 15 to 49years. The study focused on their most recent live birth in 5 years preceding the survey. We applied multistage stratified sampling to select study participants and we conducted multivariable logistic regression to establish the factors associated with health facility utilization during childbirth, using SPSS (version 25). Results: The proportion of women who gave birth at a health facility was 76.6% (7780/10,152: (95% confidence interval, CI, 75.8–77.5). The odds of women aged 15–19years giving birth at health facilities were twice as those of women aged 40 to 49years (adjusted odds ratio, AOR=2.29; 95% CI: 1.71–3.07). Residing in urban areas and attending antenatal care (ANC) were associated with health facility use. The odds of women in the northern region of Uganda using health facilities were three times of those of women in the central region (AOR=3.13; 95% CI: 2.15–4.56). Women with tertiary education (AOR=4.96; 95% CI: 2.71–9.11) and those in the richest wealth quintile (AOR=4.55; 95% CI: 3.27–6.32) had higher odds of using a health facility during child birth as compared to those with no education and those in the poorest wealth quintile, respectively. Muslims, Baganda, women exposed to mass media and having no problem with distance to health facility had higher odds of utilizing health facilities during childbirth as compared to Catholic, non Baganda, women not exposed to mass media and those having challenges with distance to access healthcare. Conclusion: Health facility utilization during childbirth was high and it was associated with decreasing age, increasing level of education and wealth index, urban residence, Northern region of Uganda, ANC attendance, exposure to mass media, tribe, religion and distance to the nearby health facility. We recommend that interventions to promote health facility childbirths in Uganda target the poor, less educated, and older women especially those residing in rural areas with less exposure to mass media.Item Factors associated with occupancy of pharmacist positions in public sector hospitals in Uganda: a cross-sectional study(Human resources for health, 2017) Ocwa Obua, Thomas; Odoi Adome, Richard; Kutyabami, Paul; Kitutu, Freddy Eric; Fadhiru Kamba, PakoyoPharmacists are invaluable resources in health care. Their expertise in pharmacotherapy and medicine management both ensures that medicines of appropriate quality are available in health facilities at the right cost and are used appropriately. Unfortunately, some countries like Uganda have shortage of pharmacists in public health facilities, the dominant providers of care. This study investigated the factors that affect the occupancy of pharmacist positions in Uganda’s public hospitals, including hiring patterns and job attraction and retention. Methods: A cross-sectional survey of 91 registered pharmacists practicing in Uganda and desk review of records from the country’s health care worker (HCW) recruiting agency was done in the months of May, June, and July, 2016. Pharmacist interviews were done using self-administered structured questionnaire and analyzed by descriptive statistics and chi-square test. Results: Slight majority (53%) of the interviewed pharmacists work in two sectors. About 60% of the pharmacists had ever applied for public hospital jobs. Of those who received offers (N=46), 30% had declined them. Among those who accepted the offers (N=41), 41% had already quit. Meanwhile, the pace of hiring pharmacists into Uganda’s public sector is too slow. Low socio-economic status of family in childhood (χ2 =2.77, p=0.10), admission through matriculation and diploma scheme (χ2 =2.37, p=0.12), internship in countryside hospitals (χ2 =2.24, p=0. 13), working experience before pharmacy school (χ2 =2.21, p=0.14), salary expectation (χ2 =1.76, p=0.18), and rural secondary education (χ2 =1.75, p=0.19) favored attraction but in a statistically insignificant manner. Retention was most favored by zero postgraduate qualification (χ2 =4.39, p=0.04), matriculation and diploma admission scheme (χ2 =2.57, p=0.11), and working experience in private sector (χ2 =2.21, p=0.14). Conclusions: The pace of hiring of pharmacists into Uganda’s public health sector is too slow and should be stepped up. Besides work incentives, affirmative action to increase admissions into pharmacy degree training programs through matriculation and diploma schemes and for children with rural childhoods should be considered.Item Factors associated with poor social support among Persons Living with HIV/AIDS at the Infectious Disease Institute HIV/AIDS clinic in Uganda, 2019: A cross-sectional study(Research Square, 2019) Nakamanya Kitibwakye, Sharon; Kitutu, Freddy Eric; Nabakooza Kigongo, Angella; Olum, Ronald; Katana, Elizabeth; Laker, EvaSocial support is known to influence desired health outcomes resulting in decrease in morbidity and mortality. HIV patients with poor social support are at risk of worse health outcomes. Little is known about the determinants of social support in the HIV population in Uganda. This study examined the determinants of social support among HIV patients on Atazanavir-based regimen at the Infectious Disease Institute HIV/AIDS clinic in Uganda. Methods We carried out a secondary analysis of data nested in a cross-sectional study to determine the prevalence of clinical jaundice among patients on Atazanavir-based second-line therapy, which was conducted at a specialist HIV center, Infectious Disease Institute (IDI) in Kampala, Uganda from April to May 2019. IDI is a specialist HIV center in Kampala, Uganda with over 7000 patients in care. The primary study consecutively sampled patients on an Atazanavir- based regimen. Social support was assessed by using a 3-item Oslo social scale. Logistic regression was used to determine the association between social support and its correlates. Results Data from 236 participants with the mean age of 40 years ±11 was analyzed. The majority were females (66.5%) and 34% were married. Up to 16.5% (39/236) had other comorbidities and less than 1% (2/236) were depressed. There was a high level of disclosure of status to either a family member, friend, spouse, or children (94%; 221/236). The prevalence of internalized stigma (4%; 9/236) and depression (2/236; 1%) was low. Only disclosure of HIV status was associated with social support (OR= 4.9, 95% CI 1.1 – 21.3, p-value= 0.038). There was no significant association of age, sex, marital status, education status, religion, other chronic comorbidities, depression, drug fatigue, and stigma with social support. Conclusion We found that good/ moderate social support was associated with disclosure of HIV status. However, the relationship between social support and disclosure of HIV status warrants further exploration using qualitative research methods.Item Health system effects of implementing integrated community case management (iCCM) intervention in private retail drug shops in South Western Uganda: a qualitative study(BMJ Glob Health, 2017) Kitutu, Freddy Eric; Mayora, Chrispus; Johansson, Emily White; Peterson, Stefan; Wamani, Henry; Bigdeli, Maryam; Shroff, Zubin CyrusIntervening in private drug shops to improve quality of care and enhance regulatory oversight may have health system effects that need to be understood before scaling up any such interventions. We examine the processes through which a drug shop intervention culminated in positive unintended effects and other dynamic interactions within the underlying health system. Methods A multifaceted intervention consisting of drug seller training, supply of diagnostics and subsidised medicines, use of treatment algorithms, monthly supervision and community sensitisation was implemented in drug shops in South Western Uganda, to improve paediatric fever management. Focus group discussions and in-depth interviews were conducted with stakeholders (drug sellers, government officials and community health workers) at baseline, midpoint and end-line between September 2013 and September 2015. Using a health market and systems lens, transcripts from the interviews were analysed to identify health system effects associated with the apparent success of the intervention. Findings Stakeholders initially expressed caution and fears about the intervention's implications for quality, equity and interface with the regulatory framework. Over time, these stakeholders embraced the intervention. Most respondents noted that the intervention had improved drug shop standards, enabled drug shops to embrace patient record keeping, parasite-based treatment of malaria and appropriate medicine use. There was also improved supportive supervision, and better compliance to licensing and other regulatory requirements. Drug seller legitimacy was enhanced from the community and client perspective, leading to improved trust in drug shops. conclusion The study showed how effectively using health technologies and the perceived efficacy of medicines contributed to improved legitimacy and trust in drug shops among stakeholders. The study also demonstrated that using a combination of appropriate incentives and consumer empowerment strategies can help harmonise common practices with medicine regulations and safeguard public health, especially in mixed health market contexts.Item High Levels of Antibiotic Resistance Patterns in Two Referral Hospitals during the Post-Ebola Era in Free-Town, Sierra Leone: 2017–2019(Tropical Medicine & Infection Disease, 2021) Koroma, Zikan; Moses, Francis; Delamou, Alexandre; Hann, Katrina; Ali, Engy; Kitutu, Freddy Eric; Namugambe, Juliet Sanyu; Harding, Doris; Hermans, Veerle; Takarinda, KudakwasheThe Post-Ebola era (2017–2019) presented an opportunity for laboratory investments in Sierra Leone. US CDC supported the Ministry of Health and Sanitation to establish a microbiological unit for routine antimicrobial sensitivity testing in two referral (pediatric and maternity) hospitals in Freetown. This study describes resistance patterns among patients’ laboratory samples from 2017 to 2019 using routine data. Samples included urine, stool, cerebrospinal fluid, pus-wound, pleural fluid, and high vaginal swabs. Selected Gram-positive and Gram-negative bacterial isolates were tested for antimicrobial susceptibility. Of 200 samples received by the laboratory, 89 returned positive bacterial isolates with urine and pus-wound swabs accounting for 75% of positive isolates. The number of positive isolates increased annually from one in 2017 to 42 in 2018 and 46 in 2019. Resistance of the cultures to at least one antibiotic was high (91%), and even higher in the pediatric hospital (94%). Resistance was highest with penicillin (81%) for Gram-positive bacteria and lowest with nitrofurantoin (13%). Gram-negative bacteria were most resistant to ampicillin, gentamycin, streptomycin, tetracycline, cephalothin and penicillin (100%) and least resistant to novobiocin (0%). Antibiotic resistance for commonly prescribed antibiotics was high in two referral hospitals, highlighting the urgent need for antimicrobial stewardship and access to reserve antibiotics.Item Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda: a prospective cohort study.(medRxiv, 2021) Graham, Hamish R.; Kamuntu, Yewande; Miller, Jasmine; Barrett, Anna; Kunihira, Blasio; Engol, Santa; Kabunga, Lorraine; Lam, Felix; Olaro, Charles; Ajilong, Harriet; Kitutu, Freddy EricHypoxaemia (low blood oxygen) is common among hospitalised patients, increasing risk of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. Methods Prospective cohort study in 30 primary care facilities in Uganda, Feb-Apr 2021. Clinical data collectors assessed blood oxygen level (SpO2) of all acutely unwell children, adolescents, and adults, and followed up children aged under 15 years with SpO2<93% to determine subsequent care and outcome. Primary outcome: proportion of children under 5 years of age with severe hypoxaemia (SpO2<90%). Secondary outcomes: severe/moderate hypoxaemia (SpO2 90-93%) by age/sex/complaint. Results Among children U5, the prevalence of severe hypoxaemia was 1.3% (95% CI 0.9 to 2.1); an additional 4.9% (3.9 to 6.1) had moderate hypoxaemia. Performing pulse oximetry according to World Health Organization guidelines exclusively on children with respiratory complaints would have missed 14% (3/21) of severe hypoxaemia and 11% (6/55) of moderate hypoxaemia. Hypoxaemia prevalence was low among children 5-14 years (0.3% severe, 1.1% moderate) and adolescents/adults 15+ years (0.1% severe, 0.5% moderate). A minority (12/27, 44%) of severely hypoxaemic patients were referred; 3 (12%) received oxygen. Conclusion Hypoxaemia is common among acutely unwell children under five years of age presenting to Ugandan primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials.Item ‘I know those people will be approachable and not mistreat us’: a qualitative study of inspectors and private drug sellers’ views on peer supervision in rural Uganda(Globalization and Health, 2020) Bagonza, Arthur; Peterson, Stefan; Mårtensson, Andreas; Mutto, Milton; Awor , Phllis; Kitutu, Freddy Eric; Linda, Gibson; Wamani, HenryPeer supervision improves health care delivery by health workers. However, in rural Uganda, self supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than ve years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self supervision currently practiced by drug sellers at district level in rural Uganda. In this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with one hundred and thirty drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management.Item Implementation of a peer support intervention to promote the detection, reporting and management of adverse drug reactions in people living with HIV in Uganda: a protocol for a quasi-experimental study(BMJ Open, 2022) Kiguba, Ronald; Byomire, Helen; Byomire Ndagije, Helen; Nambasa, Victoria; Katureebe, Cordelia; Zakumumpa, Henry; Nanyonga, Stella Maris; Nambi Ssanyu, Jacquellyn; Tregunno, Phil; Harrison, Kendal; Merle, Corinne S.; Raguenaud, Marie-Eve; Kitutu, Freddy EricPatients have contributed <1% of spontaneous adverse drug reaction (ADR) reports in Uganda’s pharmacovigilance database. Peer support combined with mobile technologies could empower people living with HIV (PLHIV) to report ADRs and improve ADR management through linkage to care. We seek to test the feasibility and effect of a peer support intervention on ADR reporting by PLHIV receiving combination antiretroviral therapy (cART) in Uganda; identify barriers and facilitators to the intervention; and characterise ADR reporting andItem Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done(Tropical Medicine & Infection Disease, 2021) Opollo, Marc Sam; Otim, Tom Charles; Kizito, Walter; Thekkur, Pruthu; Kumar, Ajay M. V.; Kitutu, Freddy Eric; Kisame, Rogers; Zolfo, MariaGlobally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobialresistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, crosssectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.Item Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi‑experimental study(Malaria journal, 2017) Kitutu, Freddy Eric; Nakayaga Kalyango, Joan; Mayora, Chrispus; Ekholm Selling, Katarina; Peterson, Stefan; Wamani, HenryFever case management is a major challenge for improved child health globally, despite existence of cheap and effective child survival health technologies. The integrated Community Case Management (iCCM) intervention of paediatric febrile illnesses though adopted by Uganda’s Ministry of Health to be implemented by community health workers, has not addressed the inaccess to life-saving medicines and diagnostics. Therefore, the iCCM intervention was implemented in private drug shops and evaluated for its effect on appropriate treatment of paediatric fever in a low malaria transmission setting in South Western Uganda. Methods: From June 2013 to September 2015, the effect of the iCCM intervention on drug seller paediatric fever management and adherence to iCCM guidelines was assessed in a quasi-experimental study in South Western Uganda. A total of 212 care-seeker exit interviews were done before and 285 after in the intervention arm as compared to 216 before and 268 care-seeker interviews at the end of the study period in the comparison arm. The intervention effect was assessed by difference-in-difference analysis of drug seller treatment practices against national treatment recommendations between the intervention and comparison arms. Observed proportions among careseeker interviews were compared with corresponding proportions from 5795 child visits recorded in patient registries and 49 direct observations of drug seller–care-seeker encounters in intervention drug shops. Results: The iCCM intervention increased the appropriate treatment of uncomplicated malaria, pneumonia symptoms and non-bloody diarrhoea by 80.2% (95% CI 53.2–107.2), 65.5% (95% CI 51.6–79.4) and 31.4% (95% CI 1.6–61.2), respectively. Within the intervention arm, drug seller scores on appropriate treatment for pneumonia symptoms and diagnostic test use were the same among care-seeker exit interviews and direct observation. A linear trend (negative slope, − 0.009 p value < 0.001) was observed for proportions of child cases prescribed any antimicrobial medicine in the intervention arm drug shops. Conclusions: The iCCM intervention improved appropriate treatment for uncomplicated malaria, pneumonia symptoms and diarrhoea. Drug seller adherence to iCCM guidelines was high, without causing excessive prescription of antimicrobial medicines in this study. Further research should assess whether this effect is sustained over time and under routine supervision models.Item It could be viral but you don’t know, you have not diagnosed it: health worker challenges in managing non-malaria paediatric fevers in the low transmission area of Mbarara District, Uganda(Malaria Journal, 2016) Johansson, Emily White; Kitutu, Freddy Eric; Mayora, Chrispus; Awor, Phyllis; Peterson, Stefan Swartling; Wamani, Henry; Hildenwall, HelenaIn 2012, Uganda initiated nationwide deployment of malaria rapid diagnostic tests (RDT) as recommended by national guidelines. Yet growing concerns about RDT non-compliance in various settings have spurred calls to deploy RDT as part of enhanced support packages. An understanding of how health workers currently manage non-malaria fevers, particularly for children, and challenges faced in this work should also inform efforts. Methods: A qualitative study was conducted in the low transmission area of Mbarara District (Uganda). In-depth interviews with 20 health workers at lower level clinics focused on RDT perceptions, strategies to differentiate nonmalaria paediatric fevers, influences on clinical decisions, desires for additional diagnostics, and any challenges in this work. Seven focus group discussions were conducted with caregivers of children under 5 years of age in facility catchment areas to elucidate their RDT perceptions, understandings of non-malaria paediatric fevers and treatment preferences. Data were extracted into meaning units to inform codes and themes in order to describe response patterns using a latent content analysis approach. Results: Differential diagnosis strategies included studying fever patterns, taking histories, assessing symptoms, and analysing other factors such as a child’s age or home environment. If no alternative cause was found, malaria treatment was reportedly often prescribed despite a negative result. Other reasons for malaria over-treatment stemmed from RDT perceptions, system constraints and provider-client interactions. RDT perceptions included mistrust driven largely by expectations of false negative results due to low parasite/antigen loads, previous anti-malarial treatment or test detection of only one species. System constraints included poor referral systems, working alone without opportunity to confer on difficult cases, and lacking skills and/or tools for differential diagnosis. Provider-client interactions included reported caregiver RDT mistrust, demand for certain drugs and desire to know the ‘exact’ disease cause if not malaria. Many health workers expressed uncertainty about how to manage non-malaria paediatric fevers, feared doing wrong and patient death, worried caregivers would lose trust, or felt unsatisfied without a clear diagnosis. Conclusions: Enhanced support is needed to improve RDT adoption at lower level clinics that focuses on empowering providers to successfully manage non-severe, non-malaria paediatric fevers without referral. This includes building trust in negative results, reinforcing integrated care initiatives (e.g., integrated management of childhood illness) and fostering communities of practice according to the diffusion of innovations theory.Item National Antimicrobial Consumption: Analysis of Central Warehouses Supplies to In-Patient Care Health Facilities from 2017 to 2019 in Uganda(Tropical Medicine & Infection Disease, 2021) Sanyu Namugambe, Juliet; Delamou, Alexandre; Moses, Francis; Ali, Engy; Hermans, Veerle; Takarinda, Kudakwashe; Thekkur, Pruthu; Nanyonga, Stella Maris; Koroma, Zikan; Ngobi Mwoga, Joseph; Akello, Harriet; Imi, Monica; Kitutu, Freddy EricAntimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions.Item “The number of clients is increasing but the supplies are reducing”: provider strategies for responding to chronic antiretroviral (ARV) medicines stock-outs in resource limited settings: a qualitative study from Uganda(BMC health services research, 2019) Zakumumpa, Henry; Matovu Kiweewa, Flavia; Khuluza, Felix; Kitutu, Freddy EricDespite the increasing frequency of ARV medicines stock-outs in Sub-Saharan Africa, there is little research inquiring into the mitigation strategies devised by frontline health facilities. Many previous studies have focused on ‘upstream’ or national-level drivers of ARVs stock-outs with less empirical attention devoted ‘downstream’ or at the facility-level. The objective of this study was to examine the strategies devised by health facilities in Uganda to respond to the chronic stock-outs of ARVs. This was a qualitative research design nested within a larger mixed-methods study. We purposively selected 16 health facilities from across Uganda (to achieve diversity with regard to; level of care (primary/ tertiary), setting (rural/urban) and geographic sub-region (northern/ central/western). We conducted 76 Semi-structured interviews with ART clinic managers, clinicians and pharmacists in the selected health facilities supplemented by on-site observations and documentary reviews. Data were analyzed by coding and thematic analyses.