Browsing by Author "Kutyabami, Paul"
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Item An assessment of Makerere University College of Health Sciences: optimizing health research capacity to meet Uganda’s priorities(BMC International Health and Human Rights, 2011) Nankinga, Ziadah; Kutyabami, Paul; Kibuule, Dan; Kalyango, Joan; Groves, Sara; Bollinger, Robert C.; Obua, CelestinoHealth research is critical to the institutional mission of the Makerere College of Health Sciences (MakCHS). Optimizing the alignment of health research capacity at MakCHS with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP), is a deliberate priority, a responsibility, and a significant opportunity for research. To guide this strategic direction, an assessment of MakCHS’s research grants and publication portfolio was conducted. Methods: A survey of all new and ongoing grants, as well as all publications, between January 2005 and December 2009 was conducted. Research, training, and education grants awarded to MakCHS’ constituent faculties and departments, were looked for through financial records at the college or by contact with funding organizations. Published manuscripts registered with PubMed, that included MakCHS faculty authors, were also analyzed. Results: A total of 58 active grants were identified, of which 18 had been initiated prior to 2005 and there were an average of about eight new grants per year. Most grants funded basic and applied research, with major focus areas being HIV/AIDS (44%), malaria (19%), maternal and child health (14%), tuberculosis (11%), mental health (3%), and others (8%). MakCHS faculty were identified as Principal Investigators (PIs) in only 22 (38%) active grants. Grant funding details were only available for one third of the active grants at MakCHS. A total of 837 publications were identified, with an average of 167 publications per year, most of which (66%) addressed the country’s priority health areas, and 58% had MakCHS faculty or students as first authors. Conclusions: The research grants and publications at MakCHS are generally well-aligned with the Ugandan Health Ministry priorities. Greater efforts to establish centralized and efficient grants management procedures are needed. In addition, greater efforts are needed to expand capacity for MakCHS faculty leadership of grants, as well as to continue to expand the contribution of MakCHS faculty to lead research publicationsItem An assessment of Makerere University College of Health Sciences: optimizing health research capacity to meet Uganda’s priorities(BMC International Health and Human Rights, 2011) Nankinga, Ziadah; Kutyabami, Paul; Kibuule, Dan; Kalyango, Joan; Groves, Sara; Bollinger, Robert C.; Obua, CelestinoHealth research is critical to the institutional mission of the Makerere College of Health Sciences (MakCHS). Optimizing the alignment of health research capacity at MakCHS with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP), is a deliberate priority, a responsibility, and a significant opportunity for research. To guide this strategic direction, an assessment of MakCHS’s research grants and publication portfolio was conducted. Methods: A survey of all new and ongoing grants, as well as all publications, between January 2005 and December 2009 was conducted. Research, training, and education grants awarded to MakCHS’ constituent faculties and departments, were looked for through financial records at the college or by contact with funding organizations. Published manuscripts registered with PubMed, that included MakCHS faculty authors, were also analyzed. Results: A total of 58 active grants were identified, of which 18 had been initiated prior to 2005 and there were an average of about eight new grants per year. Most grants funded basic and applied research, with major focus areas being HIV/AIDS (44%), malaria (19%), maternal and child health (14%), tuberculosis (11%), mental health (3%), and others (8%). MakCHS faculty were identified as Principal Investigators (PIs) in only 22 (38%) active grants. Grant funding details were only available for one third of the active grants at MakCHS. A total of 837 publications were identified, with an average of 167 publications per year, most of which (66%) addressed the country’s priority health areas, and 58% had MakCHS faculty or students as first authors. Conclusions: The research grants and publications at MakCHS are generally well-aligned with the Ugandan Health Ministry priorities. Greater efforts to establish centralized and efficient grants management procedures are needed. In addition, greater efforts are needed to expand capacity for MakCHS faculty leadership of grants, as well as to continue to expand the contribution of MakCHS faculty to lead research publications.Item Availability and Expiry of Essential Medicines and Supplies During the ‘Pull’ and ‘Push’ Drug Acquisition Systems in a Rural Ugandan Hospital(Tropical Journal of Pharmaceutical Research, 2010) Tumwine, Yona; Kutyabami, Paul; Odoi, Richard A.; Kalyango, Joan N.To assess the impact of the ‘Pull’ system on the availability and reduction of expiry of essential medicines and medical supplies and to determine factors affecting their availability in Kilembe Hospital, Uganda. Methods: Records of 27 essential medicines and 11 medical supplies were reviewed over two-year periods in the Push (2000 - 2001) and Pull system (2004 - 2005). Key informant interviews were conducted. The data were analyzed using STATA version 8. Comparison of availability was effected using Wilcoxon signed rank tests. Results: The median number of days out-of-stock for drugs and medical supplies was 94 versus 24 (p < 0.001) and 8 versus 0 (p < 0.39) for the Push and Pull systems, respectively. The mean percentage days out-of-stock in the two periods was 15.3 % versus 3.5 % (p < 0.001) and 1.8 % versus 1.3 % (p = 0.34) for drugs and medical supplies, respectively. Expired drugs were worth USD 1584 (25 items) in 2000/2001 and USD 1307 (13 items) in 2004/2005. Factors contributing to availability of supplies were inadequate training, lack of transport and inadequate funding. Conclusion: The Pull system improved availability of essential medicines and reduced the volume of expiries. Availability of funds, transport, staff training and supervision should be addressed for maximal benefits.Item Conducting an Ongoing HIV Clinical Trial During the COVID-19 Pandemic in Uganda: A Qualitative Study of Research Team and Participants’ Experiences and Lessons Learnt(BMJ, 2023-06-20) Muwanguzi, Patience . A; Kutyabami, Paul; Nasuuna, Esther. MTo explore the experiences and lessons learnt by the study team and participants of the Workplace-based HIV self-testing among Men trial during the COVID-19 pandemic in Uganda. An explorative qualitative study comprising two virtual focus group discussions (FGDs) with 12 trial team members and 32 in-depth participant interviews (N=44). Data were collected via telephone calls for in-depth interviews or Zoom for FGDs and manually analysed by inductive content analysis. Fourteen private security companies in two Uganda districts. Members of the clinical trial study team, and men working in private security companies who undertook workplace-based HIV testing. The key themes for participants experiences were: ‘challenges in accessing HIV treatment and care, and prevention services’, ‘misinformation’ and ‘difficulty participating in research activities’. The effects on HIV treatment and prevention resulted from; repercussions of the COVID-19 restrictions, participants fear of coinfection and negative experiences at health facilities. The difficulty in participating in research activities arose from m: fear of infection with COVID-19 for the participants who tested HIV negative, transport difficulties, limited post-test psychosocial support and lack of support to initiate preexposure prophylaxis. The key study team reflections focused on the management of the clinical trial, effects of the local regulations and government policies and the need to adhere to ethical principles of research. Conclusions Findings highlight the need to organise different forms of HIV support for persons living with HIV during a pandemic. Additionally, the national research regulators and ethics committees or review boards are strongly urged to develop policies and guidelines for the continuity of research and clinical trials in the event of future shocks. Furthermore, this study calls on the appropriate government agencies to ensure public and researchers’ preparedness through continuing education and support.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 Nature and history of the CIOMS International Ethical Guidelines and implications for local implementation: A perspective from East Africa(Developing World Bioethics, 2020) Barugahare, John; Kutyabami, PaulThe theme of the 10th Annual Research Ethics Conference organized by the Uganda National Council for Science and Technology (2018) was “Evolution of Research Ethics in Uganda and the Region: Past, Present and Future”. We were asked to address the topic: “The History of CIOMS and the recent changes in the international ethics guidelines: implications for local research”. The thrust of the conference was to track progress in ensuring ethical conduct of research, highlight challenges encountered, and to propose strategies for effective and meaningful implementation of international ethical guidelines in local contexts. Consequently, the purpose of this paper is to comment on the implications of the history of CIOMS ethical guidelines and suggest strategies for their effective and meaningful implementation in the East African region, and perhaps the whole of Sub‐Saharan Africa. Inferring from the ‘evolutionary’, ‘flexible’, and ‘general’ nature of the CIOMS guidelines, we proposed a six‐point strategy for ensuring their effective and meaningful implementation in local contexts. This strategy is in the form of obligations for local research regulators and researchers, the fulfillment of which will go a long way towards their smooth and meaningful implementation in local contexts. These obligations are: ensuring evidence‐ based adaptation of each individual guideline; ensuring sufficiently judicious and motivated RECs membership; acting proactively to ensure harmony between bioethics and local legal regimes; cultivating a ‘bioethics culture’ among the public; moving towards regional bioethics governance; and playing an active and meaningful role in future revisions of these guidelines.Item Non-adherence to anti-TB drugs among TB/HIV co-infected patients in Mbarara Hospital Uganda: Prevalence and associated factors(African health sciences, 2009) Amuha, Monica G.; Kutyabami, Paul; Kitutu, Freddy E.; Odoi-Adome, Richard; Kalyango, Joan N.Non-adherence to treatment remains a major obstacle to efficient tuberculosis control in developing countries. The dual infection of Tuberculosis and HIV presents further adherence problems because of high pill burden and adverse effects. This poses a risk of increased multi-drug resistant TB. However, the prevalence of non-adherence and its associated factors have not been studied in these patients in Uganda. Objectives: To determine the prevalence and factors associated with non-adherence to anti-TB drugs among TB/HIV co-infected patients in Mbarara hospital. Methods: A cross-sectional study with qualitative and quantitative data collection methods was conducted among TB/HIV coinfected adults in Mbarara hospital from January to March 2008. Consecutive sampling was used to select 140 participants. Adherence was assessed over a 5-day period prior to the interview using patients self-reports. Data was collected using an interviewer administered questionnaire. Qualitative data was collected through key informant interviews using a topic guide and was analyzed manually. Quantitative data was analyzed using STATA version 8. Logistic regression was used to determine factors associated with nonadherence. Results: The prevalence of non-adherence was 25% (95% CI=17.8-32%). Being on continuous phase of the TB regimen was significantly associated with non-adherence (OR=6.24, p<0.001). Alcohol consumption, being on antiretroviral therapy and smoking confounded the relationship between stage of the TB regimen and non-adherence. Conclusion: The prevalence of non-adherence was high. Patients that are on continuous phase of TB treatment should be supported to continue taking their drugs. In addition, patients that drink alcohol; smoke and those not on ART should be targeted with interventions to improve adherence.Item Participatory healthcare-provider orientation to improve artemetherlumefantrine-based drug treatment of uncomplicated malaria: a cluster quasi-experimental study(BMJ quality & safety, 2012) Anyama, Norbert G.; Tibenderana, James K.; Kutyabami, Paul; Kamba, Pakoyo F.; Kitutu, Freddy E.; Adome, Richard O.To assess the effect of participatory healthcare-provider orientation in enhancing patient knowledge, appropriate prescribing and dispensing of artemether-lumefantrine, during drug treatment of uncomplicated malaria. Methods: A cluster quasi-experimental study. The authors developed strategies to address challenges encountered by healthcare providers during clinical management of malaria. The primary outcome was patient knowledge on prescribed malaria drug treatment. Secondary outcomes were appropriate prescribing and provision of adequate drug dispensing information. The authors used generalised estimating equation logistic regression to investigate correlates of appropriate use of artemether-lumefantrine. Results: The proportion of patients or caretakers of paediatric patients sufficiently knowledgeable about malaria treatment increased from 16/85 (18.8%) at baseline to 33/96 (34.4%) at evaluation, OR 2.26 (95% CI 1.13 to 4.49), p¼0.020, in the intervention, and fell slightly from 49/134 (36.6%) to 35/114 (30.7%), OR 0.77, (95% CI 0.45 to 1.31), p¼0.331 in the control district. This was enhanced by the existence of drugdispensing standard operating procedures (adjusted OR 1.85, 95% CI 0.98 to 3.50; p¼0.057). The proportion of appropriate prescriptions increased from 61/87 (70.1%) to 94/112 (83.9%) in the intervention district, OR 2.23 (95% CI 1.13 to 4.40), p¼0.020 and reduced from 91/115 (79.1%) to 75/112 (67.0%) in the control district, OR 0.53, (95% CI 0.29 to 0.97), p¼0.040. The frequency of adequately dispensed prescriptions increased in the intervention district (34 (32.4%) to 53(45.3%), OR 1.73 (95% CI 1.00 to 2.99), p¼0.050) but decreased in the control location (94 (69.6%) to 71 (52.6%), OR 0.48 (95% CI 0.29 to 0.80), p¼0.004). Conclusions: Participatory healthcare-provider orientation enhanced patient knowledge, healthcare provider prescribing and dispensing of artemether-lumefantrine, bolstered by adequate medication counselling and use of drug-dispensing standard operating procedures.Item Practices and attitudes of herbalists regarding informed consent in Uganda: a qualitative study(BMC, 2024-10) Nalubega, Sumayiya; Kutyabami, Paul; Twimukye, Adelline; Kaawa-Mafigiri, David;; Sewankambo, Nelson KInformed consent (IC) is a fundamental principle in medical ethics that upholds respect for patient autonomy. Although widely applied in healthcare, its feasibility and implementation in herbal medicine have been underexplored. This study therefore aimed to explore the practices and attitudes of herbalists regarding informed consent.BACKGROUNDInformed consent (IC) is a fundamental principle in medical ethics that upholds respect for patient autonomy. Although widely applied in healthcare, its feasibility and implementation in herbal medicine have been underexplored. This study therefore aimed to explore the practices and attitudes of herbalists regarding informed consent.To achieve these objectives, a qualitative cross-sectional study was conducted from June to December 2020. Twenty-one in-depth interviews with herbalists and four key informant interviews with leaders of the different traditional medicine organizations were conducted. The data were analyzed thematically using NVivo version 12 software.METHODSTo achieve these objectives, a qualitative cross-sectional study was conducted from June to December 2020. Twenty-one in-depth interviews with herbalists and four key informant interviews with leaders of the different traditional medicine organizations were conducted. The data were analyzed thematically using NVivo version 12 software.Sixteen of the twenty-one participants acquired oral herbal medicine knowledge from their relatives. Although a positive inclination toward obtaining IC was evident, the focus was on disclosing basic information. Discussions of alternative treatments and herbal specifics were less frequent. Disease management decisions often involve shared responsibility within families or societies. Documented IC procedures are rare among herbalists, who deem consent forms unnecessary, although they recognize the potential benefits of IC in fostering trust and professionalism. Challenges hindering IC implementation included regulatory gaps, inadequate skills, and the absence of mechanisms to protect the intellectual property rights of herbal medicine.RESULTSSixteen of the twenty-one participants acquired oral herbal medicine knowledge from their relatives. Although a positive inclination toward obtaining IC was evident, the focus was on disclosing basic information. Discussions of alternative treatments and herbal specifics were less frequent. Disease management decisions often involve shared responsibility within families or societies. Documented IC procedures are rare among herbalists, who deem consent forms unnecessary, although they recognize the potential benefits of IC in fostering trust and professionalism. Challenges hindering IC implementation included regulatory gaps, inadequate skills, and the absence of mechanisms to protect the intellectual property rights of herbal medicine.This study illuminates how educational, cultural, familial, and regulatory factors influence herbalists' practices and attitudes toward informed consent.CONCLUSIONThis study illuminates how educational, cultural, familial, and regulatory factors influence herbalists' practices and attitudes toward informed consent. MEDLINE - AcademicItem Research site monitoring for compliance with ethics regulatory standards: review of experience from Uganda(BMC Medical Ethics, 2013) Ochieng, Joseph; Ecuru, Julius; Nakwagala, Frederick; Kutyabami, PaulOn site monitoring of research is one of the most effective ways to ensure compliance during research conduct. However, it is least carried out primarily for two reasons: presumed high costs both in terms of human resources and finances; and the lack of a clear framework for undertaking site monitoring. In this paper we discuss a model for research site monitoring that may be cost effective and feasible in low resource settings. Methods: This was a retrospective review of research site monitoring reports covering a period of four years. Results: The monitoring was conducted by the Uganda National Council for Science and Technology, the National Drug Authority and the National HIV/AIDS Research and Ethics Committee over the period 2007 to 2010. The monitoring team was usually three members comprising of two experts in research ethics and an assistant. A total of 28 site monitoring visits covering 40 research projects were reviewed. 25% of the site monitoring reports revealed violation of the regulatory requirement for valid ethical approval. 36% of the site reports showed some instances of informed consent violation, 28% showed violation of the rights and welfare of research participants, 38% revealed that sites did not report SAEs to regulatory authorities and many sites lacked adequate GCP and GCLP. However, most of the sites monitored had adequate facilities to conduct the respective studies and good working practices. Conclusion: This model employed by the monitoring teams to evaluate research compliance is effective in auditing ethical practice. Compliance monitoring is feasible and affordable in a resource limited setting. Research protocol non compliance is still a major problem in Uganda, and there is need for a pro-active approach to this vice by all stake holders if ethical conduct of research is to be achieved.