Browsing by Author "Ocan, Moses"
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Item Adipose-derived stromal vascular fraction (SVF) in scar treatment: a systematic review protocol(American Journal of Stem Cells, 2022) Mbiine, Ronald; Wayengera, Misaki; Ocan, Moses; Kiwanuka, Noah; Munabi, Ian; Muwonge, Haruna; Lekuya, Hervé Monka; Kawooya2, Ismael Cephas Nakanwagi3,4, Alison Annet Kinengyere; Joloba, Moses; Galukande, MosesAutologous adipose-derived stromal vascular fraction (SVF) is an emerging therapy that is being pioneered as a potential treatment for keloids and hypertrophic scars. Up to this point, there isn’t a cure for keloids and hypertrophic scars yet they comprise the commonest benign skin disorders. Despite published studies reporting potential therapeutic benefits of SVF, their use and efficacy on scar improvement are not clearly described. The aim of this review is to describe the clinical practice involved in harvesting, processing, utilization of SVF, and associated efficacy in scar treatment. Methods: We shall include published clinical articles evaluating the efficacy of SVF on improving scar characteristics and assessment scores among adults with keloids or hypertrophic scars. Article search of Medline/PubMed, Cochrane Library and Embase using Mesh terms of “scars” and “stromal vascular fraction” combined with the Boolean operators (“AND”, “OR”) will be performed by two independent researchers following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. The primary outcome measure will be the mean difference in the Scar characteristics including Scar assessment scores, scar thickness among others. Data synthesis: Descriptive data synthesis and mean differences between treatment arms will be calculated for the primary outcome of the scar assessment scores. In case more than three studies provide consistent characteristics of the scar assessment scores, a meta-analysis will be conducted. Discussion: Evidence obtained from the systematic review will form the foundation upon which further clinical trials research will be conducted in evaluating the efficacy of autologous adipose-derived stromal vascular fraction in keloid and hypertrophic scar. The systematic review has been submitted to the PROSPERO database and is currently under review.Item Antibiotic use among children under five years with diarrhea in rural communities of Gulu, northern Uganda: a cross-sectional study(BMC Public Health, 2021) Lanyero, Hindum; Ocan, Moses; Obua, Celestino; Stålsby Lundborg, Cecilia; Nanzigu, Sarah; Katureebe, Agaba; Kalyango, Joan N.; Eriksen, JaranDiarrhea is the second leading cause of mortality in children under 5 years of age globally, and the risk of death increases with practices such as restriction of fluid intake and inappropriate use of antibiotics. We determined the prevalence of antibiotic use in managing diarrhea in children under 5 years of age in rural communities of Gulu district, northern Uganda. Method: A cross-sectional study among children under 5 years with diarrhea, from households selected using multistage sampling. A researcher administered questionnaire was used to obtain data from caregivers of these children. Results: Of the 856 children recruited, 318 (37.1%, 318/856) had experienced diarrhea, where 263 (82.7%, 263/318) had diarrhea with acute respiratory infections (ARIs), and 55 (17.3%, 55/318) had diarrhea without ARIs. The majority (89.6%, 285/318) of the children had non-bloody diarrhea. A high proportion (82.8%) of the children with non-bloody diarrhea also had ARIs. Bloody diarrhea was reported for 33 (10.4%) children including those with ARIs, and only 6 of these (18.2%) children had bloody diarrhea without ARIs. Of the 318 children with diarrhea, over half (52%, CI: 46–57) were administered antibiotics. Of the 55 children who had diarrhea without ARIs, over a third (38%, CI: 26–51) were administered antibiotics. Similarly, of the 263 children with diarrhea and ARIs, 54% (CI: 48–60) were treated with antibiotics. The determinants of antibiotic use included; children living in peri-urban settings (AOR: 3.41, CI: 1.65–7.08, P = 0.001), getting treatment from health facility (AOR: 1.76, CI: 1.06–2.93, P = 0.029), and having diarrhea with ARIs (AOR: 3.09, CI: 1.49–6.42, P = 0.003). Conclusion: Antibiotic use is common among children under 5 years with diarrhea in rural communities of northern Uganda.Item A Cross Sectional Study on Knowledge and Attitudes About Organ Donation and Transplantation in an Urban Population in a Low-Income Country(Research Square, 2023) Kituuka, Olivia; Ocan, Moses; Mbiine, Ronald; Ibingira, Charles; Wayengera, Misaki; Tayebwa, MordecaiUganda’s Health Sector Development Plan (2015/16 -2019/2020) noted that most referrals for treatment abroad were for organ transplant services costing government over 5.6 million US dollars. The government of Uganda has invested in building capacity for Organ donation and transplantation services by training human resource and setting up the infrastructure in Kampala where these services can be accessed. However, there is no information on the readiness of communities and the scientific community to embrace (communities) or undertake (science) organ transplantation in the country. We set out to assess Knowledge and Attitudes about organ donation and transplantation among the urban population in Kampala. Methods: We conducted a cross-sectional survey among 395 participants from the urban population of Kampala at Garden City Mall, Wandegeya market and Nakawa market 28th May - 7th June 2021. We asked about knowledge about organ donation and transplantation, collected sociodemographic data and did a sentiment analysis of participants' attitudes towards organ donation and transplantation. Results: The M:F ratio of participants was 1:1, majority (55.9%) of participants were Baganda, two thirds of participants knew about organ donation, 90% of participants did not know of any government policy on organ donation and transplantation. Radio/television was the commonest source of information. The commonest organ donated was the kidney. Overall, there were 94.3% and 93.2% positive sentiments towards organ transplantation and organ donation respectively. The need for stricter laws governing organ donation and transplantation, corruption and fear were the main negative sentiments expressed by participants. Conclusions: Sensitization of the community is required about government policy on organ donation and transplantation, and this should be communicated through radio/television and social media. There was a positive attitude towards organ donation and transplantation.Item Experience of healthcare personnel on Co-payment mechanism and the implications on its use in private drug outlets in Uganda(Public Library of Science, 2024-05) Ocan, Moses; Bakubi, Racheal; Nakalembe, Loyce; Ekusai-Sebatta, Deborah; Sam, NsobyaMalaria treatment is faced with the challenge of access, affordability, availability, and quality of antimalarial medicines. Affordable medicines facility-malaria (AMFm) program and subsequently Co-payment mechanism were developed to help increase access to quality assured Artemisinin-based combination therapies (ACTs) in seven countries in sub-Saharan Africa. We explored through a qualitative study, experience of healthcare personnel on Co-payment mechanism and the implication on its use in private drug outlets in Uganda. Private drug outlets that reported stocking antimalarial agents in moderate-to-high and low malaria transmission settings were purposively selected for inclusion in the study. In each drug outlet, data was collected from a pharmacist/dispenser through key informant interview. The interview was done using a key informant interview guide which covered the following areas, (i) sociodemographic characteristics, ii) awareness of healthcare personnel on the co-payment mechanism, (iii) awareness of healthcare personnel on quality assured artemisinin combination therapies (QAACT), (iv) antimalarial stocking in private drug outlets, (v) antimalarial dispensing prices, (vi) considerations made while stocking, and pricing antimalarial agents, vii) challenges in antimalarial dispensing, and (viii) access to antimalarial agents in private drug outlets. Data was managed using Atlas.ti and analyzed using framework methodology. Data was collected from 25 key informants (12 pharmacists and 13 dispensers). Five themes emerged following data analysis, (i) antimalarial stocking influenced by price and client demand, (ii) access and purchasing behavior of drug outlet clients, (iii) basis of dispensing antimalarial agents in private drug outlets, (iv) awareness of QAACT, and (v) awareness of Co-payment mechanism. None of the study participants was aware of the existence of Co-payment mechanism and QAACT in the private sector. Duocotecin brand of ACTs was the most mentioned and dispensed ACT among the study participants in private drug outlets. Nearly all the pharmacists/dispensers said that many clients who request to purchase ACTs don't come with a prescription and prefer buying cheaper antimalarial agents. Study participants reported stocking and selling both ACTs and non-ACT antimalarial agents in the drug outlets. Pharmacists/dispensers in the drug outlets reported that most clients could not afford buying a full dose of an ACT. None of the study participants considered using Co-payment mechanism while stocking ACTs in the drug outlets. There is lack of awareness and utilization of Co-payment mechanism in stocking, pricing, and dispensing of ACTs among pharmacists/dispensers in private drug outlets in Uganda. The antimalarial dispensing in drug outlets was mostly based on prescriptions, clients' preferences, and medicine affordability. The Ministry of Health needs to create demand for Co-payment mechanism through public awareness campaigns, training of healthcare personnel and behavior change communication in the private sector.Item Factors predicting home storage of medicines in Northern Uganda(BMC Public Health, 2014) Ocan, Moses; Bbosa, Godfrey S.; Waako, Paul; Ogwal-Okeng, Jasper; Obua, CelestinoMedicines are kept in households Worldwide for first aid, treatment of chronic or acute disease conditions. This promotes inappropriate use of medicines and hence the associated risks. The study explored the factors which predict availability and utilization of medicines in households of Northern Uganda. Method: A cross sectional survey of 892 households was performed from November-to-December 2012. Five data collectors administered the questionnaires, respondents were requested to bring out any medicines present in their households. Demographic characteristics, drug name, quantity, source, formulation, legibility of drug labels and reasons why the medicines were being kept at home was collected. Data was analyzed using STATA 12.0 at 95% level of significance.Item Patterns and Predictors of Self-Medication in Northern Uganda(PLoS ONE, 2014) Ocan, Moses; Bwanga, Freddie; Bbosa, Godfrey S.; Bagenda, Danstan; Waako, Paul; Ogwal- Okeng, Jasper; Obua, CelestinoSelf-medication with antimicrobial agents is a common form of self-care among patients globally with the prevalence and nature differing from country to country. Here we assessed the prevalence and predictors of antimicrobial self-medication in post-conflict northern Uganda. A cross-sectional study was carried out using structured interviews on 892 adult ($18 years) participants. Information on drug name, prescriber, source, cost, quantity of drug obtained, and drug use was collected. Households were randomly selected using multistage cluster sampling method. One respondent who reported having an illness within three months in each household was recruited. In each household, information was obtained from only one adult individual. Data was analyzed using STATA at 95% level of significance. The study found that a high proportion (75.7%) of the respondents practiced antimicrobial self-medication. Fever, headache, lack of appetite and body weakness were the disease symptoms most treated through self-medication (30.3%). The commonly self-medicated antimicrobials were coartem (27.3%), amoxicillin (21.7%), metronidazole (12.3%), and cotrimoxazole (11.6%). Drug use among respondents was mainly initiated by self-prescription (46.5%) and drug shop attendants (57.6%). On average, participants obtained 13.968.8 (95%CI: 12.6–13.8) tablets/capsules of antimicrobial drugs from drug shops and drugs were used for an average of 3.762.8 days (95%CI: 3.3–3.5). Over half (68.2%) of the respondents would recommend self-medication to another sick person. A high proportion (76%) of respondents reported that antimicrobial self-medication had associated risks such as wastage of money (42.1%), drug resistance (33.2%), and masking symptoms of underlying disease (15.5%). Predictors of self-medication with antimicrobial agents included gender, drug knowledge, drug leaflets, advice from friends, previous experience, long waiting time, and distance to the health facility. Despite knowledge of associated risks, use of self-medication with antimicrobial drugs in management of disease symptoms is a common practice in post-conflict northern Uganda.Item Prevalence of arps10, fd, pfmdr-2, pfcrt and pfkelch13 gene mutations in Plasmodium falciparum parasite population in Uganda(Plos one, 2022) Ocan, Moses; Katabazi Ashaba, Fred; Mwesigwa, Savannah; Edgar, Kigozi; Kamya, Moses R.; Nsobya, Sam L.In Uganda, Artemether-Lumefantrine and Artesunate are recommended for uncomplicated and severe malaria respectively, but are currently threatened by parasite resistance. Genetic and epigenetic factors play a role in predisposing Plasmodium falciparum parasites to acquiring Pfkelch13 (K13) mutations associated with delayed artemisinin parasite clearance as reported in Southeast Asia. In this study, we report on the prevalence of mutations in the K13, pfmdr-2 (P. falciparum multidrug resistance protein 2), fd (ferredoxin), pfcrt (P. falciparum chloroquine resistance transporter), and arps10 (apicoplast ribosomal protein S10) genes in Plasmodium falciparum parasites prior to (2005) and after (2013) introduction of artemisinin combination therapies for malaria treatment in Uganda. A total of 200 P. falciparum parasite DNA samples were screened. Parasite DNA was extracted using QIAamp DNA mini kit (Qiagen, GmbH, Germany) procedure. The PCR products were sequenced using Sanger dideoxy sequencing method. Of the 200 P. falciparum DNA samples screened, sequencing for mutations in K13, pfmdr-2, fd, pfcrt, arps10 genes was successful in 142, 186, 141, 128 and 74 samples respectively. Overall, we detected six (4.2%, 6/142; 95%CI: 1.4–7.0) K13 single nucleotide polymorphisms (SNPs), of which 3.9% (2/51), 4.4% (4/91) occurred in 2005 and 2013 samples respectively. All four K13 SNPs in 2013 samples were non-synonymous (A578S, E596V, S600C and E643K) while of the two SNPs in 2005 samples, one (Y588N) is non-synonymous and the other (I587I) is synonymous. There was no statistically significant difference in the prevalence of K13 (p = 0.112) SNPs in the samples collected in 2005 and 2013. The overall prevalence of SNPs in pfmdr-2 gene was 39.8% (74/186, 95%CI: 25.1–50.4). Of this, 4.2% (4/95), 76.9% (70/91) occurred in 2005 and 2013 samples respectively. In 2005 samples only one SNP, Y423F (4.2%, 4/95) was found while in 2013, Y423F (38.5%, 35/91) and I492V (38.5%, 35/91) SNPs in the pfmdr-2 gene were found. There was a statistically significant difference in the prevalence of pfmdr-2 SNPs in the samples collected in 2005 and 2013 (p<0.001). The overall prevalence of arps10 mutations was 2.7% (2/72, 95%CI: 0.3–4.2). Two mutations, V127M (4.5%: 1/22) and D128H (4.5%: 1/22) in the arps10 gene were each found in P. falciparum parasite samples collected in 2013. There was no statistically significant difference in the prevalence of arps10 SNPs in the samples collected in 2005 and 2013 (p = 0.238). There were more pfmdr-2 SNPs in P. falciparum parasites collected after introduction of Artemisinin combination therapies in malaria treatment. This is an indicator of the need for continuous surveillance to monitor emergence of molecular markers of artemisinin resistance and its potential drivers in malaria affected regions globallyItem Prevalence of brucellosis among patients attending Wau Hospital, South Sudan(PloS one, 2018) Madut, Nuol Aywel; Nasinyama, George William; Bwalya Muma, John; Sube, Kenneth L. L.; Ocan, Moses; Muwonge, Adrian; Godfroid, Jacques; Samuel Jubara, Ambrose; Kankya, CloviceBrucellosis is a zoonotic disease of public health importance; its prevalence varies globally. In low-income countries, brucellosis is an endemic and neglected disease affecting both animals and humans. This study was intended to establish brucellosis sero-prevalence among patients attending Wau hospital, South Sudan. Across sectional study, was done among randomly selected patients attending Wau hospital. Data was collected using questionnaires and laboratory investigations. Rose Bengal plate Test (RBPT), Serum agglutination test (SAT) and Competitive Enzyme Linked Immuno Sorbent Assay (c-ELISA) was used in the analysis of blood samples serially starting with RBPT which is more sensitive and least specific then SAT. c-ELISA test which is most specific and less sensitive compared to RBPT and SAT was then used to confirm presence of Brucella antibodies in the samples. A total of 416 participants out of 1664 were enrolled to this study. The majority of participants were between 7-to-76 years of age with mean age of 30.72 (SD+/- 12.83). The sero-positivity of patient's blood samples for brucellosis using c-ELISA was 23.3% (97/416) among patients presenting to Wau hospital. Socio-demographic characteristics, occupation, clinical signs of disease and types of animals reared by animal owners showed no significant correlation with occurrence of sero-positivity among patient's blood samples for brucellosis. While ethnicity (Nilotic), knowledge of zoonotic disease, and consumption of animal urine were statistically significant (p<0.05). The study found a high prevalence of brucellosis among febrile patients attending Wau hospital general outpatient clinic. There is need for co-ordination and collaboration between veterinary and health sectors of government to help prevent and control brucellosis in the region.Item Prevalence of substandard quality artemetherlumefantrine antimalarial agents in Uganda(Research Square, 2022) Ocan, Moses; Nakalembe, Loyce; Otike, Caroline; Nambatya, Winnie; Omali, Denis; Buzibye, Allan; Nsobya, SamSubstandard antimalarial agents are a key challenge to effective malaria control and elimination efforts especially in sub-Saharan Africa. The quality of antimalarial agents in most low-andmiddle income countries (LMICs) is affected by several factors including inadequate regulation and limited resources. In this study, we assessed the pharmacopeial quality of Artemether-Lumefantrine (AL) in low and high malaria transmission settings in Uganda. Methods: This was a cross-sectional study conducted among randomly selected drug outlets (pharmacies/drug shops). The AL antimalarial agents available in drug outlets were purchased using overt method. The samples were screened for quality using visual inspection, weight uniformity and content assay tests. The assay test was done using Liquid chromatography-mass spectrometry (LC-MS) following International and Unites States Pharmacopoeia (USP) method. The samples were considered substandard if the Active Pharmaceutical Ingredient (API) content was outside 90-110% range of the label claim. Data was analysed using descriptive statistics and presented as means with standard deviations, frequencies, and proportions. Correlation between medicine quality and independent variables was determined using fisher’s exact test of independence at 95% level of significance. Results: A total of 74 AL antimalarial samples were purchased from high (49/74; 66.2%) and low (25/74; 33.8%) malaria transmission settings. The most common batch of AL was LONART, 32.4% (24/74), with 33.8% (25/74) having a ‘Green leaf logo’. Overall, prevalence of substandard quality artemetherlumefantrine was 18.9% (14/74; 95%CI: 11.4-29.7). Substandard quality AL was significantly associated with setting (p=0.002). A total of 10 samples (13.5%) failed artemether content assay while, 4 samples (5.4%, 4/74) had substandard lumefantrine content. One sample from a high malaria transmission setting failed both Artemether and Lumefantrine assay test. Of the samples that failed artemether assay test, majority, 90% had low (<90%) artemether content. Conclusion: Substandard quality AL, the recommended first-line antimalarial agent in treatment of uncomplicated malaria is common especially in high malaria transmission settings. There is need for regular surveillance and monitoring of the quality of artemisinin based antimalarial agents across the country.Item Prevalence of, and Factors Associated with, Alcohol Use Disorder among Young Adults (Aged 15–24 Years) Living with HIV/AIDS in Low-Income and Middle-Income Countries: Protocol for a Systematic Review(BMJ open, 2023) Odokonyero, Raymond Felix; Ocan, Moses; Kinengyere, Alison Annet; Nakasujja, Noeline; Muhwezi, Wilson W; Camlin, Carol S.; Hahn, J.A.Alcohol use is a global driver of HIV infection and disease progression, mediated through risky behaviour and poor antiretroviral adherence. Most studies about the burden of alcohol use among people living with HIV (PLWH)/AIDS have been done in adult populations, but less is known about young people with HIV, especially in low-income and middle-income countries (LMICs), despite the high level of alcohol use in these settings. The aim of this review is to collate evidence on the prevalence of, and factors associated with, alcohol use disorder (AUD) among young adults (aged 15–24 years) living with HIV/AIDS in LMICs.Item A systematic review of the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in sub-Saharan Africa between 1986 and 2018: protocol for a systematic review of observational studies(Systematic reviews, 2018) Rukundo, Godfrey Z.; Kemigisha, Elizabeth; Ocan, Moses; Adriko, Wilson; Akena, Dickens H.Suicide is one of the leading causes of death among children and adolescents. Most studies about the burden and risk factors for suicide have been conducted in high-income countries. However, there is a dearth in the literature about the burden and risk factors for suicide among children and adolescents in low- and middle-income countries including within Sub-Saharan Africa (SSA). There is need to summarise the available literature about the burden and risk factors for suicide among children and adolescents in SSA. In this review, we will (a) determine the overall prevalence of suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA; (b) describe the methods (such as hanging, firearms, overdose, poisoning, drowning and burning) used for suicidal attempt, and completed suicide among children and adolescents in SSA; and (c) document the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA. Methods: The review will be conducted and reported in accordance to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. We will include journal articles that have documented the prevalence and risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents aged 5–19 years in SSA. We will also include accessible grey literature about the topic. Qualitative studies will be excluded from the study since they are limited in estimating prevalence. We will search different search engines including PUBMED, EMBASE, Psych-INFO, Cochrane Library, Africa wide-information and global health using suicide, adolescents and children, SSA as the keywords. We will use a meta-analysis, should we find that there is no heterogeneity between included studies. Discussion: This protocol describes a systematic review of observational studies reporting completed suicide, suicidal ideation and suicidal attempt among children and adolescents in sub-Saharan Africa. We anticipate that once this review is complete and published, our findings will be of interest to adolescents with suicidal behaviour, their families and caregivers, clinicians and other healthcare professionals, scientists and policy makers.Item Use of antibacterials in the management of symptoms of acute respiratory tract infections among children under five years in Gulu, northern Uganda: Prevalence and determinants(PLoS ONE, 2020) Lanyero, Hindum; Eriksen, Jaran; Obua, Celestino; Stålsby Lundborg, Cecilia; Nanzigu, Sarah; Katureebe, Agaba; Kalyango, Joan N.; Ocan, MosesInappropriate use of antibacterials is a major public health challenge as it can promote emergence of resistance, wastage of financial resources, morbidity and mortality. In this study, we determined the prevalence and factors associated with antibacterial use in managing symptoms of acute respiratory tract infections (ARIs) in households in rural communities of Gulu district, northern Uganda. A cross-sectional study was conducted among households selected using multi-stage sampling. Data were collected through interviews with care-givers of children under five years, using a structured interviewer administered questionnaire. Out of the 856 children who had symptoms of ARIs, 515 (60.2%; CI: 54.5%-65.6%) were treated with antibacterials. The most commonly used antibacterials were amoxicillin (55.2%, n = 358), cotrimoxazole (15.4%, n = 100) and metronidazole (11.4%, n = 74). The determinants of antibacterial use included; getting treatment from a health facility (AOR: 1.85, CI: 1.34–2.56, P < 0.001), households located in peri-urban area (AOR: 2.54, CI: 1.34–4.84, P = 0.005), and a child having cough (AOR: 7.02, CI: 4.36–11.31, P < 0.001). The prevalence of antibacterial use among children under five years with symptoms of ARIs is high in communities of Gulu district, northern Uganda. Getting treatment from a health facility, if a household was located in a peri-urban area and having a cough are positive predictors of antibacterial use. There is need for targeted education on appropriate antibacterial use in rural communities and hospital settings where over prescription is most likely especially in treating symptoms of ARIs among children under five years.Item Validity of caregivers’ reports on prior use of antibacterials in children under five years presenting to health facilities in Gulu, northern Uganda(PLoS ONE, 2021) Lanyero, Hindum; Ocan, Moses; Obua, Celestino; Stålsby Lundborg, Cecilia; Agaba, Katureebe; Kalyango, Joan N.; Eriksen, Jaran; Nanzigu, SarahGiven the frequent initiation of antibacterial treatment at home by caregivers of children under five years in low-income countries, there is a need to find out whether caregivers’ reports of prior antibacterial intake by their children before being brought to the healthcare facility are accurate. The aim of this study was to describe and validate caregivers’ reported use of antibacterials by their children prior to seeking care at the healthcare facility. Methods A cross sectional study was conducted among children under five years seeking care at healthcare facilities in Gulu district, northern Uganda. Using a researcher administered questionnaire, data were obtained from caregivers regarding reported prior antibacterial intake in their children. These reports were validated by comparing them to common antibacterial agents detected in blood and urine samples from the children using liquid chromatography with tandem mass spectrometry (LC-MS/MS) methods.