NRU :: Browsing by Author "Ochieng, Joseph"

Browsing by Author "Ochieng, Joseph"

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Attitudes and Perceptions about the Research and Ethics Committee in Kampala, Uganda
(The International Journal Of Medicine, 2020) Ochieng, Joseph; Ibingira, Charles B. R.
The Makerere University Faculty of Medicine Research and Ethics Committee reviews and approves more than 100 new research protocols a year, yet its activities had never been evaluated as far as the researchers are concerned. Methods and results This was a cross sectional study at Makerere University Faculty of Medicine and Mulago Teaching Hospital. The survey population included all staff involved in research at the post graduate level and faculty. Most of the respondents agreed that decisions of the REC were binding 53 (75.7%),15 (21%) hold that were variable and 2(2.9%) biased. The biased attitudes of researchers regarding protocol review reduces as researchers present more protocols to the REC.
Capacity of community advisory boards for effective engagement in clinical research: a mixed methods study
(BMC medical ethics, 2021) Mugenyi, Levicatus; Mijumbi, Andrew; Nanfuka, Mastula; Agaba, Collins; Kaliba, Fedress; Seryazi Semakula, Irene; Badanga Nazziwa, Winfred; Ochieng, Joseph
Community engagement is a key component in health research. One of the ways health researchers ensure community engagement is through Community Advisory Boards (CABs). The capacity of CABs to properly perform their role in clinical research has not been well described in many resource limited settings. In this study, we assessed the capacity of CABs for effective community engagement in Uganda. Methods: We conducted a cross sectional study with mixed methods. We used structured questionnaires and key informant interviews (KII) to collect data from CAB members, trial investigators, and community liaison officers. For quantitative data, we used descriptive statistics while for qualitative data we used content analysis. Results: Seventy three CAB members were interviewed using structured questionnaires; 58.9% males, median age 49 years (IQR 24–70), 71.2% had attained tertiary education, 42.5% never attended any research ethics training, only 26% had a training in human subject protection, 30.1% had training in health research, 50.7% never attended any training about the role of CABs, and 72.6% had no guidelines for their operation. On the qualitative aspect, 24 KIIs cited CAB members to have some skills and ability to understand and review study documents, offer guidance on community norms and expectations and give valuable feedback to the investigators. However, challenges like limited resources, lack of independence and guidelines, and knowledge gaps about research ethics were cited as hindrances of CABs capacity. Conclusion: Though CABs have some capacity to perform their role in the Ugandan setting, their functionality is limited by lack of resources to facilitate their work, lack of independence, lack of guidelines for their operations and limited knowledge regarding issues of research ethics and protection of the rights of trial participants.
Consent for mobile phone surveys of non-communicable disease risk factors in low-resource settings: an exploratory qualitative study in Uganda
(Mhealth, 2019) Mwaka, Erisa; Nakigudde, Janet; Ali, Joseph; Ochieng, Joseph; Hallez, Kristina; Tweheyo, Raymond; Labrique, Alain; Gibson, Dustin G.; Rutebemberwa, Elizeus; Pariyo, George
Lack of data for timely decision-making around the prevention and control of noncommunicable diseases (NCDs) presents special challenges for policy makers, especially in resource-limited settings. New data collection methods, including pre-recorded Interactive Voice Response (IVR) phone surveys, are being developed to support rapid compilation of population-level disease risk factor information in such settings. We aimed to identify information that could be used to optimize consent approaches for future mobile phone surveys (MPS) employed in Uganda and, possibly, similar contexts. Methods: We conducted an in-depth qualitative study with key stakeholders in Uganda about consent approaches, and potential challenges, for pre-recorded IVR NCD risk factor surveys. Semi-structured interviews were conducted with 14 key informants. A contextualized thematic approach was used to interpret the results supported by representative quotes. Results: Several potential challenges in designing consent approaches for MPS were identified, including low literacy and the lack of appropriate ways of assessing comprehension and documenting consent. Communication with potential respondents prior to the MPS and providing options for callbacks were suggested as possible strategies for improving comprehension within the consent process. “Opt-in” forms of authorization were preferred over “opt-out”. There was particular concern about data security and confidentiality and how matters relating to this would be communicated to MPS respondents. Conclusions: These local insights provide important information to support optimization of consent for MPS, whose use is increasing globally to advance public health surveillance and research in constructive ways
Creation of virtual patients from CT images of cadavers to enhance integration of clinical and basic science student learning in anatomy
(Medical Teacher, 2009) Jacobson, Stanley; Epstein, Scott K.; Albright, Susan; Ochieng, Joseph; Griffiths, Jeffrey; Coppersmith, Veronica; Polak, Joseph F.
The goal of this study was to determine whether computerized tomographic (CT) images of cadavers could be used in addition to images from patients to develop virtual patients (VPs) to enhance integrated learning of basic and clinical science. Methods: We imaged 13 cadavers on a Siemens CT system. The DICOM images from the CT were noted to be of high quality by a radiologist who systematically identified all abnormal and pathological findings. The pathological findings from the CT images and the cause of death were used to develop plausible clinical cases and study questions. Each case was designed to highlight and explain the abnormal anatomic findings encountered during the cadaveric dissection. A 3D reconstruction was produced using OsiriX and then formatted into a QuickTime movie which was then stored on the Tufts University Sciences Knowledgebase (TUSK) as a VP. Results and Conclusions: We conclude that CT scanning of cadavers produces high-quality images that can be used to develop VPs. Although the use of the VPs was optional and fewer than half of the students had an imaged cadaver for dissection, 59 of the 172 (34%) students accessed and reviewed the cases and images positively and were very encouraging for us to continue.
Ethical and human rights considerations in public health in low and middle-income countries: an assessment using the case of Uganda’s responses to COVID-19 pandemic
(BMC Medical Ethics, 2020) Barugahare, John; Nakwagala, Fredrick Nelson; Mwaka Sabakaki, Erisa; Ochieng, Joseph; Sewankambo, Nelson K.
In response to COVID-19 pandemic, the Government of Uganda adopted public health measures to contain its spread in the country. Some of the initial measures included refusal to repatriate citizens studying in China, mandatory institutional quarantine, and social distancing. Despite being a public health emergency, the measures adopted deserve critical appraisal using an ethics and human rights approach. The goal of this paper is to formulate an ethics and human rights criteria for evaluating public health measures and use it to reflect on the ethical propriety of those adopted by the government of Uganda to contain the spread of COVID-19. Main body: We begin by illustrating the value of ethics and human rights considerations for public health measures including during emergencies. We then summarize Uganda’s social and economic circumstances and some of the measures adopted to contain the spread of COVID-19. After reviewing some of the ethics and human rights considerations for public health, we reflect upon the ethical propriety of some of Uganda’s responses to COVID-19. We use content analysis to identify the measures adopted by the government of Uganda to contain the spread of COVID-19, the ethics and human rights considerations commonly recommended for public health responses and their importance. Our study found that some of the measures adopted violate ethics and human rights principles. We argue that even though some human rights can sometimes be legitimately derogated and limited to meet public health goals during public health emergencies, measures that infringe on human rights should satisfy certain ethics and human rights criteria. Some of these criteria include being effective, strictly necessary, proportionate to the magnitude of the threat, reasonable in the circumstances, equitable, and least restrictive. We reflect on Uganda’s initial measures to combat the spread of COVID-19 and argue that many of them fell short of these criteria, and potentially limit their effectiveness. Conclusion: The ethical legitimacy of public health measures is valuable in itself and for enhancing effectiveness of the measures. Such legitimacy depends on the extent to which they conform to ethics and human rights principles recommended for public health measures.
Evolution of Research Ethics in a Low Resource Setting: a case of Uganda
(Developing world bioethics, 2020) Ochieng, Joseph; Kwagala, Betty; Sewankambo, Nelson; Mwaka, Erisa
The globalization of clinical research in the last two decades has led to a significant increase in the volume of clinical research in developing countries. As of 2016, Uganda was the third largest destination for clinical trials in Africa. This requires adequate capacity and systems to facilitate ethical practice. Methods: This was a retrospective study involving review of laws, guidelines, policies and records from 1896 to date. Results: Modern medicine evolved from 1896 and by the time of Uganda’s independence in 1962, a 1500 bed national referral hospital was in place and a fully-fledged medical school was established at the Makerere University. As the practice of medicine evolved in the country, so did medical research that addressed priority health issues. The growth in modern medicine was not matched with development of research infrastructure and regulatory systems. The first documented regulation of research activities was in 1970 while the first research ethics committee established in 1986 was to facilitate review of research related to the HIV/AIDs pandemic. In 1990 an Act of Parliament was passed to facilitate development and implementation of policies, hence the development of the national guidelines in 1997, training, establishment and accreditation of research ethics committees, conferences and research site monitoring.
Experiences and practices of key research team members in obtaining informed consent for pharmacogenetic research among people living with HIV: a qualitative study
(Research Ethics, 2022) Ochieng, Joseph; Kaawa-Mafigiri, David; Munabi, Ian; Nakigudde, Janet; Nabukenya, Sylvia; Nakwagala, Frederick N.; Barugahare, John; Kwagala, Betty; Ibingira, Charles; Twimwijukye, Adelline; Sewankambo, Nelson; Mwaka Sabakaki, Erisa
This study aimed to explore experiences and practices of key research team members in obtaining informed consent for pharmacogenetics research and to identify the approaches used for enhancing understanding during the consenting process. Data collection involved 15 qualitative, in-depth interviews with key researchers who were involved in obtaining informed consent from HIV infected individuals in Uganda for participation in pharmacogenetic clinical trials. The study explored two prominent themes: approaches used to convey information and enhance research participants’ understanding and challenges faced during the consenting process. Several barriers and facilitators for obtaining consent were identified. Innovative and potentially effective consenting strategies were identified in this study that should be studied and independently verified.
Feedback of Individual Genetic and Genomics Research Results: A Qualitative Study Involving Grassroots Communities in Uganda
(medRxiv, 2022) Ochieng, Joseph; Kwagala, Betty; Barugahre, John; Möller, Marlo; Moodley, Keymanthri
Genetics and genomics research (GGR) is associated with several challenges including, but not limited to, implications of sharing research findings with participants and their family members, issues of confidentiality, determining appropriate methods for providing genetic or genomic information to individuals tested, and ownership of DNA obtained from the samples. Additionally, GGR holds significant potential risk for social and psychological harms. A considerable amount of research has been conducted with resultant literature and global debate on return of genetic and genomics testing results, but such investigations are limited in the African setting, including Uganda. The objective of the study was to assess perceptions of grassroots communities on if and how feedback of individual genetics and genomics testing results should be carried out in a Ugandan setting. Methods: This was a cross-sectional study that employed a qualitative exploratory approach. A total of 42 individuals from grassroots communities representing three major ethnic groupings participated in five deliberative focus group discussions. Data were analysed through content analysis along the main themes of the study. NVivo software (QSR international 2020) was used to support data analysis and illustrative quotes were extracted.
Informed consent in clinical practice: patients’ experiences and perspectives following surgery
(BMC research notes, 2015) Ochieng, Joseph; Buwembo, William; Munabi, Ian; Ibingira, Charles; Kiryowa, Haruna; Nzarubara, Gabriel; Mwaka, Erisa
Informed consent during medical practice is an essential component of comprehensive medical care and is a requirement that should be sought all the time the doctor interacts with the patients, though very challenging when it comes to implementation. Since the magnitude and frequency of surgery related risk are higher in a resource limited setting, informed consent for surgery in such settings should be more comprehensive. This study set out to evaluate patients’ experiences and perspectives of informed consent for surgery. Methods: This was a survey of post-operative patients at three university teaching hospitals in Uganda. The participants were interviewed using guided, semi-structured questionnaires. Patients from different surgical disciplines participated in the study.
Informed consent practices for surgical care at university teaching hospitals: a case in a low resource setting
(BMC research notes, 2015) Ochieng, Joseph; Ibingira, Charles; Buwembo, William; Munabi, Ian; Kiryowa, Haruna; Kitara, David; Bukuluki, Paul; Nzarubara, Gabriel; Mwaka, Erisa
Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching Hospitals in a low resource setting.
Musculoskeletal disorder risk factors among nursing professionals in low resource settings: a cross-sectional study in Uganda
(BioMedical Central, 2014) Kitara, David L.; Munabi, Ian G.; Buwembo, William; Ochieng, Joseph
Abstract Background: Musculoskeletal disorders (MSD) constitute one of the main occupational hazards among health care workers. However, few epidemiological studies on work related MSD among nursing professionals have been carried out in Africa. The purpose of this study was to assess the work related musculoskeletal disorders and associated risk factors among nursing professionals in Uganda. Methods: This was a cross-sectional study of MSD among 880 nursing professionals from five selected hospitals in Uganda. Data was collected using a questionnaire adapted from the Dutch Musculoskeletal and Nordic Musculoskeletal questionnaires. Descriptive (mean, standard deviation and percentages) and inferential (Chi square test and logistic regression analysis) statistics were used to analyse data. Alpha level was set at p < 0.05. Results: A total of 741 completed questionnaires were analysed (response rate 85.4%). The average age of the respondents was 35.4 (SD 10.7) years and a majority were female (85.7%). The average working hours per week was 43.7 (SD 18.9 hours). The 12-month period-prevalence of MSD at anybody site was 80.8%. The most common site of MSD was the lower back (61.9%). Significant risk factors for reported MSD included often working in a slightly bent posture (adjOR 2.25, 95% CI 1.20-4.26), often working in a slightly twisted posture for long (adjOR 1.97, 95% CI 1.03-3.77), mental exhaustion (adjOR 2.05, 95% CI 1.17-3.5), being absent from the work station for more than 6 months due to illness or an accident (adjO|R, 4.35, 95% CI 1.44-13.08) and feeling rested after a break (adjOR 2.09, 95% CI 1.16-3.76). Conclusions: Musculoskeletal disorders affect more than 80% of nursing professionals in Uganda with the most commonly, affected site being the lower back. Significant risk factors for MSD include; being absent from the work station for more than 6 months due to illness or an accident, working in awkward postures, pushing/pulling of heavy loads and mental exhaustion. There is a need for greater advocacy, better working conditions and adoption of strategies to reduce occupational injuries.
Musculoskeletal disorders among nursing staff: a comparison of five hospitals in Uganda
(The Pan African Medical Journal, 2014) Munabi, Ian G.; Buwembo, William; Kitara, David L.; Ochieng, Joseph; Nabirye, Rose C.; Mwaka, Erisa S.
Introduction: Low and middle income countries have severe nursing staff shortages which is associated with risk of poor quality of patient care and increased patient exposure to adverse events. This is accompanied with increased risk of musculoskeletal disorders to the nursing staff. This paper sets out to identify and compare factors associated with musculoskeletal disorders among nursing staff in 5 different hospitals in Uganda. Methods: This was a cross sectional study on nurses from 5 different hospitals in Uganda. The study used a 12 month recall of reported Musculoskeletal disorders (MSD) among nurses. Ethical approval was obtained. Logistic regression analysis and ANOVA were used. The level of significance was set at 0.05 for all statistical tests. Results: There were 755 respondents of whom 433 (58.4%) were nurses. The prevalence of MSD at anybody site was 80.8%. There were significant differences in reported MSD among nursing staff across different hospital settings which were worse in the public hospitals as compared to the private and private not for profit hospitals (p <0.001). Age (adjusted OR 1.03, 95% CI 1.01- 1.06), self reported poor general health status (adj OR 4.5, 95% CI 2.8-7.24) and stress as suggested by waking up tired in the morning (adj OR 3.4, 95% CI 2.17-5.32) were significant associated factors for MSD in this population. Conclusion: Reported MSD among nursing staff across 5 different hospitals is worse in public as compared to private hospitals. Age, self reported poor general health status and stress were important factors for MSD in this population.
Musculoskeletal pain and school bag use: a cross-sectional study among Ugandan pupils
(BMC Research Notes, 2014) Mwaka, Erisa S.; Munabi, Ian G.; Buwembo, William; Kukkiriza, John; Ochieng, Joseph
Though seen as a convenient method of carrying books and other scholastic materials including food items, schoolbags are believed to contribute to back and other musculoskeletal problems in school going children. This study set out to determine the prevalence of low back and other musculoskeletal pains and describe their relationship with schoolbag use in pupils. Results: This was a cross-sectional descriptive study involving 532 pupils from six primary schools with a mean age of 13.6 years. Analyses included the chi- square test, independent t tests, regression analysis and test for trend across ordered groups. Backpacks were the most common type of schoolbag and younger children carried disproportionately heavier bags. Urban pupils were younger, carried significantly heavier bags, and less likely to complain about schoolbag weight than the rural pupils, About 30.8% of the pupils carried schoolbags which were more than 10% of their body weight. About 88.2% of pupils reported having body pain especially in the neck, shoulders and upper back. About 35.4% of the children reported that carrying the schoolbag was the cause of their musculoskeletal pain. The prevalence of lower back pain was 37.8%. There was significant association between low back pain and; method of bag carriage (p < 0.0001), long duration of walking (odds ratio 2.67, 95% CI 1.38- 5.16) and the time spent sitting after school (p = 0.02). Only 19% had lockers at school. Conclusion: Urban pupils were younger, carried significantly heavier bags, and less likely to complain about schoolbag weight than the rural pupils. The majority of pupils complained of musculoskeletal pain of which 35.4% was attributed to the schoolbags. The prevalence of lower back pain was 37.8%. Schools need to provide lockers and functional libraries in order to avoid excessive loading and repetitive strain injuries.
Phytochemicals and uses of Moringa oleifera leaves in Ugandan rural communities
(Journal of Medicinal Plants Research, 2010) Kasolo, Josephine N.; Bimenya, Gabriel S.; Ojok, Lonzy; Ochieng, Joseph; Ogwal-Okeng, Jasper W.
Moringa oleifera grown and used in many countries around the world is a multi-purpose tree with medicinal, nutritional and socio-economic values. In Senegal and Benin, M. oleifera leaves are dispensed as powder at health facilities to treat moderate malnutrition in children. It established the medicinal uses of M. oleifera leaves by local communities in Uganda and identified phytochemicals present in M. oleifera leaves extracts. It used quantitative and experimental methods that established the uses, and identified phytochemicals in M. oleifera leaves. Employed serial extractions, using ether, ethanol and water as solvents. The phytochemicals were qualitatively identified using standard chemicals and standard outcomes. Twenty-four medicinal uses of M. oleifera leaves were established. Phytochemicals present included: tannins, steroids and triterpenoids, flavonoids, saponins, anthraquinones, alkaloids and reducing sugars. The local communities in Uganda use M. oleifera leaves to treat common ailments. Presence of phytochemicals in the extracts, indicate possible preventive and curative property of M. oleifera leaves. There is need to standardize M. oleifera leaves use for nutrition and herbal medicine.
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, Paul
On 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.
Stakeholders’ Perspectives on Rationing COVID-19 Vaccines Amidst Extreme Scarcity: A Qualitative Study
(Research Square, 2021) Barugahare, John; Kwagala, Betty; Ochieng, Joseph
In the context of scarce health-resources robust priority setting for access to existing interventions is critical for at least two reasons: ensuring efficient use of resources, and equitable access to existing interventions. This need is more urgent, and its achievement more intractable in severely resource-constrained health systems, of Low and Middle Income Countries, such as Uganda. COVID-19 pandemic and the resulting need for large-scale and immediate vaccination amidst extreme scarcity of vaccines in Uganda necessitated an exploration of stakeholders’ perspectives on the country’s priority setting for access to COVID-19 vaccines. We aimed at exploring stakeholders’ perspectives on priority setting for COVID-19 vaccination in Ugandan. Methods: We conducted key informant and in-depth interviews with key stakeholders in the COVID-19 intervention including public health experts, clinicians, policy makers, human rights experts, bioethicists, legal fraternity, biomedical scientists and members from the general public. Stakeholders’ views were sought on the status of official guidelines for rationing COVID-19 vaccines; who they thought should get priority for vaccination and why; and what the process of setting such priorities should involve. Data were transcribed and analysed thematically using NVivo software (QSR international 2020). Results: There was concern about lack of clarity regarding context-specific guidance on priorities COVID- 19 vaccination. This concern was corroborated by the fact that national guidelines for COVID-19 vaccination are still in draft form and inaccessible to the public. Regarding who should get priority and why, dominant views indicated more concern for efficiency-cum-effectiveness at controlling the spread of the virus, although further probing revealed that some of these views were partly motivated by equity concerns. Most respondents felt that the process of developing the needed guidelines should have employed a bottom-up approach involving rigorous community engagement.
Value and importance of informed consent to researchers at Makerere University
(Annals of Tropical Medicine and Public Health, 2012) Ochieng, Joseph
Respect for persons requires that research participants be given the opportunity to make choices about what should be done to them. Many times, the process of informed consent is abused to the benefit of researchers while exploitation and harm to the research participants may occur. In Uganda, issues of questionable research ethics have been highlighted in the past. Objective: To determine the Value and importance of the informed consent process among researchers at Makerere University. Materials and Methods: This was a qualitative descriptive study design involving faculty and graduate students in the faculties of Medicine and Social Sciences. Results: Of the 37 respondents 68% were faculty while 32% were graduate students in the fields of social sciences, clinical and basic sciences. Mean research experience was 8.5 years. More than 70% of the respondents have had no formal training in research ethics. Only 22% of the respondents appreciated the need for research participants to comprehend the informed consent; 38% thought it is not always the case and in many cases their subjects do not have to comprehend, while the remaining 40% believe that research subjects’ understanding of the informed consent process may not be necessary. All respondents appreciated the importance of confidentiality although data management procedures were lacking by many. Conclusion: Most researchers appreciate the importance of confidentiality, but have limited understanding of the process of informed consent, information handling and the importance of feedback.

Browsing by Author "Ochieng, Joseph"

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