Browsing by Author "Otike, Caroline"

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    Adult Computed Tomography examinations in Uganda: Towards determining the National Diagnostic Reference Levels
    (BMC Medical Imaging, 2022) Erem, Geofrey; Ameda, Faith; Otike, Caroline; Olwit, William; Mubuuke, Aloysius G.; Schandorf, Cyril; Kisolo, Akisophel; Kawooya, Michael G.
    Diagnostic Reference Levels (DRLs), typically set at the 75th percentile of the dose distribution from surveys conducted across a broad user base using a specified dose-measurement protocol, are recommended for radiological examinations. There is a need to develop and implement DRLs as a standardisation and optimisation tool for the radiological protection of patients at Computed Tomography (CT) facilities. This was a retrospective cross-sectional study conducted in seven (7) different CT scan facilities in which participants were recruited by systematic random sampling. The study variables were dose length product (DLP) and volume-weighted CTDI (CTDIvol) for the radiation doses for head, chest, abdomen and lumbar spine CT examinations. The DRLs for CTDIvol and DLP were obtained by calculating the 3rd quartiles of the radiation doses per study site by anatomical region. The national diagnostic reference levels were determined by computation of DRLs using the 75th centile of the median values. A total of 574 patients were examined with an average age of 47.1 years. For CTDIvol estimates; there was a strong positive significant relationship between the CTDIvol and examination mAs (rs = 0.9017, p-value < 0.001), and reference mAs (rs = 0.0.7708, p-value < 0.001). For DLP estimates; there was a moderate positive significant relationships between DLP and total mAs (rs = 0.6812, p-value < 0.001), reference mAs (rs = 0.5493, p-value < 0.001). The DRLs were as follows; for head CT scan – the average median CTDIvol was 56.02 mGy and the DLP was 1260.3 mGy.cm; for Chest CT, the CTDI volume was 7.82 mGy and the DLP was 377.0 mGy.cm; for the abdomen CT, the CTDI volume 12.54 mGy and DLP 1418.3 mGy.cm and for the lumbar spine 19.48 mGy and the DLP was 843 mGy.cm, respectively. This study confirmed the need to optimize the CT scan parameters in order to lower the national DRLs. This can be achieved by extensive training of all the CT scan radiographers on optimizing the CT scan acquisition parameters. Continuous dose audits are also advised with new equipment or after every three years to ensure that values out of range are either justified or further investigated.
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    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, Sam
    Substandard 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.