Browsing by Author "Semakula, Daniel"
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Item Adverse drug reaction reporting among health care workers at Mulago National Referral and Teaching hospital in Uganda(African health sciences, 2015-12-15) Katusiime, Barbra; Semakula, Daniel; Lubinga, Solomon J.Adverse Drug Reactions (ADRs) are an important contributor to patient morbidity and hospitalisation in Uganda. Under-reporting of ADRs may increase medicine-induced morbidity and mortality among patients. This study determined the extent of ADR reporting, and associated factors, among healthcare workers in Uganda. A quantitative, cross-sectional, study was conducted. Pretested, semi-structured questionnaires were administered to 289 randomly sampled healthcare workers over a three-month period in Mulago National Referral Hospital, Uganda. The primary outcome was the proportion of healthcare workers who had ever reported an ADR. Data was double-entered in Epidata version 3.0, cleaned and exported to STATA version 10.1 for analysis. The overall response rate was 77.2% (n=223). The majority of the respondents were females (139, 62.3%). The median age of all respondents was 32.6 years (min-23; max-65). Only about 16.6% (n=37) of healthcare workers had ever reported an ADR. Very few (n= 84, 37.7%) healthcare workers knew the tools used in ADR reporting. Less than a quarter (n=41, 18.4%) of the healthcare workers knew where to report ADRs. Lack of training was reported as the major (56.5%, 126) deterrent to reporting ADRs by healthcare workers. Conclusion: Adverse drug reactions are under-reported in Uganda, and healthcare workers have insufficient knowledge of existing pharmacovigilance systems, including ADR reporting systems. To address these challenges, there is need to sensitize and train healthcare workers in patient-centred aspects of medicine surveillance, so as to provide appropriate care while optimising patient safety.Item Can an educational podcast improve the ability of parents of primary school children to assess the reliability of claims made about the benefits and harms of treatments: study protocol for a randomised controlled trial(Trials, 2017-01-21) Semakula, Daniel; Nsangi, Allen; Kaseje, Margaret; Sewankambo, Nelson K.Claims made about the effects of treatments are very common in the media and in the population more generally. The ability of individuals to understand and assess such claims can affect their decisions and health outcomes. Many people in both low- and high-income countries have inadequate aptitude to assess information about the effects of treatments. As part of the Informed Healthcare Choices project, we have prepared a series of podcast episodes to help improve people’s ability to assess claims made about treatment effects. We will evaluate the effect of the Informed Healthcare Choices podcast on people’s ability to assess claims made about the benefits and harms of treatments. Our study population will be parents of primary school children in schools with limited educational and financial resources in Uganda.Item Covid-19 Infection, Illness and Deaths Among Healthcare Workers in Low- and Middle-Income Countries: A Systematic Review Protocol(Plos, 2021-09-27) Ocan, Moses; Kawala, Brenda Allen; Semakula, Daniel; Obuku, Ekwaro AnthonyGlobally, health care workers continue to be infected, fall ill and die at the frontline of the Coronavirus disease 2019 (COVID-19) fight, an indicator of inadequate safety in health facilities. This rapid evidence synthesis aims to highlight the impacts of COVID-19 on healthcare workers in low-and middle-income countries (LMICs) in terms of infections, illnesses and deaths. A systematic review will be done. Article search will be performed by an experienced librarian in PubMed, MEDLINE Ovid, Google Scholar, COVID-END, Cochrane library and targeted search from other relevant sources. MeSH terms and Boolean operators “AND” and “OR” will be used in the article search. Independent reviewers will screen the retrieved articles using a priori criteria. Data abstraction will be done using an excel based abstraction tool and synthesized using structured narratives and summary of findings tables.Item Development of mass media resources to improve the ability of parents of primary school children in Uganda to assess the trustworthiness of claims about the effects of treatments: a human-centred design approach(Pilot and Feasibility Studies, 2019-12-29) Semakula, Daniel; Nsangi, Allen; Kaseje, Margaret; Sewankambo, Nelson KaulukusiClaims about what we need to do to improve our health are everywhere. Most interventions simply tell people what to do, and do not empower them to critically assess health information. Our objective was to design mass media resources to enable the public to critically appraise the trustworthiness of claims about the benefits and harms of treatments and make informed health choices.Item Does the use of the Informed Healthcare Choices (IHC) primary school resources improve the ability of grade-5 children in Uganda to assess the trustworthiness of claims about the effects of treatments: protocol for a cluster-randomised trial(Trials, 2017-05-18) Nsangi, Allen; Semakula, Daniel; Rosenbaum, Sarah; Kaseje, Margaret; Sewankambo, Nelson K.The ability to appraise claims about the benefits and harms of treatments is crucial for informed health care decision-making. This research aims to enable children in East African primary schools (the clusters) to acquire and retain skills that can help them make informed health care choices by improving their ability to obtain, process and understand health information. The trial will evaluate (at the individual participant level) whether specially designed learning resources can teach children some of the key concepts relevant to appraising claims about the benefits and harms of health care interventions (treatments).Item Effect of pre-operative bicarbonate infusion on maternal and perinatal outcomes among women with obstructed labour in Mbale hospital: A double blind randomized controlled trial(PLoS ONE, 2021) Musaba, Milton W.; Wandabwa, Julius N.; Ndeezi, Grace; Weeks, Andrew D.; Mukunya, David; Waako, Paul; Nankabirwa, Victoria; Tulyamuhika Mugabe, Kenneth; Semakula, Daniel; Tumwine, James K.; Barageine, Justus K.Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labor (dystocia). Its effectiveness and safety among women with obstructed labor is not known. Objective To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labor (OL) in Mbale hospital. Methods We conducted a double blind, randomized controlled trial from July 2018 to September 2019. The participants were women with OL at term (�37 weeks gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements.Item Effects of the Informed Health Choices podcast on the ability of parents of primary school children in Uganda to assess the trustworthiness of claims about treatment effects: one-year follow up of a randomised trial(Trials, 2020-02-14) Semakula, Daniel; Nsangi, Allen; Rosenbaum, Sarah; Sewankambo, Nelson K.Earlier, we designed and evaluated an educational mass media intervention for improving people’s ability to think more critically and to assess the trustworthiness of claims (assertions) about the benefits and harms (effects) of treatments. The overall aims of this follow-up study were to evaluate the impact of our intervention 1 year after it was administered, and to assess retention of learning and behaviour regarding claims about treatments.Item Effects of the Informed Health Choices primary school intervention on the ability of children in Uganda to assess the reliability of claims about treatment effects, 1-year follow-up: a cluster-randomised trial(Trials, 2020-01-06) Nsangi, Allen; Semakula, Daniel; Rosenbaum, Sarah; Lewin, Simon; Sewankambo, Nelson K.We evaluated an intervention designed to teach 10- to 12-year-old primary school children to assess claims about the effects of treatments (any action intended to maintain or improve health). We report outcomes measured 1 year after the intervention. In this cluster-randomised trial, we included primary schools in the central region of Uganda that taught year 5 children (aged 10 to 12 years). We randomly allocated a representative sample of eligible schools to either an intervention or control group. Intervention schools received the Informed Health Choices primary school resources (textbooks, exercise books and a teachers’ guide). The primary outcomes, measured at the end of the school term and again after 1 year, were the mean score on a test with two multiple-choice questions for each of the 12 concepts and the proportion of children with passing scores. We assessed 2960 schools for eligibility; 2029 were eligible, and a random sample of 170 were invited to recruitment meetings. After recruitment meetings, 120 eligible schools consented and were randomly assigned to either the intervention group (n = 60 schools; 76 teachers and 6383 children) or the control group (n = 60 schools; 67 teachers and 4430 children). After 1 year, the mean score in the multiple-choice test for the intervention schools was 68.7% compared with 53.0% for the control schools (adjusted mean difference 16.7%; 95% CI, 13.9 to 19.5; P < 0.00001). In the intervention schools, 3160 (80.1%) of 3943 children who completed the test after 1 year achieved a predetermined passing score (≥ 13 of 24 correct answers) compared with 1464 (51.5%) of 2844 children in the control schools (adjusted difference, 39.5%; 95% CI, 29.9 to 47.5). Use of the learning resources led to a large improvement in the ability of children to assess claims, which was sustained for at least 1 year.Item Effects of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically about health choices: A cluster-randomized trial(Journal of Evidence‐Based Medicine, 2023-09-21) Mugisha, Michael; Nyirazinyoye, Laetitia; Senyonga, Ronald; Semakula, Daniel; Oxman, Andrew D.The aim of this trial was to evaluate the effects of the Informed Health Choices intervention on the ability of students in Rwandan to think critically and make Informed Health Choices. We conducted a two-arm cluster-randomized trial in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools to the intervention or control. One class in each intervention school had ten 40-min lessons taught by a trained teacher in addition to the usual curriculum. Control schools followed the usual curriculum. The primary outcome was a passing score (≥ 9 out of 18 questions answered correctly) for students on the Critical Thinking about Health Test completed within 2 weeks after the intervention. We conducted an intention-to-treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts. Between February 25 and March 29, 2022, we recruited 3,212 participants. We assigned 1,572 students and 42 teachers to the intervention arm and 1,556 students and 42 teachers to the control arm. The proportion of students who passed the test in the intervention arm was 915/1,572 (58.2%) compared to 302/1,556 (19.4%) in the control arm, adjusted odds ratio 10.6 (95% CI: 6.3–17.8), p < 0.0001, adjusted difference 37.2% (95% CI: 29.5%–45.0%). The intervention is effective in helping students think critically about health choices. It was possible to improve students’ ability to think critically about health in the context of a competence-based curriculum in Rwanda, despite challenging postpandemic conditions.Item Incidence and predictors of COPD mortality in Uganda: A 2-year prospective cohort study(PLoS One, 2021-02-11) Alupo, Patricia; Wosu, Adaeze C.; Mugenyi, Levicatus; Semakula, Daniel; Katagira, Winceslaus; Kirenga, BruceData is lacking on outcomes among COPD patients in sub-Saharan Africa. The objective of the study was to assess the incidence and predictors of mortality among COPD patients enrolled in the Uganda Registry for Asthma and COPD. What is the Incidence and predictors of mortality among COPD patients in Uganda? Individuals with a diagnosis of COPD at six hospitals in Uganda were enrolled into the registry, and followed every six months. Mortality was ascertained through post-mortem reports and verbal autopsies. Mortality rates (MR), mortality rate ratios (MRR), and hazard ratios (HR) were computed to assess associations between socio-demographic, behavioural, and clinical characteristics at enrolment into the registry and mortality up to two years after. We enrolled 296 COPD patients. Median age was 60 years, and 51·3% were male. The overall mortality rate was 95·90 deaths/1000 person-years. COPD severity by post-bronchodilator FEV1 was the strongest risk factor for mortality. Compared to stage 1, adjusted hazard ratios were as follows for stage 4: 9·86 (95%CI: 1·70–57·14, p = 0·011), stage 3: 6·16 (95%CI: 1·25–30·32, p = 0·025), and stage 2: 1·76 (95%CI: 0·33–9·48, p = 0·51). Underweight patients had a higher incidence of mortality compared to normal weight patients (MRR: 3·47 (95%CI: 1·45–8·31, p = 0·0026). Among COPD patients in Uganda, two-year mortality is high, and disease severity at baseline was the strongest risk factor for mortality. Our findings suggest the need for early, accurate, diagnosis and management of COPD, to potentially improve survival.Item Informed health choices intervention to teach primary school children in lowincome countries to assess claims about treatment effects: process evaluation(BMJ open, 2019-08-02) Nsangi, Allen; Semakula, Daniel; Rosenbaum, Sarah; Nyirazinyoye, Laetitia; Kaseje, Margaret; Sewankambo, Nelson K.We developed the informed health choices (IHC) primary school resources to teach children how to assess the trustworthiness of claims about the effects of treatments. We evaluated these resources in a randomised trial in Uganda. This paper describes the process evaluation that we conducted alongside this trial.To identify factors affecting the implementation, impact and scaling up of the intervention; and potential adverse and beneficial effects of the intervention. All 85 teachers in the 60 schools in the intervention arm of the trial completed a questionnaire after each lesson and at the end of the term. We conducted structured classroom observations at all 60 schools. For interviews and focus groups, we purposively selected six schools. We interviewed district education officers, teachers, head teachers, children and their parents. We used a framework analysis approach to analyse the data.Item Informed Health Choices media intervention for improving people’s ability to critically appraise the trustworthiness of claims about treatment effects: a mixed-methods process evaluation of a randomised trial in Uganda(BMJ open, 2019-02-26) Semakula, Daniel; Nsangi, Allen; Rosenbaum, Sarah; Fretheim, Atle; Sewankambo, NelsonWe developed the informed health choices (IHC) primary school resources to teach children how to assess the trustworthiness of claims about the effects of treatments. We evaluated these resources in a randomised trial in Uganda. This paper describes the process evaluation that we conducted alongside this trial. To identify factors affecting the implementation, impact and scaling up of the intervention; and potential adverse and beneficial effects of the intervention.Item Key Concepts for Informed Health Choices: a framework for helping people learn how to assess treatment claims and make informed choices(BMJ Evid Based Med, 2018-01-30) Chalmers, Iain; Oxman, Andrew D.; Sewankambo, Nelson; Semakula, Daniel; Nsangi, Allen; Heneghan, Carl; Douglas, BadenochMany claims about the effects of treatments, though well intentioned, are wrong. Indeed, they are sometimes deliberately misleading to serve interests other than the well-being of patients and the public. People need to know how to spot unreliable treatment claims so that they can protect themselves and others from harm. The ability to assess the trustworthiness of treatment claims is often lacking. Acquiring this ability depends on being familiar with, and correctly applying, some key concepts, for example, that’ association is not the same as causation.’ The Informed Health Choices (IHC) Project has identified 36 such concepts and shown that people can be taught to use them in decision making. A randomised trial in Uganda, for example, showed that primary school children with poor reading skills could be taught to apply 12 of the IHC Key Concepts. The list of IHC Key Concepts has proven to be effective in providing a framework for developing and evaluating IHC resources to help children to think critically about treatment claims. The list also provides a framework for retrieving, coding and organising other teaching and learning materials for learners of any age. It should help teachers, researchers, clinicians, and patients to structure critical thinking about the trustworthiness of claims about treatment effects.Item Key concepts that people need to understand to assess claims about treatment effects(Journal of evidence-based medicine, 2015-11-11) Austvoll-Dahlgren, Astrid; Nsangi, Allen; Semakula, Daniel; Sewankambo, NelsonPeople are confronted with claims about the effects of treatments and health policies daily. Our objective was to develop a list of concepts that may be important for people to understand when assessing claims about treatment effects. An initial list of concepts was generated by the project team by identifying key concepts in literature and tools written for the general public, journalists, and health professionals, and consideration of concepts related to assessing the certainty of evidence for treatment effects. We invited key researchers, journalists, teachers and others with expertise in health literacy and teaching or communicating evidence-based health care to patients to act as the project's advisory groups. Twenty-nine members of the advisory group provided feedback on the list of concepts and judged the list to be sufficiently complete and organised appropriately. The list includes 32 concepts divided into six groups: (i) Recognising the need for systematic reviews of fair tests, (ii) Judging whether a comparison of treatments is fair comparison, (iii) Understanding the role of chance, (iv) Considering all the relevant fair comparisons, (v) Understanding the results of fair comparisons of treatments, (vi) Judging whether fair comparisons of treatments are relevant. The concept list provides a starting point for developing and evaluating resources to improve people's ability to assess treatment effects. The concepts are considered to be universally relevant, and include considerations that can help people assess claims about the effects of treatments, including claims that are found in mass media reports, in advertisements and in personal communication.Item Learning to think critically about health using digital technology in Ugandan lower secondary schools: A contextual analysis(PLoS One,, 2022-02-02) Ssenyonga, Ronald; Sewankambo, Nelson K.; Mugagga, Solomon Kevin; Mugisha, Michael; Semakula, Daniel; Rosenbaum, SarahThe world is awash with claims about the effects of health interventions. Many of these claims are untrustworthy because the bases are unreliable. Acting on unreliable claims can lead to waste of resources and poor health outcomes. Yet, most people lack the necessary skills to appraise the reliability of health claims. The Informed Health Choices (IHC) project aims to equip young people in Ugandan lower secondary schools with skills to think critically about health claims and to make good health choices by developing and evaluating digital learning resources. To ensure that we create resources that are suitable for use in Uganda’s secondary schools and can be scaled up if found effective, we conducted a context analysis. We aimed to better understand opportunities and barriers related to demand for the resources, how the learning content overlaps with existing curriculum and conditions in secondary schools for accessing and using digital resources, in order to inform resource development. We used a mixed methods approach and collected both qualitative and quantitative data. We conducted document analyses, key informant interviews, focus group discussions, school visits, and a telephone survey regarding information communication and technology (ICT). We used a nominal group technique to obtain consensus on the appropriate number and length of IHC lessons that should be planned in a school term. We developed and used a framework from the objectives to code the transcripts and generated summaries of query reports in Atlas.ti version 7. Critical thinking is a key competency in the lower secondary school curriculum. However, the curriculum does not explicitly make provision to teach critical thinking about health, despite a need acknowledged by curriculum developers, teachers and students. Exam oriented teaching and a lack of learning resources are additional important barriers to teaching critical thinking about health. School closures and the subsequent introduction of online learning during the COVID-19 pandemic has accelerated teachers’ use of digital equipment and learning resources for teaching. Although the government is committed to improving access to ICT in schools and teachers are open to using ICT, access to digital equipment, unreliable power and internet connections remain important hinderances to use of digital learning resources. There is a recognized need for learning resources to teach critical thinking about health in Ugandan lower secondary schools. Digital learning resources should be designed to be usable even in schools with limited access and equipment. Teacher training on use of ICT for teaching is needed.Item Low condom use at the last sexual intercourse among university students in sub-Saharan Africa: Evidence from a systematic review and meta-analysis(PLoS one, 2022-08-10) Izudi, Jonathan; Okello, Gerald; Semakula, Daniel; Bajunirwe, FrancisThere is inconsistent data about condom use at the last sexual intercourse (LSI) among university students in sub-Saharan Africa (SSA) and its association with sex, age, and condom negotiation efficacy. The primary objective of this study was to summarize the proportion of condom use at the LSI among university students in SSA. The secondary objective was to determine the association between condom use at the LSI with sex, age, and condom negotiation efficacy among university students in SSA.Item Measuring ability to assess claims about treatment effects: a latent trait analysis of items from the ‘Claim Evaluation Tools’ database using Rasch modelling(BMJ open, 2017-05-17) Austvoll-Dahlgren, Astrid; Nsangi, Allen; Semakula, Daniel; Oxman, Andrew D.The Claim Evaluation Tools database contains multiple-choice items for measuring people’s ability to apply the key concepts they need to know to be able to assess treatment claims. We assessed items from the database using Rasch analysis to develop an outcome measure to be used in two randomised trials in Uganda. Rasch analysis is a form of psychometric testing relying on Item Response Theory. It is a dynamic way of developing outcome measures that are valid and reliable. To assess the validity, reliability and responsiveness of 88 items addressing 22 key concepts using Rasch analysis. We administrated four sets of multiple-choice items in English to 1114 people in Uganda and Norway, of which 685 were children and 429 were adults (including 171 health professionals). We scored all items dichotomously. We explored summary and individual fit statistics using the RUMM2030 analysis package. We used SPSS to perform distractor analysis. Most items conformed well to the Rasch model, but some items needed revision. Overall, the four item sets had satisfactory reliability. We did not identify significant response dependence between any pairs of items and, overall, the magnitude of multidimensionality in the data was acceptable. The items had a high level of difficulty. Most of the items conformed well to the Rasch model’s expectations. Following revision of some items, we concluded that most of the items were suitable for use in an outcome measure for evaluating the ability of children or adults to assess treatment claims.Item Pediatric intussusception in Uganda: differences in management and outcomes with high-income countries(Journal of pediatric surgery, 2020-03-26) Akello, Valin; Kurigamba, Gideon; Semakula, Daniel; Kakembo, Nasser; Ozgediz, Doruk; Sekabira, JohnIn high-income countries the presentation and treatment of intussusception is relatively rapid, and most cases are correctable with radiographically-guided reduction. In low-income countries, many delays affect outcomes and surgical intervention is required. This study characterizes the burden and outcome of pediatric intussusception in Uganda.Item Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country(BMC health services research, 2019-01-25) Kintu, Andrew; Lubikire, Aggrey; Nabukenya, Mary T.; Igaga, Elizabeth; Bulamba, Fred; Semakula, Daniel; Olufolabi, Adeyemi J.There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was to assess the severity of post cesarean section pain. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction. We prospectively followed 333 women who underwent cesarean section under spinal anesthesia. Subjective assessment of the participants’ pain was done using the Visual Analogue Scale (0 to 100) at 0, 6 and 24 h after surgery. Satisfaction with pain control was ascertained at 24 h after surgery using a 2-point scale (yes/no). Participants’ charts were reviewed for records of analgesics administered. Pain control medications used in the first 24 h following cesarean section at this hospital included diclofenac only, pethidine only, tramadol only and multiple pain medications. There were mothers who did not receive any analgesic medication. The highest pain scores were reported at 6 h (median: 37; (IQR:37.5). 68% of participants reported they were satisfied with their pain control. Adequate management of post-cesarean section pain remains a challenge at Mulago hospital. Greater inter-professional collaboration, self-administered analgesia, scheduled prescription orders and increasing availability of analgesic drugs may contribute to improved treatment of postoperative pain with better pain scores.Item Postoperative Sepsis Among HIV-Positive Patients with Acute Abdomen at Tertiary Hospital in Sub-Saharan Africa: a Prospective Study(SN Comprehensive Clinical Medicine, 2019-06-15) Awale, Mohamed Abdullahi; Makumbi, Timothy; Rukundo, Gideon; Kisuze, Geoffrey; Semakula, Daniel; Galukande, MosesThe incidence of HIV in Uganda as reported by UNAIDS (2012) was increased from 6.7% in 2004 to 7.6% to 2012. The main threat to HIV-infected patients following surgery is the development of sepsis. Inadequacy of surgical supplies and human resources further hastens and complicates the postoperative sepsis in HIV patients. The objective of the study was to determine incidence and risk factors associated with postoperative sepsis, among HIV seropositive with acute abdomen. A prospective study ran for a period of 11 months from October 2015 to April 2016 in Mulago Hospital in Kampala. Eligible patients were recruited and included. Study variables included postoperative wound sepsis, type of surgery, and CD4 counts. Thirty-eight data were collected using a questionnaire then entered in the Epidata software 3.1 and analyzed by Stata software version. Sixty-two patients were recruited; of these, 42 were male, 37 were HIV-negative and 25 were HIV-positive. The proportion of patients with postoperative sepsis in the HIV-positive group was 7 (28%) and in the HIV-negative group was 8 (21.6%). The number of patients discharged in HIV-positive group was 24 (96%) and in HIV-negative group was 35 (94.6%). Among the HIV-positive group was 1 out of 25 (4) % and HIV-negative was 2 out of 37 (5.4%). The overall postoperative sepsis incidence rate was 3 per 100 person days for under observation (95% CI 0.02–0.1), and the incidence rate ratio of HIV-positive patients and HIV-negative was 1.04 (95% CI 0.32–3.3; P = 0.47. The limited health resource was associated with developing postoperative sepsis. There was a higher risk of positive operative sepsis among HIV-positive compared to HIV-negative patients undergoing surgery for acute abdominal conditions.