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ItemPrevalence and factors associated with anaemia in children aged 6–24 months living a high malaria transmission setting in Burundi(PloS ONE, 2022)Background In very young children, anaemia has been linked to increased morbidity, mortality and poor cognitive development. Although Burundi has a high burden of anaemia, which may be worsened by the high burden of malaria, little is known about the extent of the problem in very young children who are most at risk of severe disease. We estimated the prevalence, and assessed the factors associated with anaemia in children aged 6–24 months using baseline data collected as part of an on-going study evaluating the effect of Micronutrient supplementation on anaemia and cognition among children in high malaria transmission settings in Burundi. Methods Between February and March 2020, surveys were conducted in 498 households within the catchment area of Mukenke Health Center. One child aged 6–24 months was selected per household to participate in the survey. Following written informed consent, we administered a questionnaire to the child’s primary caregiver to capture information on child’s demographics, nutritional status, food intake, health (status, and morbidity and treatment-seeking practices), as well as the household markers of wealth. A physical exam was conducted, and a blood sample was collected to: 1) assess for presence of plasmodium infection using a rapid diagnosis test; 2) estimate the haemoglobin levels using a portable haemocue machine. A stool sample was also collected to examine for the presence of helminth infections. Results The prevalence of anaemia was 74.3% (95% confidence interval [CI] 61.5%-84.0%), with most of the anaemic study participants classified as having moderate anaemia (59.2%). A total of 62 (12.5%) participants had positive malaria rapid diagnosis tests. Factors significantly associated with higher odds of developing anaemia included not receiving deworming medication (adjusted Odd ratio [aOR] = 3.54, 95% CI 1.79–6.99, p<0.001), the child’s home location (Mukenke II: aOR = 2.22, 95% CI 1.89–2.62, p<0.001; Mukenke: aOR = 2.76, 95% CI 2.46–3.10, p<0.001 and Budahunga: aOR = 3.12, 95% CI 2. 94–3.31, p<0.001) and the child’s age group (Children aged 6–11 months: aOR = 2.27, 95% CI 1.32–3.91, p<0.001). Education level was inversely associated with less odds of anaemia: child’s primary care giver with a secondary (aOR = 0.67; 95% CI: 0.47–0.95, p = 0,024) and tertiary education level (aOR = 0.48; 95% CI: 0.38–0.61, p<0.001). Conclusion Anaemia is highly prevalent among young children in high malaria transmission setting. Anaemia is more prevalent among children who not dewormed and those with malaria. To prevent the long-term adverse outcomes of the anaemia in children, policy makers should focus on improving uptake of the deworming and malaria prevention programs, promote preventive interventions and improve the education of women especially in families with very young children.
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ItemAssessing readiness for provision of online pharmaceutical services by retail pharmacies in Greater Kampala Metropolitan, Uganda(Makerere University, 2024)Introduction: The first online pharmacy, Soma (www.soma.com), started in the United States in January 1999. More than two decades later, the industry has transformed due to the rise of online shopping, electronic health solutions, direct-to-consumer healthcare, and globalization of pharmaceutical manufacturing. Approximately 35,000 online pharmacies now operate worldwide. Developing countries like Uganda are experiencing the emergence of online pharmacy services, but there is limited data available regarding their readiness to provide these services. There is therefore a need to evaluate their readiness to offer these services. This study evaluated the technological infrastructure and human resource readiness for the provision of online pharmaceutical services in the Greater Kampala Metropolitan Area. Methods: This was a cross-sectional study that used both qualitative and quantitative data collection methods in the Greater Kampala Metropolitan Area. The study was able to select 272 pharmacies using proportionate stratified random sampling. Descriptive statistics were conducted using Stata version 14, with frequencies reported for quantitative data. Thematic analysis was performed on qualitative data collected from the National Drug Authority (NDA) regional managers in the Greater Kampala Metropolitan Area. Results: The majority 222(95%) of the surveyed pharmacies engaged in delivery of online pharmaceutical services, offering a diverse range of services, including tele-pharmacy 189(85%), home drug delivery 141(64%), e-prescriptions 97(44%), home delivery with follow-up 94(42%), prescription reminder services 79(36%), and online consultations 75(34%). Only 23(10%) of retail pharmacies offering online pharmaceutical services had good human resource readiness, compared to 124(56%) with good technological infrastructure readiness. However, only 19(9%) of the pharmacies offering these services had good readiness for both Technological infrastructure and Human resources. Findings also showed a lack of specific regulations and legal frameworks for the delivery of online pharmaceutical services, minimal enforcement of the quality and authenticity of products sold online, and minimal public awareness and education on online pharmaceutical services. Conclusion: Over half of the pharmacies offering online pharmaceutical services had the necessary infrastructure in place thus infrastructure readiness, but there was a lack of human resources preparedness for online pharmaceutical services. The majority of the pharmacies were engaged in providing some online services such as delivering drugs ordered over phone calls to clients. However, very few used websites and software applications to carry out transactions which are fundamental for the provision of online pharmaceutical services. Recommendation: Retail pharmacies should encourage and offer training to their staff in online pharmaceutical services so as to improve human resource readiness. The National Drug Authority should establish clear guidelines and standards for the delivery of online pharmaceutical services, addressing aspects of Technological Infrastructure and Human Resources.
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ItemDetermining the factors contributing to real-time ARV Stock Status (RASS) data quality and reporting rate in West Acholi sub-region, Uganda(Makerere University, 2024)Introduction: The World Health Organization aims for universal HIV control by 2030, requiring robust healthcare infrastructure and efficient supply chain management. In Uganda, a functional real-time ARV Stock Status (RASS) monitoring system and dashboard was developed to provide real-time intelligent data and reliable and accurate information on antiretroviral drugs and other HIV commodities. This integrates data from different information systems for timely decision-making and supports evidence-based ARV commodities supply chain management solutions. Objective: This study aimed to identify the factors influencing the quality and reporting rate for Real-Time ARV Stock Status (RASS) weekly reporting in public health facilities in the West Acholi sub-region of Uganda. Methods: A mixed-methods cross-sectional study was conducted in six public health facilities of the West Acholi sub-region. Quantitative data involved a review of 312 reports for the reporting rate. The available 180 RASS reports were reviewed for data quality; supplemental qualitative data was gathered through key informant interviews with 11 healthcare workers and stakeholders. Quantitative data was then cleaned using EPI data, and all the variables were coded and analyzed using SPSS version 21. The tables were then computed using the analyzed data from the software, and the pie charts were constructed using the Excel 2019 version. Thematic analysis was done for the key informant qualitative interviews. Analysis of RASS reports revealed a mixed level of quality, with only 40 reports (22%) categorized as good quality, having scored on both accuracy and completeness checks. The overall reporting rate was above average, with only 180 reports (57.7%). Infrastructure limitations, such as unreliable internet, lack of proper equipment, and staff transfers, were frequently cited as causes of poor-quality reporting. Lack of training on RASS and limited leadership support were cited as the causes of the poor data quality and RASS reporting rate. Conclusion: The quality of RASS reports could have been better than the national set targets. The reporting rate was slightly above average but far below the national set targets. Several factors affecting both the reporting rate and quality of reports were cited. These include staff attitude, knowledge gap, Staff transfers, poor internet connectivity, and lack of internet data bundles.
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ItemThe Clinical Presentation and Factors Associatedwith Disease Severity of Rheumatoid Arthritis inUganda: A Cross-Sectional Study( 2022)Background Rheumatoid arthritis (RA) is a chronic, debilitating disease that leads to joint destruction and disability if left untreated. Few studies on RA have been conducted in Uganda, and there is limited information on disease severity and associated factors. This study sought to characterize the clinical presentation and to determine disease severity and the factors associated with disease severity among participants with RA in Uganda. Methods Between August 2018 and February 2019, patients presenting to the rheumatology outpatient clinic in Mulago National Referral Hospital were enrolled into the study using a cross-sectional design. Participants’ demographics and clinical characteristics were collected using a study questionnaire, and laboratory results were extracted from their charts. The patients’ functionality was assessed using the Modified Health Assessment Questionnaire and their disease severity was assessed using the RA Disease Activity Score based on 28-joint count (DAS28). Results A total of 170 participants were enrolled, of whom 81.2% were female. Nearly two-thirds (111/170) were classified as having severe disease. Having a functional status score of >0.5 (adjusted odds ratio 1.7, 95% confidence interval 1.4–2.2, p<0.001) was significantly associated with severe disease. Conclusion In this population, the majority of the patients seen at the rheumatology outpatient clinic had severe disease, suggesting that patients may be presenting late, with limited early detection of the disease. Impaired functional status was associated with increased disease severity and may be used by clinicians to highlight disease severity when it is not possible to assess the RA DAS28
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ItemPrevalence of arps10, fd, pfmdr-2, pfcrt and pfkelch13 gene mutations in Plasmodium falciparum parasite population in Uganda(PloS ONE, 2022)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 ofarps10 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 potentialdrivers in malaria affected regions globally.