Browsing by Author "Obura, Bonniface"

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    Adherence to Benzathine Prophylaxis Among Rheumatic Fever and Rheumatic Heart Disease Patients Attending Outpatient Clinic at Lira Regional Referral Hospital
    (Lira University, 2022) Atala, Jenifer; Omech, Bernard; Obura, Bonniface
    Background:Secondary prevention of Rheumatic fever and Rheumatic Heart Disease with 3-4 weekly Benzathine prophylaxis is the most effective strategy in preventing disease progression and complications. Efficacy of this regimen is dependent on its rational use. However, adherence to Benzathine prophylaxis worldwide is suboptimal. Magnitude and impact of poor adherence is higher in developing countries. Methods: A retrospective cohort study design using mixed methods was done. To acquire information on adherence to monthly BPG injections, the quantitative component involved a retrospective chart review of secondary data extracted from the Lira RHD Registry. The primary information was qualitative, obtained from key informant and in-depth interviews with RHD patients, care givers, and healthcare professionals respectively. Utilizing a logistic regression model, data was evaluated. Predictors that were at alpha=0.2 were considered significant at bivariate analysis and submitted to multivariate analysis. A significant threshold was set at 0.05 and 95% confidence interval. Thematic analysis using both inductive and deductive coding was used to analyze qualitative data. Results: Overall, 57.8% (89/154) of patients adhered to their benzathine prophylactic regimen. Majority of participants had at least primary education (84/153). Those with tertiary education were 2.6 times more likely to adhere to Benzathine penicillin prophylaxis. (AOR 2.69, 95% CI: 1.00-7.3, P value 0.049). Demand side factors associated with adherence included logistics involved, suboptimal communication, patient related factors and condition related factors whereas supply side factors included medicine stockout, human resource related challenges, costs involved and poor provider client relationship. Conclusion: Adherence was sub-optimal. To address some of the issues impacting adherence to BPG prophylaxis among these patients, it is necessary to address the demand side and supply side factors associated with adherence to BPG, such as training of healthcare professionals and strengthening the sensitization and health education of patients and their caregivers on the need for the monthly BPG injections in relation to their condition.
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    Knowledge and compliance with Covid-19 infection prevention and control measures among health workers in regional referral hospitals in northern Uganda: a cross sectional online survey [version 2; peer review: 1 approved, 1 approved with reservations]
    (F1000Research, 2021) Amanya, Sharon Bright; Nyeko, Richard; Obura, Bonniface; Acen, Joy; Nabasirye, Caroline; Nakaziba, Rebecca; Oyella, Florence; Afayo, Victor; Okwir, Mark
    Background: Infection prevention and control (IPC) has increasingly been underscored as a key tool for limiting the transmission of coronavirus disease 2019 (Covid-19) and safeguarding health workers from infections during their work. Knowledge and compliance with IPC measures is therefore essential in protecting health workers. However, this has not been established among health workers in northern Uganda in light of the Covid-19 pandemic. The objective of this study was to determine the knowledge and compliance with Covid-19 infection prevention and control measures among health workers in regional referral hospitals in northern Uganda. Methods: An online cross-sectional descriptive study was conducted among health workers in regional referral hospitals within northern Uganda. A structured questionnaire was distributed to health workers via WhatsApp messenger. Sufficient knowledge was considered at a correct response score of ≥80%, while adequate compliance was rated ≥75% of the maximum score. Data were analyzed using SPSS v21. Results: Of the 213 health workers approached, 75 (35%) participated in the study. The majority were males, 39(52%) and the mean age was 36.92 years. Of the 75 participants, 52(69%) had sufficient knowledge of Covid-19 IPC while 51(68%) had adequate compliance with Covid-19 IPC. Adequate compliance was significantly associated with training in Covid-19 IPC (OR, 2.86; 95% CI, (1.04-7.88); p=0.039), access to Covid-19 IPC materials at workstations (OR, 2.90; 95% CI, (1.06 - 8.09); p=0.036), and having strong institutional support (OR, 3.08; 95% CI, (1.08 – 8.74); p=0.031). However, there was no significant relationship between knowledge and compliance with IPC (p=0.07). The socio demographic characteristics of health workershad no statistically significant relationship with Covid-19 IPC knowledge or compliance. Conclusion: Our results show fairly good knowledge and compliance with Covid-19 IPC among health workers in northern Uganda. There is need for more training and provision of guidelines to promote compliance with Covid-19 IPC. Keywords Infection prevention and control, knowledge, training, compliance
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    Medical Foods and Infant Formulas
    (Springer, 2020) Mtewa, Andrew G.; Kasali, Mushagalusa F.; Bekele, Tamirat; Obura, Bonniface
    Medical foods are foods that are formulated specifically to help in the management of diseases with particular dietary needs hardly met singly by normal diet. They are taken under medical prescription or supervision. On the other hand, infant formulas are basically foods designed for baby consumption that are intended for nutritive purposes. Some medical foods can also be designed as infant formula for ease of administration to babies. The most common types of medical foods are Ready-to-Use-Foods (RUFs) which are fortified to manage health complications, whist still maintaining high quality and safety standards. They can be used to prevent the development and/or progression of diseases. These foods need to have a scientifically determined shelf-life with a traceable trail of clinical trials as specified by international foods and health guidelines and regulations. This chapter explores the general outlook of medical foods and infant formulas including threats and future opportunities they present.
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    Off-label antibiotic use among paediatric in-patients: a mixed-method prospective study at a tertiary hospital in southwestern Uganda
    (International Journal of Clinical Pharmacy, 2020) Obura, Bonniface; Obua, Celestino
    Background The off-label use of drugs to treat children is a global practice attributed to the traditional exclusion of children from clinical trials mainly due to practical and ethical reasons. Off-label drug use carries both benefits and risks, but data regarding this use pattern are scanty in sub-Saharan Africa. Objective To determine the incidence and predictors of off-label antibiotic use in children less than 5 years admitted at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Setting A prospective drug utilisation study was conducted among in-patients at the Paediatric Ward of MRRH from May to June 2019. Methods Clinical records and treatment notes of all children aged 0 to 59 months with at least one antibiotic prescription during the admission period were reviewed and included for data collection. Key informant interviews were conducted with physicians attending to patients in the Paediatric Ward. Main outcome measure Off-label use and potential predictors of off-label antibiotic use. Results Of 427 children admitted to the Paediatric Ward, 165 (38.6%) received 366 antibiotic prescriptions. However, 359 prescriptions belonging to 162 patients were analyzed. Off-label prescriptions occurred in 18.9% (95% CI: 14.9–23.0) of antibiotic prescriptions. Two categories of off-label prescriptions were found: off-label frequency of administration (n = 55, 80.9%), and off-label doses (n = 13, 19.1%). Ceftriaxone was the most common antibiotic prescribed at off-label doses, (n = 6, 8.8%) while ampicillin was the most common antibiotic prescribed with an off-label frequency of administration, (n = 39, 57.3%). Infants (1–23 months) received the majority (47.1%) of off-label antibiotic prescriptions; neonates (0–28 days) received 27.9%, and children (24–59 months) received 25% of the prescriptions. Controlling for sex and disease severity, age category remained significantly associated with off-label antibiotic use on multivariate analysis. Conclusion Off-label frequency of administration was the major category of off-label drug use, while off-label dose was the minor category. Age was a significant factor for off-label antibiotic prescription, with infants receiving the highest number of off-label prescriptions. Attending physicians identified several justifiable circumstances that warrant off-label antibiotic use and support emerging “well-founded” off-label uses of antibiotics in different paediatric age groups
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    Variations in Trim5α and Cyclophilin A genes among HIV‑1 elite controllers and non controllers in Uganda: a laboratory‑based cross‑sectional study
    (2020) Amanya, Sharon Bright; Nyiro, Brian; Waswa, Francis; Obura, Bonniface; Nakaziba, Rebecca; Nabulime, Eva; Katabazi, Ashaba Fred; Nabatanzi, Rose; Bayiyana, Alice; Mboowa, Gerald; Kayongo, Alex; Wayengera, Misaki; Obondo, J. Sande
    Background: Tripartite Motif Containing 5 alpha (TRIM5α), a restriction factor produced ubiquitously in cells and tissues of the body plays an important role in the immune response against HIV. TRIM5α targets the HIV capsid for proteosomal destruction. Cyclophilin A, an intracellular protein has also been reported to influence HIV infectivity in a cell-specific manner. Accordingly, variations in TRIM5α and Cyclophilin A genes have been documented to influence HIV-1 disease progression. However, these variations have not been documented among Elite controllers in Uganda and whether they play a role in viral suppression remains largely undocumented. Our study focused on identifying the variations in TRIM5α and Cyclophilin A genes among HIV-1 Elite controllers and non-controllers in Uganda. Results: From the sequence analysis, the rs10838525 G > A mutation in exon 2 of TRIM5α was only found among elite controllers (30%) while the rs3824949 in the 5′UTR was seen among 25% of the non-controllers. In the Cyclophilin A promoter, rs6850 was seen among 62.5% of the non-controllers and only among 10% elite controllers. Furthermore, rs17860048 in the Cyclophillin A promoter was predominantly seen among elite controllers (30%) and 12.5% noncontrollers. From gene expression analysis, we noted that the respective genes were generally elevated among elite controllers, however, this difference was not statistically significant (TRIM5α p = 0.6095; Cyclophilin A p = 0.6389). Conclusion: Variations in TRIM5α and Cyclophillin A promoter may influence HIV viral suppression. The rs10838525 SNP in TRIM5α may contribute to viral suppression among HIV-1 elite controllers. The rs6850 in the cyclophillin A gene may be responsible for HIV-1 rapid progression among HIV-1 non-controllers. These SNPs should be investigated mechanistically to determine their precise role in HIV-1 viral suppression.