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A 10 years Trend of Peptic Ulcer Disease and other Gastrointestinal Disorders in Northern Uganda
(East and Central African Journal of Surgery, 2016) Okello, Tom Richard; Ogwang, David Martin; Pecorella, Irene
Background: The changing trend of GI disorders has not been expounded in our setting, there is need to examine the extent to which major endoscopically diagnosed upper GI disorders have changed in the last 10 years (2005 to 2015). Methods: This was a retrospective study in which endoscopically diagnosed GI disorders of Jan-Jun 2005 were compared with 2015 (10 years) for the same period Results: In the 10 years (2005 to 2015), the prevalence of peptic ulcer disease (PUD) reduced from 9.6% to 2.9% (P value 0.000), followed by esophageal varices from 10.3% to 4.0%, and duodenitis from 3.2% to 0.7% respectively. Gastritis increased from 18.4% to 48.2% (P value 0.000), followed by cancer esophagus from 3.2% to 5.1%. Conclusion: As the prevalence of PUD decreases in our community, gastritis increases hence patients with upper GI symptoms tend to suffer gastritis thus clinicians should focus on treating gastritis and eradication of Helicobacter pylori
919 Routine Hospital Acquired Infection surveys are feasible in low income health care settings and can inform quality improvement interventions
(Oxford University Press, 2014) Ochola, Emmanuel; Okello, Tom Richard; Kansiime, Jackson; Praticò, Liliana; Greco, Donato
Background. Prevention of acquisition of infection in the health care setting is imperative for reduction in morbidity and mortality for patients and health workers and improvement health care quality. However, data is scarce on prevalence and trends of hospital acquired infections (HAI) in low income settings, unlike in developed countries. We instituted annual surveys to determine HAI prevalence and determinants in a hospital in Gulu, Northern Uganda, an area recovering from over 20 years of war. Methods. An external expert mentored local hospital staff at the request of the Board, to do HAI surveys for 2 years after which a local team continues the exercise. Using standard WHO checklists. A one-day survey is done, recruiting all patients admitted in the hospital for 48hours or more. Data is collected by doctors and nurses on demographics, new diarrhea, Urinary Tract Infections (UTI), respiratory conditions, wound infection and intravenous catheter infections that were absent during admission. Urinalysis was done to confirm UTI. Results were analysed using SPSS, reporting basic statistics and p values of chi square tests comparisons. Results. A total 1174 clients were surveyed in four years, average 293 per survey. There was a 56% decline in HAI prevalence from 28% in 2010 to 14.2% in 2011 (p < 0.0001). Prevalence of HAI was 15.1% in 2013 and 14% in 2014. In different years, the key hospital acquired infections included UTI accounting for 39% (21.5-55%) of the total HAI, intravenous line infection 27% (18.2-30.4%), respiratory tract infections, 17.5% (5.5-25.5%), and surgical wound infections, 16.0% (8.7-20%). In 2013 which had UTI at 58%, UTI was present in 53.3% of catheterized clients, compared to 14.8% in 2011. Conclusion. The HAI surveys are practical, and feasible to perform, even in poor settings. The surveys prompted the institution of the hospital infection control committee. HAI surveys can generate glaring gaps, which when intervened on, like urinary catheter overstay, poor wound care, duration of iv lines, and hand washing practices, can improve care quality. The surveys can suggest corrective actions for good care practices. Nevertheless, prevention of HAI needs continuous efforts of all health workers.
Access and use of medicines information sources by physicians in public hospitals in Uganda: a cross-sectional survey
(African Health Sciences, 2008) Tumwikirize, Winifred A.; Ogwal-Okeng, Jasper; Vernby, Åsa; Anokbonggo, Willy W.; Gustafsson, Lars L.; Lundborg, Cecilia S.
Background: Rational and cost-effective prescription of medicines requires up-to-date and readily accessible medicines information. There are several studies on availability and access to medicines information sources, but have been conducted only in high-income countries. Objective: To assess medicines information sources accessed by physicians in public hospitals in Uganda, and physicians’ opinion on establishment of a medicines information centre in the country. Methods: A cross-sectional survey including 369 physicians from six district, six regional and two university hospitals. Data was collected using a semi-structured self-administered questionnaire. Results Response rate was 91%. This included 31, 136 and 168 physicians from the district, regional and university hospitals, respectively. In the district hospitals the source of medicines information reported to be most available was colleagues (100%), while in the regional and university hospitals it was literature from pharmaceutical companies (98%) and hard copy of research publications (99%) respectively. The most frequently used source in the district and regional hospitals was National Standard Treatment Guideline (90% and 73% respectively), and colleagues in university hospitals (89%). Accessibility problems with reported available sources were commonest with research publications in medical journals, both hard copy and through the internet, MIMS, pharmacists and pharmacologists. Need for a medicines information centre was indicated by 80% of the respondents. Conclusion: Majority of the physicians in public hospitals in Uganda have limited access to unbiased drug information. Therefore, there is need to assess the feasibility of establishing a drug information centre, and then assess its use during a trial period. Key words: Medicines information, physicians, Uganda
Access to ART Services: Lived Experiences and Coping Strategies of HIV-Positive Persons With Visual Impairment in Lira District, Northern Uganda
(John Wiley & Sons Ltd, 2025) Acila, Gloria Ketty; Ijorea, Noeline Aju; Kabunga, Amir; Angom, Mercy Joy; Talemwa, Sandra; Ayer, Patrick; Auma, Anna Grace
Background: Despite progress in the HIV/AIDS response, marginalized populations persistently face unique challenges in accessing essential healthcare services, including antiretroviral therapy. The aim of this qualitative study is to explore and understand the lived experiences of individuals living with HIV and visual impairment in Lira District, Northern Uganda, specifically focusing on their access to antiretroviral therapy services. Additionally, the study is aimed at identifying and analyzing the coping strategies employed by this population in navigating the intersectionality of HIV and visual impairment. Methods: This qualitative study, conducted in Lira District, Northern Uganda, employed a descriptive phenomenological design. Thirty in-depth interviews were conducted at Lira Regional Referral Hospital, focusing on individuals living with both HIV and visual impairment. Data collection involved a semistructured interview guide, addressing key issues derived from a literature review. Thematic analysis was used for data analysis, guided by Braun and Clarke’s framework. Results: Participants (N = 30) exhibited diverse sociodemographic characteristics, with ages ranging from 19 to 68 years. A number of themes emerged during data analysis: individuals developing visual impairment before and after ART initiation. Emotional challenges, strained relationships, and perceived burdenship were common themes among participants. Limited understanding of the cause of sight loss and a heightened perceived risk of HIV infection were evident. Challenges in accessing ART services included transportation difficulties, negative attitudes from healthcare workers, and a lack of trust in community drug distribution points. Participants employed various coping strategies, including prayers/religion, reliance on social support networks, denial, acceptance, and community rehabilitation. Positive religious beliefs offered hope, while social support played a crucial role in adaptation. Community rehabilitation and support were highlighted as instrumental in aiding coping. Conclusion: Despite awareness about the risk of HIV infection, significant barriers persist in accessing ART services for persons with visual impairment. Coping strategies underscore the importance of addressing psychosocial aspects. Tailored interventions, education, and policy changes are imperative to enhance inclusivity and accessibility of healthcare services for this vulnerable population in Uganda.
Acute toxicity effects of the methanolic extract of Fagara zanthoxyloides (Lam.) root-bark
(African Health Sciences, 2003) Ogwal-Okeng, Jasper; Obua, Celestino.; Anokbonggo, William W.
Background: Fagara zanthoxyloides is a well known medicinal plant in Uganda. It is used extensively in malaria and other infections. However nothing is known about its toxicity. Objective: The objective of the study was to evaluate the acute toxicity of the methanolic extract of the root-bark of F. zanthoxyloides, in mice. Methods: Methanolic extract of the root-bark of the plant was administered orally to mice at various dose levels to determine the acute toxic effects and the median lethal dose (LD50) in mice. Results: The LD50 of the methanolic extract was found to be 5.0 g/Kg body weight within 95 % confidence limits. The mice showed signs of cerebral irritation before dying. Histopathological examinations of the viscera showed congestion and focal necrosis of the liver and renal tubules. Conclusion: It was concluded that the extract of F. zanthoxyloides is safe, however the cerebral mechanism that lead to the death of the mice need to be investigated further.
Adverse drug reactions in patients admitted on Internal Medicine wards in a district and Regional Hospital in Uganda
(African Health Sciences, 2011) Tumwikirize, WA; Ogwal-Okeng, Jasper; Vernby, A; Anokbonggo, W; Gustafsson, L; Lundborg, s
Introduction: The burden of both community and hospital acquired adverse drug reactions (ADRs) are some of the important issues in pharmacotherapy. At the time of this study there was very scanty literature in this area from Africa. Objective: This study was done to determine the frequency and characteristics of ADRs in patients admitted on medical wards in public hospitals. Methods: This was a longitudinal observational study on 728 adult patients on medical wards in one regional and one district hospitals. Community and hospital acquired ADRs were assessed. Results: Thirty three patients (4.5%) were admitted with suspected ADR, and an ADR was the reason for hospitalization in 1.5%. Most ADRs were due to antiparasitic products, mainly quinine (61%). Community acquired ADRs prolonged hospital stay, 5.6 days vs 4.0 days (p-value < 0.001). During hospitalization ADRs occurred in 49.5% of the patients. Antiparasitic products, predominantly quinine, were the commonest drugs class associated with ADRs (85.9%). Hospital acquired ADRs did not affect hospital stay, 4.2 days vs 3.9 (p-value 0.129). Conclusion: ADRs are an important cause of morbidity in patients, both in the community and in hospitals, and the majority are associated with the commonly used drugs
Aflatoxins in Uganda: An Encyclopedic Review of the Etiology, Epidemiology, Detection, Quantification, Exposure Assessment, Reduction, and Control
(International Journal of Microbiology, 2020) Omara, Timothy; Nassazi, Winfred; Omute, Tom; Aburu, Awath; Laker, Fortunate; Kalukusu, Raymond; Musau, Bashir; Nakabuye, Brenda Victoria; Kagoya, Sarah; Otim, George; Adupa, Eddie
Uganda is an agrarian country where farming employs more than 60% of the population. Aflatoxins remain a scourge in the country, unprecedentedly reducing the nutritional and economic value of agricultural foods. *is review was sought to synthetize the country’s major findings in relation to the mycotoxins’ etiology, epidemiology, detection, quantification, exposure assessment, control, and reduction in different matrices. Electronic results indicate that aflatoxins in Uganda are produced by Aspergillus flavus and A. parasiticus and have been reported in maize, sorghum, sesame, beans, sunflower, millet, peanuts, and cassava. *e causes and proliferation of aflatoxigenic contamination of Ugandan foods have been largely due to poor pre-, peri-, and postharvest activities, poor government legislation, lack of awareness, and low levels of education among farmers, entrepreneurs, and consumers on this plague. Little diet diversity has exacerbated the risk of exposure to aflatoxins in Uganda because most of the staple foods are aflatoxin-prone. On the detection and control, these are still marginal, though some devoted scholars have devised and validated a sensitive portable device for on-site aflatoxin detection in maize and shown that starter cultures used for making some cereal-based beverages have the potential to bind aflatoxins. More efforts should be geared towards awareness creation and vaccination against hepatitis B and hepatitis A to reduce the risk of development of liver cancer among the populace.
Aflatoxins metabolism, effects on epigenetic mechanisms and their role in carcinogenesis
(Health, 2013) Bbosa, Godfrey S.; Kitya, David; odda, John; Ogwal-Okeng, Jasper
Chronic consumption of aflatoxin-contaminated foods is a global problem in both developing and developed countries especially where there is poor regulation of their levels in foods. In the body, aflatoxins (AFBs) mainly AFB1 are bio- transformed to various metabolites especially the active AFB1-exo-8,9-epoxide (AFBO). The AFB, AFBO and other metabolites interact with various biomolecules in the body including nu- cleic acids such as DNA and RNA and the vari- ous metabolic pathways such as protein syn- thesis, glycolytic pathway and electron trans- port chain involved in ATP production in body cells. The AFB interacts with DNA to form AFB- DNA adducts causing DNA breakages. The AFB and its metabolites induce the up regulation of nuclear receptors such as pregnane X receptor (PXR), constitutive androstane receptor (CAR), and aryl hydrocarbon receptor (AhR) through gene expression that regulates the metabolizing enzymes such as CYP450 involved in Phase I and Phase II metabolism of xenobiotics. AFB ac- tivates these nuclear receptors to produce the metabolizing enzymes. The AFB1 is metabolized in the body by cytochrome P450 (CYP450) enzyme isoforms such as CYP1A2, CYP1A2, CYP3A4/ CYP3A5, and CYP3A7 in fetus, glutathione S- transferase, aflatoxin B1-aldehyde reductase leading to reactive metabolites, some of which can be used as aflatoxin exposure biomarkers. These enzymes are involved in the Phase I and Phase II metabolic reactions of aflatoxins. The CYP1A2 is the principal metabolizer of aflatoxin at low concentrations while the reverse is true for CYP3A4. The accumulation of AFB and its metabolites in the body especially the AFB1-exo-8,9-epoxide depletes the glutathione (GSH) due to the formation of high amounts of epoxides and other reactive oxygen species (ROS). The AFB, AFB1-exo-8,9-epoxide and other metabo- lites also affect the epigenetic mechanisms in- cluding the DNA methylation, histone modifica-tions, maturation of miRNAs as well as the daily formation of single nucleotide polymorphism (SNP) where AFB exposure may facilitate the process and induces G:C to T:A transversions at the third base in codon 249 of TP53 causing p53 mutations reported in hepatocellular carcinoma (HCC). The changes in epigenetic mechanisms lead to either epigenetic inactivation or epige- netic derepression and all these affect the gene expression, cellular differentiation and growth. AFB also through epigenetic mechanisms pro- motes tumorigenesis, angiogenesis, invasion and metastasis in hepatocellular carcinoma. However, the formation of the small amounts of AFB1 from AFB2 is suspected to cause the carcinogenicity of AFB2 in humans and animals. Chronic afla- toxins exposure leads to formation of reactive AFBO metabolites in the body that could acti- vate and de-activates the various epigenetic me- chanisms leading to development of various cancers.
African Health Sciences Vol 12 Issue 4 December 2012518Endoscopic findings in upper gastrointestinal bleeding patients atLacor hospital, northern Uganda
(African Health Sciences, 2012) Alema, ON; Ogwang, David Martin; Okello, Tom Richard
Background: Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. Objective: To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda. Methods: The study was carried out at Lacor hospital, located at northern part of Uganda. The record of 224 patients who underwent endoscopy for upper gastrointestinal bleeding over a period of 5 years between January 2006 and December 2010 were retrospectively analyzed. Results: A total of 224 patients had endoscopy for UGIB which consisted of 113 (50.4%) males and 111 (49.6%) females, and the mean age was 42 years ± SD 15.88. The commonest cause of UGIB was esophagealvarices consisting of 40.6%, followed by esophagitis (14.7%), gastritis (12.6%) and peptic ulcer disease (duodenal and gastric ulcers) was 6.2%. The malignant conditions (gastric and esophageal cancers) contributed to 2.6%. Other less frequent causes of UGIB were hiatus hernia (1.8), duodenitis (0.9%), others-gastric polyp (0.4%). Normal endoscopic finding was 16.1% in patients who had UGIB Conclusions: Esophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment as compared to the west which is mainly peptic ulcer disease.
Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness
(BMC Medicine, 2015) Kiguli, Sarah; Maitland, Kathryn; George, Elizabeth C; Olupot-Olupot, Peter; Opoka, Robert O; Engoru, Charles; Akech, Samuel O; Nyeko, Richard; Mtove, George; Reyburn, Hugh; Levin, Michael; Babiker, Abdel G; Gibb, Diana M; Crawley, Jane
Background: Severe anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group. Methods: We present data from a large controlled trial of fluid resuscitation (Fluid Expansion As Supportive Therapy (FEAST) trial) on the prevalence, clinical features, and transfusion management of anaemia in children presenting to hospitals in three East African countries with serious febrile illness (predominantly malaria and/or sepsis) and impaired peripheral perfusion. Results: Of 3,170 children in the FEAST trial, 3,082 (97%) had baseline haemoglobin (Hb) measurement, 2,346/3,082 (76%) were anaemic (Hb <10 g/dL), and 33% severely anaemic (Hb <5 g/dL). Prevalence of severe anaemia varied from 12% in Kenya to 41% in eastern Uganda. 1,387/3,082 (45%) children were transfused (81% within 8 hours). Adherence to WHO transfusion guidelines was poor. Among severely anaemic children who were not transfused, 52% (54/103) died within 8 hours, and 90% of these deaths occurred within 2.5 hours of randomisation. By 24 hours, 128/1,002 (13%) severely anaemic children had died, compared to 36/501 (7%) and 71/843 (8%) of those with moderate and mild anaemia, respectively. Among children without severe hypotension who were randomised to receive fluid boluses of 0.9% saline or albumin, mortality was increased (10.6% and 10.5%, respectively) compared to controls (7.2%), regardless of admission Hb level. Repeat transfusion varied from ≤2% in Kenya/Tanzania to 6 to 13% at the four Ugandan centres. Adverse reactions to blood were rare (0.4%). Conclusions: Severe anaemia complicates one third of childhood admissions with serious febrile illness to hospitals in East Africa, and is associated with increased mortality. A high proportion of deaths occurred within 2.5 hours of admission, emphasizing the need for rapid recognition and prompt blood transfusion. Adherence to current WHO transfusion guidelines was poor. The high rates of re-transfusion suggest that 20 mL/kg whole blood or 10 mL/kg packed cells may undertreat a significant proportion of anaemic children. Future evaluation of the impact of a larger volume of transfused blood and optimum transfusion management of children with Hb of <6 g/dL is warranted.
An Analysis of Post-Traumatic Stress Disorder and Quality of Life Among Adults Living with HIV in Western Uganda
(HIV/AIDS - Research and Palliative, 2024) Kabunga, Amir; Kigongo, Eustes; Udho, Samson; Auma, Anna Grace; Tumwesigye, Raymond; Musinguzi, Marvin; Acup, Walter; Akello, Anne Ruth; Okalo, Ponsiano; Nabaziwa, Jannat; Shikanga, Enos Mwirotsi; Halima, Namata
Background: HIV/AIDS remains a significant global public health issue, profoundly impacting infected individuals. Living with HIV involves complex mental health dynamics, with post-traumatic stress disorder (PTSD) being a prevalent challenge. This study aims to examine the correlation between PTSD and quality of life among HIV-positive individuals in western Uganda. Material and Methods: Conducted between May and July 2023, this facility-based cross-sectional study surveyed 439 participants from four HIV clinics in southwestern Uganda. Data were collected through interviewer-administered questionnaires, analyzed using descriptive statistics, simple linear regression, and multiple linear regression (p<0.05). Results: Respondents had a mean age of 40.6 years, with 68.3% female, 54.9% married, and 55.1% lacking formal education. The reported PTSD prevalence among HIV-positive individuals was 33.7%, significantly correlating with reduced overall quality of life (β = −4.52; p<0.001). The social quality of life had the highest mean score of 14.24 (±3.45) while the environmental quality of life had the lowest mean score 11.89 (±2.68). Conclusion: Our study reveals a concerning prevalence of PTSD, affecting 1 in 3 individuals, emphasizing the pressing need for comprehensive mental health support within HIV care settings. We observed a significant negative impact of PTSD on overall quality of life, particularly in physical and social aspects. Integrating mental health screening into routine HIV care is crucial, using validated tools like the PSTD Checklist Civilian Version, alongside training for healthcare providers to recognize PTSD symptoms in the context of HIV diagnosis and treatment.
Anger and Bitter Hearts: The Spread of Suicide in Northern Ugandan Families
(Journal of Anthropology, 2019) Oboke, Henry; Whyte, Susan Reynolds
In many societies, the phenomenon of suicide provides a particularly powerful example of how something sinister might ‘run in the family’. In the Acholi sub-region of northern Uganda, concerns about its capacity to spread increased during and after the Lord’s Resistance Army war. Based on interviews with bereaved families in 2016 and historical material on suicide, we offer an analysis of suicide as an approach to the contagious connections of kin. Successful and attempted suicides were often preceded by affective contamination of family relations through feelings of neglect, humiliation, abuse, indignation and resentment that made hearts bitter. Anger finally moved people to take their lives, often leaving behind questions of liability. Suicide requires that we consider these questions together with notions of personhood and mutuality of being. The concept of affective contamination contributes to the understanding of both suicide and contagious kinship connections.
Anti-malarial drug use, appropriateness and associated factors among children under-fve with febrile illnesses presenting to a tertiary health facility: a cross sectional study
(Malaria Journal, 2023) Nyeko, Richard; Otim, Felix; Obiya, Evelyn Miriam; Abala, Catherine
Background Malaria is endemic in 95% of Uganda and constitutes the country’s most signifcant public health prob lem—being the leading cause of morbidity and mortality, especially among children under fve years of age. The cur rent national malaria treatment policy is to use artemisinin-based combination therapy (ACT) as frst-line treatment, and recommends parasitological confrmation of malaria before therapy. Adherence to this policy, however, remains suboptimal, with the self-initiated home-based therapy being common—posing undue exposures to, and pressure on the current artemisinin-based combinations, with the danger of emergence of drug resistance. The study evalu ated the anti-malarial use and its appropriateness among febrile children under fve presenting to a tertiary health facility in northern Uganda in light of the current malaria treatment policy. Methods This was a cross-sectional study in a tertiary health facility in northern Uganda between March and Sep tember 2021. Children aged 6–59 months with fever were selected using systematic random sampling. A pretested interviewer-administered questionnaire was used to collect clinical data from the caregivers. Data were analysed using SPSS version 23. Descriptive statistics and multiple logistic regression models were applied. P-value<0.05 was considered for statistical signifcance. Results Seventy-two (34.3%) of the 210 children with fever in this study used anti-malarials prior to the hospital visit, 29.2% (21/72) of which were on a self-medication basis, 22.2% (16/72) were empiric prescriptions—all of which inappropriate, and only 48.6% (35/72) were prescribed based on a parasitological diagnosis of malaria. The most commonly used anti-malarials were artemether-lumefantrine 60/72 (88.3%), while a lesser proportion of quinine 7/72 (9.7%), artesunate 3/72 (4.2%) and dihydroartemisinin-piperaquine 2/72 (2.8%) were used. The factors independently associated with anti-malarial use among the children with febrile illnesses were duration of fever (p=0.001); level of the nearest facility (p=0.027), distance from the nearest health facility (p=0.025), and caregivers’ age (p=0.038). Conclusions Inappropriate use of anti-malarials for childhood febrile illnesses is prevalent in the study setting, facilitated by the ease of over-the-counter access, empiric prescription and use of leftover anti-malarials. This calls for a need to address communities’ health-seeking behaviour and the health providers’ practice alike.
Anti-Plasmodium falciparum activity of Aloe dawei and Justicia betonica
(African Journal of Pharmacy and Pharmacology, 2013) Bbosa, Godfrey S.; Kyegombe, David B.; Lubega, Aloysius; Musisi, Nathan; Ogwal-Okeng, Jasper; Odyek, Olwa
Malaria is a fatal disease caused by different Plasmodium species of parasites and has remained the major killer of humans worldwide especially the children under five years of age and pregnant women. In this study, the anti-Plasmodia activities of the crude leaf ether extracts of Aloe dawei (AD) and Justicia betonica (JB) on Plasmodium falciparum were investigated, with chloroquine diphosphate as a positive control. The results showed that ether extracts of JB had EC50 of 13.36 (95% CI: 8.032 to 22.23) μg/ml and AD had 7.965 (95% CI: 3.557 to 17.84) μg/ml. The chloroquine diphosphate had EC50 of 24.86 (95% CI: 9.239 to 66.89) μg/ml. The qualitative phytochemical analysis of the ether extract showed that JB contains steroids and triterpenoids, alkaloids and saponins while AD contained steroids and triterpenoids, anthraquinolones, alkaloids and saponins. The results provides evidence that JB and AD contain compounds with anti-P. falciparum activity and hence their use by the traditional herbalist and local communities in treatment of malaria.
Antibiograms from community-acquired uropathogens in Gulu, northern Uganda - a cross-sectional study
(BMC infectious diseases, 2013) Odongo, Charles O; Anywar, Denis A; Luryamamoi, Kenneth; Odongo, Pancras
Background: Urinary tract infections (UTI) are common in clinical practice and empirical treatment is largely employed due to predictability of pathogens. However, variations in antibiotic sensitivity patterns do occur, and documentation is needed to inform local empirical therapy. The current edition of the Uganda Clinical Guidelines recommends amoxicillin or cotrimoxazole as choice drugs for empirical treatment of community-acquired UTI. From our clinical observations, we suspected that this recommendation was not effective in our setting. In order to examine validity, we sought to identify bacteria from community-acquired infections and determine their susceptibility against these antibiotics plus a range of potentially useful alternatives for treatment of UTI. Methods: A cross-sectional study of mid-stream urine collected from 339 symptomatic patients over a three-month period at Gulu regional referral hospital. Qualitative culture and identification of bacteria and antibiotic sensitivity testing using the modified Kirby-Bauer disk diffusion method was done. Participants’ demographic and clinical characteristics were collected using a standard form. Results were analyzed by simple proportions among related variables and confidence intervals computed using binomial exact distribution. Results: Eighty two cultures were positive for UTI. Staphylococcus spp (46.3%) and Escherichia coli (39%) were the most common pathogens. There was high resistance to cotrimoxazole (73.2%), nalidixic acid (52.4%) and amoxicillin (51.2%). The most favorable antibiograms were obtained with gentamicin, amoxicillin-clavulanate and levofloxacin where 85.4%, 72.0%, 67.1% of isolates respectively, were either sensitive or intermediate. Only 51% of isolates were sensitive to ciprofloxacin. Conclusion: There was high resistance to most antibiotics tested in this study. The recommendations contained in the current edition of the Uganda Clinical Guidelines are not in tandem with antibiotic sensitivity pattern of uropathogens seen in our setting. Amoxicillin-clavulanate or gentamicin should be considered for replacement of amoxicillin and cotrimoxazole for empirical treatment of UTI in our setting.
Antibiotic prescription practices among prescribers for children under five at public health centers III and IV in Mbarara district
(PLOS ONE, 2020) Okello, Nelson; Oloro, Joseph; Kyakwera, Catherine; Kumbakumba, Elias; Obua, Celestino
Introduction Rational use of medicines requires that patients receive medications appropriate to their clinical needs. Irrational prescription of antibiotics has been reported in many health systems across the world. In Uganda, mainly nurses and assistant medical officers (Clinical officers) prescribe for children at level III and IV primary care facilities (health center II and IV). Nurses are not primarily trained prescribers; their antibiotic prescription maybe associated with errors. There is a need to understand the practices of antibiotic prescription among prescribers in the public primary care facilities. We therefore determined antibiotic prescription practices of prescribers for children under five years at health center III and IV in Mbarara district, South Western Uganda. Methods This was a retrospective descriptive cross-sectional study. We reviewed outpatient records of children <5 years of age retrospectively. Information obtained from the outpatient registers were captured in predesigned data abstraction form. Health care providers working at health centers III and IV were interviewed using a structured questionnaire. They provided information on socio-demographic, health facility, antibiotic prescription practices and availability of reference tools. Data was analyzed using STATA software version 13�0. Results There were 1218 outpatients records of children under five years reviewed and 35 health care providers interviewed. The most common childhood illness diagnosed was upper respiratory tract infection. It received the most antibiotic prescription (53%). The most commonly prescribed oral antibiotics were cotrimoxazole and amoxicillin, and ceftriaxone and benzyl penicillin were the commonest prescribed injectable antibiotics. Up to 68.4% of the antibiotic prescription was irrational. No prescriber or facility factors were associated with irrational antibiotic prescription practices.
Antifungal Medicinal Plants Used by Communities Adjacent to Bwindi Impenetrable National Park, South-Western Uganda
(European Journal of Medicinal Plants, 2015) Esezah, Kakudidi; Anywar, Godwin; Ayorekire, Fredrick; Ogwal-Okeng, Jasper
Communities adjacent to Bwindi Impenetrable National Park (BINP) in South-western Uganda largely depend on traditional herbal treatment for basic health care. The aim of this study was to investigate the use of medicinal plants in the treatment of fungal infections by these communities. Data was collected using semi-structured interviews, focus group discussions and through direct observation. A total of 415 respondents were interviewed including 71 traditional healers, herbal medicine traders and health workers. Twenty six medicinal plants belonging to 16 families were documented. Fabaceae with four species, Asteraceae Lamiaceae and Solanaceae each with three species. Eight different fungal infections were identified. The commonest fungal infection was Tinea corporis (44.3%), while the least common fungal infection was Tinea unguium (1.2%). Eighty-six percent of the respondents reported that they had ever suffered from at least one fungal infection. Out of these, 72% had exclusively used herbal medicine for treatment, while 28% had used both herbal and western medicine for treatment. Pentas longiflora, Tetradenia riparia, Erucastrum arabicum, Erigeron floribundus and Coleus latifolius were ranked as highly effective plants by the traditional healers. Leaves (78.6%) were the most commonly used parts. Female herbalists were more involved in conservation by cultivating the medicinal plant species than men. The use of several plant species provides alternatives when others are not available. Fungal infections are common and most of the respondents exclusively use herbal medicine to treat fungal infections
Antimalarial Activity of Aspilia pruliseta, a Medicinal Plant from Uganda
(Planta Medica : Journal of Medicinal Plant and Natural Product Research, 2010) Sebisubi, Fred Musoke; Odyek, Olwa; Anokbonggo, William Wilberforce; Ogwal-Okeng, Jasper; Carcache-Blanco, Esperanza J.; Ma, Cuiying; Orjala, Jimmy; Tan, Ghee T.
Aspilia prulisetaSchweinf. (Asteraceae) is a medicinal plant in-digenous to Uganda and the neighboring countries of East Africa.It has been used extensively by the rural population for the treat-ment of fevers and malaria. During the antimalarial evaluation ofthis plant, four nontoxic diterpenes were isolated that possessedmoderate activity against chloroquine-sensitive (D6) and chloro-quine-resistant (W2) clones ofPlasmodium falciparum, with IC50values ranging from 14 to 23 μM. These moderately active com-pounds included the previously undescribed diterpene,ent-15β-senecioyloxy-16,17-epoxy-kauran-18-oic acid that demonstrat-ed an IC50value of 23.4 μM against clone D6, but was devoid ofactivity against clone W2. Four additional diterpenes were ob-tained from the aerial parts ofA. pruliseta, but these known com-pounds were essentially inactive. The moderate activities of se-lect diterpenes ofA. prulisetacould account collectively for thehistorical and enduring use of this plant in traditional Africanmedicine.
Antimicrobial activity and phytochemical fingerprints of five crude extracts obtained from indigenous medicinal plants of Uganda
(Research in Pharmaceutical Biotechnology, 2017) Katuura, Esther; Bbosa, Godfrey Sande; Waako, Paul; Ogwal-Okeng, Jasper
Five crude extracts from four Ugandan plants were screened in vitro for their antimicrobial activity and phytochemical composition. They included the chloroform extracts of Bothliocline longipes, Maesa lanceolata, Trimeria bakeri, Rhus natalensis and the petroleum ether extract of T. bakeri. The plant crude extracts were tested against Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 49619) and Entamoeba sp. Antimicrobial activities of the plants were determined by using the agar well diffusion and agar well dilution methods. The plant extracts showed activity against all the tested organisms with the zones of inhibition ranging from 4 to 19 mm. All the extracts inhibited the growth of S. aureus while the strongest activity was found for T. bakeri against S. aureus and Entamoeba sp. at 19 mm. Other plant extracts that induced strong antimicrobial activity were the chloroform extract of R. natalensis with an inhibition diameter of 13 mm against both S. aureas and P. aeruginosa and 9 mm diameter inhibition against E. coli. Only T. bakeri showed growth inhibition of S. aureus (4 mm). The minimum inhibitory concentration (MIC) was observed against S. aureus at 0.25 g/ml by the T. bakeri and B. longipes plant extracts. Sterol and triterpenes, fatty acids, flavanoids, coumarins and alkaloids were determined in T. bakeri, B. longipes, R. natalensis and M. lanceolata. The presence of these compounds indicates that the plants may contain an active compound or one that can be used as a template for the development of a new antimalarial or antibiotic medicine.
Antiplasmodial activity of extracts of selected medicinal plants used by local communities in western Uganda for treatment of malaria
(African Journal of Ecology, 2007) Katuura, Esther; Waako, Paul; Tabuti, John R. S.; Bukenya-Ziraba, Remigius; Ogwal-Okeng, Jasper
This study investigated the antiplasmodial activity of ten medicinal plants used to treat malaria in Southwestern Uganda. The study plants were Bothlioclines longpipes (Olive and Hiern), N.E.Br., Toddalia asiatica (L.) Lam., Maesa lanceolata Forssk., Indigofera emerginella steud. Ex A. Rich., Lantana trifolia L., Vernonia lasiopus O. Hoffm., Trimmeria bakeri Gilg., Rhus natalensis Bernh. ex. Krauss Erythrophleum pyrifolia and Conyza sp. Dry powdered plant material was extracted by sequential cold maceration using petroleum ether, chloroform and ethanol solvents respectively. Extracts were subjected to in vitro antiplasmodial screening against wild strains of Plasmodium falciparum using the nitro-tetrazolium blue-based lactate dehydrogenase assay. The chloroform extract of M. lanceolata (EC50 1.60 lg ml)1.), showed the highest antiplasmodial activity followed by R. natalensis (EC50 1.80 lg ml)1). Other extracts with significant activity were the chloroform leaf extract of Bothriocline longipes (EC50 3.66 lg ml)1) and the petroleum ether root extract of T. bakeri (EC50 3.955 lg ml)1).

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