Existing capacity to manage pharmaceuticals and related commodities in East Africa: an assessment with specific reference to antiretroviral therapy.

BACKGROUND: East African countries have in the recent past experienced a tremendous increase in the volume of antiretroviral drugs. Capacity to manage these medicines in the region remains limited. Makerere University, with technical assistance from the USAID supported Rational Pharmaceutical Management Plus (RPM Plus) Program of Management Sciences for Health (MSH) established a network of academic institutions to build capacity for pharmaceutical management in the East African region. The initiative includes institutions from Uganda, Tanzania, Kenya and Rwanda and aims to improve access to safe, effective and quality-assured medicines for the treatment of HIV/AIDS, TB and Malaria through spearheading in-country capacity. The initiative conducted a regional assessment to determine the existing capacity for the management of antiretroviral drugs and related commodities. METHODS: Heads and implementing workers of fifty HIV/AIDS programs and institutions accredited to offer antiretroviral services in Uganda, Kenya, Tanzania and Rwanda were key informants in face-to-face interviews guided by structured questionnaires. The assessment explored categories of health workers involved in the management of ARVs, their knowledge and practices in selection, quantification, distribution and use of ARVs, nature of existing training programs, training preferences and resources for capacity building. RESULTS: Inadequate human resource capacity including, inability to select, quantify and distribute ARVs and related commodities, and irrational prescribing and dispensing were some of the problems identified. A competence gap existed in all the four countries with a variety of healthcare professionals involved in the supply and distribution of ARVs. Training opportunities and resources for capacity development were limited particularly for workers in remote facilities. On-the-job training and short courses were the preferred modes of training. CONCLUSION: There is inadequate capacity for managing medicines and related commodities in East Africa. There is an urgent need for training in aspects of pharmaceutical management to different categories of health workers. Skills building activities that do not take healthcare workers from their places of work are preferred.

Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors.

BACKGROUND: Non-adherence to diabetes treatment leads to poor glucose control and increases the risk of disease complications. The prevalence and factors associated with non-adherence in resource limited settings should be determined so as to lower the impact of a disease that is on the increase, on the health systems which are already overburdened with communicable diseases. OBJECTIVES: To determine the prevalence and factors associated with non-adherence to diabetes treatment. METHODS: A cross sectional study was carried out from February to April 2004 in Mulago Hospital, Uganda. The participants were 402 type 1 and 2 diabetic patients selected from the outpatients' diabetic clinic using systematic sampling. They were aged 18 years and above, had been taking diabetes treatment for at least one month and gave informed consent to participate. Non-adherence was assessed using patients' self reports. RESULTS: The prevalence of non-adherence was 28.9% (n = 116, 95%CI = 24.5 - 33.3%). Factors that were independently associated with non-adherence were: female gender (OR = 2.9, 95%CI = 1.4 - 6.3), not understanding the drug regimen well (OR = 4.0, 95%CI = 1.0 - 16.3), affording only some or none of prescribed drugs (OR = 3.7, 95%CI = 1.8 - 7.6) and longer time since last since last visit to a health worker (OR = 7.3, 95%CI = 2.7 - 19.9). CONCLUSIONS: Adherence to diabetic treatment was suboptimal. There is need to improve it through strategies helping patients understand their drug regimens, always availing drugs in the hospital so that they do not have to buy them and giving shorter time between visits to health worker. Further studies should be done to find out why females were not adhering to treatment so as to improve their adherence.

The challenge of re-treatment pulmonary tuberculosis at two teaching and referral hospitals in Uganda.

BACKGROUND: With an annual tuberculosis (TB) incidence of about 350 cases per 100,000 of the population, Uganda is a high burden country. Moreover, it is evident that some TB patients have been treated for a previous episode of the disease. OBJECTIVE: To highlight the burden of re-treatment pulmonary TB and examine patient factors associated with re-treatment among adults at two teaching and referral hospitals, Mbarara and Mulago. METHODS: A descriptive cross sectional study with data collection between September 2004 and March 2005; we calculated the prevalence and used logistic regression to explore factors associated with re-treatment. RESULTS: The prevalence of re-treatment pulmonary TB at Mbarara based on medical records was 30.0% (95%CI: 21.2 to 40.0), and 21.3% (95%CI: 12.9 to 31.8) from exit interviews. The corresponding estimates at Mulago hospital were 12.0% (95% CI: 6.4 to 20.0) and 43.9% (33.0 to 55.3). Compared to the 18-26 year age category, the prevalence odds ratio (POR) for a seven-year increase in age was 1.54 (95%CI: 1.04-2.28; p = 0.027), while female patients were 0.39 (95%CI: 0.17-0.90; p = 0.025) times less likely to report re-treatment disease than males, in this facility-based study. CONCLUSIONS: Re-treatment pulmonary TB is frequent at the two teaching and referral hospitals. A contribution to re-treatment prevention should entail more rigorous management of new TB cases, particularly at lower levels of care.

Chloroquine in the Ugandan market fails quality test: a pharmacovigilance study.

BACKGROUND: Antimalaria treatment failure has been partly attributed to poor quality antimalarials in the drug market. A 1998 survey in Kampala showed that 55% of tablets and 62% of injection forms of chloroquine failed the quality test. OBJECTIVE: This study was carried out as a follow-up to establish the quality of chloroquine tablet and injection dosage forms in the Ugandan drug market from June - November 2001. METHODS: Chloroquine tablets and injection dosage forms, randomly purchased from pharmacies and drug shops in the four regions of Uganda, were assayed for content of the active ingredient according to the USP standard, using the HPLC method. RESULTS: Of the tablets samples surveyed, 39% failed the content test with 11% having sub-normal and 28% having supra-normal amounts, whilst 51% of the injection samples failed with 40% and 11% having sub-normal and supra-normal amounts respectively. CONCLUSION: There was overall improvement in the quality of chloroquine in Uganda compared with the 1998 figures, but the failure rates are still unacceptably high. The variations in the chloroquine amounts in both the tablet and injection forms may contribute to chloroquine toxicity or poor response during treatment. More vigorous pharmacovigilance on drugs entering the Ugandan drug market is needed.