Antimalarial Activity of Some Plants Used in Traditional Medicine in Uganda

This work was done to identify some of the plants used in the treatment of malaria in Uganda and to investigate their efficacy in the in-vitro assays. Plumbago zeylenica and Cryptolepis sanguinolenta showed marked activity on the chloroquine resistant and chloroquine sensitive strains of Plasmodium falciparum. Plumbagin, a quinone, was isolated from Plumbago zeylenica, and found to have antimalarial activity with IC50 of 178 ng/ml on chloroquine sensitive and 188 ng/ml on chloroquine resistant strains. Cytotoxicity assays on KB cell lines indicated that the extract was selective for Plasmodium falciparum. The Selective Index was 5 in both strains of Plasmodium falciparum. It was concluded that some of the plants used for malaria contain compounds with antimalarial activity, which can be useful leads for the development of new antimalarial drugs. Key Words: Antimalarial activity, Plumbago zeylenica, Cryptolepis sanguinolenta, plumbagin East and Central African Journal of Pharmaceutical Sciences Vol.5(2) 2002: 33-3

Access and use of medicines information sources by physicians in public hospitals in Uganda: a cross-sectional survey

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. African Health Sciences Vol. 8 (4) 2008: pp. 220-22

The availability of six tracer medicines in private medicine outlets in Uganda​

OBJECTIVES: Many low income countries struggle to provide safe and effective medicines due to poor public health care infrastructure, budgetary constraints, and lack of human resource capacity. Private sector pharmacies and drug shops are used by a majority of the population as an alternative to public pharmacies. This study looks at the availability of six essential medicines in private drug outlets across Uganda. METHODS: A standardised medicines availability survey developed by the World Health Organization and Health Action International was adapted for use in this project to collect availability data for six tracer medicines in 126 private medicine outlets across four districts in Uganda from September 2011 to October 2012. RESULTS: Artemisinin-based combination treatments and metformin were the most commonly found medicines in the private medicine outlets surveyed. Ninty-nine percent of all outlets carried artemisinin-based combinations while 93% of pharmacies and 53% of drug shops stocked metformin. Oxytocin was found in one third of outlets surveyed. Fluoxetine was in 70% of pharmacies yet was not found in any drug shops. Rifampicin and lamivudine were found infrequently in outlets across all districts; 10% and 2%, respectively. Not all brands found in surveyed outlets were listed on the Ugandan National Drug Register. In particular, five unlisted brands of rifampicin were found in private medicine outlets. CONCLUSIONS: The regulatory process should be improved through the enforcement of outlet licensing and medicine registration. Additional studies to elucidate the reasons behind the use of private medicine outlets over the public sector would assist the government in implementing interventions to increase use of public sector medicine outlets

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

A systematic review conducted by Sanjay Basu and colleagues reevaluates the evidence relating to comparative performance of public versus private sector healthcare delivery in low- and middle-income countries

Importance of Drug Concentrations and Nutritional Status During Fixed-Dose Chloroquine and Sulfadoxine/Pyrimethamine Combination Treatment of Malaria

The importance of drug concentrations, nutritional status and other host factors were explored in uncomplicated falciparum malaria therapy with fixed-dose chloroquine+sulfadoxine/pyrimethamine (CQ+SP). A total of 83 children were treated. Younger children (6-24months) were given half-strength (HS) and older children (2-5years) full-strength (FS) CQ+SP as recommended. The concentrations of CQ and sulfadoxine (S) were determined by HPLC in 100μl of capillary blood on filter paper. Multiple logistic regressions were used to determine associations with outcomes. Stunting (height-for-ag

Adverse drug reactions in patients admitted on Internal Medicine wards in a district and Regional Hospital in Uganda

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. Antiparasiticproducts, 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

Adverse drug reactions in patients admitted on Internal Medicine wards in a district and Regional Hospital in Uganda

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. Antiparasiticproducts, 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

Use of a pilot drug information centre

Introduction: Provision of access to drug information by prescribers and other health care professionals is important in pharmacotherapy. At the time of this study there was very scanty literature in this area from Africa. Objective: To assess use of a pilot drug information centre (DIC) which was set up in a department of Pharmacology and Therapeutics in a university teaching hospital in Uganda. Methods: This was a situational analysis with a prospective study design. The pilot DIC was established and its use over an eleven-month period was assessed. The received queries were evaluated for source of the query, reason for the query and type of query. Results: During the 11 months 297 queries were received, 72.3% of which were from public hospitals. Most werefrom prescribing doctors (54.2%). Majority were on drug-drug interaction (41.2%), followed by therapy (23.2%). Out of 197 specific drug requests, 65.5% were on antiretroviral. Conclusion: We found that healthcare professionals were enthusiastically using the drug information centre. It is, therefore, necessary and feasible to establish a DIC in Uganda that will enable these professionals to readily access drug information

Pharmacokinetic interactions between chloroquine, sulfadoxine and pyrimethamine and their bioequivalence in a generic fixed-dose combination in healthy volunteers in Uganda

Background: A pre-packaged fixed-dose formulation of chloroquine (CQ) and sulfadoxine/pyrimethamine (S/P) combination (Homapak) is widely used for the treatment of falciparum malaria in Ugandan children. It is however a product whose pharmacokinetics and interactions have not been studied. Objectives: To explore possible pharmacokinetic interactions between CQ and S/P during co-administration, and to determine their bioavailability in the locally made Homapak compared to the Good Manufacturing Practice (GMP) made formulations.Methods: Thirty-two adult healthy volunteers were randomized into four groups and given single oral doses of fixed-dose CQ+S/P combination (Homapak), or GMP formulations of S/P (Fansidar), CQ (Pharco), or their combination. Plasma samples were followed for 21 days, analysed by HPLC-UV methods, with pharmacokinetic modeling using the WinNonlin software. Results: Sulfadoxine in Homapak was more rapidly absorbed (ka = 0.55 h-1) than in Fansidar + CQ (ka = 0.27 h-1, p=0.004), but not more than S in Fansidar alone group (ka = 0.32 h-1, p=0.03). No significant differences were observed in the other pharmacokinetic parameters of S, P and CQ when given together or separately. The relative bioavailability of CQ and S in Homapak showed bioequivalence to reference formulations. Conclusions: There were no pharmacokinetic interactions between CQ, S and P when the compounds were given together, however, more investigations would be needed to explore this further. Compared with GMP made drugs, both S and CQ are bioequivalent in Homapak, the Ugandan made fixed-dose formulation. Furthermore, the absorption of S was more rapid which could be advantageous in malaria treatment. Keywords: sulfadoxine, pyrimethamine, chloroquine, bioequivalence, pharmacokinetic interactions African Health Sciences Vol. 6(2) 2006: 86-9