What Privacy and Confidentiality Mechanisms are used in the Electronic Health Records (Clinical Master and ICT4 M-Power systems)? A design Science Research Approach.

Background:  Patients are required to share information with their doctors to facilitate correct diagnosis and determination of treatment, especially to avoid adverse drug interactions. Despite efforts to fully implement and adopt Electronic Health Records System, there is limited attention to fully secure patients’ details. Issues of privacy and confidentiality still remain a major concern at health facilities mainly in developing countries like Uganda. This study aimed to determine what privacy and confidentiality mechanisms are used in the EHRs (Clinical Master and ICT4 M-Power systems  Methods:  The study used a design science research approach that adopted qualitative methods. Data Flow Diagrams were used to design the desired artifact while the development of the encryption and decryption tool, we used the Hypertext Pre-Processor(PHP) time platform, which is an object-oriented programming language and is a block component that is made up of Cascade Style Sheet (CSS) and HTML(hypertext markup language ) embedded in PHP for it to be fully functional and be able to connect to and run on the server where most of the records and details of the activities are stored in the database.   Results: The respondents pointed at various current mechanisms for privacy and confidentiality that included; user credentials, segregation of roles, Physical access control, international access policies, interlocked interface screens, and training of users. Conclusion: The inclusion of encryption and decryption features are very vital to enhancing health facilities’ capacity and measures for establishing the privacy and confidentiality of patients’ data. Recommendation:  The Ministry of Health, Uganda, and implementers of EHR should adopt the encryption and decryption tool for use at the health facilities as the second layer of security to ensure the privacy and confidentiality of patients’ data.

ADHERENCE TO THE ROUTINE NON-PHARMACOLOGIC INTERVENTIONS AMONG PATIENTS WITH CHRONIC ILLNESSES AT A RURAL HEALTH FACILITY SETTING OF UGANDA. A CROSS-SECTIONAL STUDY.

Background The study aimed at determining the prevalence of adherence to routine non-pharmacological interventions such as counseling, diet and regular physical exercises among patients in a rural health facility setting of Uganda. Methodology: A cross-sectional survey design was used to study 328 Patients who had spent at least 2 years with Chronic Illnesses such as Diabetes, HIV and hypertension accessing services at Luweero Health Centre IV. Simple random sampling technique was used to select the patients during visiting hours at the respective clinics from 20th of June 2018 to 20th of July 2018. The data was entered and analyzed using Statistical Package for Social Sciences (SPSS-Version 20). Results: A total of 326 patients with Chronic Illnesses were studied. 236 (72.4%) were having HIV, 54 (16.6%) were hypertensive, 25 (7.7%) were diabetic, and 11(3.4%) were having both HIV and hypertension. The prevalence of adherence to routine counseling is 69.6%, and this is highest among patients with hypertension (81.5%) and lowest among patients with Diabetes ( 56%). The prevalence of adherence to special diet is 71.5%, and is highest among patients with HIV and hypertension and those with HIV alone (91.1%) and lowest among patients with Hypertension (20.4%). The prevalence of adherence to routine physical exercises is 23.0%. This is highest among patients with Diabetes (48%) and lowest among patients with HIV (17.7%).   Conclusion: Majority (71.5%) of patients with chronic illnesses adhered to special diet, followed by counselling (69.6%) and only 23% of the patients adhered to physical exercises. Recommendation: The non-pharmacologic interventionists should design and institute group visiting mechanisms especially among patients that are unmarried if routine adherence is to be improved

Occurrence of Escherichia Coli in Packaged Drinking Water Distributed in Katabi Sub County Uganda. A Cross Sectional Study.

Background: The world health organization (WHO) estimates that about a 1.1billion people drink unsafe water globally, and over 1.7 million deaths occur annually due to the consumption of water that is of faecal origin. Water in sachets is readily available and affordable but there is no concern about its safety. The purpose of this study was to assess the occurrence of Escherichia coli in packaged drinking water distributed in the Katabi sub country using the membrane filtration technique, isolation of organisms, and subjecting them to biochemical tests. The study was conducted in 2017. Methodology: A cross-sectional study design was used where Rwenzori, Riham water, Nevana, Highland, Blue wave, and sachet water were purposively selected in the main trading center within the Wakiso district. A total of 5 bottled water and 10 sachets of water were used. Duplicate sample (2) bottles of water from each were used. Therefore 30 samples of packaged water were used in this study. The bacteria were grown on media and confirmed using biochemical tests. Results: Sachet water contained pink lactose fermenting colonies on MacConkey culture media. Bottled water had no growth. The pink colonies were positive with Kligler iron agar (KIA), triple sugar iron agar (TSI), and sulphur and indole motility (SIM) positive.  Conclusion and recommendation       The majority of sachet water was contaminated with Escherichia coli an indicator of faecal contamination; and therefore, unsuitable for human consumption. The government of Uganda should carry out surveillance activities to enforce strict hygienic measures on sachet water producers and distributors.     

PRACTICE OF WOMEN AGED 25-49 YEARS IN RELATION TO CERVICAL CANCER SCREENING IN ENTEBBE MUNICIPALITY, WAKISO DISTRICT, UGANDA. A CROSS-SECTIONAL STUDY.

Background: Cervical cancer is the most common cancer among Ugandan women of reproductive age. Unfortunately, despite the evidence of methods for prevention, most of the women remain unscreened. In addition, current estimates indicate that 6,413 Ugandan women are diagnosed annually with 4301 deaths. The main purpose of this study was to investigate practice in relation to Cervical Cancer Screening among women aged between 25-49 years in Entebbe Municipality, Wakiso district. Method:  This descriptive cross-sectional study assessed practices in relation to Cervical Cancer screening among women aged between 25-49 years in Entebbe Municipality, Wakiso District; Proportionate sampling was used to select 246 participants from each division for interviews. Interviewer administered questionnaire was used to collect data from the study participants. Collected data was cleaned, coded, and entered in MS Excel spreadsheet 2013 and it was then exported to EPI- INFO Version 7 statistical software for Windows for analysis. The study findings were then presented using tables, graphs, and charts Results:  Only 17.07% of Women in Entebbe Municipality had screened for Cervical Cancer. 76.7% screened only once, 38.88% screened because of awareness that is created, and 30% screened during outreaches. Conclusion:  Cervical cancer screening is still low among women in Entebbe Municipality thus leading to poor actual practice. Recommendation: There is a need to further educate women and the general public on the availability and need for Cervical Cancer screening

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Active phytochemicals present in the Guava Tree (Psidium Guajava) leaf Extracts that grow in Uganda.

Background:   The Guava tree is small in the myrtle family (Myrtaceae), native to Mexico, Central America, the Caribbean, and northern South America. It contains a high content of organic and inorganic compounds like secondary metabolites such as antioxidants, polyphenols, antiviral compounds, and anti-inflammatory compounds. Such chemicals are produced by plants through primary or secondary metabolism whereas Guava products have been used as a source of medicine and while they have proved to work effectively, little is known about the composition of such plant origin products from Uganda.   Methodology:    The maceration method of extraction was used to obtain the guava extract. The leaves were crushed into a powder using a blender and 20g of the powder was added into differently labeled beakers containing 100mls of distilled water and 100mls of increasing concentration of methanol from 30%, 50%, and 70%. The analysis involved Saponins, Phenols and Tannins, Terpenoids, Flavonoids, and Glycosides, and Laboratory tests are done included the Ferric Chloride test, Shinoda test, Salkowski test, Concentrate H2SO4 test, and Foam test.   Results and discussion:    Phytochemicals (Saponins, Phenols and Tannins, Terpenoids, Flavonoids, and Glycosides) are present in the leaves of the guava tree (Psidium guajava) that grows in Uganda. Psidium guajava extract obtained using distilled water contained all the phytochemicals tested apart from terpenoids which showed a negative test result. Methanol of increasing concentrations can also be used to extract phytochemicals from the leaves.   Conclusions and recommendations:    It’s now evident that the Guava tree that grows in Uganda contains phytochemicals (secondary metabolites). Water and methanol of 30%, 50%, and 70% can be used for extraction. Future detailed studies in Africa should focus on the purification of these active secondary metabolites and also determine their concentration. Other parts of the plant such as its bark, roots, and fruits need to be studied

Antimicrobial activity of Guava tree (Psidium Guajava) leaf extract and selected Commercial Antibiotics on Bacterial isolates from Kisubi Hospital

oai:ojs2.sjhresearchafrica.org:article/1Background: Plant species such as the guava have been used in Uganda and elsewhere in the world to treat some of the medical conditions associated with bacteria, this is due to the increased number of drug resistant bacteria in the world. In this study, the antimicrobial activity of guava leaf extracts against some of the disease causing bacteria isolated from Kisubi hospital in Uganda is discussed. Methods: The guava leafs were collected from a plantation near Zika forest in Uganda (0°7′27″N 32°31′32″E / 0.12417°N 32.52556°E / 0.12417; 32.52556) and samples were put in a bag and transferred to the university laboratory where they were identified. The extracts were obtained by maceration using distilled water, 30%, 50% and 70 % methanol as the extraction solvents. Antimicrobial susceptibility testing was conducted using the disc diffusion method. Results: Gram-negative Escherichia coli was sensitive to the plant extract and synthetic commercial drugs such as trimethoprim-sulfamethozole, ciprofloxacin, and Gentamicin. Pseudomonas aeruginosa was resistant to all drugs. Streptococcus pneumonia and Staphylococcus aureus were all sensitive to the plant extracts with measurable inhibition zones. Conclusion: The Guava tree leaf crude extracts have antimicrobial activity against drug-resistant bacteria. More studies should be carried out to know the potency and the concentration of different plant origin extracts

Occurrence of Proteinuria and its Predisposing Factors among Pregnant Women Attending Antenatal Care Clinic at St. Francis Hospital Nsambya.

Background: Proteinuria refers to a condition where more than trace amounts of proteins are found in normal urine. Proteinuria is a defining dysfunction of pre-eclampsia Proteinuria is one of the cardinal indications of pre-eclampsia, a common and severe complication in pregnancy. Also, there are several factors responsible for its occurrence among pregnant women. The study aimed to establish the occurrence of proteinuria among pregnant women and to establish the predisposing factors of proteinuria among pregnant women attending antenatal care services in St. Francis Hospital Nsambya. Methodology:  This was a cross-sectional study where qualitative and quantitative data was collected. Participants’ urine samples were taken off and analysed macroscopically, protein detection using uristics, and 25% SSA and then microscopic examination done once they had consented. Results:  Out of 96 participants, the occurrence of proteinuria was 9.4% (p = 0.094) and it was increasing with the increase in the age of the pregnant women. The predisposing factors to proteinuria in pregnancy were urinary tract infections (88.9%) (p = 0.889), hypertension (11.1%) (p = 0.111) and gestation age.  Conclusion and recommendation:  Clients who receive antenatal care services in St. Francis Hospital Nsambya antenatal clinic should routinely be screened for proteinuria. Wider research about proteinuria among pregnant women should be done to establish a more nationalistic occurrence. Health education should emphasize the importance of pregnant women reporting urinary tract infections after being empowered with its signs and symptoms even without pain. This is because urinary tract infections can lead to complications in pregnancy and could become fatal

PERSONAL FACTORS RELATED TO ADHERENCE TO THE ROUTINE NON-PHARMACOLOGIC INTERVENTIONS AMONG PATIENTS WITH CHRONIC ILLNESSES ATTENDING LUWEERO HC IV. A CROSS-SECTIONAL STUDY.

Background The aim of this study is to document the personal factors related to adherence to the routine non-pharmacologic interventions among patients with chronic illnesses attending Luweero HC IV.Non- pharmacological interventions refer to science-based and non-invasive interventions on human health that aim to prevent, treat, or cure health problems; Chronic illnesses refer to diseases that cannot be prevented through vaccination or cured by medication neither can they just disappear but take lasts for three or more months or even for life.There are specific interventions for each of the chronic disease are recommended. Personal factors like marital status are key in this study.Therefore, the study seeksto assess the personal factors related to adherence to the routine non-pharmacologic interventions among patients with chronic illnesses attending Luweero HC IV. Methodology The study adopted a cross-sectional survey design in which quantitative data were collected using a questionnaire from 326 patients with chronic illnesses visiting Luweero Health Centre IV. Results The study shows that adherence to routine non-pharmacologic interventions is highest amongst the married patients with chronic illnesses 65.6% and lowest amongst the unmarried patients 39.2%. This difference is statistically significant (OR=0.338; 95% CI: p= 0.001).Similarly adherence to routine non-pharmacological interventions was highest amongst educated patients 63.2% and lowest amongst the uneducated 34.0%. The variation in adherence statistically significant (OR=0.299; 95% CI: 0.591-0.151; p = 0.000). Conclusion Patients who visit the health Centre’s with different background and thoughts about the illness they have, perceived severity, benefits and threats remain high and barrier low. Recommendation Non-pharmacologic interventionists and government through its line ministry of health should put in place education sensitive information giving mechanisms as to permit patients at different educational levels to make use of non-pharmacologic interventions