Etando A, Amu AA, Haque M, Schellack N, Kurdi A, Alrasheedy AA, Timoney A, Mwita JC, Rwegerera GM, Patrick O, Niba LL, Boahen-Boaten BB, Tabi FB, Amu OY, Acolatse J, Incoom R, Sefah IA, Guantai AN, Opanga S, Chikowe I, Khuluza F, Kibuule D, Kalemeera F, Hango E, Lates J, Fadare J, Ogunleye OO, Saleem Z, Oosthuizen F, Cordier W, Matlala M, Meyer JC, Schellack G, Massele A, Malande OO, Kalungia AC, Sichone J, Banda SS, Zaranyika T, Campbell S, Godman B.

Healthcare

Background: Multiple measures introduced early to restrict COVID-19 have dramatically impacted the teaching of medical and pharmacy students, exacerbated by the lack of infrastructure and experience with e-learning at the start of the pandemic. In addition, the costs and reliability of the Internet across Africa pose challenges alongside undertaking clinical teaching and practical programmes. Consequently, there is a need to understand the many challenges and how these were addressed, given increasingly complex patients, to provide future direction.

Method: An exploratory study was conducted among senior-level medical and pharmacy educators across Africa, addressing four key questions, including the challenges resulting from the pandemic and how these were dealt with.

Results: Staff and student members faced multiple challenges initially, including adapting to online learning. In addition, concerns with the lack of equipment (especially among disadvantaged students), the costs of Internet bundles, and how to conduct practicals and clinical teaching. Multiple activities were undertaken to address these challenges. These included training sessions, developing innovative approaches to teaching, and seeking ways to reduce Internet costs. Robust approaches to practicals, clinical teaching, and assessments have been developed.

Conclusions: Appreciable difficulties to teaching arising from the pandemic are being addressed across Africa. Research is ongoing to improve education and assessments.

2021-12-13

Newton PN Bond KC 53 signatories from 20 countries

The Lancet. Global health

2020-04-01

Felix Khuluza Stephen Kigera Richard W. O. Jähnke Lutz Heide

Malaria Journal

2016-04-01

Ogunleye O Basu D Mueller D Sneddon J Seaton R Yinka-Ogunleye A Wamboga J Miljković N Mwita J Rwegerera G Massele A Patrick O Niba L Godman B

Frontiers in pharmacology

2020-01-01

Felix Khuluza Lutz Heide Maarten Postma

PLOS ONE

2017-04-01

Nhomsai Hagen Girish Sailor Thomas Bizimana P. Claver Kayumba Felix Khuluza Lutz Heide

PLOS ONE

2020-09-02

BMC health services research

BACKGROUND:Despite the increasing frequency of ARV medicines stock-outs in Sub-Saharan Africa, there is little research inquiring into the mitigation strategies devised by frontline health facilities. Many previous studies have focused on 'upstream' or national-level drivers of ARVs stock-outs with less empirical attention devoted 'down-stream' or at the facility-level. The objective of this study was to examine the strategies devised by health facilities in Uganda to respond to the chronic stock-outs of ARVs. METHODS:This was a qualitative research design nested within a larger mixed-methods study. We purposively selected 16 health facilities from across Uganda (to achieve diversity with regard to; level of care (primary/ tertiary), setting (rural/urban) and geographic sub-region (northern/ central/western). We conducted 76 Semi-structured interviews with ART clinic managers, clinicians and pharmacists in the selected health facilities supplemented by on-site observations and documentary reviews. Data were analyzed by coding and thematic analyses. RESULTS:Participants reported that facility-level contributors to stock-outs include untimely orders of drugs from suppliers and inaccurate quantification of ARV medicine needs due to a paucity of ART program data. Internal stock management solutions for mitigating stock-outs which emerged include the substitution of ARV medicines which were out of stock, overstocking selected medicines and the use of recently expired drugs. The external solutions for mitigating stock-outs which were identified include 'borrowing' of ARVs from peer-providers, re-distributing stock across regions and upward referrals of patients. Systemic drivers of stock-outs were identified. These include the supply of drugs with a short shelf life, oversupply and undersupply of ARV medicines and migration pressures on the available ARVs stock at case-study facilities. CONCLUSION:Health facilities devised internal stock management strategies and relied on peer-provider networks for ARV medicines during stock-out events. Our study underscores the importance of devising interventions aimed at improving Uganda's medicines supply chain systems in the quest to reduce the frequency of ARV medicines stock-outs at the front-line level of service delivery. Further research is recommended on the effect of substituting ARV medicines on patient outcomes.

2019-05-15

Nhomsai Hagen Felix Khuluza Lutz Heide

BMC Pregnancy and Childbirth

2020-03-01

Nhomsai Hagen Thomas Bizimana P. Claver Kayumba Felix Khuluza Lutz Heide

The American Journal of Tropical Medicine and Hygiene

2020-08-03

Newton PN Bond KC Oxford Statement signatories

The Lancet. Global Health

2019-12-01

Godman, Brian and Leong, Trudy and Abubakar, Abdullahi Rabiu and Kurdi, Amanj and Kalemeera, Francis and Rwegerera, Godfrey Mutashambara and Patrick, Okwen and Lum Niba, Loveline and Ibrahim, Kamilou and Amu, Adefolarin A and Matowa, Patrick and Acolatse, Joseph and Incoom, Robert and Sefah, Israel and Opanga, Sylvia and Njeri, Lisper Wangeci and Kimonge, David and Oluka, Margaret and Chikowe, Ibrahim and Khuluza, Felix and Phiri, Henry and Kibuule, Dan and Hango, Ester and Sani, Ibrahim Haruna and Malande, Oliver Ombeva and Piloya-Were, Thereza and Alutuli, Luke and Kalungia, Aubrey Chichonyi and Chaibva, Blessmore Vimbai and Zaranyika, Trust and Haque, Mainul and Allocati, Eleonora and Campbell, Stephen and Adwubi, Eunice Twumwaa and Ogunleye, Olayinka

Internal Medicine: Open Access

Background: Prevalence rates of diabetes mellitus are growing across Africa with an appreciable number likely to be on insulin to manage their condition. This has significant implications on future morbidity and mortality exacerbated by high complication rates. Complication rates in patients requiring insulins are enhanced by hypoglycaemia. Long acting insulin analogues were developed to reduce hypoglycaemia and improve patient compliance. However, they are typically appreciably more expensive than human and other insulins in Africa, and continuing controversies surrounding their benefits limits their listing on national Essential Medicine Lists (EMLs). Biosimilars can reduce the prices long-acting insulin analogues. This needs assessing.

Methods: Mixed methods approach including documentation of insulin utilisation patterns and prices among a range of African countries. In addition, input from senior level government, academic, and healthcare professionals from across Africa on the current situation with long-acting insulin analogues as well as potential changes needed to enhance future funding of long-acting analogue biosimilars.

Results: There is variable listing of long-acting insulin analogues on national EMLs across Africa due to their high prices and issues of affordability. Even when listed, utilisation of long-acting insulin analogues is limited by similar issues including affordability. Appreciably lowering the prices of long-acting insulin analogues via biosimilars should enhance future listing on EMLs and use accompanied by educational and other initiatives. However, this will require increased competition to lower prices.

Conclusion: There are concerns with value and funding of long-acting insulin analogues across Africa including biosimilars. A number of activities have been identified to improve future funding and listing on EMLs.

2021-09-15

Khuluza F

Malawi Medical Journal

2014-06-01

Felix Khuluza Christine Haefele-Abah Khin Thet Wai

PLOS ONE

2019-02-01

LIFE

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.

2021-06-07

Felix Khuluza

PLOS ONE

Objective: To assess the prevalence and factors associated with substandard and falsified (SF) medicines among antibiotic, antimalarial, antihypertensive and antidiabetic medicines in Malawi.

Methods: We conducted a cross-sectional study in 23 public, faith-based and private health facilities in Zomba, Machinga and Nsanje districts. We analyzed oral medicine samples of commonly used medicines among antibiotics, antimalarial, antihypertensive and antidiabetics in accordance with Malawi Essential Medicines List and local treatment guidelines. These medicines were subjected to visual inspection for any defects and screening for the content of active pharmaceutical ingredient and disintegration of dosage units. Samples that failed during screening and at least 10% of those that passed were subjected to pharmacopeia assay and dissolution test for confirmation. We used thin layer chromatography and disintegration test methods provided in the Global Pharma Health Fund minilab® for the screening purposes. We conducted confirmatory test using High-Performance Liquid Chromatography (HPLC) or ultra-violet/visible spectrophotometer and dissolution.

Results: Of the 293 medicine samples collected, 14.3% were SF medicines. Among the SF medicines were 12.5% of Amlodipine (1/8), 19.2% of Amoxicillin (5/26), 72.2% of Atenolol (8/11), 21.2% of Ciprofloxacin (7/33), 14.3% of Enalapril (1/7), 44.4% of Flucloxacillin (4/9), and 35.7% of sulfadoxine/ pyrimethamine (10/28). Medicine quality was associated with therapeutic medicine class, stated origin of manufacturer, primary packaging material and geographical location. Antimalarial and antidiabetic medicines were of better quality as compared to antibiotics, odds ratio OR 4.2 (95% CI 1.7-9.49), p < 0.002 and OR 5.6 (95% CI 1.21-26.09), p < 0.028 respectively. In terms of stated country of origin, the prevalence of SF medicines was 30% (15/50), 33% (9/27), 26.7% (4/15) and 6.6% (8/122) for medicines stated to be manufactured in Malawi, China, Kenya and India respectively.

Conclusion: This study presents the first findings on the assessment of quality of medicines since the establishment of the national pharmacovigilance center in 2019 in Malawi. It is revealed that the problem of SF medicines is not improving and hence the need for further strengthening of quality assurance systems in Malawi.

2022-12-27

Olayinka O. Ogunleye, Debashis Basu, Debjani Mueller, Jacqueline Sneddon, R. Andrew Seaton, Adesola F. Yinka-Ogunleye, Joshua Wamboga, Nenad Miljković, Julius C. Mwita, Godfrey Mutashambara Rwegerera, Amos Massele, Okwen Patrick, Loveline Lum Niba, Melaine Nsaikila, Wafaa M. Rashed, Mohamed Ali Hussein, Rehab Hegazy, Adefolarin A. Amu, Baffour Boaten Boahen-Boaten, Zinhle Matsebula, Prudence Gwebu, Bongani Chirigo, Nongabisa Mkhabela, Tenelisiwe Dlamini, Siphiwe Sithole, Sandile Malaza, Sikhumbuzo Dlamini, Daniel Afriyie, George Awuku Asare, Seth Kwabena Amponsah, Israel Sefah, Margaret Oluka, Anastasia N. Guantai, Sylvia A. Opanga, Tebello Violet Sarele, Refeletse Keabetsoe Mafisa, Ibrahim Chikowe, Felix Khuluza, Dan Kibuule, Francis Kalemeera, Mwangana Mubita, Joseph Fadare, Laurien Sibomana, Gwendoline Malegwale Ramokgopa, Carmen Whyte, Tshegofatso Maimela, Johannes Hugo, Johanna C. Meyer, Natalie Schellack, Enos M. Rampamba, Adel Visser, Abubakr Alfadl, Elfatih M. Malik, Oliver Ombeva Malande, Aubrey C. Kalungia, Chiluba Mwila, Trust Zaranyika, Blessmore Vimbai Chaibva, Ioana D. Olaru, Nyasha Masuka, Janney Wale, Lenias Hwenda, Regina Kamoga, Ruaraidh Hill, Corrado Barbui, Tomasz Bochenek, Amanj Kurdi, Stephen Campbell, Antony P. Martin, Thuy Nguyen Thi Phuong, Binh Nguyen Thanh and Brian Godman

Frontiers in Pharmacology

2021-01-14

Felix Khuluza Stephen Kigera Lutz Heide

The American Journal of Tropical Medicine and Hygiene

2017-02-01

Ogunleye OO Basu D Mueller D Sneddon J Seaton RA Yinka-Ogunleye AF Wamboga J Miljković N Mwita JC Rwegerera GM Massele A Patrick O Godman B

Frontiers in pharmacology

2020-09-01