Ekwaro OBUKU | Makerere University (original) (raw)

Papers by Ekwaro OBUKU

Systematic Reviews, Nov 15, 2023

Background Wounds inflict pain and affect human health causing high expenditure on treatment and ... more Background Wounds inflict pain and affect human health causing high expenditure on treatment and management. Herbal crude extracts are used in traditional medicine as a treatment for wounds and other illnesses. However, the progress in the use of plants has been deterred due to their poor solubility and poor bioavailability requiring administration at high doses. It has been established that nanoencapsulation of herbal products in nanocarriers (size 1 nm to 100 nm) such as nanofibers, nanoparticles, nanospheres, and nanoliposomes greatly improves their efficacy. Due to their small and large surface area, nanocarriers are more biologically active, improve bioavailability, protect the drug from deterioration, and release it to the targeted site in a sustainable manner. Aim The review aims to collate and appraise evidence on the efficacy of nano encapsulated herbal extracts in the treatment of induced wounds in animal models. Methods The review will be protocol-driven and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols (PRISMA-P) and protocol guidelines for systematic review and metaanalysis for animal intervention studies. The final review will be conducted and reported with reference to PRISMA 2020 statement. Studies will be searched in Pub Med, ProQuest, Web of Science, Medline Ovid, EMBASE, and Google Scholar. The PRISMA flow criteria will be followed in screening the articles for inclusion. Data extraction form will be designed in Excel spreadsheet 2013 and data extracted based on the primary and secondary outcomes. Risk of bias assessment will be done using SYRCLE's risk of bias tool for animal studies. Data analysis will be done using narrative and quantitative synthesis. Expected results We hope to make meaningful comparisons between the effectiveness of the herb-loaded nanomaterials and other interventions (controls) in the selected studies, based on the primary and secondary outcome measures. We expect that these findings to inform clinical practice on whether preclinical studies show enough quality evidence on the efficacy and safety of herbal-loaded nanomaterials that can be translated into clinical trials and further research.

PLOS ONE, Nov 1, 2023

Introduction The practice of creating large databases has become increasingly common by combining... more Introduction The practice of creating large databases has become increasingly common by combining research participants' data into larger repositories. Funders now require that data sharing be considered in newly funded research project, unless there are justifiable reasons not to do so. Access to genomic data brings along a host of ethical concerns as well as fairness and equity in the conduct of collaborative research between researchers from high-income and low-and middle-income countries. Materials and methods This systematic review protocol will be developed in line with PRISMA-guidelines which refers to Open Science Framework, registered in PROSPERO (https://www.crd.york.ac.uk/ prospero/) record CRD42022297984 and published in a peer reviewed journal. Data sources will include PubMed, google scholar, EMBASE, Web of science and MEDLINE. Both published and grey literature will be searched. Subject matter experts including bioethicists, principal investigators of genomic research projects and research administrators will be contacted. After de-duplication, titles and abstracts will be screened for eligibility. Data extraction will be undertaken using a piloted form designed in EPPI-Reviewer software before conducting risk of bias assessments by a pair of reviewers, acting independently. Any discrepancies will be resolved by consensus. Analysis will be done using a structured narrative synthesis and where feasible metanalysis. This review will attempt to highlight the

Research Square (Research Square), May 30, 2023

Background Accurate and affordable laboratory testing is key for timely diagnosis and appropriate... more Background Accurate and affordable laboratory testing is key for timely diagnosis and appropriate management of COVID-19 patients. As such, robust evidence regarding diagnostic accuracy and costs of available tests would inform policy and practice especially in resource-limited settings. We aimed to determine the diagnostic test accuracy, costs and utility of laboratory test strategies for COVID-19 in LMICs. Methods This was a multi-staged protocol-driven systematic review conducted in line with PRISMA guidelines for diagnostic test accuracy studies (PRISMA-DTA). We searched for relevant literature in six databases including: PubMed, Google Scholar, MEDLINE, SCOPUS, Web of Science, and the WHO Global Index Medicus. Studies were screened and coded in pairs. We conducted a structured narrative and quantitative synthesis of the results guided by Fryback and Thornbury framework. The primary outcome was COVID-19 diagnostic test accuracy. The results were reported following the PRISMA-DTA. Results Thirteen articles were from studies in China and one from Turkey. All studies included used the Real-time polymerase chain reaction test (RT-PCR) as their reference test. 21.4% (n = 3) of articles were determining the diagnostic accuracy of the PCR test. The remaining studies (n = 11) used other COVID-19 tests as the index tests. It is generally observed that the tests were more speci c than sensitive pooled sensitivity and speci city was 87.6%, (95% CI: 82.2% − 93%), 98.1% (95% CI: 96.4%-100%) respectively. The Reverse-transcription loop-mediated isothermal ampli cation (RT-LAMP) tests had the highest sensitivity as compared to RT-PCR, serological and chemiluminescent immunoassays (CLIA). The speci city and sensitivity of the tests were highest when bronchial lavage samples were used and lowest with the use of serum specimens/sample. No study documented cost of the diagnostic test used. Conclusion The evidence on COVID-19 testing in LMICs is summarized in this systematic review. The RT-PCR was used as the reference test in all studies. The diagnostic assays' combined sensitivity and speci city were 87.55% and 98.10%, respectively. In the reviewed literature, no study reported on the cost and cost effectiveness of diagnostic tests. Finally, no studies were carried out on the African continent. Registration: This review was registered in PROSPERO No. CRD42020209528. And the protocol published here https://bmjopen.bmj.com/content/11/10/e050296 Background The coronavirus disease (COVID-19) is a pandemic that resulted into serious and signi cant morbidity and mortality globally. In order to prevent the spread of the disease, early and accurate diagnosis is critical (1). Therefore, proper clinical management and control of this pandemic necessitates prioritizing rapid laboratory testing of appropriate specimens from patients meeting the suspected case de nition for COVID-19 and diagnosis (2). Currently, the gold standard for the diagnosis of SARS-CoV-2 infection involves detection of viral nucleic acid using nucleic acid ampli cation tests (NAATs) such as the reverse transcription polymerase chain reaction (RT-PCR)(3). Nucleic acid ampli cation assays target regions on the SARS-CoV-2 genome particularly the E, RdRP, N and S genes (3). The RT-PCR assay is characterized by rapid detection, high sensitivity, and speci city hence recommended for diagnosis of early COVID-19 infections (4). However, the RT-PCR assay is complex, time-consuming (long turnaround time) and associated with risk of eliciting false-negative and false-positive results because it is easily affected by factors such as collection time, sample type, and nature of sample preservation (1, 5, 6). Each PCR test may cost hundreds of dollars and requires the use of sophisticated equipment, expensive reagents and highly skilled labor (1, 7) all of which constitute a potential barrier to majority of the population. Furthermore, this method is unable to meet the principles of early detection, early isolation, and early treatment hence inauspicious to the prevention and control of the epidemic (5). Besides the NAATs, immunoassays have been developed as supplemental tools for rapid detection of antibodies (IgM and IgG) against COVID-19 or SARS-CoV-2 antigens (using rapid antigen tests) in biological samples like nasopharyngeal secretions (1, 8-11). The serological immunoassays detect antibodies to SARS-CoV-2 and these may include the enzyme-linked immunosorbent assays (ELISAs), chemiluminescent immunoassays (CLIAs) and lateral ow immunoassays (LFIAs) (2, 12). Serological tests are indirect measures of the infection and have proven to be useful in con rming past COVID-19 infections (2, 8). They therefore aid in investigating an ongoing outbreak, retrospective assessment of the attack rate or extent of an outbreak (2). Rapid antigen tests such as lateral ow immunoassays that detect the presence of SARS-CoV-2 viral proteins (antigens) in respiratory tract specimens are also currently used in diagnosis of COVID (3, 13). They are based on immunochromatography, which employs antibodies spotted onto nitrocellulose membranes that interact with speci c antigens from the patient sample (1). Immunoassays are less costly, more accessible to patients and have a short turnaround time compared to the RT-PCR assays (1, 2). Therefore, they are very important for real-time patient management and infection control decisions. However, they are likely to suffer from poor sensitivity in early infection mostly due to the low infectious burden or sampling variability (8). Existing evidence also highlights inconsistencies in the diagnostic accuracy of these assays. More so, most of the evidence on diagnostic accuracy is largely from developed countries, where the Covid-19 curves Data Sources We performed article search was in the following databases; PubMed, Google Scholar, MEDLINE, SCOPUS, Web of Science and the WHO Global Index Medicus. Additional targeted searches were conducted in websites of organizations championing COVID-19 management for grey literature including but not limited to manufacturers of COVID-19 laboratory tests, centers for disease control and prevention (CDC) in Africa, China, Europe and the USA; World Health Organization (WHO); specialized research institutions in Africa such as the

African Health Sciences, Dec 27, 2022

Background: There is uncertainty about the actual burden of childhood TB in Uganda, but underesti... more Background: There is uncertainty about the actual burden of childhood TB in Uganda, but underestimation is acknowledged. We aimed at determining prevalence, factors associated with PTB among children attending PHC facilities in Kampala. Methods: This was a cross-sectional study of 255 children, with presumed TB, attending six health facilities in Kampala, Uganda, in March 2015. Socio-demographic, clinical, and laboratory data were collected using a questionnaire. TB was diagnosed using "Desk Guide" algorithms. Sputum based on ZN/FM and/or Gene-Xpert. Logistic regression was used to assess associations with outcomes. Results: Overall, prevalence of PTB 13.7 % (2.6-24.8). Among HIV-positive, the prevalence of PTB was 41.7%, while among malnourished children, 21.7% and contacts, 89.3%. The factors that influenced PTB included: tobacco smoker at home (OR = 1.6, 95 % CI: 1.07-6.86), stunting (OR = 2.2, 95 % CI: 1.01-4.15). Only 5.3% of the smear-negative TB children and 81.3% of the smear-positive children were initiated on treatment within a month of diagnosis. Conclusion: Clinical TB among children is underdiagnosed and undertreated. There is a need for more sensitive and specific diagnostic tests, need ways to disseminate and promote uptake of standardized clinical algorithms. Also, contact TB tracing should be strengthened so that such cases can be actively detected even at community level.

International Journal of Technology Assessment in Health Care, Dec 1, 2014

Objectives: This paper describes the development and findings for a policy brief on "Advancing th... more Objectives: This paper describes the development and findings for a policy brief on "Advancing the Integration of Palliative Care into the National Health System" and the subsequent use of this report. Methods: Key stakeholders involved with palliative care helped identify the problem and potential policy solutions to scale up these services within the health system. A working group of national stakeholder representatives and external reviewers commented on and contributed to successive drafts of the report. Research describing the problem, policy options and implementation considerations was identified by reviewing government documents, routinely collected data, electronic literature searches, contact with key informants, and reviewing the reference lists of relevant documents that were retrieved. Results: The palliative burden is not only high but increasing due to the rise in population and life expectancy. A few options for holistic, supportive care include: Home-based care increases chances of a peaceful death for the terminally ill surrounded by their loved ones; supporting informal caregivers improves their quality of life and discharge planning reduces unscheduled admissions and has the potential to free up capacity for acute care services. A combination of strategies is needed to effectively implement the proposed options as discussed further in this article. Conclusions: The policy brief report was used as a background document for two stakeholder dialogues whose main outcome was that a comprehensive national palliative care policy should be instituted to include all the options, which need to be integrated within the public health system. A draft policy is now in process.

Adaptation and mitigation strategies for climate change-a review of the attributes of transformat... more Adaptation and mitigation strategies for climate change-a review of the attributes of transformational change in the energy and public health sectors: systematic review and evidence gap map protocol. PROSPERO 2020 CRD42020220671

Aids Care-psychological and Socio-medical Aspects of Aids/hiv, Oct 1, 2013

Depressive disorders are highly prevalent in Africa where diseases such as HIV/AIDS are common. T... more Depressive disorders are highly prevalent in Africa where diseases such as HIV/AIDS are common. The aim of this study was to assess the validity of commonly used depression screening instruments in a setting characterized by low literacy, where patients may not be able to self-administer depression scales. We explored the validity of the Patient Health Questionaire-9 (PHQ-9), Centre for Epidemiological Surveys for Depression (CES-D), and the Kessler-10 (K-10), using the Mini International Neuropsychiatric Instrument (MINI) as a gold standard in 368 persons living with HIV/AIDS (PLWHA) in Uganda. The shorter versions of the K-10 and PHQ-9 were extracted to assess their performance in comparison to the longer versions. We used STATA 11.2 to analyze the data. The prevalence of a MINI defined depression in this patient sample was 17.4%. The three instruments all performed well, with areas under the curve (AUC) ranging from 0.82 to 0.96. The PHQ-9 showed the best performance characteristics with an AUC of 0.96, a sensitivity of 91.6%, and specificity 81.2%. The extracted versions performed more modestly. All three instruments showed good properties as screening tools; the PHQ-9 has particularly high sensitivity and specificity, and so can be considered useful for screening HIV-positive patients for depression.

PLOS ONE, Feb 28, 2013

Objective: The HIV/AIDS epidemic has evolved with an increasing burden in older adults. We assess... more Objective: The HIV/AIDS epidemic has evolved with an increasing burden in older adults. We assessed for knowledge about aging and HIV/AIDS, among clinicians in Kampala district, Uganda. Methods: A cross-sectional survey of 301 clinicians complemented by 9 key-informant interviews between May and October 2011. Data was analyzed by multivariable logistic regression for potential determinants of clinician knowledge about HIV/ AIDS in older adults, estimating their adjusted Odds Ratios (aOR) and 95% confidence intervals (95% CI) using Stata 11.2 software. Results: Two-hundred and sixty-two questionnaires (87.7%) were returned. Respondents had a median age of 30 years (IQR 27-34) and 57.8% were general medical doctors. The mean knowledge score was 49% (range 8.8%-79.4%). Questions related to co-morbidities in HIV/AIDS (non-AIDS related cancers and systemic diseases) and chronic antiretroviral treatment toxicities (metabolic disorders) accounted for significantly lower scores (mean, 41.7%, 95% CI: 39.3%-44%) compared to HIV/AIDS epidemiology and prevention (mean, 65.7%, 95% CI: 63.7%-67.7%). Determinants of clinician knowledge in the multivariable analysis included (category, aOR, 95% CI): clinician age (30-39 years; 3.28:1.65-9.75), number of persons with HIV/AIDS seen in the past year (less than 50; 0.34:0.14-0.86) and clinical profession (clinical nurse practitioner; 0.31:0.11-0.83). Having diploma level education had a marginal association with lower knowledge about HIV and aging (p = 0.09). Conclusion: Our study identified gaps and determinants of knowledge about HIV/AIDS in older adults among clinicians in Kampala district, Uganda. Clinicians in low and middle income countries could benefit from targeted training in chronic care for older adults with HIV/AIDS and long-term complications of antiretroviral treatment.

The Cochrane library, Aug 1, 2014

Analysis 2.1. Comparison 2 Selective serotonin reuptake inhibitors (SSRI) versus tricyclic antide... more Analysis 2.1. Comparison 2 Selective serotonin reuptake inhibitors (SSRI) versus tricyclic antidepressants (TCA), Outcome 1 Improvement in depression: HAM-D score: continuous (follow-up score

PLOS ONE, Oct 2, 2013

Objective: Clinical and immunological data about HIV in older adults from low and middle income c... more Objective: Clinical and immunological data about HIV in older adults from low and middle income countries is scarce. We aimed to describe differences between younger and older adults with HIV starting antiretroviral therapy in two low-income African countries. Methods: Setting: HIV clinics in Uganda and Zimbabwe. Design: Secondary exploratory cross-sectional analysis of the DART randomized controlled trial. Outcome Measures: Clinical and laboratory characteristics were compared between adults aged 18-49 years (younger) and ≥ 50 years (older), using two exploratory multivariable logistic regression models, one with HIV viral load (measured in a subset pre-ART) and one without. Results: A total of 3316 eligible participants enrolled in DART were available for analysis; 219 (7%) were ≥ 50 years and 1160 (35%) were male. Across the two adjusted regression models, older adults had significantly higher systolic blood pressure, lower creatinine clearance and were consistently less likely to be females compared to younger adults with HIV. Paradoxically, the models separately suggested that older adults had statistically significant (but not clinically important) higher CD4+ cell counts and higher plasma HIV-1 viral copies at initiation. Crude associations between older age and higher baseline hemoglobin, body mass index, diastolic blood pressure and lower WHO clinical stage were not sustained in the adjusted analysis. Conclusions: Our study found clinical and immunological differences between younger and older adults, in a cohort of Africans starting antiretroviral therapy. Further investigations should explore how these differences could be used to ensure equity in service delivery and affect outcomes of antiretroviral therapy.

BMC Public Health, Apr 25, 2023

Background Despite the discovery of vaccines, the control, and prevention of Coronavirus disease ... more Background Despite the discovery of vaccines, the control, and prevention of Coronavirus disease 2019 (COVID-19) relied on non-pharmaceutical interventions (NPIs). This article describes the development and application of the Public Health Act to implement NPIs for COVID-19 pandemic control in Uganda. Methods This is a case study of Uganda's experience with enacting COVID-19 Rules under the Public Health Act Cap. 281. The study assessed how and what Rules were developed, their influence on the outbreak progress, and litigation. The data sources reviewed were applicable laws and policies, Presidential speeches, Cabinet resolutions, statutory instruments, COVID-19 situation reports, and the registry of court cases that contributed to a triangulated analysis. Results Uganda applied four COVID-19 broad Rules for the period March 2020 to October 2021. The Minister of Health enacted the Rules, which response teams, enforcement agencies, and the general population followed. The Presidential speeches, their expiry period and progress of the pandemic curve led to amendment of the Rules twenty one (21) times. The Uganda Peoples Defense Forces Act No. 7 of 2005, the Public Finance Management Act No. 3 of 2015, and the National Policy for Disaster Preparedness and Management supplemented the enacted COVID-19 Rules. However, these Rules attracted specific litigation due to perceived infringement on certain human rights provisions. Conclusions Countries can enact supportive legislation within the course of an outbreak. The balance of enforcing public health interventions and human rights infringements is an important consideration in future. We recommend public sensitization about legislative provisions and reforms to guide public health responses in future outbreaks or pandemics.

International Journal for Equity in Health

Background Addressing persistent and pervasive health inequities is a global moral imperative, wh... more Background Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. Methods We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: ...

Health Security

International Health Regulations (2005) capacities in 2017. The action plan enhanced national hea... more International Health Regulations (2005) capacities in 2017. The action plan enhanced national health security awareness, but implementation efforts were affected by limited funding, excess of activities, and challenges related to monitoring and evaluation. To improve implementation, Uganda conducted a multisectoral health security self-assessment in 2021 using the second edition of the JEE tool and developed a 1-year operational plan. From 2017 to 2021, Uganda's composite ReadyScore improved by 20%, with improvement in 13 of the 19 technical areas. Indicator scores showing limited

In 2013, Makerere University College of Health Sciences (MakCHS) received funding support from th... more In 2013, Makerere University College of Health Sciences (MakCHS) received funding support from the International Development Research Centre, Canada, to establish an Africa Centre for Systematic Reviews and Knowledge Translation. The aim of the Centre is to build capacity for knowledge translation for health policy in Uganda and East Africa. The Centre is steadily transforming Uganda and the East African region into an environment that is driven by evidence informed health policy and action, and one that is self-reliant in capacity for evidence synthesis and knowledge translation. The Centre team comprises clinical epidemiologists, public health physicians, health policy analysts, health systems researchers and library and information scientists. The paper examines the instructional and research roles of health sciences librarians at the Centre, in informing evidence-based medical practice and health policy-making. The paper was informed by data from the Centre activities: courses c...

Background: Wounds inflict pain and affect human health causing high expenditure on treatment and... more Background: Wounds inflict pain and affect human health causing high expenditure on treatment and management. Herbal crude extracts are used in traditional medicine as a treatment for wounds and other illnesses. However, the progress in the use of plants has been deterred due to their poor solubility and, poor bioavailability requiring administration at high doses. It has been established that nanoencapsulation of herbal products in nanocarriers (size 1nm to 100nm) such as nanofibers, nanoparticles, nanospheres, and nanoliposomes greatly improves their efficacy. Due to their small and large surface area, nanocarriers are more biologically active, improve bioavailability, protect the drug from deterioration, and release it to the targeted site in a sustainable manner. Aim: The review aims to collate and appraise evidence on the efficacy of nano encapsulated herbal exracts in the treatment of induced wounds in animal models. Methods: The review will be protocol-driven and conducted ac...

Clinical Infectious Diseases, May 21, 2012

The Journal of Infectious Diseases, Jul 17, 2012

Background. Treatment of multidrug-resistant or extensively drug-resistant tuberculosis (DR-tuber... more Background. Treatment of multidrug-resistant or extensively drug-resistant tuberculosis (DR-tuberculosis) is challenging because commonly used second-line drugs are poorly efficacious and highly toxic. Although World Health Organization group 5 drugs are not recommended for routine use because of unclear activity, some may have untapped potential as more efficacious or better tolerated alternatives. Methods. We conducted an exhaustive review of in vitro, animal, and clinical studies of group 5 drugs to identify critical research questions that may inform their use in current treatment of DR-tuberculosis and clinical trials of new DR-tuberculosis regimens. Results. Clofazimine may contribute to new short-course DR-tuberculosis regimens. Beta-lactams merit further evaluation-specifically optimization of dose and schedule. Linezolid appears to be effective but is frequently discontinued due to toxicity. Thiacetazone is too toxic to warrant further evaluation. Mycobacterium tuberculosis has intrinsic inducible resistance to clarithromycin. Conclusions. Clofazimine and beta-lactams may have unrealized potential in the treatment of DR-tuberculosis and warrant further study. Serious toxicities or intrinsic resistance limit the utility of other group 5 drugs. For several group 5 compounds, better understanding of structure-toxicity relationships may lead to better-tolerated analogs.

Journal of Clinical Epidemiology, Jun 1, 2023