Background—misinformation and mistrust often undermines community vaccine uptake, yet information in rural communities, especially of developing countries, is scarce. This study aimed to identify major challenges associated with coronavirus disease 2019 (COVID-19) vaccine clinical trials among healthcare workers and staff in Uganda. Methods—a rapid exploratory survey was conducted over 5 weeks among 260 respondents (66% male) from healthcare centers across the country using an online questionnaire. Twenty-seven questions assessed knowledge, confidence, and trust scores on COVID-19 vaccine clinical trials from participants in 46 districts in Uganda. Results—we found low levels of knowledge (i.e., confusing COVID-19 with Ebola) with males being more informed than females (OR = 1.5, 95% CI: 0.7–3.0), and mistrust associated with policy decisions to promote herbal treatments in Uganda and the rushed international clinical trials, highlighting challenges for the upcoming Oxford–AstraZeneca vaccinations. Knowledge, confidence and trust scores were higher among the least educated (certificate vs. bachelor degree holders). We also found a high level of skepticism and possible community resistance to DNA recombinant vaccines, such as the Oxford–AstraZeneca vaccine. Preference for herbal treatments (38/260; 14.6%, 95% CI: 10.7–19.3) currently being promoted by the Ugandan government raises major policy concerns. High fear and mistrust for COVID-19 vaccine clinical trials was more common among wealthier participants and more affluent regions of the country. Conclusion—our study found that knowledge, confidence, and trust in COVID-19 vaccines was low among healthcare workers in Uganda, especially those with higher wealth and educational status. There is a need to increase transparency and inclusive participation to address these issues before new trials of COVID-19 vaccines are initiated.

Background Irrational prescription of drugs can lead to high cost of treatment thus limiting access to essential medicines. We assessed the affordability and appropriateness of prescriptions written for diabetic patients in Eastern Uganda. Methods We collected secondary data from the health management information system registers of patients who attended the outpatient medical clinic at Mbale regional referral hospital from January 2019 to December 2019. The average cost of the prescriptions was calculated and adjusted odds ratios for predictors for unaffordability estimated using logistic regression. Computed scores for indicators of rational drug prescription were used to assess the extent of rational prescribing. Results The median cost per prescription was USD 11.34 (IQR 8.1, 20.2). Majority of the diabetic patients (n = 2462; 94.3%, 95% CI: 93.3–95.1%) could not afford the prescribed drugs. Predictors for unaffordability were if a prescription contained: ≥ 4 medicines (AOR = 12.45; 95% CI: 3.9–39.7); an injectable (AOR = 5.47; 95%CI: 1.47–20.32) and a diagnosis of diabetes mellitus with other comorbidities (AOR = 3.36; 95%CI: 1.95–5.78). Having no antidiabetic drug prescribed was protective for non-affordability (AOR = 0.38; 95%CI: 0.24–0.61). The average number of drugs per prescription was 2.8. The percentage prescription of drugs by generic name and from the essential medicine and health supplies list of Uganda were (6160/7461; 82.6%, 96% CI: 81.7%-83.4%) and (6092/7461; 81.7%, 95% CI: 80.8%-82.5%) respectively against WHO standard of 100%. Conclusion The majority of diabetic patients (94.3%) in Eastern Uganda cannot afford to buy prescribed medicines. The government should therefore ensure that essential medicines are readily accessible in public health facilities.

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Background: Whereas the efficacy of Entada abyssinica (fabaceae) extracts against various ailments has been scientifically validated, its safety has not been established. This study was undertaken to evaluate the toxicity effects of methanolic stem bark extract of E. abyssinica on biochemical, haematological and histological parameters of Wistar albino rats following repeated oral administration.Methods: Wistar albino rats of both sexes were randomized into groups and orally administered daily with determined doses (150, 300 and 600 mg/kg) of E. abyssinica methanolic extract using 1% tween 80 in distilled water as a control for 28 days. On the 29th day, all the animals were sacrificed and dissected to collect blood and selected organs. The serum and whole blood were assayed for biochemical and haematological parameters respectively while selected organs were examined for histopathological lesions. Numerical data was analyzed using graph pad prism and expressed as mean ± standard error of mean. The differences between the treatment and control groups were tested for statistical significance using one-way analysis of variance and/or Student’s t-test.Results: In repeated daily oral doses (150, 300 and 600 mg/kg), the methanolic stem bark extract of E. abyssinica did not cause significant alteration in majority of the biochemical and hematological indices. However, the extract significantly elevated the level of uric acid (all doses), aspartate aminotransferase (300 and 600 mg/kg), low density lipoproteins (150 mg/kg) and mean corpuscular heamoglobin concentration (all doses). On the other hand, the extracts reduced high density lipoproteins (150 and 300 mg/kg), mean corpuscular volume (all doses), haematocrit (150 and 600 mg/kg), mean platelet volume (150 and 600 mg/kg) and procalcitonin (150 mg/kg). In the vital organs, there were no significant lesions observed except at the highest dose (600 mg/kg) where there was mild evidence of lymphocyte infiltration in the liver and focal interstitial nephritis.Conclusion: The methanolic stem bark extract of E. abyssinica is relatively safe in Wistar albino rats when repetitively administered orally in small doses for a prolonged period of time. We recommend more chronic toxicity studies and clinical trials on herbal remedies containing this plant to ensure that its use is free of potential toxicity to humans.

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BackgroundThe Phosphatase and tensin-induced putative kinase 1 (PINK1B9) mutant for Drosophila melanogaster is a key tool that has been used in assessing the pathology of Parkinsonism and its possible remedy. This research was targeted toward determining the effects of ethanolic extract of propolis, with levodopa therapy in the management of Parkinsonism.MethodThe PINK1B9 flies were divided into groups and fed with the different treatment doses of ethanoic extract of propolis. The treatment groups were subjected to 21 days of administration of propolis and the levodopa at different doses after which percentage climbing index, antioxidant activity and lifespan studies were done.ResultsPropolis alone improved motor activity, antioxidant and lifespan in Drosophila melanogaster than in PINK1 flies. Propolis in combination with levodopa significantly (P<0.05) improved physiological parameters at higher than lower concentrations in Parkinsonism Drosophila melanogaster demonstrating its importance in managing side effects associated with levodopa.ConclusionPropolis is a novel candidate as an alternative and integrative medicinal option to use in the management of Parkinsonism in both animals and humans at higher concentrations.

Background: Crassocephalum vitellinum is widely used by traditional medical practitioners and local people in East Africa to manage a large number of ailments including hepatitis 1. However, its hepatoprotective effects had not been evaluated prior to this study. The aim of this study was to assess the effect of an ethanolic leaf extract of Crassocephalum vitellinum against rifampicin-induced liver toxicity in Wistar rats. Methods: Increasing doses of an ethanolic leaf extract of C. vitellinum were administered to Wistar rats daily for 35 days, together with rifampicin given orally as suspension. After the treatment period, Assessment of hepatoprotective activity was done by analysis of serum levels of biochemical and histopathological effects on the liver. Results: The results showed that administration of C. vitellinum extract significantly prevented drug- induced increase in serum levels of liver biomarker enzymes and also decreased the hepatocellular necrosis and inflammatory cells infiltration.Conclusion: The plant extract loweres the liver biomarker enzymes (ALT, ALP, AST) and preserves the histomorphology of the hepatocytes which is suggestive that the plant possess hepatoprotective properties. Keywords: Crassocephalum vitellinum; antitubercular drugs; drug-induced hepatotoxicity; hepatoprotective agents.

Background: Antimicrobial resistance (AMR) is an important global health concern, projected to contribute to significant mortality, particularly in developing countries. This study aimed to determine the knowledge, perceptions of clinical health professions students towards antimicrobial resistance and rational use of medicine and confidence level to prescribe antimicrobials. Methods: An online descriptive cross-sectional survey was conducted among clinical health professions students across 9 medical schools in Uganda. A semi-structured questionnaire using Kobo Toolbox form was shared among participants via WhatsApp Messenger (Meta, California, USA). Knowledge was categorized using modified Bloom’s cut-off. One-way ANOVA, Chi-square or Fisher’s exact test, and logistic regression were used to assess the association between dependent and independent variables. A p<0.05 was considered statistically significant. Results: We surveyed 681 participants, most were pursuing a Bachelor of Medicine and Surgery degree (n=433, 63.6%), with a mean age of 24 (standard deviation: 3.6) years. Most participants (n=596, 87.5%) had sufficient knowledge about antimicrobial resistance with a mean score of 85 ± 14.2%. There was a significant difference in mean knowledge scores of year 4 (86.6%) compared to year 3 (82.4%) (p=0.002) and year 5 (88.0%) compared to year 3 (82.4%) (p<0.001). Most participants (n=456, 66.9%), were confident on making an accurate diagnosis of infection, and choosing the correct antimicrobial agent to use (n=484, 71.1%). Conclusion: Health profession students exhibited good knowledge on antimicrobial resistance and high self-perceived confidence on antimicrobial prescriptions however they still agreed that a separated course unit on AMR is necessary.