David Mukanga's research while affiliated with Bill & Melinda Gates Foundation and other places

Publications (50)

Article
Full-text available
The public health context is becoming increasingly more complex requiring highly trained professionals equipped with knowledge, competencies and tools to address or transform current and future challenges. Doctoral degree training offers an opportunity to build the capacity to detect and respond to such dynamic health challenges. In this paper, we...
Article
Full-text available
There is a critical skills gap on the African continent in regulatory sciences, and an acknowledged need to develop a long‐term strategy for training and professional development of African regulatory personnel. Capacity building programs for African regulators should link education, training and research with career development in an approach that...
Article
Full-text available
Rationale aims and objectives: Appropriate treatment of pediatric fever in rural areas remains a challenge and maybe partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on the appropriate treatment of pneumonia symptoms, uncomplicated malaria, and non-bloody di...
Preprint
There is a critical skills gap on the African continent in regulatory sciences, and an acknowledged need to develop a long-term strategy for training and professional development of African regulatory personnel. Capacity building programs for African regulators should link education, training and research with career development in an approach that...
Article
Full-text available
Access to essential medicines is a key pillar of any health system seeking to deliver universal health coverage. Science-based, independent regulation of medical products is a critical part of ensuring that only quality essential medicines reach the patients who need them. • In this article, we explore the progress the East African Community's Medi...
Article
Full-text available
Independent, science-based regulation of medical products is a critical part of ensuring quality healthcare. When conducted in a transparent, science-based, efficient, accountable, and predictable manner, it can help ensure access to quality products that patients need. • Several factors determine access to medicines, including treatment policy, pr...
Article
Requiring regional or in-country confirmatory clinical trials before approval of drugs already approved elsewhere delays access to medicines in low- and middle-income countries and raises drug costs. Here, we discuss the scientific and technological advances that may reduce the need for in-country or in-region clinical trials for drugs approved in...
Article
Full-text available
Background: Support supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for Class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers. Without support supervision, inappropriate treatment of malaria, pneumonia and diarrhoea among c...
Preprint
Full-text available
Background Support supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers.As such, inappropriate treatment of malaria, pneumonia and diarrhoea among children under five year...
Preprint
Full-text available
Background Support supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers. As such, inappropriate treatment of malaria, pneumonia and diarrhoea among children under five yea...
Preprint
Full-text available
Background: Appropriate treatment of paediatric fever in rural areas remains a challenge and may be partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on appropriate treatment of pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children...
Article
Full-text available
Background Despite significant progress, pneumonia is still the leading cause of infectious deaths in children under five years of age. Poor adherence to antibiotics has been associated with treatment failure in World Health Organisation (WHO) defined clinical pneumonia; therefore, improving adherence could improve outcomes in children with fast-br...
Article
Full-text available
Background Despite recent progress, pneumonia remains the largest infectious killer of children globally. This paper describes outcomes of not treating community-diagnosed fast-breathing pneumonia on patient recovery. Methods We conducted an exploratory subanalysis of an observational prospective cohort study in Malawi. We recruited children (2–59...
Article
Full-text available
Background The World Health Organization (WHO) recommends injectable artesunate given either intravenously or by the intramuscular route for definitive treatment for severe malaria and recommends a single intramuscular dose of intramuscular artesunate or intramuscular artemether or intramuscular quinine, in that order of preference as pre-referral...
Article
Full-text available
It is estimated that pneumonia is responsible for 15% of childhood deaths worldwide. Recent research has shown that hypoxia and malnutrition are strong predictors of mortality in children hospitalized for pneumonia. It is estimated that 15% of children under 5 who are hospitalized for pneumonia have hypoxaemia and that around 1.5 million children w...
Article
Full-text available
Pneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia...
Article
Full-text available
Improved referral algorithms for children with non-severe pneumonia at the community level are desirable. We sought to identify predictors of oral antibiotic failure in children who fulfill the case definition of World Health Organization (WHO) non-severe pneumonia. Predictors of greatest interest were those not currently utilized in referral algor...
Article
Full-text available
To accelerate progress in reducing child mortality, many countries in sub–Saharan Africa have adopted and scaled–up integrated community case management (iCCM) programs targeting the three major infectious killers of children under–five. The programs train lay community health workers to assess, classify and treat uncomplicated cases of pneumonia w...
Article
Full-text available
The health workforce is one of the key building blocks for strengthening health systems. There is an alarming shortage of curative and preventive health care workers in developing countries many of which are in Africa. Africa resultantly records appalling health indices as a consequence of endemic and emerging health issues that are exacerbated by...
Article
Full-text available
Introduction: Cholera outbreaks have occurred periodically in Uganda since 1971. The country has experienced intervals of sporadic cases and localized outbreaks, occasionally resulting in prolonged widespread epidemics. Methods: Cholera surveillance data reported to the Uganda Ministry of Health from 2007 through 2011 were reviewed to determine...
Article
Full-text available
Overuse and misuse of antibiotics is a serious global problem. While resistance to older antibiotics is increasing, development of newer molecules has stalled. Resistance to the existing antibiotics that is largely driven by their high-volume use is a global public health problem. Uganda is one of the countries where prescription-only drugs, includ...
Article
Full-text available
Background While there are biomedical drugs for managing diabetes mellitus, some patients with diabetes use traditional medicine. The aim of the study was to explore why patients with diabetes use traditional medicine for the treatment of diabetes. Methods The study was conducted in Iganga and Bugiri districts in Eastern Uganda using four focus gr...
Article
Full-text available
Background: Among the factors contributing to the high maternal morbidity and mortality in Uganda is the high proportion of pregnant women who do not deliver under supervision in health facilities. This study aimed to identify the independent predictors of health facility delivery in Busia a rural district in Uganda with a view of suggesting measu...
Article
Full-text available
Evidence on the impact of using diagnostic tests in community case management of febrile children is limited. This effectiveness trial conducted in Burkina Faso, Ghana, and Uganda, compared a diagnostic and treatment package for malaria and pneumonia with presumptive treatment with anti-malarial drugs; artemisinin combination therapy (ACT). We enro...
Article
The concept of animal and human health experts working together toward a healthier world has been endorsed, but challenges remain in identifying concrete actions to move this one health concept from vision to action. In 2008, as a result of avian influenza outbreaks in West Africa, international donor support led to a unique opportunity to invest i...
Article
Full-text available
Background: Use of diagnostics in integrated community case management (iCCM) of fever is recognized as an important step in improving rational use of drugs and quality of care for febrile under-five children. This study assessed household access, acceptability and utilization of community health workers (CHWs) trained and provided with malaria ra...
Article
Full-text available
The objective of this work is to describe the experience of the Uganda Public Health School Without Walls (PHSWOW) in training public health professionals at post-graduate level to offer leadership in planning, delivery of health services and research within a decentralized health system. As one of the constituents of the Makerere University Colleg...
Article
Full-text available
Laboratories are integral to the delivery of quality health care and for public health functions; however laboratory systems and services are often neglected in resource-poor settings such as the East African region. In order to sustainably strengthen national laboratory systems in resource-poor countries, there is a need to train laboratory person...
Article
Full-text available
The occurrence of major zoonotic disease outbreaks in Sub-Saharan Africa has had a significant impact on the already constrained public health systems. This has, as a result, justified the need to identify creative strategies to address threats from emerging and re-emerging infectious diseases at the human-animal-environmental interface, and implem...
Article
Full-text available
Rwanda still suffers from communicable diseases which frequently lead to epidemics. In addition to other health workforce needs, Rwanda also lacks a public health workforce that can operate multi-disease surveillance and response systems at the national and sub-national levels.In 2009 and 2010 the Rwanda Ministry of Health and its partners from the...
Article
Full-text available
The Central African Field Epidemiology and Laboratory Training Program (CAFELTP) is a 2-year public health leadership capacity building training program. It was established in October 2010 to enhance capacity for applied epidemiology and public health laboratory services in three countries: Cameroon, Central African Republic, and the Democratic Rep...
Article
Full-text available
The West Africa Field Epidemiology and Laboratory Training Program (WA-FELTP) which was established in September 2007, is an inter-country, competency-based, in-service and post -graduate training program in applied epidemiology and public health that builds the capacity to strengthen the surveillance and response system as well as epidemic control...
Article
Full-text available
The Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) is a comprehensive two-year competency-based training and service program designed to build sustainable public health expertise and capacity. Established in 2009, the program is a partnership between the Ethiopian Federal Ministry of Health, the Ethiopian Health and Nutrition...
Article
Full-text available
Networks are a catalyst for promoting common goals and objectives of their membership. Public Health networks in Africa are crucial, because of the severe resource limitations that nations face in dealing with priority public health problems. For a long time, networks have existed on the continent and globally, but many of these are disease-specifi...
Article
Full-text available
In an effort to contain the frequently devastating epidemics in sub-Saharan Africa, the World Health Organization (WHO) Regional Office for Africa launched the Integrated Disease Surveillance and Response (IDSR) strategy in an effort to strengthen surveillance and response. However, 36 sub-Saharan African countries have been described as experienci...
Article
Full-text available
The Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) was established in 2008 as a partnership among the Ministry of Health and Social Welfare (MOHSW), Muhimbili University of Health and Allied Sciences, National Institute for Medical Research, and local and international partners. TFELTP was established to strengthen the capacit...
Article
Full-text available
Despite an increasing recognition of non- communicable diseases (NCDs) in sub-Saharan Africa, there is lack of well established surveillance systems for these diseases. In an effort to understand burden of NCDs in low-resource settings, the African Field Epidemiology Network launched a pilot project in 2009 to routinely capture patient data in the...
Article
Objective: To determine the competence of community health workers (CHWs) to correctly assess, classify and treat malaria and pneumonia among under-five children after training. Methods: Consultations of 182 under-fives by 14 CHWs in Iganga district, Uganda, were observed using standardised checklists. Each CHW saw 13 febrile children. Two paedi...
Article
Full-text available
There is increased interest in strengthening health systems for developing countries. However, at present, there is common uncertainty about how to accomplish this task. Specifically, several nations are faced with an immense challenge of revamping an entire system. To accomplish this, it is essential to first identify the components of the system...
Article
Full-text available
Laboratory is one of the core capacities that countries must develop for the implementation of the International Health Regulations (IHR[2005]) since laboratory services play a major role in all the key processes of detection, assessment, response, notification, and monitoring of events. While developed countries easily adapt their well-organized r...
Article
Full-text available
The current shortage of human resources for health threatens the attainment of the Millennium Development Goals. There is currently limited published evidence of health-related training programmes in Africa that have produced graduates, who remain and work in their countries after graduation. However, anecdotal evidence suggests that the majority o...
Article
Full-text available
Many malarious countries plan to introduce artemisinin combination therapy (ACT) at community level using community health workers (CHWs) for treatment of uncomplicated malaria. Use of ACT with reliance on presumptive diagnosis may lead to excessive use, increased costs and rise of drug resistance. Use of rapid diagnostic tests (RDTs) could address...
Article
The child health card provides a way of following up all of the important aspects of a child's health particularly immunization and nutrition. Two previous studies in Uganda showed that up to 57% of mothers did not have their children's cards. This is likely to place the child's health and well-being at risk. Factors responsible for the low use and...
Article
Rationale: There is limited literature on linkages-collaboration, competition and referral of patients-between public and private health sectors. A study to assess linkages was done, among other reasons, to establish whether such linkages can improve health outcomes in Uganda. Like in other developing countries, in Uganda, the rural poor shoulder a...

Citations

... Lack of evidence about the relevance of capacity strengthening interventions is often discussed (38). Prospective monitoring and evaluation of such programmes is deemed as key in ascertaining the value of the investment and ultimately guiding continued funding and sustainability inquests (39). In this study, we drew on PHINEO's systematized four-part capacity building evaluation framework based on the theory of change to systematically assess the short-and long-term effects of our sponsored RCORE CT staff training in achieving a set of intended changes in CT oversight at the level of recipient fellow's NMRAs. ...
... Given the capacity differences in regulating medical products in African Member States, it is important to note that the African Union (AU) Member States and Regional Economic Communities (RECs) are making significant efforts to improve access to safe, quality, and efficacious medical products through strengthening and harmonising medicines regulatory systems. Studies show that the reluctance from companies manufacturing medical products to register their products in African markets is one of the major factors delaying access to medicines (Sillo et al., 2020). Reasons for this reluctance is due to the lengthy application process, the time, expense, and effort needed for this registration process in each NRA (Sillo et al., 2020). ...
... With the launch of the EAC-MRH programme, the EAC authorities have made substantial progress in reducing timelines for registration of medical products using the joint review process. A study of the EAC-MRH pilot phase (2012-2017) by Mashingia and colleagues found that registration timelines were reduced from 24 months to 8-12 months for products reviewed using this process (Mashingia et al., 2020). ...
... Worldwide experience with all LSD types has uncovered no known founder effect or specific geographic predilection [27][28][29]. It is important to consider the international translation of clinical trials for novel drug treatments in resource-poor countries along with the development of collaborative, international data sets [30]. Disparities within countries should also be considered. ...
... If disseminated and made available to a wider range of animal healthcare and antibiotic providers, such as formal and informal animal healthcare providers, IPs and drug shop owners, these could serve to raise awareness for judicious ABU. Similar antibiotic stewardship interventions have been conducted in human health settings with positive results [37,38]. Durrance-Bagal et al. [39] and Swai et al. (2010) [40] argue that a One Health approach involving human and animal healthcare providers as well as community members is necessary when developing interventions to mitigate the risk of zoonotic diseases. ...
... The findings also lower than previous studies conducted in Ethiopia (67.9% and 92.6%). 33,45 Moreover, it is higher than previous Ethiopian studies conducted in Tigray (21%), 34 Harar (34%), 35 Yirgalem (37.9%), 46 and other LMICs (Nigeria (51.0%), 38 Malawi (20%), 47 and Malaysia (34.8%) 48 ). ...
... We retrieved 1521 references from database searches, screened 1131 unique articles and identified 26 articles for full-text screening. Of these, 12 were excluded because it was impossible to extract data specific to patients with chest indrawing pneumonia (n = 8) [24][25][26][27][28][29][30][31] or specific to those managed at home (n = 4) [32][33][34][35]. We included 14 studies in the qualitative synthesis (Figure 1). ...
... This study shows that the morbidity of severe adult malaria in Niger during the peak period remains high (34.1%). This situation is comparable to that reported by other studies in sub-Saharan Africa and India [6][7][8][9][10][11]. ...
... No discounting or age-weighting was applied, in line with guidance established since the Global Burden of Disease 2010 report, (21) and given the acute nature of the disease of interest. (22) All costs related to equipment purchase and maintenance, as well as staff training and monitoring, were annualized over the expected twoyear lifespan of a pulse oximeter using the straight-line method. ...
... There are several respiratory distress instruments from high-income countries (HIC), with many being developed specifically for single pathologies such as bronchiolitis [9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Several models have been developed in resource-limited settings, to assess for primary outcomes of mortality or antibiotic-treatment failure in children with severe bacterial pneumonia, namely; The Mamtani score from India, modified Respiratory Index of Severity in Children (RISC) from Kenya, RISC-Malawi and the original RISC Score from South Africa [15,[34][35][36][37][38]. However, the income and health provisions in these countries are broad, varying between lowincome (LIC) Malawi, and upper-middle income (UMIC) South Africa. ...