Mohan P. Joshi
@msh.org
Senior Principal Technical Advisor for GHSA/AMR and Pharmaceutical Services
Management Sciences for Health (MSH)
RESEARCH, TEACHING, or OTHER INTERESTS
Infectious Diseases, Public Health, Environmental and Occupational Health, Health Policy
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Reuben Kiggundu, J.P. Waswa, Niranjan Konduri, Hassan Kasujja, Marion Murungi, Patrick Vudriko, Harriet Akello, Eric Lugada, Cecilia Muiva, Esther Were,et al.
Elsevier BV
Marion Murungi, Helen Byomire Ndagije, Reuben Kiggundu, Diana Nakitto Kesi, JP Waswa, Kalidi Rajab, Mark Barigye, Allan Serwanga, Leonard Manirakiza, Hassan Kasujja,et al.
Elsevier BV
Getachew Alemkere, Hailu Tadeg, Workineh Getahun, Wendosen Shewarega, Asrat Agalu, Mohan P. Joshi, and Niranjan Konduri
Elsevier BV
Reuben Kiggundu, Edgar Lusaya, Jeremiah Seni, J. P. Waswa, Francis Kakooza, Dinah Tjipura, Kate Kikule, Cecilia Muiva, Mohan P. Joshi, Andy Stergachis,et al.
Springer Science and Business Media LLC
Abstract Background Antimicrobial resistance (AMR) is a global health security threat and is associated with increased morbidity and mortality. One of the key drivers of AMR is the inappropriate use of antibiotics. A key component of improving antibiotic use is conducting antimicrobial use (AMU) surveillance. Methods USAID Medicines Technologies and Pharmaceutical Services Program has supported the implementation of antimicrobial stewardship activities, including setting up systems for AMU surveillance in Tanzania and Uganda. Results from both countries have been previously published. However, additional implementation experience and lessons learned from addressing challenges to AMU surveillance have not been previously published and are the subject of this narrative article. Results The team identified challenges including poor quality data, low digitalization of tools, and inadequate resources including both financial and human resources. To address these gaps, the Program has supported the use of continuous quality improvement approaches addressing gaps in skills, providing tools, and developing guidelines to fill policy gaps in AMU surveillance. Recommendations to fill these gaps, based on the Potter and Brough systematic capacity building model have been proposed. Conclusions Strengthening AMU surveillance through using a capacity-building approach will fill gaps and strengthen efforts for AMR control in both countries.
JP Waswa, Reuben Kiggundu, Niranjan Konduri, Hassan Kasujja, Lynn Lieberman Lawry, and Mohan P. Joshi
Elsevier BV
Reuben Kiggundu, JP Waswa, Hilma N Nakambale, Francis Kakooza, Hassan Kassuja, Marion Murungi, Harriet Akello, Seru Morries, Mohan P Joshi, Andy Stergachis,et al.
BMJ
BackgroundAppropriate antimicrobial use is essential for antimicrobial stewardship (AMS). Ugandan hospitals are making efforts to improve antibiotic use, but improvements have not been sufficiently documented and evaluated.MethodsSix Ugandan hospitals implemented AMS interventions between June 2019 and July 2022. We used the WHO AMS toolkit to set-up hospital AMS programmes and implemented interventions using continuous quality improvement (CQI) techniques and targeting conditions commonly associated with antibiotic misuse, that is, urinary tract infections (UTIs), upper respiratory tract infections (URTIs) and surgical antibiotic prophylaxis (SAP). The interventions included training, mentorship and provision of clinical guidelines to support clinical decision-making. Quarterly antibiotic use surveys were conducted.ResultsData were collected for 7037 patients diagnosed with UTIs. There was an increase in the proportion of patients receiving one antibiotic for the treatment of UTI from 48% during the pre-intervention to 73.2%, p<0.01. There was a 19.2% reduction in the number of antimicrobials per patient treated for UTI p<0.01. There was an increase in use of nitrofurantoin, the first-line drug for the management of UTI. There was an increase in the use of Access antibiotics for managing UTIs from 50.4% to 53.8%. The proportion of patients receiving no antimicrobials for URTI increased from 26.3% at pre-intervention compared with 53.4% at intervention phase, p<0.01. There was a 20.7% reduction in the mean number of antimicrobials per patient for URTI from the pre-intervention to the intervention phase, from 0.8 to 0.6, respectively, p<0.001 and reduction in the number of treatment days, p=0.0163. Among patients undergoing surgery, 49.5% (2212) received SAP during the pre-intervention versus 50.5% (2169) during the intervention.ConclusionsUsing CQI approaches to focus on specific causes of inappropriate antibiotic use led to desirable overall reductions in antibiotic use for URTI and UTI.
JP Waswa, Reuben Kiggundu, Mohan P. Joshi, Joseph Mpagi, Hassan Kasujja, Marion Murungi, Henry Kajumbula, Esther Were, Dan Schwarz, Kamada Lwere,et al.
Frontiers Media SA
The government of Uganda, through its Ministry of Health, previously adopted curriculum review as a mechanism to respond to public health threats such as HIV/AIDS and include content in primary and secondary schools. This approach contributes to raising public awareness, a key strategy recommended by the World Health Organization to support the global response to the threat of antimicrobial resistance (AMR). This policy brief, developed for policymakers related to school curricula, aims to advocate for and support integration of AMR content in Uganda's primary and secondary level school curricula. The policy brief supports efforts by the multisectoral National AMR Subcommittee to create awareness on this issue as part of its role in facilitating the operationalization of Uganda's National Action Plan on AMR.
Reuben Kiggundu, Rachel Wittenauer, JP Waswa, Hilma N. Nakambale, Freddy Eric Kitutu, Marion Murungi, Neville Okuna, Seru Morries, Lynn Lieberman Lawry, Mohan P. Joshi,et al.
MDPI AG
Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.
Mohan P. Joshi, Tamara Hafner, Gloria Twesigye, Antoine Ndiaye, Reuben Kiggundu, Negussu Mekonnen, Ndinda Kusu, Safoura Berthé, Edgar Peter Lusaya, Alphonse Acho,et al.
Springer Science and Business Media LLC
Abstract Background Increasingly, there has been recognition that siloed approaches focusing mainly on human health are ineffective for global antimicrobial resistance (AMR) containment efforts. The inherent complexities of AMR containment warrant a coordinated multisectoral approach. However, how to institutionalize a country’s multisectoral coordination across sectors and between departments used to working in silos is an ongoing challenge. This paper describes the technical approach used by a donor-funded program to strengthen multisectoral coordination on AMR in 11 countries as part of their efforts to advance the objectives of the Global Health Security Agenda and discusses some of the challenges and lessons learned. Methods The program conducted a rapid situational analysis of the Global Health Security Agenda and AMR landscape in each country and worked with the governments to identify the gaps, priorities, and potential activities in multisectoral coordination on AMR. Using the World Health Organization (WHO) Joint External Evaluation tool and the WHO Benchmarks for International Health Regulations (2005) Capacities as principal guidance, we worked with countries to achieve key milestones in enhancing effective multisectoral coordination on AMR. Results The program’s interventions led to the achievement of key benchmarks recommended actions, including the finalization of national action plans on AMR and tools to guide their implementation; strengthening the leadership, governance, and oversight capabilities of multisectoral governance structures; establishing and improving the functions of technical working groups on infection prevention and control and antimicrobial stewardship; and coordinating AMR activities within and across sectors. Conclusion A lot of learning still needs to be done to identify best practices for building mutual trust and adequately balancing the priorities of individual ministries with cross-cutting issues. Nevertheless, this paper provides some practical ideas for countries and implementing partners seeking to improve multisectoral coordination on AMR. It also demonstrates that the WHO benchmark actions, although not intended as an exhaustive list of recommendations, provide adequate guidance for increasing countries’ capacity for effective multisectoral coordination on AMR in a standardized manner.
Mohan P. Joshi, Chifumbe Chintu, Mirfin Mpundu, Dan Kibuule, Oliver Hazemba, Tenaw Andualem, Martha Embrey, Bayobuya Phulu, and Heran Gerba
Informa UK Limited
ABSTRACT The multi-faceted complexities of antimicrobial resistance (AMR) require consistent action, a multidisciplinary approach, and long-term political commitment. Building coalitions can amplify stakeholder efforts to carry out effective AMR prevention and control strategies. We have developed and implemented an approach to help local stakeholders kick-start the coalition-building process. The five-step process is to (1) mobilise support, (2) understand the local situation, (3) develop an action plan, (4) implement the plan, and (5) monitor and evaluate. We first piloted the approach in Zambia in 2004, then used the lessons learned to expand it for use in Ethiopia and Namibia and to the regional level through the Ecumenical Pharmaceutical Network [EPN]. Call-to-action declarations and workshops helped promote a shared vision, resulting in the development of national AMR action plans, revision of university curricula to incorporate relevant topics, infection control activities, engagement with journalists from various mass media outlets, and strengthening of drug quality assurance systems. Our experience with the coalition-building approach in Ethiopia, Namibia, Zambia, and with the EPN shows that coalitions can form in a variety of ways with many different stakeholders, including government, academia, and faith-based organisations, to organise actions to preserve the effectiveness of existing antimicrobials and contain AMR.
Richard Valimba, Jafary Liana, Mohan P Joshi, Edmund Rutta, Martha Embrey, Maganga Bundala, and Bryceson Kibassa
Springer Science and Business Media LLC
Abstract Objectives A public-private partnership in Tanzania launched the accredited drug dispensing outlet (ADDO) program to improve access to quality medicines and pharmaceutical services in rural areas. ADDO dispensers play a potentially important role in promoting the rational use of antimicrobials, which helps control antimicrobial resistance (AMR). The study objectives were to 1) improve dispensing practices of antimicrobials, 2) build ADDO dispensers’ awareness of the consequences of misusing antimicrobials, and 3) educate consumers on the correct use of antimicrobials through the use of printed materials and counseling. Methods Our intervention targeted ADDO dispensers and community members in Kilosa district. We promoted AMR awareness using posters hung in public places, health facilities, and ADDOs; sensitizing 84 health care providers on AMR issues; and providing training and on-site support for 124 ADDO dispensers to increase their AMR knowledge and dispensing skills. Baseline and endline assessments included direct observation of dispensers’ practices; interviews with ADDO dispensers (71 at baseline and 68 at endline) regarding dispensing experiences; 230 exit interviews with ADDO customers regarding use of antimicrobials during monitoring visits; and review of ADDO records. Indicators were based on product availability, dispensing practices, customers’ knowledge of how to take their medicines, and dispenser and public awareness of the AMR threat. Results Availability of tracer antimicrobials increased by 26% (p = 0.0088), and the proportion of ADDOs with unauthorized items decreased from 53% to 13% (p = 0.0001). The percentage of ADDO dispensers following good dispensing practices increased from an average of 67% in the first monitoring visit to an average of 91% during the last visit (p = 0.0001). After the intervention, more dispensers could name more factors contributing to AMR and negative consequences of inappropriate antimicrobial use, and over 95% of ADDO customers knew important information about the medicines they were dispensed. Conclusions Providing educational materials and equipping ADDO dispensers with knowledge and tools helps significantly improve community medicine use and possibly reduces AMR. The number of community members who learned about AMR from ADDO dispensers indicates that they are an important source of information on medicine use.
Assegid Mengistu, Johannes Gaeseb, Gottfried Uaaka, Christophine Ndjavera, Kennedy Kambyambya, Lazarus Indongo, Francis Kalemeera, Christopher Ntege, David Mabirizi, Mohan P Joshi,et al.
Springer Science and Business Media LLC
David A. Wachter, Mohan P. Joshi, and Binaya Rimal
Wiley
Summary objectives To assess over‐the‐counter antimicrobial dispensing by drug retailers in Kathmandu, Nepal, for rationality, safety, and compliance with existing government regulations. methods Standardized cases of dysuria in a young adult male and acute watery diarrhoea in a child were presented by a mock patient to retailers at 100 randomly selected pharmacies. Questions asked by retailers and advice and medications given at their initiative were recorded. results All retailers engaged in diagnostic and therapeutic behaviour beyond their scope of training or legal mandate. Historical information obtained by retailers was inadequate to determine the nature or severity of disease or appropriateness of antimicrobial therapy. 97% (95% CI = 91.5–99.4%) of retailers dispensed unnecessary antimicrobials in diarrhoea, while only 44% (95% CI = 34.1–54.3%) recommended oral rehydration therapy and only 3% (95% CI = 0.6–8.5%) suggested evaluation by a physician. 38% (95% CI = 28.5–48.2%) gave antimicrobials in dysuria, yet only 4% (95% CI = 1.1–9.9%) adequately covered cystitis. None covered upper urinary tract or sexually transmitted infections, conditions which could not be ruled out based on the interviews, and only 7% (95% CI = 2.9–13.9%) referred for a medical history and physical examination necessary to guide therapy. conclusions Although legislation in Nepal mandates a medical prescription for purchase of antibiotics, unauthorized dispensing is clearly problematic. Drug retailers in our study did not demonstrate adequate understanding of the disease processes in question to justify their use of these drugs. Risks of such indiscretion include harm to individual patients as well as spread of antimicrobial resistance. More intensive efforts to educate drug retailers on their role in dispensing, along with increased enforcement of existing regulations, must be pursued.
M. P. Joshi
Springer Science and Business Media LLC
Mohan P. Joshi, Takao Sugimoto, and Budiono Santoso
Wiley
Mohan P Joshi
SAGE Publications
Mohan P. Joshi and P. T. Jayawickramarajah
Informa UK Limited
A short pharmacotherapy package based on a WHO manual on good prescribing was introduced for the second-year undergraduate medical students at the Institute of Medicine in Kathmandu. The method used was interactive discussions between students and teacher coupled with role-plays by students in solving therapeutic problems. All the students felt that the package was useful and interesting and it was recommended for future students. This preliminary experience shows that a short problem-orientated pharmacotherapy package can be integrated easily and successfully into teacher-centred and discipline-based pharmacology teaching.
P R Sharma, R K Adhikari, M P Joshi, M Lal, T Chodon, B M Pokhrel, R S Shrestha, and I B Shrestha
SAGE Publications
Intravenous chloramphenicol plus penicillin versus intramuscular ceftriaxone for the treatment of pyogenic meningitis in Nepalese children A comparative study was done at 150-bed Kanti Children’s Hospital in Kathmandu to assess the efficacy of intravenous (i.v.) chloramphenicol plus penicillin versus intramuscular (i.m.) ceftriaxone for the treatment of pyogenic meningitis. Children aged 5 months to 5 years admitted on Sundays and Wednesdays to the Hospital for a period of 6 months (November 1993 to April 1994) with the diagnosis of pyogenic meningitis were included in the study. Patients who had already been given antibiotics prior to admission were not included in the study. The diagnosis was based on clinical features (fever of acute onset, vomiting, convulsion, and bulging fontanelle in infants) and the examination of cerebrospinal fluid (CSF). The CSF was subjected to cell count and latex agglutination test. Only those patients having a total CSF cell count of more than 100 with more than 60% polymorphs were included in the study. Patients were randomized to receive either i.v. chloramphenicol + benzyl penicillin every 6 h for 14 days