49 50 Improvement of the ADR reporting form for Uganda seems necessary. Therefore, our research team designed a form that is relevant to the inpatient setting and

captures additional information required for causality assessment of Baricitinib mechanism suspected medicines. This form will be tested in a follow-up study on inpatients. Other suggestions to improve ADR reporting by respondents included: increased visibility of the NPC and giving useful feedback to ADR reporters, introducing telephone and online reporting systems, increasing onsite support supervision, making ADR forms more available, providing training and continued medical education of HCPs as suggested elsewhere,51 and sensitising the public to ADRs. The absence of a national PV policy, however, coupled

with the lack of proper coordination between the NPC and numerous health programmes and sentinel sites may undermine efforts to strengthen the countrywide PV system.17 For example, in Uganda’s teaching hospitals, could some clinical grand rounds address PV and suspected serious ADRs? Although previous studies suggested a positive relationship between older age and ADR reporting,52 53 we found that older HCPs (≥30 years) were less likely than their younger counterparts to have reported suspected ADRs in the past 12 months. These contrasting results might be attributed to idiosyncratic differences between HCPs and healthcare systems in Europe and Africa in such a way that younger staff, as in our study, may have had more PV training. There is, as yet, limited published literature from other African settings. Our respondents were, on average, 10 years younger when compared with studies conducted in Europe.29 We suggest that older HCPs in Uganda be targeted in future strategies on improved ADR reporting. In contrast to other studies,53 training on how to report ADRs

was not significantly associated with increased ADR reporting. Given the cross-sectional study design we used, it was not possible to establish whether PV training preceded ADR reporting, or vice versa; therefore we were unable to assess their temporal relationship. That notwithstanding, Lopez-Gonzalez Dacomitinib et al8 have suggested that multifaceted interventions, as opposed to single educational programmes, increase to a greater extent HCPs’ PV awareness and motivate them to report ADRs. A low level of PV awareness may lead to under-reporting of ADRs.54 In our study, knowing to whom to report was an important factor for ADR reporting in the final logistic regression. We also observed that the proportion (31%: 95% CI 29% to 34%) of respondents aware of the existence of Uganda’s NPC is lower than reported for Nigeria (52% (51/99):95% CI 42% to 61%).