34 HCPs who had ever encountered XL184 a fatal ADR were twice as likely to report an ADR as HCPs who had not. Correspondingly, development of a serious or fatal ADR was the most frequently cited reason for ADR reporting. We also found that HCPs who suggested possible ways of improving the ADR reporting system were more likely to have reported an ADR in the previous 12 months.58 HCPs who agreed with the statement ‘I would only report an ADR if I was sure that it was related to the use of a particular drug’ (diffidence) were less likely to report suspected ADRs. Apart from diffidence and lethargy/indifference (‘I do not know how information reported in the ADR form is used’),

none of the other Inman factors was associated with ADR reporting.8 32 59 Diffidence and lethargy can be targeted in educational interventions to promote ADR reporting and by improved feedback to ADR reporters. Although provision of financial incentives to reporters was the fifth most frequently cited suggestion to improve ADR reporting, it was not statistically significant

in the logistic regression for the odds on ADR reporting and these findings are consistent with those in the developed world.60 In private for-profit health facilities, HCPs were less likely to have reported ADRs in the previous 12 months than their counterparts in the public sector. In addition, HCPs in hospitals (public and private) were twice as likely as those from other health facilities (HCs II and III, community pharmacies, drug shops) to have reported suspected ADRs in the previous 12 months. Whereas few PV scale-up activities in

Africa have given priority to the private sector,16 22 more public–private collaboration could strengthen PV systems in our SSA setting.61 Our study had several limitations. First, we used self-report as the main method of enquiry and this may have introduced recall bias. Second, we may have experienced social desirability bias as HCPs may not have given frank responses for fear of being embarrassed if they were not reporting ADRs. However, as we used self-administered questionnaires without respondents’ names, the potential for this bias was reduced. Third, the cross-sectional design that we used could GSK-3 not establish temporal relationships between ADR reporting in the past year and some explanatory factors. Fourth, there was over-representation of doctors and pharmacists/pharmacy technicians versus nurses. Finally, several respondents may have referred to the same suspected ADR but this did not have a significant bearing since our main focus was assessment of individual ADR reporting behaviour rather than on individual ADRs. Our study has, however, generated key insights on determinants in Uganda for HCPs’ ADR suspicion and reporting.