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Chiumia FK, Chithope-Mwale C, Abikoloni F, Matchaya V, Gaviyawo T, Khuluza F. Availability, pricing, and affordability of essential medicines for pediatric population in Malawi. Front Pharmacol 2024; 15:1379250. [PMID: 38666031 PMCID: PMC11043549 DOI: 10.3389/fphar.2024.1379250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Objective Lack of access to essential medicines negatively impacts on the quality of healthcare delivery and increases morbidity and mortality, especially to the vulnerable pediatric population. We assessed the availability, pricing, and affordability of pediatric formulations in Malawi. Methodology The study was conducted in 76 health facilities (public, faith-based and private pharmacies, and clinics) from the northern and southern regions of Malawi from March to May 2023. We adapted the WHO/HAI method for the assessment of both availability and pricing of medicines. Data on availability were collected from stock card records using a WHO/HAI template and medicine prices were provided by the pharmacy personnel who were managing the facilities. Availability of medicines was calculated as the percentage of facilities which had a stock of the respective medicine at the time of data collection while medicine prices was assessed by calculating the median prices of each medicine. To assess the affordability of the medicines, we calculated the number of days it takes for a person who is receiving the government-set minimum wage to work to pay for a treatment course of common indications. The study was approved by the KUHES ethics committee under the numbers U.12/22/3900 and U.12/22/3903. Results and conclusion The overall availability of pediatric medicines was 38.1% for public health facilities, 53.7% for private retail pharmacies and drug stores, 49.5% for private clinics and 48.3% for Christian Health Association of Malawi (CHAM) facilities. We found the illegal availability of prescription-only medicines of up to 54% in medicine stores. Medicine median prices were higher in the private clinics followed by retail pharmacies and drugs stores. CHAM had the lowest median prices for medicines of all the sectors. More than 50% of medicines were found to be affordable as less than a day's wage was required to purchase the treatment. We found poor availability of pediatric formulation among public, CHAM, and private sectors in Malawi. This may affect the quality of care among pediatric patients and therefore contribute to morbidity and mortality in Malawi. The supply of medicines and health commodities needs to consider needs of special populations such as children to achieve universal health coverage.
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Affiliation(s)
| | | | | | | | | | - Felix Khuluza
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
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Jha P, Ambwani S, Singh S, Bhardwaj P, Babu Varthya S, Charan J. Availability of the Essential Medicines is Community Pharmacies: A Cross-Sectional Study. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221080370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Pallavi Jha
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Sneha Ambwani
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pankaj Bhardwaj
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Shobhan Babu Varthya
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
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Bavdekar SB. Improving Availability of Pediatric Formulations. Indian J Pediatr 2021; 88:213-214. [PMID: 33507521 DOI: 10.1007/s12098-021-03673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sandeep B Bavdekar
- Department of Pediatrics, Surya Children's Hospital, Mumbai, 400054, India.
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Sri Ranganathan S, Thiyahiny SN, Balasubramaniam R, Beneragama BVSH. Changing Trend in the Availability of Key Essential Medicines for Children in a Resource-Limited Country. Indian J Pediatr 2021; 88:178-179. [PMID: 32564296 DOI: 10.1007/s12098-020-03409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - S N Thiyahiny
- Department of Pharmacology, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - R Balasubramaniam
- National Hospital of Sri Lanka, Ministry of Healthcare and Nutrition, Colombo, Sri Lanka
| | - B V S H Beneragama
- Office of Deputy Director/Laboratory Services, Ministry of Healthcare and Nutrition, Colombo, Sri Lanka
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Martínez NA, Fernández-Álvarez F, Delgado ÁV, Badillo-García ML, Raba J, Cerutti SE, Arias JL. First steps in the formulation of praziquantel nanosuspensions for pharmaceutical applications. Pharm Dev Technol 2020; 25:892-898. [PMID: 32321344 DOI: 10.1080/10837450.2020.1756320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Praziquantel (PZQ), a broad spectrum anthelmintic drug, cannot be found in acceptable dosage forms for elderly patients, paediatric patients, and for veterinary use. In fact, very little has been done up to now in the formulation of liquid dosage forms, being they always formulated for parenteral administration. To beat this important challenge, it was accomplished a comprehensive analysis of the influence of two elementary physicochemical aspects, i.e. surface thermodynamic and electrokinetic properties, on the colloidal stability of PZQ nanosuspensions. The hydrophobic character of the drug, intensely determining the flocculation curves, was confirmed by the thermodynamic characterization. The electrophoretic characterization, in combination with the sedimentation and relative absorbance versus time curves, highlighted that the electrical double layer thickness and the surface charge can play an essential role in the stability of the pharmaceutical colloid. Finally, it was demonstrated that controlling the pH values and the incorporation of electrolytes can help in formulating PZQ aqueous nanosuspensions with appropriate stability and redispersibility behaviours for pharmaceutical use.
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Affiliation(s)
- Noelia A Martínez
- Department of Pharmacy, Faculty of Chemistry, Biochemistry, and Pharmacy, National University of San Luis, San Luis, Argentina.,Institute of Chemistry of San Luis (INQUISAL), National Council of Scientific and Technical Investigations (CONICET), National University of San Luis, San Luis, Argentina
| | - Fátima Fernández-Álvarez
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Ángel V Delgado
- Department of Applied Physics, Faculty of Sciences, University of Granada, Granada, Spain
| | - María Luisa Badillo-García
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Julio Raba
- Institute of Chemistry of San Luis (INQUISAL), National Council of Scientific and Technical Investigations (CONICET), National University of San Luis, San Luis, Argentina
| | - Soledad E Cerutti
- Institute of Chemistry of San Luis (INQUISAL), National Council of Scientific and Technical Investigations (CONICET), National University of San Luis, San Luis, Argentina
| | - José L Arias
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Granada, Spain.,Institute of Biopathology and Regenerative Medicine (IBIMER), University of Granada, Granada, Spain.,Biosanitary Institute of Granada (ibs.GRANADA), Andalusian Health Service (SAS), University of Granada, Granada, Spain
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Hoppu K. Essential Medicines for Children. Clin Pharmacol Ther 2017; 101:718-720. [DOI: 10.1002/cpt.661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 11/08/2022]
Affiliation(s)
- K Hoppu
- Poison Information Centre, Children's Hospital, and Clinical Pharmacology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Shimazawa R, Ikeda M. Approval status and evidence for WHO essential medicines for children in the United States, United Kingdom, and Japan: a cross-sectional study. J Pharm Policy Pract 2017; 10:4. [PMID: 28070339 PMCID: PMC5217454 DOI: 10.1186/s40545-016-0094-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background The WHO Model List of Essential Medicines for Children (EMLc) covers medicines for globally high-burden diseases. Regulatory approval in high-income countries ensures evidence and dosage form but usually focuses on diseases common in those countries and not in low- and middle-income countries. Methods This cross-sectional study assessed supporting evidence for the 346 medicines in the 5th WHO EMLc and their approval data from the United States, United Kingdom, and Japan. Results Of the 346 EMLc medicines, 307 were approved in one or more of the three countries, 278 of which had supporting evidence of efficacy. The percentage of medicines approved in one or more of the three countries was lowest for antiparasitics (60%) whereas 100% for medicines for cancers and musculoskeletal and respiratory conditions were approved. Five of the 30 EMLc antineoplastics had no supporting paediatric evidence. Of the 39 EMLc medicines unapproved in all three countries, 26 were indicated for neglected infectious diseases (NIDs). Ten of the 26 had supporting paediatric evidence. Seventeen of the 39 unapproved medicines had no paediatric dosage form available, and all 17 were indicated for NIDs. Conclusions Most EMLc medicines for diseases common in the three countries had supporting evidence, which was closely associated with approval, whereas a substantial number of medicines for NIDs were unapproved in the three countries, regardless of whether they had supporting evidence. Because of the limited contribution to the EMLc from high income countries, appropriate incentive mechanisms for pharmaceutical companies are required to make paediatric development for NIDs feasible and effective. Electronic supplementary material The online version of this article (doi:10.1186/s40545-016-0094-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rumiko Shimazawa
- Department of Clinical Pharmacology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
| | - Masayuki Ikeda
- Department of Medical Informatics, Kagawa University Hospital, Miki-cho Ikenobe, Kagawa 761-0793 Japan
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Downing J, Powell RA, Marston J, Huwa C, Chandra L, Garchakova A, Harding R. Children's palliative care in low- and middle-income countries. Arch Dis Child 2016; 101:85-90. [PMID: 26369576 DOI: 10.1136/archdischild-2015-308307] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/27/2015] [Indexed: 11/03/2022]
Abstract
One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs--highlighting examples of best practice among service models in Malawi, Indonesia and Belarus--before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, London, UK Makerere University, Kampala, Uganda
| | | | - Joan Marston
- International Children's Palliative Care Network, Bloemfontein, South Africa
| | - Cornelius Huwa
- Palliative Care Support Trust, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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