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Tabernero P, Swamidoss I, Mayxay M, Khanthavong M, Phonlavong C, Vilayhong C, Sichanh C, Sengaloundeth S, Green MD, Newton PN. A random survey of the prevalence of falsified and substandard antibiotics in the Lao PDR. J Antimicrob Chemother 2022; 77:1770-1778. [PMID: 35137095 PMCID: PMC7614350 DOI: 10.1093/jac/dkab435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In 2012, a stratified random survey, using mystery shoppers, was conducted to investigate the availability and quality of antibiotics sold to patients in the private sector in five southern provinces of the Lao People's Democratic Republic (Laos). METHODS A total of 147 outlets were sampled in 10 districts. The active pharmaceutical ingredient (API) content measurements for 909 samples, including nine APIs (amoxicillin, ampicillin, ceftriaxone, ciprofloxacin, doxycycline, ofloxacin, sulfamethoxazole, tetracycline and trimethoprim), were determined using HPLC. RESULTS All the analysed samples contained the stated API and we found no evidence for falsification. All except one sample had all the units tested with %API values between 75% and 125% of the content stated on the label. However, we identified the presence of substandard antibiotics: 19.6% (201/1025) of samples had their units outside the 90%-110% content of the label claim and 18.3% (188/1025) of the samples had units outside the International Pharmacopoeia/United States Pharmacopoeia assay (percentage of label claim) specifications. Trimethoprim had a high number of samples [51.6% (64)] with units below the limit range, followed by ceftriaxone [42.9% (3)] and sulfamethoxazole [34.7% (43)]. Doxycycline, ofloxacin and ciprofloxacin had the highest number of samples with high API content: 43.7% (38), 14.7% (10) and 11.8% (2), respectively. Significant differences in %API were found between stated countries of manufacture and stated manufacturers. CONCLUSIONS With the global threat of antimicrobial resistance on patient outcomes, greater understanding of the role of poor-quality antibiotics is needed. Substandard antibiotics will have reduced therapeutic efficacy, impacting public health and control of bacterial infections.
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Affiliation(s)
- Patricia Tabernero
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Public Health Unit, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain
| | - Isabel Swamidoss
- Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuf?eld Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | | | - Chindaphone Phonlavong
- Bureau of Food and Drug Inspection (BFDI), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Chanthala Vilayhong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Chanvilay Sichanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sivong Sengaloundeth
- Food and Drug Department (FDD), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Michael D. Green
- Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuf?eld Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory, Nuf?eld Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Bounlu M, Auditeau E, Vorachit S, Chivorakoun P, Souvong V, Soukhasem T, Sannikone S, Preux PM, Boumediene F. Management of epilepsy in Laos: Perceptions of healthcare professionals from Vientiane Capital province and traditional healers in Southern Laos. J Tradit Complement Med 2021; 11:46-52. [PMID: 33511061 PMCID: PMC7817710 DOI: 10.1016/j.jtcme.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/21/2019] [Accepted: 12/26/2019] [Indexed: 11/03/2022] Open
Abstract
Background and aim Traditional practices are deeply rooted in Lao people's perceptions and beliefs about health and illness.The objective of the study was to understand the perceptions of healthcare professionals and traditional healers regarding the management of epilepsy in Laos, and their reciprocal views. Experimental procedure An observational study was carried out in two areas of Laos from February to May 2017. Semi directive questionnaires were used to collect quantitative and qualitative data. Semiotic square was carried out to highlight relationships between attitudes of traditional healers and healthcare professionals. For quantitative approach, the proportions were reported, and the test used was Fisher's test for nominal variables. The mean and standard deviation expressed the continuous variables and the Student's t-test was used. Results and conclusion Epilepsy was cited by 90.9% of traditional healers as a convulsive disease with saliva or urine, and herbal medicines were predominantly used (86.4%) to treat it. Few healthcare professionals (26.5%) pointed out that they knew remedies to treat epilepsy other than antiepileptic drugs (AEDs), and 76.5% of healthcare professionals mentioned that epilepsy was a disease which only AEDs could treat. On the other hand, 54.5% of traditional healers confirmed a traditional remedy could cure completely epilepsy through long-term use. Ninety percent of traditional healers said the collaboration with healthcare professionals was a good idea and 44.1% of the healthcare professionals group said was complicated.The combination of these medicines for the management of epilepsy needs to be adapted to Lao's medical context.
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Affiliation(s)
- Mayoura Bounlu
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Emilie Auditeau
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Somchit Vorachit
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Phetvongsinh Chivorakoun
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Vimalay Souvong
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Thidachanh Soukhasem
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Sonesimmaly Sannikone
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Pierre-Marie Preux
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Farid Boumediene
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
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Sengxeu N, Dufat H, Boumediene F, Vorachit S, Chivorakoun P, Souvong V, Manithip C, Preux P, Ratsimbazafy V, Jost J. Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR. Epilepsia Open 2020; 5:550-561. [PMID: 33336126 PMCID: PMC7733656 DOI: 10.1002/epi4.12432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Epilepsy is a chronic condition treatable by cost-effective antiepileptic drugs (AEDs), but limited access to treatment was documented. The availability and affordability of good quality of AEDs play a significant role in access to good health care. This study aimed to assess the availability, affordability, and quality of long-term AEDs in Lao PDR. METHOD A cross-sectional study was performed in both public and private drug supply chains in urban and rural areas in Lao PDR. Data on AEDs availability and price were obtained through drug suppliers. Affordability was estimated as the number of day wages the lowest-paid government employee must work to purchase a monthly treatment. Samples of AEDs were collected, and the quality of AEDs was assessed through Medicine Quality Assessment Reporting Guidelines. RESULTS Out of 237 outlets visited, only 50 outlets (21.1% [95% CI 16.1-26.8]) had at least one AED available. The availability was significantly different between urban (24.9%) and rural areas (10.0%), P = .017. Phenobarbital 100 mg was the most available (14.3%); followed by sodium valproate 200 mg (9.7%), phenytoin 100 mg (9.7%), and carbamazepine 200 mg (8.9%). In provincial/district hospitals and health centers, AEDs were provided free of charge. In other healthcare facilities, phenytoin 100 mg and phenobarbital 100 mg showed the best affordability (1.0 and 1.2 day wages, respectively) compared to carbamazepine 200 mg (2.3 days) and other AEDs. No sample was identified as counterfeit, but 15.0% [95% CI 7.1-26.6] of samples were classified as of poor quality. SIGNIFICANCE We quantified and qualified the various factors contributing to the high treatment gap in Lao PDR, adding to diagnostic issues (not assessed here). Availability remains very low and phenobarbital which is the most available and affordable AED was the worst in terms of quality. A drug policy addressing epilepsy treatment gap would reduce these barriers.
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Affiliation(s)
- Noudy Sengxeu
- INSERMUniv. Limoges, CHU LimogesIRDU1094 Tropical NeuroepidemiologyInstitute of Epidemiology and Tropical NeurologyGEISTLimogesFrance
- Faculty of pharmacyUniversity of Health sciencesVientianeLao PDR
| | - Hanh Dufat
- Natural Products, Analysis and SynthesisCiTCoM‐UMR 8038 CNRS/Université de Paris, Faculty of Health‐Pharmacy, Université de ParisParisFrance
| | - Farid Boumediene
- INSERMUniv. Limoges, CHU LimogesIRDU1094 Tropical NeuroepidemiologyInstitute of Epidemiology and Tropical NeurologyGEISTLimogesFrance
| | | | | | | | | | - Pierre‐Marie Preux
- INSERMUniv. Limoges, CHU LimogesIRDU1094 Tropical NeuroepidemiologyInstitute of Epidemiology and Tropical NeurologyGEISTLimogesFrance
| | - Voa Ratsimbazafy
- INSERMUniv. Limoges, CHU LimogesIRDU1094 Tropical NeuroepidemiologyInstitute of Epidemiology and Tropical NeurologyGEISTLimogesFrance
| | - Jeremy Jost
- INSERMUniv. Limoges, CHU LimogesIRDU1094 Tropical NeuroepidemiologyInstitute of Epidemiology and Tropical NeurologyGEISTLimogesFrance
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Tabernero P, Swamidoss I, Mayxay M, Khanthavong M, Phonlavong C, Vilayhong C, Yeuchaixiong S, Sichanh C, Sengaloundeth S, Green MD, Newton PN. A random survey of the prevalence of falsified and substandard antibiotics in the Lao PDR. J Antimicrob Chemother 2020; 74:2417-2425. [PMID: 31049576 PMCID: PMC6640311 DOI: 10.1093/jac/dkz164] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patricia Tabernero
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Public Health Unit, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain
| | - Isabel Swamidoss
- U.S. Centers for Disease Control and Prevention (CDC), Division of Parasitic Diseases and Malaria, Atlanta, GA, USA
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Centre for Tropical Medicine & Global Health, Nuffield Research Building, Churchill Hospital, University of Oxford, Oxford, UK.,Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | | | - Chindaphone Phonlavong
- Bureau of Food and Drug Inspection (BFDI), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Chanthala Vilayhong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sengchanh Yeuchaixiong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Chanvilay Sichanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
| | - Sivong Sengaloundeth
- Food and Drug Department (FDD), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Michael D Green
- U.S. Centers for Disease Control and Prevention (CDC), Division of Parasitic Diseases and Malaria, Atlanta, GA, USA
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine & Global Health, Nuffield Research Building, Churchill Hospital, University of Oxford, Oxford, UK.,Infectious Diseases Data Observatory, Nuffield Research Building, Churchill Hospital, University of Oxford, Oxford, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Differences in knowledge about epilepsy and antiepileptic drugs among pharmacy-dispensing workers in Cambodia and in Lao PDR. Epilepsy Behav 2020; 103:106834. [PMID: 31884119 DOI: 10.1016/j.yebeh.2019.106834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022]
Abstract
UNLABELLED Epilepsy is the most common neurological disorder encountered in primary care in Southeast Asia. People with epilepsy require long-term therapy management. Nonadherence to antiepileptic drugs (AEDs) has been identified as a major factor in suboptimal control of epilepsy. Pharmacies offer patients a first-line point of contact with the healthcare system. Many pharmacies operate with limited or nonqualified human resources that can lead to insufficient knowledge, inappropriate supply of medicines, and insufficient counseling. OBJECTIVE The aim of this study was to evaluate the qualification and knowledge concerning epilepsy and AEDs among pharmacy-dispensing workers who sell drugs to people with epilepsy. METHOD A cross-sectional qualitative study was conducted in public and private pharmacies, in both urban and rural areas of Cambodia and Lao People's Democratic Republic (Lao PDR). The knowledge was collected through a questionnaire. RESULTS A total of 180 respondents from 123 outlets in the two countries were included in this study. A proportion of 40.8% (31) of respondents in Cambodia and 38.5% (40) in Lao PDR were pharmacists, followed by sellers who did not received any healthcare training with a proportion of 18.4% (14) in Cambodia compared to 20.2% (21) in Lao PDR. Head trauma was cited as the main cause of epilepsy by 72.4% (55) in Cambodia and 27.2% (28) in Lao PDR (p < 0.001). Epilepsy was considered as a contagious disease by 6.6% (5) of respondents in Cambodia compared to 18.4% (19) in Lao PDR (p = 0.03). Eighty-seven percent (66) of respondents in Cambodia knew at least one long-term AED versus 67.3% (70) in Lao PDR (p = 0.003). Phenobarbital was mentioned in more than 90.0% of cases in both countries. In overall, 15.4% (21) thought that if seizures are controlled for some months, people with epilepsy could stop taking their AEDs. Only one respondent from Lao PDR was aware of drug-drug interaction between AEDs and oral contraception. CONCLUSION An educational intervention should be implemented to improve the knowledge of epilepsy and AEDs for pharmacy-dispensing workers. This could include advice for all pharmacy-dispensing workers in order to improve AED management and follow-up of therapeutic adherence.
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Gutema G, Engidawork E. Affordability of commonly prescribed antibiotics in a large tertiary teaching hospital in Ethiopia: a challenge for the national drug policy objective. BMC Res Notes 2018; 11:925. [PMID: 30587231 PMCID: PMC6307120 DOI: 10.1186/s13104-018-4021-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/15/2018] [Indexed: 12/02/2022] Open
Abstract
Objective In national drug policies of many countries, ensuring availability and affordability of essential medicines is indicated among the major policy objectives. To achieve the objectives, countries with low and middle income compile such medicines into NEMLs. This study aims to determine availability and affordability of commonly prescribed antibiotics at a tertiary hospital in Ethiopia by assessing (in private and public pharmacies) 13 antibiotics constituting DU90% at the hospital. Results Availability of the antibiotics in the private and public pharmacies was 92.3% and 98.5%, respectively. Average MPRs for the antibiotics were 4.1 and 2.7, respectively, in the private and public pharmacies. The days’ wages (in median prices) ranged from 0.2 for treating acute diarrhea with doxycycline to 415.8 for treating HAP in public pharmacies. Costs of a single day treatment with antibiotics purchased from the public pharmacies ranged from USD 0.1 for acute diarrhea to USD 29.7 for HAP. For the private pharmacies, the range was from USD 0.1 for toxoplasmosis to USD 54.9 for HAP. This study showed that treatments of commonly diagnosed infectious conditions at TASH remain unaffordable according to the WHO/HAI criteria. Electronic supplementary material The online version of this article (10.1186/s13104-018-4021-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Girma Gutema
- East African Policy Research Institute, Addis Ababa, Ethiopia. .,University of Oslo, Oslo, Norway.
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
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Nizard M, Jost J, Tanamasoandro R, Andriambololona R, Megherbi M, Solofomalala GD, Marquet P, Preux PM, Ratsimbazafy V. Overview of accessibility and quality of antiepileptic drugs in Madagascar. Seizure 2016; 41:134-40. [DOI: 10.1016/j.seizure.2016.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022] Open
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Bazargani YT, Ewen M, de Boer A, Leufkens HGM, Mantel-Teeuwisse AK. Essential medicines are more available than other medicines around the globe. PLoS One 2014; 9:e87576. [PMID: 24533058 PMCID: PMC3922716 DOI: 10.1371/journal.pone.0087576] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) promotes the development of national Essential Medicines Lists (EMLs) in order to improve the availability and use of medicines considered essential within health care systems. However, despite over 3 decades of international efforts, studies show an inconsistent pattern in the availability of essential medicines. We evaluated and compared the availability of essential medicines, and medicines not included in national EMLs, at global and regional levels. METHODS Medicine availability in the public and private sector were calculated based on data obtained from national and provincial facility-based surveys undertaken in 23 countries using the WHO/HAI methodology. The medicines were grouped according to their inclusion ('essential') or exclusion (termed 'non-essential') in each country's EML current at the time of the survey. Availability was calculated for originator brands, generics and any product type (originator brands or generics) and compared between the two groups. Results were aggregated by WHO regions, World Bank country income groups, a wealth inequality measure, and therapeutic groups. FINDINGS Across all sectors and any product type, the median availability of essential medicines was suboptimal at 61·5% (IQR 20·6%-86·7%) but significantly higher than non-essential medicines at 27·3% (IQR 3·6%-70·0%). The median availability of essential medicines was 40·0% in the public sector and 78·1% in the private sector; compared to 6·6% and 57·1% for non-essential medicines respectively. A reverse trend between national income level categories and the availability of essential medicines was identified in the public sector. INTERPRETATION EMLs have influenced the provision of medicines and have resulted in higher availability of essential medicines compared to non-essential medicines particularly in the public sector and in low and lower middle income countries. However, the availability of essential medicines, especially in the public sector does not ensure equitable access.
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Affiliation(s)
- Yaser T. Bazargani
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Margaret Ewen
- Health Action International-Global, Amsterdam, the Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Hubert G. M. Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Aukje K. Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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Bhalla D. Michel Dumas and Pierre-Marie Preux: promoting tropical neurology silently--the gist of their contributions. Neuroepidemiology 2014; 42:139-43. [PMID: 24481209 DOI: 10.1159/000357354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022] Open
Abstract
This article presents the contribution by two senior French Neurologists over the past three decades in building, developing and promoting 'tropical neurology' in a number of neglected countries of Asia, Africa and Latin America. It talks about the 'human, dedicational and contributive value' of these two experts who do not come from an English-speaking world. It highlights meaningful changes that have been achieved in different tropical countries as a result of their direct contribution. This overview may likely be a cause for learning and motivation to others to really work in and for tropical countries, where a large proportion of global health burden is to be found.
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Affiliation(s)
- Devender Bhalla
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France
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Conway J, Bero L, Ondari C, Wasan KM. Review of the quality of pediatric medications in developing countries. J Pharm Sci 2013; 102:1419-33. [PMID: 23450511 DOI: 10.1002/jps.23474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/15/2013] [Accepted: 01/18/2013] [Indexed: 12/27/2022]
Abstract
The quality of essential medicines for pediatric populations in developing countries is largely unknown. This review examines quality studies (2000-2011) of medicines on the WHO Essential Medicine List for Children, the quality of a subset of pediatric formulations, and the association of these poor quality medicines with adverse clinical outcomes. We searched Embase, Medline, BIOSIS, and IPA using MeSH subject terms for quality measures, medicine formulations, and substandard medicines and combined these with 267 medicines, and 91 low-income and lower-middle-income countries. Seventy articles met our inclusion criteria examining the quality of 75 medicines from 28 countries. Content and dissolution tests were utilized most often. Results indicate that antibacterials, antifungals, and antiretrovirals were consistently of good quality. Quality tests on pediatric formulations were performed on 55 of 75 of the medicines studied and followed the general trend of quality results. Three studies were included that examined clinical consequences of substandard medicines-two cases of diethylene glycol poisoning and one case of substandard malaria drugs. We conclude that there is a need for more quality studies of pediatric formulations of essential medicines in developing countries and their clinical consequences.
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Affiliation(s)
- Jocelyn Conway
- Neglected Global Diseases Initiative, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
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Harimanana A, Chivorakul P, Souvong V, Preux PM, Barennes H. Is insufficient knowledge of epilepsy the reason for low levels of healthcare in the Lao PDR? BMC Health Serv Res 2013; 13:41. [PMID: 23379720 PMCID: PMC3585716 DOI: 10.1186/1472-6963-13-41] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 12/28/2012] [Indexed: 11/10/2022] Open
Abstract
Background The treatment gap for epilepsy is considerable in low and middle-income countries. In the Lao PDR it is estimated at over 90%. Health workers play a significant role in bridging the gap between people with epilepsy (PWE) and access to epilepsy care. In a national survey we assessed: 1) the knowledge and practices of health workers in the Lao PDR towards the disease, and, 2) patient attendance at health facilities. Methods We conducted a random three-stage sampling of health workers at the provincial, district and health center levels in 2009. Results Overall, 284 health workers were enrolled in 50 health facilities of 11 provinces: health centers 24.7%; district hospitals 23.2%; and province hospitals 52.1%. Only a minority of these (2.5%) recalled ever having received training or seeking information on epilepsy. Our survey showed a lack of knowledge in diagnosing and prescribing drugs for epilepsy, including phenobarbital, the first-line of treatment. The majority of respondents (59.9%) was unaware of the availability of antiepileptic drugs in health facilities. Only 10 (20%) health facilities, and no health centres, received people with epilepsy. It was estimated that one PWE per month receives medical attention. Traditional beliefs about PWE were common; such as the idea that epilepsy could be transmitted through saliva (63.2%). A higher attendance of PWE was observed in province hospitals where the knowledge of epilepsy care was higher. Global acceptance of people with epilepsy was low. Conclusions The low level of knowledge of epilepsy on the part of health workers may be contributing to the wide treatment gap in the Lao PDR. Improving knowledge of this disease and increasing the availability of antiepileptic drugs will reduce misconceptions about epilepsy, thus encouraging more PWE to seek treatment. Community-based educational programs and extensive advocacy for people with epilepsy only began in 2009.
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Affiliation(s)
- Aina Harimanana
- Institut Francophone pour la Médecine Tropicale (IFMT), BP 9519, Vientiane, Lao PDR, Laos
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Harimanana A, Clavel S, Chivorakul P, Perez F, Preux PM, Barennes H. Associated factors with adherence to antiepileptic drug in the capital city of Lao PDR. Epilepsy Res 2012. [PMID: 23182965 DOI: 10.1016/j.eplepsyres.2012.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Available medical care for epilepsy and antiepileptic drugs (AED) are provided in Vientiane Municipality by district hospitals supported by a non-governmental organization, which is referred to as a community-based intervention (CB), and reference hospital which is referred to as hospital-based interventions (HB). Identifying underlying factors of AED adherence is of public health interest. A community-based cross-sectional survey among randomly selected patients with epilepsy (PWE) who were being cared in Vientiane Municipality was undertaken in 2010. The Morisky scale was used to assess the level of adherence. Univariate and multivariate logistic regression analyses were performed to address predictive factors. Overall, 99 PWE were included in the study. Overall adherence was estimated at 57.6%, 57.1% and 58.0% for the HB and CB group, respectively. High level of adherence was related to illiteracy, being on monotherapy and experiencing fewer seizures. Implementing closer medical care at primary level to PWE improves the likelihood of reducing primary and secondary treatment gap which is related to PWEs' adherence. An active intervention through a downstream channel of training of medical health staff from reference level to community level enhances the prescription of adequate AED, the improvement of the quality of relation between PWE and medical staff.
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Affiliation(s)
- Aina Harimanana
- Institut de la Francophonie pour la Médecine Tropicale, BP 9519 Vientiane, Lao Democratic People's Republic
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Talnov AN, Isaeva E, Savotchenko AV, Dovgalets GV, Ochoa JG, Holmes GL, Isaev D. Electrolyte therapy reduces spike-and-wave discharges in the WAG/Rij rat model of absence epilepsy. Epilepsy Behav 2012; 24:399-402. [PMID: 22749239 PMCID: PMC3408819 DOI: 10.1016/j.yebeh.2012.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/21/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
Abstract
Although antiepileptic drugs are often effective in the control of seizures, some patients show little or no improvement. As alternative treatments, different dietary modifications were shown to be beneficial for patients with poor tolerance for AEDS. Previous reports have shown that rice-based oral electrolyte hydration therapy is effective in seizure control in patients with refractory absence seizures. In the present study, using an animal model of absence epilepsy, we showed that the occurrence of spike-and-wave discharges significantly decreases upon switching to electrolyte therapy. We also showed that consumption of solution with the same osmolarity as rice-based oral electrolyte solution leads to a decrease in the number of spike-and-wave discharges per hour. We suggest that the antiepileptic effect of rice-based oral electrolyte hydration therapy can be at least in part due to hyperosmolarity of the ingested solution.
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Affiliation(s)
- Arkadij N. Talnov
- Department of Physiology of Movements, Bogomoletz Institute of Physiology, Kiev, Ukraine,Department of Cellular Membranology, Bogomoletz Institute of Physiology, Kiev, Ukraine
| | - Elena Isaeva
- Department of Cellular Membranology, Bogomoletz Institute of Physiology, Kiev, Ukraine,Department of Neurology, Neuroscience Center at Dartmouth, Dartmouth Medical School, Lebanon, New Hampshire, USA
| | - Alina V. Savotchenko
- Department of Cellular Membranology, Bogomoletz Institute of Physiology, Kiev, Ukraine
| | - Galina V. Dovgalets
- Department of Physiology of Movements, Bogomoletz Institute of Physiology, Kiev, Ukraine
| | - Juan G. Ochoa
- Department of Neurology, University of South Alabama College of Medicine, Mobile, Alabama, USA
| | - Gregory L. Holmes
- Department of Neurology, Neuroscience Center at Dartmouth, Dartmouth Medical School, Lebanon, New Hampshire, USA
| | - Dmytro Isaev
- Department of Neurology, Neuroscience Center at Dartmouth, Dartmouth Medical School, Lebanon, New Hampshire, USA,State Key Laboratory for Molecular and Cellular Biology, Kiev, Ukraine
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Abstract
PURPOSE OF REVIEW This review discusses recent literature relevant to the diagnosis and treatment of epilepsy in developing countries with particular attention to underlying causes, natural history, and advances made toward optimizing systems of care and bridging the treatment gap. RECENT FINDINGS Prospective data suggest that cerebral malaria-induced brain injury may explain the high prevalence of epilepsy in malaria-endemic regions. Population-based mortality studies support the long proposed hypothesis that seizure-related deaths contribute to excessive premature mortality. WHO guidelines have the potential to improve care, but macrolevel barriers related to pharmaceutical regulation and distribution continue to contribute to the treatment gap. Evidence-based guidelines endorsed by the WHO and American Academy of Neurology regarding the optimal management of comorbid epilepsy and HIV may raise awareness regarding critical drug interactions between antiepileptic drugs and antiretrovirals, but are also problematic as the treatment regimen and diagnostic facilities routinely available in developing countries will prevent most healthcare providers from following the recommendations. SUMMARY New insights into the causes, natural history and best care practices for epilepsy in developing countries are available but without prioritization and action from policy makers, the present treatment gap will likely to persist.
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Chivorakoun P, Harimanana A, Clavel S, Jousseaume S, Barennes H. Épilepsie au Laos : le difficile parcours d’un antiépileptique de première ligne contribue à la forte carence de traitement. Rev Neurol (Paris) 2012; 168:221-9. [DOI: 10.1016/j.neurol.2012.01.584] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 12/25/2011] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
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17
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Thurman DJ, Beghi E, Begley CE, Berg AT, Buchhalter JR, Ding D, Hesdorffer DC, Hauser WA, Kazis L, Kobau R, Kroner B, Labiner D, Liow K, Logroscino G, Medina MT, Newton CR, Parko K, Paschal A, Preux PM, Sander JW, Selassie A, Theodore W, Tomson T, Wiebe S. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia 2011; 52 Suppl 7:2-26. [PMID: 21899536 DOI: 10.1111/j.1528-1167.2011.03121.x] [Citation(s) in RCA: 606] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Worldwide, about 65 million people are estimated to have epilepsy. Epidemiologic studies are necessary to define the full public health burden of epilepsy; to set public health and health care priorities; to provide information needed for prevention, early detection, and treatment; to identify education and service needs; and to promote effective health care and support programs for people with epilepsy. However, different definitions and epidemiologic methods complicate the tasks of these studies and their interpretations and comparisons. The purpose of this document is to promote consistency in definitions and methods in an effort to enhance future population-based epidemiologic studies, facilitate comparison between populations, and encourage the collection of data useful for the promotion of public health. We discuss: (1) conceptual and operational definitions of epilepsy, (2) data resources and recommended data elements, and (3) methods and analyses appropriate for epidemiologic studies or the surveillance of epilepsy. Variations in these are considered, taking into account differing resource availability and needs among countries and differing purposes among studies.
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Affiliation(s)
- David J Thurman
- CDC National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA.
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18
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Lim YJ, Chan SY, Ko Y. Stigma and health-related quality of life in Asian adults with epilepsy. Epilepsy Res 2009; 87:107-19. [DOI: 10.1016/j.eplepsyres.2009.08.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 06/26/2009] [Accepted: 08/23/2009] [Indexed: 11/28/2022]
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19
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Mac TL, Gaulier JM, Le VT, Vu AN, Preux PM, Ratsimbazafy V. Quality of antiepileptic drugs in Vietnam. Epilepsy Res 2008; 80:77-82. [DOI: 10.1016/j.eplepsyres.2008.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 03/08/2008] [Accepted: 03/10/2008] [Indexed: 10/22/2022]
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20
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The challenge of epilepsy control in deprived settings: Low compliance and high fatality rates during a community-based phenobarbital program in rural Laos. Epilepsia 2008; 49:539-40. [DOI: 10.1111/j.1528-1167.2007.01529_3.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Tran DS, Zen J, Strobel M, Odermatt P, Preux PM, Huc P, Delneuville L, Barennes H. The challenge of epilepsy control in deprived settings: Low compliance and high fatality rates during a community-based phenobarbital program in rural Laos. Epilepsia 2007. [DOI: 10.1111/j.1528-1167.2007.01462.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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