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Schurer JM, Murara E, van Oirschot J, Ooms G. Antivenom for sale? Availability and affordability of snakebite medicines across public and private health facilities in Rwanda. Toxicon 2023; 234:107292. [PMID: 37734455 DOI: 10.1016/j.toxicon.2023.107292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
Antivenom is considered the safest and most effective treatment against snake envenomation (SBE); however, global shortages mean that many low-income countries struggle to meet demand. In Rwanda, chronic shortages of essential medicines are an important barrier to robust healthcare delivery and discourage snakebite victims from seeking hospital care. The aim of this retrospective, cross-sectional study was to evaluate the availability and affordability of commodities to treat SBE at hospitals and health centers. In total, our team interviewed pharmacy managers at 111 public and 31 private health facilities (N = 142) to complete a validated quantitative questionnaire, entering data electronically through KoBoCollect. Commodity prices were collected in 2023RWF and for the lowest cost item across any category. A commodity was considered affordable if a treatment regimen cost less than one day's wages, using the international poverty line to approximate a low-income worker's wages. Across all health facilities, mean availability of SBE commodities was relatively good (77.1%). Snake antivenom was only available at public hospitals and was concentrated in urban rather than rural areas. Two snake antivenom types were observed, one of which was not appropriate for treating envenomation by East African snakes. Overall, this meant that only 4.2% of facilities stocked safe and effective antivenom. Black stones, an ineffective traditional treatment, were sold by 5.6% of health providers. Moreover, antivenom did not meet the minimum threshold for affordability, costing on average 10 days of work for a single dose among uninsured individuals. Altogether, this study highlights serious performance gaps among pharmacies responsible for procuring and supplying SBE commodities and helps to explain the widespread belief that SBE treatment is unaffordable at hospitals and health centers. Urgent action is needed to ensure that all hospital and health center pharmacies located in high-risk areas stock appropriate antivenom and that re-stocking time for essential medicines is reduced.
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Affiliation(s)
- Janna M Schurer
- Center for One Health, University of Global Health Equity, Butaro, Rwanda; Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine at Tufts University, North Grafton, USA.
| | - Elijah Murara
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | | | - Gaby Ooms
- Health Action International, Amsterdam, the Netherlands; Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.
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Rurangwa C, Ndayisenga J, Sezirahiga J, Nyirimigabo E. Availability and affordability of anticancer medicines at cancer treating hospitals in Rwanda. BMC Health Serv Res 2023; 23:717. [PMID: 37391753 DOI: 10.1186/s12913-023-09706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Availability and accessibility of anti-cancer medicines is the pillar of cancer management, and it is one of the main concerns in low-income countries including Rwanda. The objective of this study was to assess the availability and affordability of anticancer medicines at cancer-treating hospitals in Rwanda. METHODOLOGY A descriptive cross-sectional study was conducted at 5 cancer-treating hospitals in Rwanda. Quantitative data were collected from stock cards and software that manage medicines and included the availability of anti-cancer medicines at the time of data collection, their stock status within the last two years, and the selling price. RESULTS The study found the availability of anti-cancer medicines at 41% in public hospitals at the time of data collection, and 45% within the last two years. We found the availability of anti-cancer medicines at 45% in private hospitals at the time of data collection, and 61% within the last two years. 80% of anti-cancer medicines in private hospitals were unaffordable while 20% were affordable. The public hospital that had most of the anti-cancer medicines in the public sector provided free services to the patients, and no cost was applied to the anti-cancer medicines. CONCLUSION The availability of anti-cancer medicines in cancer-treating hospitals is low in Rwanda, and most of them are unaffordable. There is a need to design strategies that can increase the availability and affordability of anti-cancer medicines, for the patients to get recommended cancer treatment options.
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Affiliation(s)
- Clement Rurangwa
- Immunization, Vaccines and Health Supply Chain Management, College of Medicines and Health Sciences, EAC Regional Centre of Excellence for Vaccines, University of Rwanda, Kigali, Rwanda.
| | - Jerome Ndayisenga
- African Research and Community Health Initiative (ARCH Initiative), Kigali, Rwanda
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Stolbrink M, Thomson H, Hadfield RM, Ozoh OB, Nantanda R, Jayasooriya S, Allwood B, Halpin DMG, Salvi S, de Oca MM, Mortimer K, Rylance S. The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review. Lancet Glob Health 2022; 10:e1423-e1442. [PMID: 36113528 PMCID: PMC9638033 DOI: 10.1016/s2214-109x(22)00330-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured, and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost, and affordability of WHO's essential medicines for asthma and COPD in LMICs. METHODS A systematic review of the literature was done by searching seven databases to identify research articles published between Jan 1, 2010, and June 30, 2022. Studies on named essential medicines for asthma and COPD in LMICs were included and review articles were excluded. Two authors (MS and HT) screened and extracted data independently, and assessed bias using Joanna Briggs Institute appraisal tools. The main outcome measures were availability (WHO target of 80%), cost (compared with median price ratio [MPR]), and affordability (number of days of work of the lowest paid government worker). The study was registered with PROSPERO, CRD42021281069. FINDINGS Of 4742 studies identified, 29 met the inclusion criteria providing data from 60 LMICs. All studies had a low risk of bias. Six of 58 countries met the 80% availability target for short-acting beta-agonists (SABAs), three of 48 countries for inhaled corticosteroids (ICSs), and zero of four for inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) combination inhalers. Costs were reported by 12 studies: the range of MPRs was 1·1-351 for SABAs, 2·6-340 for ICSs, and 24 for ICS-LABAs in the single study reporting this. Affordability was calculated in ten studies: SABA inhalers typically cost around 1-4 days' wages, ICSs 2-7 days, and ICS-LABAs at least 6 days. The included studies showed heterogeneity. INTERPRETATION Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was particularly true for inhalers containing corticosteroids. FUNDING WHO and Wellcome Trust.
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Affiliation(s)
- Marie Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.
| | | | - Ruth M Hadfield
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia; Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA
| | - Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences Kampala, Kampala, Uganda
| | - Shamanthi Jayasooriya
- British Thoracic Society Global Health Group, London, UK; University of Sheffield, Sheffield, UK
| | - Brian Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa; Tygerberg Hospital, Cape Town, South Africa
| | - David M G Halpin
- Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; University of Exeter Medical School, Exeter, UK
| | - Sundeep Salvi
- Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Maria Montes de Oca
- Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; Universidad Central de Venezuela, Caracas, Venezuela; Centro Medico de Caracas Hospital, Caracas, Venezuela
| | - Kevin Mortimer
- The International Union Against Tuberculosis and Lung Disease, Paris, France; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sarah Rylance
- Noncommunicable Disease Management Unit, WHO, Geneva, Switzerland
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The Prediction of Essential Medicines Demand: A Machine Learning Approach Using Consumption Data in Rwanda. Processes (Basel) 2021. [DOI: 10.3390/pr10010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Today’s global business trends are causing a significant and complex data revolution in the healthcare industry, culminating in the use of artificial intelligence and predictive modeling to improve health outcomes and performance. The dataset, which was referred to is based on consumption data from 2015 to 2019, included approximately 500 goods. Based on a series of data pre-processing activities, the top ten (10) essential medicines most used were chosen, namely cotrimoxazole 480 mg, amoxicillin 250 mg, paracetamol 500 mg, oral rehydration salts (O.R.S) sachet 20.5 g, chlorpheniramine 4 mg, nevirapine 200 mg, aminophylline 100 mg, artemether 20 mg + lumefantrine (AL) 120 mg, Cromoglycate ophthalmic. Our study concentrated on the application of machine learning (ML) to forecast future trends in the demand for essential drugs in Rwanda. The following models were created and applied: linear regression, artificial neural network, and random forest. The random forest was able to predict 10 selected medicines with an accuracy of 88 percent with the train set and 76 percent with the test set, and it can thus be used to forecast future demand based on past consumption data by inputting a month, year, district, and medicine name. According to our findings, the random Forest model performed well as a forecasting model for the demand for essential medicines. Finally, data-driven predictive modeling with machine learning (ML) could become the cornerstone of health supply chain planning and operational management.
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