Essential medicines for breast cancer in low and middle income countries

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

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Stock-Outs of Essential Medicines Among Community Health Workers (CHWs) In Low- And Middle-Income Countries (LMICs): A Systematic Literature Review of The Extent, Reasons, And Consequences

10.21203/rs.3.rs-692874/v1 ◽

2021 ◽

Author(s):

Abimbola Olaniran ◽

Jane Briggs ◽

Ami Pradhan ◽

Erin Bogue ◽

Benjamin Schreiber ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Grey Literature ◽

Community Level ◽

Health Centers ◽

Essential Medicines ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Abstract Background: This paper explores the extent of community-level stock-out of essential medicines among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006 - March 2021. Papers containing information on (i) the percentage of CHWs stocked out or (ii) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis. Results: Two reviewers screened 1083 records; 78 evaluations were included. Over the last fifteen years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79 - 29.07] vs 9.17 % [CI 95%: 8.64 - 9.70], respectively). A comparison of the period 2006-2015 and 2016-2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22 -26.50] to 48.65% [CI 95%: 48.02- 49.28] while that of health centers increased from 7.79% [95% CI: 7.16 - 8.42] to 14.28% [95% CI: 11.22- 17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization. Conclusion: Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most.

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Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers

Cost Effectiveness and Resource Allocation ◽

10.1186/1478-7547-12-13 ◽

2014 ◽

Vol 12 (1) ◽

pp. 13 ◽

Cited By ~ 9

Author(s):

Kristie Venhorst ◽

Sten G Zelle ◽

Noor Tromp ◽

Jeremy A Lauer

Keyword(s):

Breast Cancer ◽

Decision Analysis ◽

Cancer Control ◽

Middle Income ◽

Policy Makers ◽

Multi Criteria Decision Analysis ◽

Middle Income Countries ◽

Breast Cancer Control ◽

Low And Middle Income

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Breast Cancer in Low- and Middle-Income Countries

Clinics in Laboratory Medicine ◽

10.1016/j.cll.2017.10.013 ◽

2018 ◽

Vol 38 (1) ◽

pp. 161-173 ◽

Cited By ~ 10

Author(s):

Yehoda M. Martei ◽

Lydia E. Pace ◽

Jane E. Brock ◽

Lawrence N. Shulman

Keyword(s):

Breast Cancer ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Selection of Blood, Blood Components, and Blood Products as Essential Medicines in 105 Low- and Middle-Income Countries

Transfusion Medicine Reviews ◽

10.1016/j.tmrv.2019.10.005 ◽

2020 ◽

Vol 34 (2) ◽

pp. 94-100

Author(s):

Washington T. Samukange ◽

Helga Gardarsdottir ◽

Hubert G.M. Leufkens ◽

Aukje K. Mantel-Teeuwisse

Keyword(s):

Essential Medicines ◽

Blood Components ◽

Blood Products ◽

Middle Income ◽

Middle Income Countries ◽

Selection Of ◽

Low And Middle Income

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Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers

Journal of Global Oncology ◽

10.1200/jgo.2016.007641 ◽

2017 ◽

Vol 3 (5) ◽

pp. 490-496 ◽

Cited By ~ 4

Author(s):

Olalekan Olasehinde ◽

Carla Boutin-Foster ◽

Olusegun I. Alatise ◽

Adewale O. Adisa ◽

Oladejo O. Lawal ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Low Income ◽

Screening Program ◽

Cross Sectional Survey ◽

Middle Income ◽

Screening Programs ◽

Middle Income Countries ◽

Low And Middle Income

Purpose In low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria. Materials and Methods A cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire. Results A total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. Conclusion The majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.

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Breast Oncoplasty Surgery in Low- and Middle-Income Countries: Lessons From India

Journal of Global Oncology ◽

10.1200/jgo.18.10250 ◽

2018 ◽

Vol 4 (Supplement 3) ◽

pp. 22s-22s

Author(s):

Chaitanyanand B. Koppiker ◽

Santosh Dixit ◽

Aijaz Ul Noor ◽

Laleh Busheri ◽

Gail Lebovic ◽

...

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Degree Program ◽

Health Clinic ◽

Middle Income ◽

Middle Income Countries ◽

Patient Reported ◽

Hospitalization Costs ◽

Hands On ◽

Low And Middle Income

Purpose Breast cancer is the most common cancer in India, affecting all socio-economic strata. Despite its growing global acceptance, Breast Oncoplasty Surgery (BOS) remains nascent in India, necessitating local context-specific innovative delivery models for clinicians and the general public. Here, we present experiences from Orchids Breast Health Clinic (OBHC; Pune, India) with the implementation of BOS clinical services, training, and research and community outreach. Methods OBHC, a dedicated breast unit, has established the first dedicated BOS clinic in India, conducted hands-on training workshops for trainee surgeons, developed an MCh degree program in breast oncoplasty with the University of East Anglia (Norwich, United Kingdom), undertaken BOS research in Indian patients, and created outreach programs to popularize BOS. Results A cost-effective one surgeon–dual role concept wherein the same surgeon performs onco- and plastic surgery and one-stage implant-based breast reconstruction has been adopted. Since 2013, BOS cases included BCS (n = 440), breast reconstruction (n = 210), and therapeutic mammoplasty (n = 135). The unavailability of acellular dermal matrices has prompted the innovation of a surgical technique, termed Advanced Autologous Dermal Sling, which uses vascularized local tissue as implant cover. Significant improvement in postsurgery outcomes and protection against radiation complications has been observed. BOS hospitalization costs have been reduced by 50% thereby, which has led to high rates of acceptance (80%) of BOS in patients at OBHC. Young breast surgeons from across India and South Asian Association for Regional Cooperation countries have enrolled in the MCh degree program, which involves an embedded curriculum with online didactic modules and hands-on training workshops in Pune, India. Longitudinal follow-up after 1, 3, and 5 years postsurgery in the study cohorts is undertaken for post-BOS outcomes using clinical assessment (Bakers scale) and patient-reported outcomes measures (BREAST-Q questionnaire). Multiple research projects are undergoing peer-review before publication. To increase awareness of BOS among Indian women, community awareness campaigns with the theme of Losing Is Not an Option are underway via public talks, symposia, marathon, and op-eds in electronic and print media. Conclusion The OBHC model of Affordable Excellence in BOS, developed in the Indian context, can be extrapolated to benefit patients with breast cancer from other low- and middle-income countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

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How does performance-based financing affect the availability of essential medicines in Cameroon? A qualitative study

Health Policy and Planning ◽

10.1093/heapol/czz084 ◽

2019 ◽

Vol 34 (Supplement_3) ◽

pp. iii4-iii19 ◽

Cited By ~ 2

Author(s):

Isidore Sieleunou ◽

Anne-Marie Turcotte-Tremblay ◽

Manuela De Allegri ◽

Jean-Claude Taptué Fotso ◽

Habakkuk Azinyui Yumo ◽

...

Keyword(s):

Qualitative Study ◽

Health Services ◽

Healthcare Providers ◽

Study Data ◽

Essential Medicines ◽

Middle Income ◽

Middle Income Countries ◽

Performance Based Financing ◽

Low And Middle Income

Abstract Performance-based financing (PBF) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. Although a few studies have examined the effects of PBF on the availability of essential medicines (EMs) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. Our research aimed to explore how PBF in Cameroon influenced the availability of EMs, and to understand the pathways leading to the experiential dimension related with the observed changes. The design was an exploratory qualitative study. Data were collected through in-depth interviews, using semi-structured questionnaires. Key informants were selected using purposive sampling. The respondents (n = 55) included health services managers, healthcare providers, health authorities, regional drugs store managers and community members. All interviews were recorded, transcribed and analysed using qualitative data analysis software. Thematic analysis was performed. Our findings suggest that the PBF programme improved the perceived availability of EMs in three regions in Cameroon. The change in availability of EMs experienced by stakeholders resulted from several pathways, including the greater autonomy of facilities, the enforced regulation from the district medical team, the greater accountability of the pharmacy attendant and supply system liberalization. However, a sequence of challenges, including delays in PBF payments, limited autonomy, lack of leadership and contextual factors such as remoteness or difficulty in access, was perceived to hinder the capacity to yield optimal changes, resulting in heterogeneity in performance between health facilities. The participants raised concerns regarding the quality control of drugs, the inequalities between facilities and the fragmentation of the drug management system. The study highlights that some specific dimensions of PBF, such as pharmacy autonomy and the liberalization of drugs supply systems, need to be supported by equity interventions, reinforced regulation and measures to ensure the quality of drugs at all levels.

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