Evaluating essential medicines for treating childhood cancers: availability, price and affordability study in Ghana

Abstract Introduction Access to childhood cancer medicines is a critical global health challenge. There is a lack of sufficient context-specific data in Ghana on access to essential medicines for treating childhood cancers. Here, we present an analysis of essential cancer medicine availability, pricing, and affordability using the pediatric oncology unit of a tertiary hospital as the reference point. Method Data on prices and availability of 20 strength-specific essential cancer medicines and eight non-cancer medicines were evaluated using the modified World Health Organization (WHO)/Health Action International method. Two pharmacies in the hospital and four private pharmacies around the hospital were surveyed. We assessed their median price ratio using the WHO international reference price guide. The number of days wages per the government daily wage salary was used to calculate the affordability of medicines. Results The mean availability of essential cancer medicines and non-cancer medicines at the hospital pharmacies were 27 and 38% respectively, and 75 and 84% respectively for private pharmacies. The median price ratio of cancer medicines was 1.85, and non-cancer medicines was 3.75. The estimated cost of medicines for treating a 30 kg child with Acute lymphoblastic leukaemia was GHȻ 4928.04 (US$907.56) and GHȻ 4878.00 (US$902.62) for Retinoblastoma, requiring 417 and 413-days wages respectively for the lowest-paid unskilled worker in Ghana. Conclusion The mean availability of cancer medicines at the public and private pharmacies were less than the WHO target of 80%. The median price ratio for cancer and non-cancer medicines was less than 4, yet the cost of medicines appears unaffordable in the local setting. A review of policies and the establishment of price control could improve availability and reduce medicines prices for the low-income population.

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Availability, prices and affordability of essential medicines in Zhejiang Province, China

PLoS ONE ◽

10.1371/journal.pone.0241761 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241761

Author(s):

Zuojun Dong ◽

Qiucheng Tao ◽

Bobo Yan ◽

Guojun Sun

Keyword(s):

Public Sector ◽

Zhejiang Province ◽

Essential Medicines ◽

World Health ◽

Price Ratio ◽

Public And Private ◽

The Public ◽

The Mean ◽

Daily Wage ◽

Health Organization

Objective To evaluate the availability, prices, and affordability of essential medicines in Zhejiang Province, China. Methods The survey was carried out in Zhejiang Province in 2018 following the methodology of the World Health Organization (WHO) and Health Action International (HAI). This method is an international standard method.Data on 50 medicines were collected from public health facilities and private pharmacies. Medication prices were compared with international reference prices to obtain a median price ratio. The affordability of medicines was measured based on the daily wage of the lowest-paid unskilled government worker. In private pharmacies, the mean availability of Originator Brands (OBs) and Lowest-priced Generics (LPGs) was 36.7% and 40.3%, respectively. Findings The effects of the mean availability of OBs and LPGs were seen in private pharmacies. Correspondingly, the average availability of OBs and LPGs was 41.8% and 35.1% in the public sector, respectively. In the public sector, the median price ratios (MPRs) were 5.21 for generics and 13.49 for OBs. In the private sector, the MPRs were 4.94 for generics and 14.75 for OBs. Treating common diseases with LPGs was generally affordable, while treatment with OBs was less affordable. Conclusions In Zhejiang Province, low availability was observed for medicines surveyed in the public and private sectors. Price differences between originator brands and generics in both sectors are apparent. OBs were more expensive than LPGs in both the public and private sectors. Low availability affects access to essential medicines. Policy measures should be taken to improve the availability of essential medicines.

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Examination of WHO/INRUD Core Drug Use Indicators at Public Primary Healthcare Centers in Kisii County, Kenya

10.1101/2020.03.15.20036269 ◽

2020 ◽

Author(s):

Faith A. Okalebo ◽

Eric M. Guantai ◽

Aggrey O. Nyabuti

Keyword(s):

Drug Use ◽

Low Income ◽

Primary Healthcare ◽

Essential Medicines ◽

World Health ◽

Low Income Countries ◽

Rational Use ◽

Health Organization ◽

Consultation Time ◽

Primary Healthcare Centers

ABSTRACTBackgroundIrrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study set out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/ International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology.MethodsTen PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three-hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use.ResultsThe average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6– 1.8), percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs actually dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6% (recommended: 100%) and percentage of patients with correct knowledge of dispensed drugs was 54.7% (recommended: 100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available.ConclusionThe survey shows irrational drug use practices, particularly polypharmacy, non-generic prescribing, overuse of antibiotics, short consultation time and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.

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Examination of WHO/INRUD Core Drug Use Indicators at Public Primary Healthcare Centers in Kisii County, Kenya

Advances in Pharmacological and Pharmaceutical Sciences ◽

10.1155/2020/3173847 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Aggrey O. Nyabuti ◽

Faith A. Okalebo ◽

Eric M. Guantai

Keyword(s):

Drug Use ◽

Low Income ◽

Primary Healthcare ◽

Essential Medicines ◽

World Health ◽

Low Income Countries ◽

Rational Use ◽

Health Organization ◽

Consultation Time ◽

Primary Healthcare Centers

Background. Irrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study sets out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology. Methods. Ten PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use. Results. The average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6–1.8), and the percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs actually dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6% (recommended: 100%), and the percentage of patients with correct knowledge of dispensed drugs was 54.7% (recommended: 100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available. Conclusion. The survey shows irrational drug use practices, particularly polypharmacy, nongeneric prescribing, overuse of antibiotics, short consultation time, and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.

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Price, availability and affordability of medicines

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v6i1.604 ◽

2014 ◽

Vol 6 (1) ◽

Cited By ~ 10

Author(s):

Brenda S. Mhlanga ◽

Fatima Suleman

Keyword(s):

Supply Chain ◽

Public Sector ◽

Low Income ◽

Essential Medicines ◽

World Health ◽

Middle Income ◽

Originator Brand ◽

Private And Public ◽

Daily Wage ◽

Health Organization

Background: Medicines play an important role in healthcare, but prices can be a barrier to patient care. Few studies have looked at the prices of essential medicines in low- and middle-income countries in terms of patient affordability.Aim: To determine the prices, availability and affordability of medicines along the supply chain in Swaziland.Setting: Private- and public-sector facilities in Manzini, Swaziland.Methods: The standardised methodology designed by the World Health Organization and Health Action International was used to survey 16 chronic disease medicines. Data were collected in one administrative area in 10 private retail pharmacies and 10 public health facilities. Originator brand (OB) and lowest-priced generic equivalent (LPG) medicines were monitored and these prices were then compared with international reference prices (IRPs). Affordability was calculated in terms of the daily wage of the lowest-paid unskilled government worker.Results: Mean availability was 68% in the public sector. Private sector OB medicines were priced 32.4 times higher than IRPs, whilst LPGs were 7.32 times higher. OBs cost473% more than LPGs. The total cumulative mark-ups for individual medicines range from 190.99% – 440.27%. The largest contributor to add-on cost was the retail mark-up (31% – 53%). Standard treatment with originator brands cost more than a day’s wage.Conclusion: Various policy measures such as introducing price capping at all levels of the medicine supply chain, may increase the availability, whilst at the same time reducing the prices of essential medicines for the low income population.

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Availability, prices and affordability of essential medicines: A cross-sectional survey in Hanam province, Vietnam

PLoS ONE ◽

10.1371/journal.pone.0260142 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260142

Author(s):

Huong Thi Thanh Nguyen ◽

Dai Xuan Dinh ◽

Trung Duc Nguyen ◽

Van Minh Nguyen

Keyword(s):

Public Sector ◽

Urban Areas ◽

Health Facilities ◽

Essential Medicines ◽

World Health ◽

Price Ratio ◽

The Public ◽

Private Medicine ◽

The Mean ◽

Medicine Outlets

Objective To measure medicines’ prices, availability, and affordability in Hanam, Vietnam. Methods The standardized methodology developed by the World Health Organization (WHO) and Health Action International was used to survey 30 essential medicines (EMs) in 30 public health facilities and 35 private medicine outlets in 2020. The availability of medicine was computed as the percentage of health facilities in which this medicine was found on the data-collection day. International reference prices (IRPs) from Management Sciences for Health (2015) were used to compute Median Price Ratio (MPR). The affordability of treatments for common diseases was computed as the number of days’ wages of the lowest-paid unskilled government worker needed to purchase medicines prescribed at a standard dose. Statistic analysis was done using R software version 4.1.1. Results The mean availability of originator brands (OBs) and lowest-priced generics (LPGs) was 0.7%, 63.2% in the public sector, and 13.7%, 47.9% in the private sector, respectively. In private medicine outlets, the mean availability of both OBs and LPGs in urban areas was significantly higher than that in rural areas (p = 0.0013 and 0.0306, respectively). In the public sector, LPGs’ prices were nearly equal to their IRPs (median MPRs = 0.95). In the private medicine outlets, OBs were generally sold at 6.24 times their IRPs while this figure for LPGs was 1.65. The affordability of LPGs in both sectors was good for all conditions, with standard treatments costing a day’s wage or less. Conclusion In both sectors, generic medicines were the predominant product type available. The availability of EMs was fairly high but still lower than WHO’s benchmark. A national-scale study should be conducted to provide a comprehensive picture of the availability, prices, and affordability of EMs, thereby helping the government to identify the urgent priorities and improving access to EMs in Vietnam.

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Chemistry of Iodinated Contrast Media (ICM): A Minireview

Mini-Reviews in Organic Chemistry ◽

10.2174/1570193x17666201127105348 ◽

2020 ◽

Vol 17 ◽

Author(s):

Maithili Pramod Joshi ◽

Ameya Chaudhari ◽

Prashant S. Kharkar ◽

Shreerang V. Joshi

Keyword(s):

Adverse Effects ◽

Contrast Media ◽

Aqueous Solubility ◽

Synthetic Methods ◽

Essential Medicines ◽

World Health ◽

Iodinated Contrast Media ◽

Environmental Aspects ◽

Iodinated Contrast ◽

Health Organization

: Historically, the use of Iodinated Contrast Media (ICM) for diagnostic purposes, particularly radiography and computed tomography (CT), is well-known. Many of the ICM are included in the World Health Organization (WHO)’s List of Essential Medicines. Depending on the chemotype and the presence of ionizable functional group(s), the ICM are categorized in the ionic/nonionic monomers/dimers. The lipophilicity, aqueous solubility, viscosity and osmolality are major characteristics dictating their use for one procedure versus the other. Over last several decades, substantial advancement occurred in the design and development of novel ICM, solely to reduce their propensity to cause adverse effects. Given the nature of their acute usage, some of the agents with appreciable toxicity are still used. Understanding their chemistry aspects is crucial to appreciate, acknowledge and justify the usage of these extremely important torch-bearers of diagnostic agent’s class. The present review article presents an in-depth overview of the synthetic methods, therapeutic indications, potential adverse effects along with the commercial and environmental aspects of ICM. The safety and tolerability of these agents is a field that has gained significant importance, which is given due importance in the discussion.

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Novel Coronavirus 2019 Outbreak: A Global Epidemic

Letters in Drug Design & Discovery ◽

10.2174/1570180817999200802033916 ◽

2020 ◽

Vol 17 (12) ◽

pp. 1458-1464

Author(s):

Sweta Kamboj ◽

Rohit Kamboj ◽

Shikha Kamboj ◽

Kumar Guarve ◽

Rohit Dutt

Keyword(s):

World Health ◽

Upper Respiratory Tract ◽

Global Epidemic ◽

The Public ◽

The Government ◽

Tract Disease ◽

The 1960S ◽

Novel Coronavirus ◽

Health Organization ◽

The Impact

Background: In the 1960s, the human coronavirus was designated, which is responsible for the upper respiratory tract disease in children. Back in 2003, mainly 5 new coronaviruses were recognized. This study directly pursues to govern knowledge, attitude and practice of viral and droplet infection isolation safeguard among the researchers during the outbreak of the COVID-19. Introduction: Coronavirus is a proteinaceous and infectious pathogen. It is an etiological agent of severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). Coronavirus, appeared in China from the seafood and poultry market last year, which has spread in various countries, and has caused several deaths. Methods: The literature data has been taken from different search platforms like PubMed, Science Direct, Embase, Web of Science, who.int portal and complied. Results: Corona virology study will be more advanced and outstanding in recent years. COVID-19 epidemic is a threatening reminder not solely for one country but all over the universe. Conclusion: In this review article, we encapsulated the pathogenesis, geographical spread of coronavirus worldwide, also discussed the perspective of diagnosis, effective treatment, and primary recommendations by the World Health Organization, and guidelines of the government to slow down the impact of the virus are also optimistic, efficacious and obliging for the public health. However, it will take a prolonged time in the future to overcome this epidemic.

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ARIMA model for forecasting COVID-19 Death cases in India (Preprint)

10.2196/preprints.24107 ◽

2020 ◽

Author(s):

Jeya Sutha M

Keyword(s):

Arima Model ◽

Public Health Emergency ◽

World Health ◽

The People ◽

The World ◽

The Status ◽

The Government ◽

Health Organization ◽

Spread Of Infection ◽

Death Cases

UNSTRUCTURED COVID-19, the disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious disease. On January 30, 2020 the World Health Organization declared the outbreak as a Public Health Emergency of International Concern. As of July 25, 2020; 15,947,292 laboratory-confirmed and 642,814 deaths have been reported globally. India has reported 1,338,928 confirmed cases and 31,412 deaths till date. This paper presents different aspects of COVID-19, visualization of the spread of infection and presents the ARIMA model for forecasting the status of COVID-19 death cases in the next 50 days in order to take necessary precaution by the Government to save the people.

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Influenza vaccination during pregnancy and influencing factors in Korea: A multicenter questionnaire study of pregnant women and obstetrics and gynecology doctors

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03984-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Byung Soo Kang ◽

San Ha Lee ◽

Woo Jeng Kim ◽

Jeong Ha Wie ◽

In Yang Park ◽

...

Keyword(s):

Influenza Vaccination ◽

Pregnant Women ◽

Influencing Factors ◽

World Health ◽

Obstetrics And Gynecology ◽

Health Authorities ◽

The Government ◽

Vaccine Information ◽

Health Organization ◽

Maternal Influenza

Abstract Background Although the World Health Organization and health authorities in most countries recommend that pregnant women receive inactivated influenza virus vaccines, coverage remains low. This study aimed to investigate (1) the proportion of pregnant women who received an influenza vaccination and influencing factors and (2) the proportion of obstetrics and gynecology (OBGYN) doctors who routinely recommend influenza vaccination to pregnant women and influencing factors. Methods Two separate, anonymized questionnaires were developed for physicians and pregnant and postpartum women and were distributed to multicenters and clinics in South Korea. The proportions of women who received influenza vaccination during pregnancy and OBGYN doctors who routinely recommend the influenza vaccine to pregnant women were analyzed. Independent influencing factors for both maternal influenza vaccination and OBGYN doctors’ routine recommendations to pregnant women were analyzed using log-binomial regression analysis. Results The proportion of self-reported influenza vaccination during pregnancy among 522 women was 63.2%. Pregnancy-related independent factors influencing maternal influenza vaccination were “(ever) received information about influenza vaccination during pregnancy” (OR 8.9, 95% CI 4.17–19.01), “received vaccine information about from OBGYN doctors” (OR 11.44, 95% CI 5.46–24.00), “information obtained from other sources” (OR 4.38, 95% CI 2.01–9.55), and “second/third trimester” (OR 2.41, 95% CI 1.21–4.82).. Among 372 OBGYN doctors, 76.9% routinely recommended vaccination for pregnant women. Independent factors effecting routine recommendation were “working at a private clinic or hospital” (OR 5.33, 95% CI 2.44–11.65), “awareness of KCDC guidelines” (OR 3.11, 95% CI 1.11–8.73), and “awareness of the 2019 national free influenza vaccination program for pregnant women” (OR 4.88, 95% CI 2.34–10.17). OBGYN doctors most commonly chose ‘guidelines proposed by the government or public health (108, 46%) and academic committees (59, 25%), as a factor which expect to affect the future recommendation Conclusion This study showed that providing information about maternal influenza vaccination, especially by OBGYN doctors, is crucial for increasing vaccination coverage in pregnant women. Closer cooperation between the government and OBGYN academic societies to educate OBGYN doctors might enhance routine recommendations.

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Vaccination Coverage for Routine Vaccines and Herd Immunity Levels against Measles and Pertussis in the World in 2019

Vaccines ◽

10.3390/vaccines9030256 ◽

2021 ◽

Vol 9 (3) ◽

pp. 256

Author(s):

Pedro Plans-Rubió

Keyword(s):

Vaccination Coverage ◽

Action Plan ◽

Herd Immunity ◽

World Health ◽

Immunization Programs ◽

National Immunization ◽

The World ◽

Measles Vaccination ◽

The Mean ◽

Health Organization

In 2012, the World Health Organization (WHO) established the Global Vaccine Action Plan with the objective to promote essential vaccinations in all countries and achieve at least 90% vaccination coverage for all routine vaccines by 2020. The study assessed the mean percentages of vaccination coverage in 2019 for 13 routine vaccines, vaccination coverage variation from 2015 to 2019, and herd immunity levels against measles and pertussis in 2019 in countries and regions of WHO. In 2019, the mean percentages of vaccination coverage were lower than 90% for 10 (78.9%) routine vaccines. The mean percentages of vaccination coverage also decreased from 2015 to 2019 for six (46.2%) routine vaccines. The prevalence of individuals with vaccine-induced measles immunity in the target measles vaccination population was 88.1%, and the prevalence of individuals with vaccine-induced pertussis immunity in the target pertussis vaccination population was 81.1%. Herd immunity against measles viruses with Ro = 18 was established in 63 (32.5%) countries but not established in any region. Herd immunity against pertussis agents was not established in any country and in any region of WHO. National immunization programs must be improved to achieve ≥90% vaccination coverage in all countries and regions. Likewise, it is necessary to achieve ≥95% vaccination coverage with two doses of measles vaccines and three doses of pertussis vaccines in all countries and regions.

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