scholarly journals High global consumption of potentially inappropriate fixed dose combination antibiotics: Analysis of data from 75 countries

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0241899
Author(s):  
Barbara Bortone ◽  
Charlotte Jackson ◽  
Yingfen Hsia ◽  
Julia Bielicki ◽  
Nicola Magrini ◽  
...  
Keyword(s):  
The United States ◽  
Antibiotic Consumption ◽  
Essential Medicines ◽  
World Health ◽  
Fixed Dose ◽  
Middle Income ◽  
Us Fda ◽  
Analysis System ◽  
Health Organization ◽  
Data Analysis System

Antibiotic fixed dose combinations (FDCs) can have clinical advantages such as improving effectiveness and adherence to therapy. However, high use of potentially inappropriate FDCs has been reported, with implications for antimicrobial resistance (AMR) and toxicity. We used a pharmaceutical database, IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS®), to estimate sales of antibiotic FDCs from 75 countries in 2015. Antibiotic consumption was estimated using standard units (SU), defined by IQVIA as a single tablet, capsule, ampoule, vial or 5ml oral suspension. For each FDC antibiotic, the approval status was assessed by either registration with the United States Food and Drug Administration (US FDA) or inclusion on the World Health Organization (WHO) Essential Medicines List (EML). A total of 119 antibiotic FDCs were identified, contributing 16.7 x 109 SU, equalling 22% of total antibiotic consumption in 2015. The most sold antibiotic FDCs were amoxicillin-clavulanic acid followed by trimethoprim/sulfamethoxazole and ampicillin/cloxacillin. The category with the highest consumption volume was aminopenicillin/β-lactamase inhibitor +/- other agents. The majority of antibiotic FDCs (92%; 110/119) were not approved by the US FDA. Of these, the most sold were ampicillin/cloxacillin, cefixime/ofloxacin and metronidazole/spiramycin. More than 80% (98/119) of FDC antibiotics were not compatible with the 2017 WHO EML. The countries with the highest numbers of FDC antibiotics were India (80/119), China (25/119) and Vietnam (19/119). There is high consumption of FDC antibiotics globally, particularly in middle-income countries. The majority of FDC antibiotic were not approved by either US FDA or WHO EML. International initiatives such as clear guidance from the WHO EML on which FDCs are not appropriate may help to regulate the manufacturing and sales of these antibiotics.

scholarly journals Availability of Essential Medicines in a Country in Conflict: A Quantitative Insight from Yemen

2020 ◽  
Vol 18 (1) ◽  
pp. 175
Author(s):  
Mohamed Izham Mohamed Ibrahim ◽  
Mohammed Alshakka ◽  
Nazeh Al-abd ◽  
Awsan Bahattab ◽  
Wafa Badulla
Keyword(s):  
Essential Medicines ◽  
World Health ◽  
Private Hospitals ◽  
Public And Private ◽  
Middle Income ◽  
Short Supply ◽  
Healthcare Facilities ◽  
Private Healthcare ◽  
Healthcare Settings ◽  
Health Organization

Background: Medicine and medical supplies are often in short supply in countries suffering from the scourge of conflict. Effective medicine supply policies are lacking in many low- and middle-income countries (LMICs), particularly during conflict. This study aimed to assess the availability of essential medicines in both the public and private healthcare sectors. Methods: The study was conducted by administering a survey from November 2017 to February 2018 using the World Health Organization/Health Action International (WHO/HAI) guidelines and methodology. Thirty healthcare facilities in thirteen districts from three governorates in Yemen were included in the assessment of thirty essential medicines. The results were reported as frequencies and percentages of outlets with available medicines on the day of data collection. Results: A set of 30 vital and essential medicines were selected from the list of essential medicines that are used in healthcare centers in Yemen to treat prevalent diseases. In general, only 52.8% of the selected medicines were available in public and private healthcare settings. The distribution and availability of medicines in the three governorates were approximately equal. The availability of medicines was better in the private healthcare settings, specifically 73.3% in private hospitals and approximately 79.7% in private pharmacies. Conclusions: The availability of essential medicines during this state of conflict in three governorates in Yemen is low, in both public and private hospitals and healthcare centers. Many of the medications that were not available are used to treat chronic illnesses.

scholarly journals Going global: the adoption of the World Health Organization’s enabling recommendation on oral pre-exposure prophylaxis for HIV

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 489 ◽  
Author(s):  
Ioannis Hodges-Mameletzis ◽  
Shona Dalal ◽  
Busisiwe Msimanga-Radebe ◽  
Michelle Rodolph ◽  
Rachel Baggaley
Keyword(s):  
Sub Saharan Africa ◽  
Essential Medicines ◽  
World Health ◽  
Middle Income ◽  
Income Status ◽  
The World ◽  
Sub Saharan ◽  
Health Organization ◽  
Exposure Prophylaxis ◽  
Oral Prep

In September 2015, the World Health Organization (WHO) launched evidence-based guidelines by recommending that any person at substantial HIV risk should be offered oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) as an additional prevention choice. Since 2017, PrEP medicines have also been listed in the WHO’s Essential Medicines List, including TDF/emtricitabine (FTC) and TDF in combination with lamivudine (3TC). A descriptive policy review and analysis of countries adopting WHO’s 2015 recommendation on oral PrEP was conducted. As of June 2018, we identified 35 countries that had some type of policy on oral PrEP, and an additional five countries where a specific policy on PrEP is currently pending. A total of 19 high-income countries (HICs) and 21 low- and middle-income countries (LMICs) have adopted or have a pending policy. Most countries that have adopted or pending PrEP are in the European (42.9%) or African (30.0%) region. TDF/FTC is the most commonly recommended PrEP drug in the guidelines reviewed, although seven countries, namely in sub-Saharan Africa (6/7), are also recommending the use of TDF/3TC for PrEP. In sum, by the end of 2018, at least 40 countries (20.6%) are anticipated to have adopted WHO’s oral PrEP recommendation. Nonetheless, policy uptake does not reflect broader programmatic coverage of PrEP services, which remain limited across all settings, irrespective of income status. Enhancing global partnerships is needed to support and track ongoing policy adoption and to ensure that policy is translated into meaningful implementation of PrEP services.

Addressing the Needs of Children With Complex Communication Needs and Their Partners in Areas of Poverty: To Haiti and Back

2017 ◽  
Vol 2 (12) ◽  
pp. 23-36
Author(s):  
Jessica Gormley
Keyword(s):  
Best Practice ◽  
The United States ◽  
World Health ◽  
Middle Income ◽  
Complex Communication Needs ◽  
Case Examples ◽  
The World Bank ◽  
Communication Needs ◽  
Health Organization ◽  
Communication Disability

An estimated 1 billion people (15% of the world's population) experience a disability, such as a communication disability. Individuals with disabilities have an increased likelihood of living in poverty and often experience decreased access to medical, educational, and rehabilitation services (Danquah et al., 2014; World Health Organization & The World Bank, 2011) with approximately two-thirds of the world's poor living in low-and middle-income nations such as Haiti (Rank & Yadama, 2007). The aim of this article is to describe augmentative and alternative (AAC) service delivery considerations for speech-language pathologists (SLPs) who work with individuals who live in poverty. Case examples of AAC services within areas of poverty in Haiti and the United States are provided to illustrate practice recommendations. To achieve best-practice standards, SLPs who provide AAC services must consider how poverty might influence a family's socio-historic context, access to resources and services, and community participation goals. Furthermore, it is critical that SLPs recognize individuals' and families' strengths, evaluate the sustainability of AAC services, and work within a team to empower individuals with complex communication needs to participate in desired roles within the community.

scholarly journals Price, availability and affordability of medicines

2014 ◽  
Vol 6 (1) ◽  
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.

scholarly journals What’s new for the clinician – summaries of recently published papers

2021 ◽  
Vol 76 (09) ◽  
pp. 565-566
Author(s):  
Veerasamy Yengopal
Keyword(s):  
South African ◽  
Meta Analysis ◽  
Severe Disease ◽  
Convincing Evidence ◽  
Essential Medicines ◽  
World Health ◽  
World Population ◽  
Middle Income ◽  
The World ◽  
Health Organization

To date, very few treatments have been demonstrated to reduce the burden of morbidity and mortality from COVID-19. Although corticosteroids have been proven to reduce mortality in severe disease, there has been little convincing evidence on interventions that may prevent disease, reduce hospitalizations, and reduce the numbers of people progressing to critical disease and death. Ivermectin is a well-known medicine that is approved as an antiparasitic by the World Health Organization and the US Food and Drug Administration. It is widely used in lowand middle-income countries to treat worm infections. Also used for the treatment of scabies and lice, it is one of the World Health Organization’s Essential Medicines.1 With total doses of ivermectin distributed apparently equalling one-third of the present world population,1 ivermectin at the usual doses (0.2–0.4 mg/kg) is considered extremely safe for use in humans.1 In addition to its antiparasiticactivity, it has been noted to have antiviral and anti-inflammatory properties, leading to an increasing list of therapeutic indications. South African authorities approved the use of a drug used to control parasites in humans and livestock to treat coronavirus patients. Additionally, in January 2021, the South African Health Products Regulatory Authority (SAHPRA) announced that ivermectin, would be allowedfor use on compassionate grounds in a controlled-access program. Ivermectin locally has been used for the prevention and/or management of Covid-19 infection. This has resulted in a huge black market trade of ivermectin in South Africa as many health professionals and others have taken to social media and other platforms to profile this drug as an effective treatment for the covid-19 viral infection. Roman and colleagues (2021)1 conducted a systematic review and meta-analysis to evaluate treatment effects of Ivermectin (IVM) on clinical outcomes and adverse events (AEs) in people with COVID-19.

scholarly journals Monitoring the World Health Organization Global Target 2025 for Exclusive Breastfeeding: Experience From the United States

2017 ◽  
Vol 33 (3) ◽  
pp. 578-581 ◽  
Author(s):  
Priya M. Gupta ◽  
Cria G. Perrine ◽  
Jian Chen ◽  
Laurie D. Elam-Evans ◽  
Rafael Flores-Ayala
Keyword(s):  
United States ◽  
World Health Organization ◽  
Exclusive Breastfeeding ◽  
The United States ◽  
World Health ◽  
Middle Income ◽  
Dietary Recall ◽  
Health And Nutrition ◽  
24 Hour Recall ◽  
Health Organization

Background: Exclusive breastfeeding under 6 months, calculated from a single 24-hour recall among mothers of children 0 to 5 months of age, is a World Health Organization (WHO) indicator used to monitor progress on the 2025 global breastfeeding target. Many upper-middle-income and high-income countries, including the United States, do not have estimates for this indicator. Research aim: To describe the prevalence of exclusive breastfeeding under 6 months in the United States. Methods: We used a single 24-hour dietary recall from the National Health and Nutrition Examination Survey 2009-2012 to calculate the prevalence of exclusive breastfeeding under 6 months. We discuss our results in the context of routine breastfeeding surveillance, which is reported from a national survey with different methodology. Results: Among children younger than 6 months, 24.4%, 95% confidence interval [17.6, 31.1], were exclusively breastfed the previous day. Conclusion: To our knowledge, this is the first estimate of the WHO indicator of exclusive breastfeeding under 6 months for the United States. This study supports the global surveillance and data strategy for reporting to the WHO on the 2025 target for exclusive breastfeeding.

scholarly journals COVID-19 therapeutics for low- and middle-income countries: a review of re-purposed candidate agents with potential for near-term use and impact

2021 ◽  
Author(s):  
Daniel Maxwell ◽  
Kelly C. Sanders ◽  
Oliver Sabot ◽  
Ahmad Hachem ◽  
Alejandro Llanos-Cuentas ◽  
...  
Keyword(s):  
The United States ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Clinical Trial Registries ◽  
Oral Agents ◽  
The Us ◽  
Near Term ◽  
Health Organization ◽  
Low And Middle Income

Low- and middle-income countries (LMICs) face significant challenges in the control of COVID-19, given limited resources, especially for inpatient care. In a parallel effort to that for vaccines, the identification of therapeutics that have near-term potential to be available and easily administered is critical. Using the United States, European Union, and World Health Organization clinical trial registries, we reviewed COVID-19 therapeutic agents currently under investigation. The search was limited to oral or potentially oral agents, with at least a putative anti-SARS-CoV-2 virus mechanism, and with at least 3 registered trials. We describe the available evidence regarding agents that met these criteria and additionally discuss the need for additional investment by the global scientific community in large well-coordinated trials of accessible agents and their combinations in LMICs. The search yielded 636, 175, and 930 trials, in the US, EU, and WHO trial registers, respectively. These trials covered 17 oral or potentially oral repurposed agents that are currently used as antimicrobials and immunomodulatory therapeutics and therefore have established safety. The available evidence regarding proposed mechanism of actions, clinical efficacy, and potential limitations is summarized. We also identified the need for large well-coordinated trials of accessible agents and their combinations in LMICs. Several repurposed agents have potential to be safe, available, and easily administrable to treat COVID-19. To prevent COVID-19 from becoming a neglected tropical disease, there is critical need for rapid and coordinated effort in their evaluation and the deployment of those found to be efficacious.

scholarly journals COVID-19 in Low-Middle Income Setting Of Central America Four Region: Limitations on Prevention, Diagnosis, Management and Economic Implications

2020 ◽  
Vol 1 (3) ◽  
pp. 01-02
Author(s):  
Eleazar Sanchez
Keyword(s):  
Public Health ◽  
Central America ◽  
The United States ◽  
Public Health Emergency ◽  
World Health ◽  
Middle Income ◽  
Economic Implications ◽  
The World ◽  
Novel Coronavirus ◽  
Health Organization

The outbreak of novel coronavirus 2019 has spread rapidly; starting in Wuhan China, reporting a cluster of cases of Pneumonia associated with 2019-nCoV on December 31, 2019. Now with confirmed cases around the world, approximately 128 of 195 countries in total. By the end of January 2020, the World Health Organization declared the current COVID-19 epidemic a Public Health Emergency of International Concern (PHIC) along with the first confirmed case in the United States.

Chemistry of Iodinated Contrast Media (ICM): A Minireview

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.

Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review

2021 ◽  
pp. 101053952110260
Author(s):  
Mairead Connolly ◽  
Laura Phung ◽  
Elise Farrington ◽  
Michelle J. L. Scoullar ◽  
Alyce N. Wilson ◽  
...  
Keyword(s):  
Preterm Birth ◽  
National Level ◽  
Health Indicators ◽  
Western Pacific ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Definition Of ◽  
Health Organization ◽  
The Impact

Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.

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