Availability and affordability of essential medicines and diagnostic tests for diabetes mellitus in sub-Saharan Africa: A systematic review.

2020 ◽  
Author(s):  
Davis KIBIRIGE ◽  
Richard E Sanya ◽  
Isaac Sekitoleko ◽  
David Katende ◽  
David Atuhe ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Blood Glucose ◽  
Serum Creatinine ◽  
Diagnostic Tests ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Eastern Africa ◽  
Urine Protein ◽  
Sub Saharan

Abstract Background Currently, sub-Saharan Africa (SSA) is experiencing a steady increase in the prevalence of diabetes mellitus (DM) coupled with a prevailing high burden of communicable diseases. To effectively address this burgeoning burden of DM, optimal access to affordable essential medicines and diagnostic tests for DM in healthcare systems should be prioritised. We conducted a systematic review of the evidence on the availability and affordability of essential medicines and diagnostic tests for DM in SSA as recommended by the World Health Organization Package of Essential Non-communicable Disease Interventions for Primary Health Care in Low-Resource Settings. Methods PubMed, Science Direct and African Journals Online databases were searched for original research articles conducted in sub-Saharan Africa and published between 2000 and 2018 reporting availability and affordability of essential medicines and diagnostic tests for diabetes mellitus. Results Twenty one original cross-sectional studies were included in the systematic review, with the majority conducted in Eastern Africa (n=11, 58%). The availability of essential medicines and diagnostic tests was largely sub-optimal. For oral hypoglycaemic agents and insulin, angiotensin-converting-enzyme inhibitors, statins and aspirin, availability ranged from 0-100%, 0-96.5%, 0-84% and 53%-100% respectively. Considering diagnostic tests, availability of blood glucose tests, urine protein and ketone tests, serum creatinine tests, lipid profile tests and electrocardiography ranged from 6-100%, 33.3-100%, 0-86.4%, 0-65.9% and 5.7-54.6% respectively. The lowest priced generic (LPG) glibenclamide, metformin and aspirin cost <1.2 days’ wages. However, the cost of LPG insulin (any type), captopril and simvastatin ranged from 3.85-18.7 days’ wages, 1.2-6.41 days’ wages and 6.5-30 days’ wages respectively. Blood glucose tests, urine protein and ketone tests and serum creatinine tests cost <3.3 days’ wages. Conclusions Optimal access to affordable essential medicines and diagnostic tests for DM remains a significant challenge in SSA. This represents a significant barrier towards the attainment of sustainable development goals and universal health coverage. Pragmatic region-specific solutions are urgently needed to address this challenge.

scholarly journals Implementation of Medicines Pricing Policies In Sub-Saharan Africa: Systematic Review

2021 ◽  
Author(s):  
Augustina Koduah ◽  
Leonard Baatiema ◽  
Anna Cronin de Chavez ◽  
Anthony Danso-Appiah ◽  
Irene A Kretchy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Policy Implementation ◽  
Access To Medicines ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Inclusion Criteria ◽  
Policy Actors ◽  
Pricing Policies ◽  
Private And Public ◽  
Sub Saharan

Abstract Background: High medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA), are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability. However, evidence on the experiences of implementations of these policies in SSA settings appears limited. To bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries? Methods: We identified policies, examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines.Results: Of the 5595 studies identified, 32 met the inclusion criteria. The results showed fourteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were: limited awareness about policies, lack of regulatory capacity, and lack of price transparency in external reference pricing process. Key facilitators were: favourable policy environment on essential medicines, strong political will, and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines were mixed. Reductions in prices were reported occasionally and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines.Conclusions: Implementation of medicine pricing policies in SSA shows some mixed evidence of improved availability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications: avoiding ‘one-size-fits-all’ approach, engaging both private and public sector policy actors in policy implementation and continuously monitor implementation and effects of policies. Systematic review protocol registration: PROSPERO registration number CRD42020178166.

scholarly journals Diabetes mellitus among patients attending TB clinics in Dar es Salaam: a descriptive cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Patricia J. Munseri ◽  
Henrika Kimambo ◽  
Kisali Pallangyo
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Fasting Blood Glucose ◽  
Cross Sectional Study ◽  
Dar Es Salaam ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Family History Of Diabetes ◽  
History Of ◽  
Sub Saharan

Abstract Background A bi-directional interaction between diabetes mellitus and tuberculosis is well established and has been likened to that between HIV and TB. Whereas HIV screening is standard of care test in sub Saharan Africa TB programs, the same is not true for diabetes mellitus (DM). Sub Saharan Africa, a region with high TB infection rates, is going through an epidemiological transition with rapidly rising prevalence of diabetes. We aimed at characterizing TB patients with DM in order to identify factors associated with TB-DM dual disease among patients attending TB clinics in Dar es Salaam. Methods A cross-sectional study was conducted between September 2016 and January 2017 among patients attending TB clinics in Dar es Salaam. We collected socio-demographic characteristics, anthropometric measurements and screened for diabetes by measuring fasting blood glucose that was followed by a 2 h postprandial glucose for participants with impaired fasting blood glucose. We examined for socio-demographic and clinical factors associated with diabetes using logistic regression analysis. Results Of the 660 enrolled participants with TB, 25 (3.8%) were on treatment for diabetes while 39 (6.1%) and 147 (23%) of the remaining 635 participants were ultimately diagnosed with DM and impaired fasting blood glucose respectively. The overall prevalence of DM was 9.7% (64/660). Independent risk factors for diabetes included: age > 44 years {OR 4.52, 95% CI: [1.28–15.89]}; family history of diabetes {OR 3.42, 95% [CI 1.88–6.21]}. HIV sero-positive TB patients were less likely to have DM compared to those who were HIV sero-negative {OR 0.35, 95% CI [0.17–0.73]}. Conclusions Screening for diabetes should be advocated for TB patients aged above 44 years and/or with a family history of diabetes. HIV sero-negative TB patients were more likely to have DM compared to those who were HIV sero-positive. Further studies are needed to confirm this observation and the underlying factors.

SOCIOECONOMIC STATUS AS A RISK FACTOR FOR HIV INFECTION IN WOMEN IN EAST, CENTRAL AND SOUTHERN AFRICA: A SYSTEMATIC REVIEW

2004 ◽  
Vol 37 (1) ◽  
pp. 1-36 ◽  
Author(s):  
JANET MAIA WOJCICKI
Keyword(s):  
Systematic Review ◽  
Socioeconomic Status ◽  
Hiv Infection ◽  
Southern Africa ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Low Ses ◽  
Causal Pathway ◽  
Sub Saharan

This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women’s access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female’s SES and fourteen also included a measurement of partner’s SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner’s SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES.

scholarly journals Pregnancy cohorts and biobanking in sub-Saharan Africa: a systematic review

2020 ◽  
Vol 5 (11) ◽  
pp. e003716
Author(s):  
Jeffrey N Bone ◽  
Kelly Pickerill ◽  
Mai-Lei Woo Kinshella ◽  
Marianne Vidler ◽  
Rachel Craik ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Collection ◽  
Grey Literature ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Reference List ◽  
Inclusion Criteria ◽  
Discovery Science ◽  
Sub Saharan ◽  
Expert Input

BackgroundTechnological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked samples with potential to enhance discovery science opportunity.MethodsInclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were screened in a three-stage process based on title, abstract and full text by two independent reviewers. The review is registered on PROSPERO (CRD42019147483).ResultsFourteen SSA studies met the inclusion criteria from database searches (n=8), reference list searches (n=2) and expert input (n=4). Three studies have ongoing data collection. The most represented countries were South Africa and Mozambique (Southern Africa) (n=3), Benin (Western Africa) (n=4) and Tanzania (Eastern Africa) (n=4); including an estimated 31 763 women. Samples commonly collected were blood, cord blood and placenta. Seven studies collected neonatal samples. Common clinical outcomes included maternal and perinatal mortality, malaria and preterm birth.ConclusionsIncreasingly numerous pregnancy cohorts in SSA that include biobanking are generating a uniquely valuable resource for collaborative discovery science, and improved understanding of the high regional risks of maternal, fetal and neonatal morbidity and mortality. Future studies should align protocols and consider their added value and distinct contributions.

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