Management of Childhood Rheumatic Diseases During the COVID-19 Pandemic: A Survey on Parental Approaches and Involvements in the Treatment Procedure

Objectives: This study aimed to seek the approaches of parents in medical management of their children with rheumatic disorders during the COVID-19 outbreak. Methods: This cross-sectional study was conducted based on an online questionnaire survey at Children’s Medical Center Hospital of Tehran University of Medical Sciences, Tehran, Iran. The participants were selected based on their institutional records. The questionnaires contained questions covering all the basic information related to the patients and their parents, as well as the approaches that parents had taken to manage the rheumatic disease of their children during the outbreak of COVID-19. Results: A total number of 125 valid questionnaires were collected. Based on our results, 13 out of 129 parents had discontinued their children’s medicines due to COVID-19 concerns, 4 had respiratory disease symptoms but 9 had not any signs of pulmonary involvements. Thus, the overall response rate was calculated 89.6%. However, among the symptomatic cases 19 out of 23 rheumatoid cases had continued to take their routine medications, and the response rate among this group was obtained 82.6%. Among these 13 cases, 7 children had worsened symptoms; however 6 had no changes in the disease symptoms. Seventy-six out of 125 children had been visited by a doctor in the last 2 months, while the remaining 49 cases did not. Twenty-three children (18.4%) had respiratory disease symptoms in the last two months, 19 of whom (82.6%) had continued their rheumatic drugs, but 4 (17.3%) had stopped. Only 3 of 125 children had confirmed COVID-19 infection. Conclusions: None of the parents who had visited a pediatric rheumatologist during this time had discontinued their children’s medicines. Therefore, close contact with doctors or online consultation could benefit them during the COVID-19 era.

Poor availability of essential medicines for women and children threatens progress towards Sustainable Development Goal 3 in Africa

BackgroundMost maternal and child deaths are preventable or treatable with proven, cost-effective interventions for infectious diseases and maternal and neonatal complications. In 2015 sub-Saharan Africa accounted for up to 66% of global maternal deaths and half of the under-five deaths. Access to essential medicines and commodities and trained healthcare workers to provide life-saving maternal, newborn and post-natal care are central to further reductions in maternal and child mortality.MethodsAvailable data for 24 priority medicines for women and children were extracted from WHO service availability and readiness assessments conducted between 2012 and 2015 for eight countries in sub-Saharan Africa. The mean availability of medicines in facilities stating they provide services for women or children and differences by facility type, ownership and location are reported.ResultsThe mean availability of 12 priority essential medicines for women ranged from 22% to 40% (median 33%; IQR 12%) and 12 priority medicines for children ranged from 28% to 57% (median 50%; IQR 14%). Few facilities (<1%) had all nominated medicines available. There was higher availability of priority medicines for women in hospitals than in primary care facilities: range 32%–80% (median 61%) versus 20%–39% (median 23%) and for children’s medicines 31%–71% (median 58%) versus 27%–57% (median 48%). Availability was higher in public than private facilities: for women’s medicines, range 21%–41% (median 34%) versus 4%–36% (median 27%) and for children’s medicines 28%–58% (median 51%) versus 5%–58% (median 46%). Patterns were mixed for rural and urban location for the priority medicines for women, but similar for children’s medicines.ConclusionsThe survey results show unacceptably low availability of priority medicines for women and children in the eight countries. Governments should ensure the availability of medicines for mothers and children if they are to achieve the health sustainable development goals.

Quality Assessment of Some Essential Children’s Medicines Sold in Licensed Outlets in Ashanti Region, Ghana

The quality of 68 samples of 15 different essential children’s medicines sold in licensed medicine outlets in the Ashanti Region, Ghana, was evaluated. Thirty-two (47.1%) of the medicines were imported, mainly from India (65.6%) and the United Kingdom (28.1%), while 36 (52.9%) were locally manufactured. The quality of the medicines was assessed using content of active pharmaceutical ingredient (API), pH, and microbial limit tests, and the results were compared with pharmacopoeial standards. Twenty-six (38.2%) of the samples studied passed the official content of API test while 42 (61.8%) failed. Forty-nine (72.1%) of the samples were compliant with official specifications for pH while 19 (27.9%) were noncompliant. Sixty-six (97.1%) samples passed the microbial load and content test while 2 (2.9%) failed. Eighteen (26.5%) samples passed all the three quality evaluation tests, while one (1.5%) sample (CFX1) failed all the tests. All the amoxicillin suspensions tested passed the three evaluation tests. All the ciprofloxacin, cotrimoxazole, flucloxacillin, artemether-lumefantrine, multivitamin, and folic acid samples failed the content of API test and are substandard. The overall API failure rate for imported products (59.4%) was comparable to locally manufactured (63.9%) samples. The results highlight the poor quality of the children’s medicines studied and underscore the need for regular pharmacovigilance and surveillance systems to fight this menace.