1
|
Vogler S. Tackling medicine shortages during and after the COVID-19 pandemic: Compilation of governmental policy measures and developments in 38 countries. Health Policy 2024; 143:105030. [PMID: 38484475 DOI: 10.1016/j.healthpol.2024.105030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 04/20/2024]
Abstract
In response to increasing shortages of medicines, governments have implemented legislative and non-legislative policy measures. This study aimed to map these policies across high-income countries in Europe and beyond as of 2023 and to analyse developments in governmental approaches since the beginning of the pandemic. Information was collated from 38 countries (33 European countries, Australia, Brazil, Canada, Israel and Saudi Arabia) based on a survey conducted with public authorities involved in the Pharmaceutical Pricing and Reimbursement Information (PPRI) network in 2023. 34 countries requested pharmaceutical companies to notify national registers of upcoming shortages and 20 countries obliged manufacturers and/or wholesalers to stock supply reserves of critically needed medicines. Further common measures included export bans for defined medicines (18 countries), regulatory measures to facilitate import and use of alternative medicines (35 countries) and multi-stakeholder coordination (28 countries). While the legislation of 26 countries allows imposing sanctions, particularly for non-compliance to reporting requirements, fines were rather rarely imposed. Since 2022, at least 18 countries provided financial incentives, usually in the form of price increases of some off-patent medicines. Overall, several policies to address medicine shortages were taken in recent years, in some countries as part of a comprehensive package (e.g., Australia, Germany). Further initiatives to secure medicine supply in a sustainable manner were being prepared or discussed.
Collapse
Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG / Austrian National Public Health Institute), Stubenring 6, 1010 Vienna, Austria; Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany.
| |
Collapse
|
2
|
Deressa HD, Abuye H, Adinew A, Ali MK, Kebede T, Habte BM. Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia. Glob Health Res Policy 2024; 9:12. [PMID: 38584277 PMCID: PMC10999076 DOI: 10.1186/s41256-024-00352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/31/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia's public and private medicine outlets with respect to availability and affordability parameters. METHODS A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days' wages required by the lowest paid government worker (LPGW) to purchase a one month's supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices. RESULTS Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO's target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month's supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively. CONCLUSIONS There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.
Collapse
Affiliation(s)
- Hachalu Dugasa Deressa
- School of Pharmacy, College of Health Sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia
- Addis Ababa City Administration Regional Health Bureau, Addis Ababa, Ethiopia
| | - Habtamu Abuye
- Department of Pharmacy, College of Medicine and Health Sciences, Wachemo University, Hossaena, Ethiopia
| | - Alemayehu Adinew
- School of Pharmacy, College of Health Sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, US
- Emory Global Diabetes Research Center of the Woodruff Health Sciences Center and Emory University, Atlanta, GA, US
| | - Tedla Kebede
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bruck Messele Habte
- School of Pharmacy, College of Health Sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia.
| |
Collapse
|
3
|
Shrestha R, Hayes B, Poudel A, Munday D. Availability and Affordability of Essential Palliative Care Medicines in Nepal: A cross-sectional study. J Pain Symptom Manage 2024:S0885-3924(24)00707-3. [PMID: 38582330 DOI: 10.1016/j.jpainsymman.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/26/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024]
Abstract
CONTEXT The government of Nepal adopted 2017 Nepalese National Strategy for Palliative Care (NSPC), which proposed that Essential Palliative Care Medicines (EPCMs) listed by International Association for Hospice and Palliative Care (IAHPC) should be available at each healthcare institution. In 2017 after the issuing of NSPC, the Lancet Commission developed an EPCM list. OBJECTIVE To evaluate the inclusion of EPCMs recommended by both IAHPC and Lancet in national medicinal programmes, their availability and affordability in Nepal. METHOD A cross-sectional descriptive study of availability of EPCMs in Nepal, their inclusion in National Essential Medicines List (NEML), Government Health Insurance Medicines List (GHIML), Government Fixed Rate Medicines List (GFRML) and free medicines list. Affordability was assessed using the WHO Daily-Define-Dose and the Nepal Government-defined minimum daily wage. RESULT 27/33(82%) of the IAHPC-EPCMs and 41/60(68%) of the recommended formulations were available in Nepal. All the Lancet Commission recommended EPCMs were available in Nepal. Morphine was available in all formulations used in palliative care. 22%, 18% and 10% of IAHPC-EPCMs were available cost free via district hospitals, primary health centres and health posts, respectively. Government had not included opioids on both free and fixed price list. 24/33(73%) of IAHPC-EPCMs were available on the GHIML. 19/41(46%) available EPCMs were affordable. CONCLUSION Many EPCM formulations included in NSPC of Nepal are not available, and most available EPCMs are unaffordable if purchased out-of-pocket. While the availability is better with government health insurance scheme, many people are not registered for this. Further improvements should follow the development of a Nepalese palliative care formulary.
Collapse
Affiliation(s)
| | | | - Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | | |
Collapse
|
4
|
Qashqari L, Shakweer D, Alzaben AS, Hanbazaza MA. Investigation of cost and availability of gluten-free food in Jeddah, KSA. J Taibah Univ Med Sci 2024; 19:422-428. [PMID: 38419959 PMCID: PMC10899026 DOI: 10.1016/j.jtumed.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/08/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
Objective The prevalence of celiac disease (CD) in KSA is progressively increasing. Consistent adherence to a gluten-free (GF) diet is the only effective CD treatment. The availability and cost of GF food are important factors in adherence to a GFD. The objective of this study was to investigate the cost and availability of GF food in a sample of local stores and supermarkets across Jeddah province in KSA. Method Eleven supermarkets in Jeddah, KSA, ranging from high budget/quality supermarkets to low-budget stores, were visited. Eight food categories were evaluated, including flour, breakfast cereals, breads, pastas, and snacks (e.g., biscuits, cookies, snack bars, and chips). The availability and cost of GF and gluten containing (GC) items within these food categories were recorded. Each item included in these food categories was counted, and the overall average price was calculated. Results A total of 233 GF and 24 GC products were found. Supermarket 1 had the highest availability of GF foods (n = 90), followed by supermarket 2 (n = 34), supermarket 3 (n = 30), supermarket 4 (n = 23), supermarket 5 (n = 21), supermarket 6 (n = 18), supermarket 7 (n = 9), and supermarket 8 (n = 8). The median price per 100 g was significantly greater for GF than GC products (p < 0.05). The cost of GF products was significantly higher than that of GC products (p < 0.05); consequently, GF foods were twice as expensive as their GC counterparts. Conclusion The availability of GF products was limited, and GF products were more expensive than standard GC products. High cost and limited availability are major roadblocks to GFD adherence among people with CD. Governmental organizations must cooperate with healthcare providers and food industries to ensure that GF foods are widely available and affordable for people with CD, to minimize financial pressure and improve health quality.
Collapse
Affiliation(s)
- Lamya Qashqari
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, KSA
| | - Dana Shakweer
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, KSA
| | - Abeer S Alzaben
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, KSA
| | - Mahitab A Hanbazaza
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, KSA
| |
Collapse
|
5
|
Marionneau V, Selin J, Impinen A, Roukka T. Availability restrictions and mandatory precommitment in land-based gambling: effects on online substitutes and total consumption in longitudinal sales data. BMC Public Health 2024; 24:809. [PMID: 38486180 PMCID: PMC10941527 DOI: 10.1186/s12889-024-18325-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/10/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Gambling causes important harms in societies. According to the public health approach, the most effective policies to reduce harms target full populations. Availability restrictions and mandatory precommitment are among the most effective measures. However, restrictions on the availability of some gambling products or channels may also be offset by increased consumption in other products. Substitution effects can have negative public health impacts due to differing harm potential across different gambling products. This paper uses longitudinal sales data (2019-2022) from the Finnish gambling monopoly Veikkaus. During the observation period, the availability of gambling was restricted in Finland due to subsequent waves of Covid-19-related restrictions. In addition, the gambling monopoly introduced mandatory precommitment to land-based EGMs. We focus on how these restrictive policy changes impacted the total consumption of gambling and possible substitution effects. METHODS The Finnish gambling monopoly provided weekly theoretical loss data per gambling product category and gambling channel (online, land-based) for the period of January 2019 - July 2022 based on a statutory obligation. We analysed the effects of availability restrictions and other public health measures on the consumption of different products using descriptive time series and regression analyses. We compared the sale of land-based products to online equivalents at product category level and included main policy change periods in the models. RESULTS Total consumption of gambling declined during 2019-2022 mainly due to reduced land-based electronic gambling machine (EGM) consumption. Declines in land-based EGM sales were not offset by online alternatives or other close substitutes in the long term. However, during the first wave of Covid-19, there was an observable substitution of land-based table games by online alternatives and land-based horse betting and possibly sports betting by online horse betting. Overall, the results also show that Covid-19 functioned as a boost to an already existing trend of increasing digitalisation of gambling. CONCLUSIONS The study provides empirical support for the effectiveness of public health-oriented policies in reducing the total consumption of gambling. Availability restrictions and mandatory precommitment are therefore likely to also reduce the burden of harms of gambling to individuals and societies.
Collapse
Affiliation(s)
- Virve Marionneau
- Centre for Research on Addiction, Control, and Governance (CEACG), Faculty of Social Sciences, University of Helsinki, Unioninkatu 33, Helsinki, 00014, Finland.
- Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00271, Finland.
| | - Jani Selin
- Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00271, Finland
| | - Antti Impinen
- Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00271, Finland
| | - Tomi Roukka
- Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00271, Finland
| |
Collapse
|
6
|
Li Y, Zhang M, Xu Y, Li X, Lu T. Availability, price, and affordability of anti-hepatitis B virus drugs: a cross-sectional study in China. Int J Clin Pharm 2024:10.1007/s11096-024-01706-0. [PMID: 38472597 DOI: 10.1007/s11096-024-01706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/20/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The global prevalence of hepatitis B virus (HBV) has presented a persistent challenge for public health prevention and treatment. However, studies that assess the public's access to anti-HBV drugs are absent. AIM To examine the availability, pricing, and affordability of anti-HBV drugs in Jiangsu province, China and provide recommendations for improvement. METHOD An enhanced methodology developed by the World Health Organization (WHO) and Health Action International was applied in a cross-sectional study that included 1026 healthcare facilities distributed in 13 prefectural-level cities in Jiangsu province. RESULTS Since almost all drugs had an availability of less than 30%, the accessibility of anti-HBV drugs was notably low. Primary healthcare facilities had the lowest availability, reporting 1.4% for Original Brands (OBs) and 1.7% for lowest-priced generics (LPGs). Furthermore, the northern Jiangsu region recorded the lowest availability at 0.7%. LPGs demonstrated higher availability than OBs, with median availability probabilities of 2.6% and 1.4%, respectively. The drugs listed on the WHO Essential Medicines List exhibited higher availability than those on other lists. The median price ratios for OBs, LPGs, and volume-based purchasing drugs were 0.83, 0.50, and 0.27, respectively, less than 1.5 times the international reference price. Despite favorable pricing, affordability rate was 23% for urban residents and 0% for rural residents, which was discouraging. CONCLUSION Low availability and affordability of anti-HBV drugs were observed. Policy recommendations should emphasize the improvement of LPG availability by incentivizing priority prescribing. Healthcare subsidies should be provided more effectively and equitably.
Collapse
Affiliation(s)
- Yue Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 210009, People's Republic of China
| | - Mengdie Zhang
- Department of Pharmaceutical Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yi Xu
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, People's Republic of China
| | - Xin Li
- Department of Pharmaceutical Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, People's Republic of China
| | - Tao Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 210009, People's Republic of China.
| |
Collapse
|
7
|
Thakral V, Raturi G, Sudhakaran S, Mandlik R, Sharma Y, Shivaraj SM, Tripathi DK, Sonah H, Deshmukh R. Silicon, a quasi-essential element: Availability in soil, fertilizer regime, optimum dosage, and uptake in plants. Plant Physiol Biochem 2024; 208:108459. [PMID: 38484684 DOI: 10.1016/j.plaphy.2024.108459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024]
Abstract
The essentiality of silicon (Si) has always been a matter of debate as it is not considered crucial for the lifecycles of most plants. But beneficial effects of endogenous Si and its supplementation have been observed in many plants. Silicon plays a pivotal role in alleviating the biotic and abiotic stress in plants by acting as a physical barrier as well as affecting molecular pathways involved in stress tolerance, thus widely considered as "quasi-essential". In soil, most of Si is found in complex forms as mineral silicates which is not available for plant uptake. Monosilicic acid [Si(OH)4] is the only plant-available form of silicon (PAS) present in the soil. The ability of a plant to uptake Si is positively correlated with the PAS concentration of the soil. Since many cultivated soils often lack a sufficient amount of PAS, it has become common practice to supplement Si through the use of Si-based fertilizers in various crop cultivation systems. This review outlines the use of natural and chemical sources of Si as fertilizer, different regimes of Si fertilization, and conclude by identifying the optimum concentration of Si required to observe the beneficial effects in plants. Also, the different mathematical models defining the mineral dynamics for Si uptake at whole plant scale considering various natural factors like plant morphology, mineral distribution, and transporter expression have been discussed. Information provided here will further help in increasing understanding of Si role and thereby facilitate efficient exploration of the element as a fertilizer in crop production.
Collapse
Affiliation(s)
- Vandana Thakral
- Department of Biotechnology, Central University of Haryana, Jant-Pali, Mahendragarh, Haryana, India; Department of Biotechnology, Panjab University, Chandigarh, India
| | - Gaurav Raturi
- Department of Biotechnology, Panjab University, Chandigarh, India
| | - Sreeja Sudhakaran
- Department of Biotechnology, Central University of Haryana, Jant-Pali, Mahendragarh, Haryana, India; Department of Biotechnology, Panjab University, Chandigarh, India
| | - Rushil Mandlik
- Department of Biotechnology, Central University of Haryana, Jant-Pali, Mahendragarh, Haryana, India; Department of Biotechnology, Panjab University, Chandigarh, India
| | - Yogesh Sharma
- Regional Centre for Biotechnology, Faridabad, Haryana, India
| | - S M Shivaraj
- Department of Science, Alliance University, Bengaluru, India
| | - Durgesh Kumar Tripathi
- Crop Nanobiology and Molecular Biology Lab, Amity Institute of Organic Agriculture (AIOA), Amity University, Noida, Uttar Pradesh, India
| | - Humira Sonah
- Department of Biotechnology, Central University of Haryana, Jant-Pali, Mahendragarh, Haryana, India.
| | - Rupesh Deshmukh
- Department of Biotechnology, Central University of Haryana, Jant-Pali, Mahendragarh, Haryana, India.
| |
Collapse
|
8
|
Lancaster KE, Stockton M, Remch M, Wester CW, Nash D, Brazier E, Adedimeji A, Finlayson R, Freeman A, Hogan B, Kasozi C, Kwobah EK, Kulzer JL, Merati T, Tine J, Poda A, Succi R, Twizere C, Tlali M, Groote PV, Edelman EJ, Parcesepe AM. Availability of substance use screening and treatment within HIV clinical sites across seven geographic regions within the IeDEA consortium. Int J Drug Policy 2024; 124:104309. [PMID: 38228025 PMCID: PMC10939808 DOI: 10.1016/j.drugpo.2023.104309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Overwhelming evidence highlights the negative impact of substance use on HIV care and treatment outcomes. Yet, the extent to which alcohol use disorder (AUD) and other substance use disorders (SUD) services have been integrated within HIV clinical settings is limited. We describe AUD/SUD screening and treatment availability in HIV clinical sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS In 2020, 223 IeDEA HIV clinical sites from 41 countries across seven geographic regions completed a survey on capacity and practices related to management of AUD/ SUD. Sites provided information on AUD and other SUD screening and treatment practices. RESULTS Sites were from low-income countries (23%), lower-middle-income countries (38%), upper-middle income countries (17%) and high-income counties (23%). AUD and SUD screening using validated instruments were reported at 32% (n=71 located in 12 countries) and 12% (n=27 located in 6 countries) of the 223 sites from 41 countries, respectively. The North American region had the highest proportion of clinics that reported AUD screening (76%), followed by East Africa (46%); none of the sites in West or Central Africa reported AUD screening. 31% (n=69) reported both AUD screening and counseling, brief intervention, psychotherapy, or Screening, Brief Intervention, and Referral to Treatment; 8% (n=18) reported AUD screening and detox hospitalization; and 10% (n=24) reported both AUD screening and medication. While the proportion of clinics providing treatment for SUD was lower than those treating AUD, the prevalence estimates of treatment availability were similar. CONCLUSIONS Availability of screening and treatment for AUD/SUD in HIV care settings is limited, leaving a substantial gap for integration into ongoing HIV care. A critical understanding is needed of the multilevel implementation factors or feasible implementation strategies for integrating screening and treatment of AUD/SUD into HIV care settings, particularly for resource-constrained regions.
Collapse
Affiliation(s)
| | - Melissa Stockton
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Molly Remch
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Denis Nash
- City University of New York (CUNY), New York, NY, USA
| | - Ellen Brazier
- City University of New York (CUNY), New York, NY, USA
| | | | | | - Aimee Freeman
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Breanna Hogan
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Judiacel Tine
- Centre Hospitalier National Universitaire de Fann, Dakar, Senagal
| | - Armel Poda
- Université Polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Regina Succi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Christelle Twizere
- Centre National de Référence en Matière de VIH/SIDA au Burundi, Bujumbura, Burundi
| | - Mpho Tlali
- University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | | | | |
Collapse
|
9
|
Lu VM, Niazi TN. The epidemiologic associations of food availability with national incidence and mortality rates of pediatric central nervous system tumors. Childs Nerv Syst 2024; 40:445-451. [PMID: 37606833 DOI: 10.1007/s00381-023-06134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The epidemiology of central nervous system (CNS) tumors in pediatric patients worldwide continues to be defined. To date, there has been no evaluation of how national food availability may associate with the incidence and mortality of these tumors. Correspondingly, the aim of this study was to define if such associations exist. METHODS The most updated incidence and mortality rates of CNS tumors in pediatric patients were abstracted by country from the Global Burden of Disease database. Data regarding food availability parameters were identified and abstracted from the Food Systems Dashboard database. Associations were tested using univariate and multivariate regression analyses. RESULTS There were sufficient data in a total of 175 countries worldwide describing the required outcomes. Median incidence and mortality rates across these countries were 1.63 per 100,000 and 0.80 per 100,000, respectively. Higher incidence rates of pediatric CNS tumors were statistically associated with lower availability of fruit and vegetables (P = 0.02), higher average protein supply (P < 0.01), lower share of dietary energy from cereal and roots (P < 0.01), lower supply of meat (P < 0.01), lower supply of nuts and seeds (P < 0.01), lower supply of vegetable oils (P < 0.01), and higher supply of vegetables (P < 0.01). Higher mortality rates due to pediatric CNS tumors were statistically associated with lower availability of fruit and vegetables (P = 0.048), lower supply of fish (P = 0.046), and lower supply of nuts and seeds (P = 0.04). When categorizing countries based on income status, there was a decrease in significant associations found more pronounced in low-middle income countries. CONCLUSIONS There are many novel associations between national food availability and the incidence and mortality rates of pediatric CNS tumors across the world, which may be more pronounced and divergent in low-middle income countries. A greater understanding is needed to identify what specific components of the significant parameters influence these trends and how public health efforts may best address these associations to improve overall outcomes.
Collapse
Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA.
- Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL, USA.
| | - Toba N Niazi
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
- Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL, USA
| |
Collapse
|
10
|
Nyarko E, Ameho EK, Iddi S, Asiedu L. Challenges associated with the availability, accessibility, and use of antivenoms for treating snakebite envenoming in Ghana: A MaxDiff experiment design. Toxicon 2024; 238:107594. [PMID: 38191031 DOI: 10.1016/j.toxicon.2023.107594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
Successful snakebite envenoming (SBE) treatment requires safe, effective, and quality-assured antivenom products specifically tailored to combat endemic venomous snake species. This study aims to identify the challenges associated with the availability, accessibility, and use of antivenoms for treating SBE. The data for this study were obtained from a cross-sectional study involving healthcare workers from two districts (namely Afram Plains North and Afram Plains South) in the Eastern Region of Ghana. Through the MaxDiff design methodology, we quantify the challenges associated with the availability, accessibility, and use of antivenoms. Responses from a simple random sample of 203 healthcare workers were included in this study. Participants identified the high cost of antivenoms as the most challenging factor that limits the availability, accessibility, and use of antivenoms for treating SBE. Other important challenges were the lack of access to effective antivenoms in remote areas when needed and the increased use of unorthodox and harmful practices, followed by resort to unorthodox and harmful practices and the lack of effective antivenoms to address envenoming from local species in some instances. However, poor outcomes from using substandard antivenoms, stock-outs, inadequate number of manufacturers, and the resort to substandard, cheap, and harmful antivenoms were traded off. Also, poor utilization of antivenoms, suboptimal utilization of antivenoms (low quality, under-dose), use of ineffective, substandard antivenoms, and flooding of the market with products that have not been evaluated thoroughly were underscored. Our findings provide essential data to guide discussions on barriers to the availability, accessibility, and use of antivenoms for treating SBE to improve the supply of antivenoms, enhance the effectiveness of snakebite treatment, and improve patient care quality in Ghana. Multi-component strategies are needed to address the challenges identified, such as intensified advocacy, ongoing education and community engagement, healthcare worker training, and leveraging institutional and governance structures.
Collapse
Affiliation(s)
- Eric Nyarko
- Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Box LG 115, Legon, Accra, Ghana.
| | - Ebenezer Kwesi Ameho
- Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Box LG 115, Legon, Accra, Ghana
| | - Samuel Iddi
- Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Box LG 115, Legon, Accra, Ghana
| | - Louis Asiedu
- Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Box LG 115, Legon, Accra, Ghana
| |
Collapse
|
11
|
Gakinahe GU, Rutungwa E, Mbonyinshuti F, Kayitare E. Availability of antimalarial medicines and inventory management at the community level: a case study of Bugesera district in Rwanda. BMC Health Serv Res 2024; 24:136. [PMID: 38267916 PMCID: PMC10809492 DOI: 10.1186/s12913-024-10605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Malaria is a public health hazard globally, with Sub-Saharan Africa accounting for more than 90% of malaria deaths, primarily affecting children under the age of five. In Rwanda, malaria interventions include the availability of antimalarial medications, notably Artemisinin-based combination treatments (ACTs) and quick diagnostic test kits (RDTs). However, the availability of antimalarial medicines and its related inventory management at community level in Rwanda has yet to be identified. METHODS The study was conducted using a descriptive cross-sectional research design. The study involved the Community Health Workers (CHWs) in Bugesera District, working as a team of one male-female pair called Binômes. CHWs provide Integrated Community Case Management (iCCM) and treatment of Malaria in the villages. The sample size was 295 and respondents were selected using convenient random sampling from 15 sectors of Bugesera District, each cell being represented. A structured research questionnaire was used to collect data. The questionnaires were filled by CHWs who were available for this study at the time of data collection. Collected data were exported to SPSS version 26 for coding and analysis. RESULTS The CHWs reported to be actively involved in managing the antimalarial medicines inventory. Overall, 64.1% of CHWs indicated that the population could easily obtain antimalarial medicines from community health workers and 31.2% attested that people could also obtain antimalarial medicines from the health centers. Majority of respondents 78% confirmed that the CHWs had the appropriate storage conditions for antimalarial medicines, while the overall stock out recorded was 3.20%. Furthermore, CHWs described some challenges, including but not limited to, lack of appropriate or dependable transportation and inappropriate medicines storage. Transportation was reported as a critical barrier for accessing antimalarial medicines. The majority, 70,85% travel on foot while 25.4% reported that CHWs walk for a distance between 1 and 2 h for resupply of antimalarial medicines. CONCLUSION This study investigated the availability of antimalarial medicines and inventory management challenges at community level in Rwanda. Addressing these challenges will reduce the rate of stockout and increase the availability of antimalarial medicine at community level. Appropriate storage, and reduction of stock out rate, will serve to strengthen the current CHWs system, and provide critical guidance for the evolution of CHWs' systems in Rwanda.
Collapse
Affiliation(s)
- Godelive Umulerwa Gakinahe
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Eugene Rutungwa
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- School of Business, College of Business and Economics, University of Rwanda, Kigali, Rwanda.
| | | | - Egide Kayitare
- School of Medicine and Pharmacy, College of Medicine and health sciences, University of Rwanda, Kigali, Rwanda
| |
Collapse
|
12
|
Lane J, Nakambale H, Kadakia A, Dambisya Y, Stergachis A, Odoch WD. A systematic scoping review of medicine availability and affordability in Africa. BMC Health Serv Res 2024; 24:91. [PMID: 38233851 PMCID: PMC10792840 DOI: 10.1186/s12913-023-10494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The most recent World Medicines Situation Report published in 2011 found substantial medicine availability and affordability challenges across WHO regions, including Africa. Since publication of the 2011 report, medicine availability and affordability has risen on the international agenda and was included in the Sustainable Development Goals as Target 3.8. While numerous medicine availability and affordability studies have been conducted in Africa since the last World Medicines Situation Report, there has not been a systematic analysis of the methods used in these studies, measures of medicine availability and affordability, categories of medicines studied, or geographic distribution. Filling this knowledge gap can help inform future medicine availability and affordability studies, design systems to monitor progress toward Sustainable Development Goal Target 3.8 in Africa and beyond, and inform policy and program decisions to improve medicine availability and affordability. METHODS We conducted a systematic scoping review of studies assessing medicine availability or affordability conducted in the WHO Africa region published from 2009-2021. RESULTS Two hundred forty one articles met our eligibility criteria. 88% of the articles (213/241) reported descriptive studies, while 12% (28/241) reported interventional studies. Of the 198 studies measuring medicine availability, the most commonly used measure of medicine availability was whether a medicine was in stock on the date of a survey (124/198, 63%). We also identified multiple other availability methods and measures, including retrospective stock record reviews and self-reported medicine availability surveys. Of the 59 articles that included affordability measures, 32 (54%) compared the price of the medicine to the daily wage of the lowest paid government worker. Other affordability measures were patient self-reported affordability, capacity to pay measures, and comparing medicines prices with a population-level income standard (such as minimum wage, poverty line, or per capita income). The most commonly studied medicines were antiparasitic and anti-bacterial medicines. We did not identify studies in 22 out of 48 (46%) countries in the WHO Africa Region and more than half of the studies identified were conducted in Ethiopia, Kenya, Tanzania, and/or Uganda. CONCLUSION Our results revealed a wide range of medicine availability and affordability assessment methodologies and measures, including cross-sectional facility surveys, population surveys, and retrospective data analyses. Our review also indicated a need for greater focus on medicines for certain non-communicable diseases, greater geographic diversity of studies, and the need for more intervention studies to identify approaches to improve access to medicines in the region.
Collapse
Affiliation(s)
- Jeff Lane
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Hilma Nakambale
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Asha Kadakia
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Yoswa Dambisya
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Andy Stergachis
- Departments of Pharmacy and Global Health, Schools of Pharmacy and Public Health, University of Washington, Seattle, WA, USA
| | - Walter Denis Odoch
- Afya Research and Development Institute, Kampala, Uganda
- World Health Organization, Harare, Zimbabwe
| |
Collapse
|
13
|
Kabera JC, Mukanyangezi MF. Influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: a case of Rwanda Southern Province. BMC Health Serv Res 2024; 24:14. [PMID: 38178088 PMCID: PMC10768461 DOI: 10.1186/s12913-023-10459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Stock-outs of some life-saving drugs, such as emergency obstetric drugs, are evident in many health facilities and have been reported to be the leading cause of maternal mortality and morbidity for women from low and middle income countries (LMICs). For many cases, this situation is associated with poor inventory management practices. The aim of this study was to investigate the influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: case of the Rwanda Southern Province. Moreover, to gain a better grasp of the problem and to suggest possible areas for improvement. METHODS An institutional-based cross-sectional study was carried out in all ten district hospitals (DHs) providing maternal health care and dispensing emergency obstetric drugs namely; Kigeme DH, Munini DH, Kabutare DH, Kibilizi DH, Gakoma DH, Nyanza DH, Ruhango DH, Gitwe DH, Kabgayi DH and Remera Rukoma DH. Both quantitative and qualitative data were collected and analyzed. Oxytocin injection, Misoprostol tablet and Magnesium sulphate injection as recommended emergency obstetric drugs by WHO, UNFPA and Rwanda Essential Medicines list were included in the study. RESULTS The study revealed that keeping logistics management tools up to date is the backbone of inventory management practices in the availability of medicines and medical supplies. The results showed that hospitals with up-to-date logistics tools for their pharmaceutical management were 33.25 times more likely to have their emergency obstetric drugs in stock at all times compared to those that do not regularly update their logistics tools. The proper use of bin cards and electronic software (e-LMIS) contributed greatly to reducing the stock-out rate of emergency obstetric drugs by 89.9% and reduction of unusable to usable stock ratio by appropriate use of simple techniques such as the Min-Max inventory control model by 79%. Over an 18-month period, misoprostol tablet had the highest average days (32) of stock-outs (5.9%), followed by magnesium sulphate injection with an average of 31 days (5.7%), and oxytocin injection with an average of 13 days (2.4%). CONCLUSION Proper use of pharmaceutical management tools within hospitals premises positively influence the availability of life-saving drugs, such as emergency obstetric drugs. Adequate supply chain staffing in health facilities is the most important key to improving inventory management practices and medicine availability.
Collapse
Affiliation(s)
- Jean Claude Kabera
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicines and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Marie Françoise Mukanyangezi
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| |
Collapse
|
14
|
Eshetu BK, Tafere TZ, Asrade G, Haile TG. Process evaluation of the 90-90-90 targets of surge project in Addis Ababa, Ethiopia: a case study evaluation. BMC Health Serv Res 2024; 24:5. [PMID: 38166848 PMCID: PMC10763381 DOI: 10.1186/s12913-023-10415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) is a major public health problem that continues to pose an enormous challenge to mankind's survival worldwide. In urban Ethiopia, the HIV prevalence among adults aged 15-49 years is 2.9%, while in Addis Ababa, it is 3.4%. To take the edge off, the Ethiopian government has been implementing the 90-90-90 strategy also known as the surge project, in urban cities. However, the implementation of the program has not been evaluated. Thus, we evaluated the process of the 90-90-90 targets of the surge project in Addis Ababa, Ethiopia. METHODS We conducted a case study with concurrent mixed-methods evaluation. We used indicator-driven evaluation dimensions -availability and accommodation dimensions from the health services access and compliance and fidelity from implementation fidelity frameworks to test the program process theory with a total of 52 indicators. We interviewed a total of 419 clients and 210 healthcare providers and reviewed 417 clients' cards and 17 registries. We also conducted 30 key informant interviews and resource inventory. A binary logistic regression analysis was done to identify factors associated with clients' satisfaction. We transcribed and translated the qualitative data and analysed thematically. Finally, we judged the overall process of the surge project based on the pre-seated judgmental criteria as; needs urgent improvement, needs improvement and well implemented. RESULTS We found that 90% of the project process was as per the program process theory measured by the availability of resources (95.8%), compliance (88.0%), fidelity (84.7%), and accommodation of services (89.3%). We found a shortage of human power, test kits, and viral load testing machines. The commitment of health care providers, provider-client interaction, and clients' satisfaction with the service at card rooms were found to be poor. Moreover, being aged 15-24, being married and government government-employed were negatively associated with clients' satisfaction with antiretroviral therapy services. CONCLUSION The process of the surge project needs improvement. Moreover, the achievements of the first two 90-90 targets were poor. Therefore, implementers need to take intensified action for the availability of resources and to improve the commitment of healthcare providers through refreshment training.
Collapse
Affiliation(s)
| | - Tesfahun Zemene Tafere
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Geta Asrade
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Tsegaye Gebremedhin Haile
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| |
Collapse
|
15
|
Ge X, Fan Y, Zhai H, Chi J, Putnis CV, Wang L, Zhang W. Direct observations of nanoscale brushite dissolution by the concentration-dependent adsorption of phosphate or phytate. Water Res 2024; 248:120851. [PMID: 37976955 DOI: 10.1016/j.watres.2023.120851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
With the development of agricultural intensification, phosphorus (P) accumulation in croplands and sediments has resulted in the increasingly widespread interaction between inorganic and organic P species, which has been, previously, underestimated or even ignored. We quantified the nanoscale dissolution kinetics of sparingly soluble brushite (CaHPO4·2H2O, DCPD) over a broad range of phosphate and/or phytate concentrations by using in situ atomic force microscopy (AFM). Compared to water, we found that low concentrations of phosphate (1-1000 µM) or phytate (1-100 µM) inhibited brushite dissolution by slowing single step retraction. However, with increasing phosphate or phytate concentrations to 10 mM, there was a reverse effect of dissolution promotion at brushite-water interfaces. In situ observations of the coupled dissolution-reprecipitation showed that phosphate precipitated more readily than phytate on brushite surfaces, with the formation of amorphous calcium phosphate (ACP). For a fundamental understanding, zeta potential and in situ Raman spectroscopy (RS) revealed that the concentration-dependent dissolution is attributed to the reverse of outer-sphere to inner-sphere adsorption with increasing phosphate or phytate concentrations. In addition, the mineralization of phytate with outer-sphere adsorption by phytase was higher than that with inner-spere adsorption, and the presence of phytate delayed ACP phase transformation to hydroxylapatite (HAP). These in situ observations and analyses may fill the knowledge gaps of interaction between inorganic and organic P species in P-rich terrestrial and aquatic environments, thereby implicating their biogeochemical cycling and the associated availability.
Collapse
Affiliation(s)
- Xinfei Ge
- College of Resources and Environment, Huazhong Agricultural University, Wuhan 430070, China; Department of Environmental Science, Zhejiang University, Hangzhou 310058, China; Zhejiang Provincial Key Laboratory of Organic Pollution Process and Control, Hangzhou 310058, China
| | - Yuke Fan
- College of Resources and Environment, Huazhong Agricultural University, Wuhan 430070, China
| | - Hang Zhai
- Department of Civil and Environmental Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Jialin Chi
- College of Resources and Environment, Huazhong Agricultural University, Wuhan 430070, China
| | - Christine V Putnis
- Institut für Mineralogie, University of Münster, Münster 48149, Germany; School of Molecular and Life Sciences, Curtin University, Perth 6845, Australia
| | - Lijun Wang
- College of Resources and Environment, Huazhong Agricultural University, Wuhan 430070, China
| | - Wenjun Zhang
- College of Resources and Environment, Huazhong Agricultural University, Wuhan 430070, China.
| |
Collapse
|
16
|
Han Z, Zhang D, Fan L, Zhang J, Zhang M. A Dynamic Bayesian Network model to evaluate the availability of machinery systems in Maritime Autonomous Surface Ships. Accid Anal Prev 2024; 194:107342. [PMID: 37871387 DOI: 10.1016/j.aap.2023.107342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/21/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Abstract
With their complex structure, multiple failure modes and lack of maintenance crew, the safety problem of Maritime Autonomous Surface Ships' (MASS) machinery systems are becoming an important research topic. The present study presents an availability model for ship machinery systems incorporating a maintenance strategy based on Dynamic Bayesian Networks (DBN). First, the availability of conventional ship machinery systems is evaluated and used as a benchmark based on the configuration and planned maintenance strategy. Secondly, the availability of MASS machinery systems is compared to the benchmark, before the introduction of any changes to the ship's configuration and planned maintenance strategy. Finally, the availability improvement strategies, including redundant designs and planned maintenance strategies at port, are proposed based on sensitivity analysis and planned maintenance cost minimization. To exemplify the model's application, a case study of a cooling water system is explored. Based on a sensitivity analysis using the model, it is possible to decide which components need to be redundant. Different redundancy designs and corresponding planned maintenance strategies can be adopted to meet the availability demand. It is also shown that redundancy and enhanced detection capabilities reduce much of the planned maintenance cost. This framework can be used in the early design stages to determine whether the MASS machinery systems' availability is at least equivalent to that of conventional ships, and has certain reference significance for redundant configuration designs and MASS planned maintenance strategy schedule.
Collapse
Affiliation(s)
- Zhepeng Han
- School of Transportation and Logistics Engineering, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China; Intelligent Transportation Systems Research Center, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China
| | - Di Zhang
- School of Transportation and Logistics Engineering, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China; State Key Laboratory of Maritime Technology and Safety, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China; National Engineering Research Center for Water Transport Safety, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China
| | - Liang Fan
- Intelligent Transportation Systems Research Center, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China; State Key Laboratory of Maritime Technology and Safety, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China; National Engineering Research Center for Water Transport Safety, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China.
| | - Jinfen Zhang
- Intelligent Transportation Systems Research Center, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China; State Key Laboratory of Maritime Technology and Safety, Wuhan University of Technology, 1040 Heping Avenue, Wuhan, Hubei 430063, PR China; Inland Port and Shipping Industry Research Co. Ltd. Shaoguan, Guangdong 512100, PR China
| | - Mingyang Zhang
- Department of Mechanical Engineering, Marine Technology Group, Aalto University, Espoo, Finland
| |
Collapse
|
17
|
Deng J, Mayai AT, Kayitare E, Ntakirutimana T, Swallehe O, Bizimana T. Assessment of prices, availability and affordability of essential medicines in Juba County, South Sudan. J Pharm Policy Pract 2023; 16:172. [PMID: 38158563 PMCID: PMC10757353 DOI: 10.1186/s40545-023-00675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Access to safe, effective, affordable, and high-quality medications has been included in the Sustainable Development Goals (SDGs) of the United Nations as a crucial step towards attaining universal health coverage. Access to medicines is a fundamental human right. If medicines are accessible and affordable, they save lives by reducing mortality and morbidity associated with acute and chronic diseases. WHO recommends that all countries voluntarily reach the minimum target of 80% availability of medicines by 2025. The primary purpose of this research is to assess access to essential medicines in Juba County, South Sudan. METHODS This study was undertaken using the standard World Health Organization/Health Action International Organization (WHO/HAI) approach for surveying the prices, availability, and affordability of medicines. A survey was conducted in six payams of Juba County, South Sudan, and 55 health facilities were assessed. RESULTS Prices for generic medicines were better in faith-based health facilities with a median price ratio of 1.95. Private pharmacies and private clinics had MPRs of 4.64 and 4.32, respectively. Local prices were high compared to International referent prices. Availability of medicines was highest in the faith-based health facilities (65.5%) and slightly lower in private pharmacies (55.4%), private clinics (57.7%) and public (50.4%) sectors. Most of the surveyed medicines were unaffordable. The medicines needed to treat non-communicable diseases cost up to 33.7-day wages for one full course of treatment. CONCLUSIONS In South Sudan, medicines are poorly available in all sectors. Medicines are affordable in the public sector but Most medicines are unaffordable in private pharmacies, private clinics and faith-based health facilities. Poor medicines availability in the public sector contributes to the overall unaffordability of medicines in all the other sectors.
Collapse
Affiliation(s)
- Justin Deng
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Egide Kayitare
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences (CMHS), University of Rwanda, Kigali, Rwanda.
| | - Theoneste Ntakirutimana
- Department of Environmental Health Sciences, School of Public Health, College of Medicine and Health Sciences (CMHS), University of Rwanda, Kigali, Rwanda
| | - Omary Swallehe
- Department of Business Studies, School of Business, Dar es Salaam Campus College, Mzumbe University, Mzumbe, Tanzania
| | - Thomas Bizimana
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences (CMHS), University of Rwanda, Kigali, Rwanda
| |
Collapse
|
18
|
Sarnola K, Koskinen H, Klintrup K, Astrup C, Kurko T. Uptake and availability of new outpatient cancer medicines in 2010-2021 in Nordic countries - survey of competent authorities. BMC Health Serv Res 2023; 23:1437. [PMID: 38110924 PMCID: PMC10729379 DOI: 10.1186/s12913-023-10421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Nordic countries excel in cancer care, but studies on uptake, costs, or managed entry agreements of cancer medicines have not been conducted recently. The aim of this study was to examine the uptake and availability of orally administered new cancer medicines in Nordic countries. Orally administered cancer medicines enable and are used in the community as part of outpatient care. Firstly, we studied the distribution, costs and adoption of managed entry agreements of these medicines, and secondly, uptake of and managed entry agreements for cancer medicines used in outpatient care that were granted marketing authorization in Europe in 2010-2021. METHODS An E-mail survey of competent authorities, meaning pharmaceutical service organizers, payers or other government or non-government actors developing pharmaceutical service operations, in Denmark, Finland, Iceland, Norway, and Sweden in April-June 2022. The data were analysed using frequencies and percentages for descriptive analysis. RESULTS The distribution of cancer medicines has similarities in Finland, Iceland, Norway, and Sweden, where cancer medicines can be distributed both via hospitals or hospital pharmacies for inpatient use, and via community pharmacies for outpatient use. In Denmark, cancer medicines are predominantly distributed via publicly funded hospitals. In all countries that provided data on the costs, the costs of cancer medicines had notably gone up from 2010 to 2021. The number of reimbursable medicines out of new cancer medicines varied from 36 products in Denmark and Iceland to 51 products in Sweden, out of 67 studied products. Managed entry agreements, often with confidential discounts, were in use in all Nordic countries. The number of agreements and the cancer types for which agreements were most often made varied from three agreements made in Iceland to 35 agreements made in Finland, out of 67 studied products. Average days from authorization to reimbursement of new cancer medicines varied from an average of 416 to 895 days. CONCLUSIONS Nordic countries share similar characteristics but also differ in terms of the details in distribution, adopted managed entry agreements, market entry, and availability of new orally administered cancer medicines used in the outpatient care. The costs of cancer medicines have increased in all Nordic countries during the last decade. Due to differences in health care and because orally administered cancer medicines can be dispensed at community and hospital pharmacies in all studied countries other than Denmark, the number of reimbursable medicines and managed entry agreements vary between countries. However, Nordic countries show good agreement for 2010 to 2021 in entry and reimbursement decisions of novel cancer medicines.
Collapse
Affiliation(s)
- Kati Sarnola
- Research Unit, Social Insurance Institution of Finland (Kela), P.O. Box 450, Helsinki, 00056 KELA, Finland.
| | - Hanna Koskinen
- Research Unit, Social Insurance Institution of Finland (Kela), P.O. Box 450, Helsinki, 00056 KELA, Finland
| | - Katariina Klintrup
- Medical Advisory Centre, Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - Cecilie Astrup
- Business Intelligence and Health Economy, Amgros I/S, Copenhagen, Denmark
| | - Terhi Kurko
- Research Unit, Social Insurance Institution of Finland (Kela), P.O. Box 450, Helsinki, 00056 KELA, Finland
| |
Collapse
|
19
|
Engelbrecht-Wiggans EA, Sundel MH, Newland JJ, Seyoum N, Brown RF. Parental leave policies in general surgery residencies. Am J Surg 2023:S0002-9610(23)00663-3. [PMID: 38160066 DOI: 10.1016/j.amjsurg.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Prospective residents use program websites to glean information regarding parental leave policies. This study investigates the online availability and content of parental leave policies for general surgery residency programs. METHODS Parental leave policy information was collected from general surgery residency program and Graduate Medical Education (GME) websites. Descriptive statistics and multivariable logistic regression were used for analysis. RESULTS Of the 344 general surgery residency programs, parental leave policies were found on 6% of program and 52% of GME websites. Family Medical Leave Act policies were reported the most, followed by maternity, then paternity, and then adoption/other clauses. Academic programs, program location in the Southeastern US and larger program size were all significant predictors of online policy availability. CONCLUSIONS General surgery parental leave policies vary and are not readily available online. These findings identify a significant opportunity for surgery residency programs to improve the disclosure of parental leave policy information.
Collapse
Affiliation(s)
| | - Margaret H Sundel
- University of Maryland Medical Center, Department of Surgery, 22 S Greene St, Baltimore, MD, 21201, USA.
| | - John J Newland
- University of Maryland Medical Center, Department of Surgery, 22 S Greene St, Baltimore, MD, 21201, USA.
| | - Nahom Seyoum
- University of Maryland School of Medicine, 655 W Baltimore St S, Baltimore, MD, 21201, USA.
| | - Rebecca F Brown
- University of Maryland Medical Center, Department of Surgery, 22 S Greene St, Baltimore, MD, 21201, USA.
| |
Collapse
|
20
|
Yuan Y, Liu S, Huang Y, Zi J, Chen CE. In Situ Understanding of the Effect of Manure on the Availability of Sulfonamide Antibiotics in Soils Using DGT. Bull Environ Contam Toxicol 2023; 112:9. [PMID: 38081971 DOI: 10.1007/s00128-023-03831-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023]
Abstract
In this study, the effects of manure on the availability of sulfonamide antibiotics (SAs) in soils were explored in situ by the Diffusive gradients in thin films (DGT) technique. Five antibiotics, including sulfadiazine (SDZ), sulfamethoxazole (SMX), sulfamethazine (SMZ), sulfachloropyridazine (SCP), and sulfadimethoxine (SDM), were selected as target compounds. Results showed that the manure application to soil could reduce the antibiotic availability indicated by DGT. DGT measurement (CDGT) showed good correlations with the soil solution concentrations (Cd). Manure application can suppress the fluxes of SAs from the soil to the soil solution. Using the DGT-induced soil/sediment flux model (DIFS), the labile pool size (Kdl), the rate constants (k1, k-1) of adsorption and desorption and response time (Tc) of SAs in soils were obtained. The addition of manure increased extractable fraction, labile pool size (Kdl) and k1 but decreased k-1. Together with the nonlinear relationship between DGT fluxes and the reciprocal of diffusive layer thickness (Δg), these findings suggested that the release of SAs from soil particles into the soil solution is thermodynamically and kinetically limited, and the manure application could enhance this limitation. This study offers insight into antibiotic availability in soils caused by manure application.
Collapse
Affiliation(s)
- Yilin Yuan
- School of Environment/Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Sisi Liu
- School of Environment/Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Yuerui Huang
- School of Environment/Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Jinxin Zi
- School of Environment/Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Chang-Er Chen
- School of Environment/Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China.
| |
Collapse
|
21
|
Malheiro C, Prodana M, Cardoso DN, Soares AMVM, Morgado RG, Loureiro S. Soil habitat function after innovative nanoagriproducts application: Effect of ageing on the avoidance behaviour of the soil invertebrates Enchytraeus crypticus and Folsomia candida. Sci Total Environ 2023; 901:165955. [PMID: 37536601 DOI: 10.1016/j.scitotenv.2023.165955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023]
Abstract
Research on nanotechnology with applications in agriculture has been gathering attention because it may achieve a good balance between agricultural production and environmental integrity. Among the vast nanomaterials, layered double hydroxides (LDHs) are a promising solution for supplying crops with macro- and/or micronutrients. Still, little is known about their safety implications for non-target organisms, such as soil invertebrates. The habitat function of soils might be impacted by potential stressors, which can be assessed through avoidance behaviour tests. This study aimed to assess the effect of two innovative agriproducts, Zn-Al-NO3 LDH and Mg-Al-NO3 LDH, on the avoidance behaviour of the enchytraeid Enchytraeus crypticus and the collembolan Folsomia candida, over time. Simultaneously, Zn and Mg potential release from LDHs to soil was evaluated. Overall, the behaviour of soil invertebrates differed between species, with enchytraeids being more sensitive to LDHs-treated soils than collembolans, possibly explained by their different physiological traits. The behaviour of soil organisms also depended on the LDH structural composition and was time-variable. Soil treated with Zn-Al-NO3 LDH was perceived as less favourable compared to Mg-Al-NO3 LDH, which was preferred to clean soil at most tested concentrations. LDHs toxicity was partly, but not exclusively, related to Zn and Mg release. Cations release over time was demonstrated in the chemical assessment. Still, LDHs toxicity to soil invertebrates decreased as increasing AC50 values were derived over time. Slower dissolution over time might explain the decrease in toxicity. Our study demonstrates that both soil invertebrates could sense LDHs in soil and eventually adapt their behaviour by avoiding or preferring, according to the type and level of LDH present.
Collapse
Affiliation(s)
- C Malheiro
- CESAM - Centre for Environmental and Marine Studies & Department of Biology, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
| | - M Prodana
- CESAM - Centre for Environmental and Marine Studies & Department of Biology, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - D N Cardoso
- CESAM - Centre for Environmental and Marine Studies & Department of Biology, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - A M V M Soares
- CESAM - Centre for Environmental and Marine Studies & Department of Biology, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - R G Morgado
- CESAM - Centre for Environmental and Marine Studies & Department of Biology, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - S Loureiro
- CESAM - Centre for Environmental and Marine Studies & Department of Biology, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| |
Collapse
|
22
|
Ayako JA, Karimi PN, Rutungwa E, Ngenzi JL, Nyongesa KW, Jillo RH, Kavere MH, Shambaro AG. Factors affecting the availability of tracer health commodities in public facilities at Tana River County, Kenya. J Pharm Policy Pract 2023; 16:145. [PMID: 37968772 PMCID: PMC10648676 DOI: 10.1186/s40545-023-00658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Delivery of quality healthcare is significantly based on the level of commitment among health facilities. This includes building a strong system with the continued availability of tracer commodities. Human resources, financing, health information provision, and technologies integrated into the care environment have been vital in defining improved care. METHODS This was a cross-sectional study conducted in health facilities in Tana River County. A census method was used where all 62 health facilities across different tiers of healthcare delivery were considered. Out of 62 facilities, 60 participated in the study. A structured questionnaire and a checklist were used to collect data. Data were analysed using both descriptive and inferential statistics at 0.05 level of significance. Statistical Package for Social Sciences version 26 was used for data analysis. RESULTS Majority of the participants were nurses (71.7%), male (68.3%), and diploma holders (78.3%). The mean availability of the tracer commodities was 68.73%. The human resource-related factors influencing availability were personnel training on commodity management (β = 4.56, 95%CI 2.29-11.21, p = 0.012) and presence of pharmaceutical technicians dispensing commodities (β = 2.85, 95%CI 1.29-5.21, p = 0.005) Financial factors investigated revealed that those who were in county hospitals (β = 19.11, 95%CI 7.39-30.83, p = 0.002) and facilities which has disbursement of budgetary allocation on time (β = 12.08, 95%CI 3.11-23.57, p = 0.002) had higher availability of tracer commodities. CONCLUSION There was moderate availability of tracer commodities which was influenced by training, personnel, level of the facility, and budget allocation on time.
Collapse
Affiliation(s)
- Japheth Araka Ayako
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Tana River County Government (004), Mombasa, Kenya
| | | | - Eugene Rutungwa
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- School of Business, College of Business and Economics, University of Rwanda, Kigali, Rwanda.
| | - Joseph Lune Ngenzi
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | | | | |
Collapse
|
23
|
Mkamba BS, Rutungwa E, Karimi PN, Ngenzi JL. Factors that influence the availability of childhood vaccine in healthcare facilities at Tana River County, Kenya. J Pharm Policy Pract 2023; 16:142. [PMID: 37957739 PMCID: PMC10641990 DOI: 10.1186/s40545-023-00648-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Routine vaccine is a cost-effective health intervention against vaccine preventable diseases (VPD). Tremendous gains have been realized since the introduction of vaccines. Despite the gains, access to the lifesaving commodity has remained a major obstacle globally. Various factors have been associated with vaccine stock-out. This research assessed the factors that influence the availability of vaccines in healthcare facilities at Tana River County in Kenya. METHODS Cross-sectional design was adopted. Census sampling technique was used where all 61 immunizing healthcare facilities were included. The study was carried out in Tana River County which is located in the coastal part of Kenya. A structured questionnaire was used to collect the data. The researchers requested for authorization from relevant bodies and consent from participants. Data were collected, cleaned and recorded in Microsoft excel. STATA version 14 was used to analyze data. Both descriptive and inferential statistics were used in the analysis at 0.05 level of significance. RESULTS The study revealed that 62.71% of the facilities experienced routine vaccine stock-out. There was statistically significant association between availability of vaccines and work experience (p = 0.001), training on immunization services (p = 0.027), catchment area map with target population displayed in the facility (p = 0.049), and use of target population method in vaccine forecasting (p = 0.004). The independent predictor of vaccine availability was work experience (p = 0.025). CONCLUSION There was inadequate vaccine forecasting, vaccine stock management practices and accountability. Work experience was the main factor that affected their availability in the health facilities.
Collapse
Affiliation(s)
- Billy Said Mkamba
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicines and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Eugene Rutungwa
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicines and Health Sciences, University of Rwanda, Kigali, Rwanda.
- School of Business, College of Business and Economics, University of Rwanda, Kigali, Rwanda.
| | | | - Joseph Lune Ngenzi
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicines and Health Sciences, University of Rwanda, Kigali, Rwanda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| |
Collapse
|
24
|
Hu M, Xu M, Chen Y, Ye Z, Zhu S, Cai J, Zhang M, Zhang C, Huang R, Ye Q, Ao H. Therapeutic potential of toosendanin: Novel applications of an old ascaris repellent as a drug candidate. Biomed Pharmacother 2023; 167:115541. [PMID: 37738795 DOI: 10.1016/j.biopha.2023.115541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 09/24/2023] Open
Abstract
Toosendanin (TSN), extracted from Melia. toosendan Sieb.et Zucc. and Melia. azedarach L., has been developed into an ascaris repellent in China. However, with the improvement of public health protection, the incidence of ascariasis has been reduced considerably, resulting in limited medical application of TSN. Therefore, it is questionable whether this old ascaris repellent can develop into a drug candidate. Modern studies have shown that TSN has strong pharmacological activities, including anti-tumor, anti-botulinum, anti-viral and anti-parasitic potentials. It also can regulate fat formation and improve inflammation. These researches indicate that TSN has great potential to be developed into a corresponding medical product. In order to better development and application of TSN, the availability, pharmacodynamics, pharmacokinetics and toxicology of TSN are summarized systematically. In addition, this review discusses shortcomings in the current researches and provides useful suggestions about how TSN developed into a drug candidate. Therefore, this paper illustrates the possibility of developing TSN as a medical product, aimed to provide directions for the clinical application and further research of TSN.
Collapse
Affiliation(s)
- Minghao Hu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China
| | - Min Xu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China
| | - Yuchen Chen
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China
| | - Zhangkai Ye
- Xinjiang Normal University, Urumqi 830017, Xinjiang, China
| | - Shunpeng Zhu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China
| | - Jia Cai
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China
| | - Mengxue Zhang
- First School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Chi Zhang
- School of health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China
| | - Ruizhen Huang
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China.
| | - Qiang Ye
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China.
| | - Hui Ao
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China; Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, China.
| |
Collapse
|
25
|
Dine RD, Uwamahoro V, Oladapo JO, Eshun G, Effiong FB, Kyei-Arthur F, Tambe AB. Assessment of the availability, accessibility, and quality of sexual and reproductive health services for young people in conflict affected zones of Cameroon: a mixed method study. BMC Health Serv Res 2023; 23:1159. [PMID: 37884966 PMCID: PMC10601185 DOI: 10.1186/s12913-023-10142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Despite ongoing programs to improve young people's Sexual and Reproductive Health Services (SRHS) in the conflict plagued North West and South West Regions of Cameroon, there is limited evidence-based information evaluating SRHS. This study, therefore, aims to investigate the availability, accessibility, and quality of SRHS provided to young people in the North West and South West Regions of Cameroon. METHOD This is a cross-sectional mixed-methods sequential explanatory study conducted among healthcare providers and young people between 10 and 24 years in 6 selected urban and rural areas in North West and South West regions. Data was collected between December 2021 and September 2022 using an adopted checklist. A descriptive analysis was conducted for quantitative data. An inductive analysis was conducted for the qualitative data to construct themes. The findings from the quantitative and qualitative responses were triangulated. RESULTS There were 114 participants, 28 healthcare providers and 86 young people. Most provider participants were nurses (n = 18, 64.3%), working in religious facilities (n = 14, 50.0%), with diplomas as state registered nurses (n = 9, 32.1%). Also, more than half of young people (51.2%) were less than 20 years old, while there were more male young people (51.2%) than female young people (48.8%). Most respondents agreed that SRHS services were available, though they think they are not designed for young people and have limited awareness campaigns about the services. Reasons such as limited use of written guidelines, affected quality of SRHS. Participants revealed shyness, resistance from religious groups and families, insecurities from political instability, and inadequate training, among others, as barriers to SRH accessibility. CONCLUSION The study shows that SRHS are available but are not specifically designed for young people. Inadequate publicity for these services, coupled with the political crises and the ongoing COVID-19 pandemic, has increased young people's inaccessibility to SRHS. Young people usually have to finance the cost of most of the SRHS. The quality of service delivery in the facilities is inadequate and must therefore be improved by developing safe, youth-friendly centers staffed with well-trained service providers.
Collapse
Affiliation(s)
| | | | | | - Gilbert Eshun
- Seventh-Day Adventist Hospital, Agona, Asamang, Ghana
| | | | - Frank Kyei-Arthur
- University of Environment and Sustainable Development, Somanya, Ghana
| | | |
Collapse
|
26
|
Liyanage CK, Gunawardane M, Kumaradasa PP, Ranasinghe P, Jayakody RL, Galappatthy P. A national survey on registered products, availability, prices, and affordability of 100 essential medicines in community pharmacies across Sri Lanka. BMC Health Serv Res 2023; 23:1121. [PMID: 37858145 PMCID: PMC10585786 DOI: 10.1186/s12913-023-10137-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Availability of essential medicines that meet the expected quality standards, in appropriate dosage forms at affordable prices is a fundamental prerequisite to fulfill healthcare needs of given a population. This study assessed available products, prices and affordability of essential medicines (EM) in community pharmacies in Sri Lanka with comparison of registration status from the National Medicines Regulatory Authority(NMRA). METHODS A cross-sectional island-wide survey of 80 pharmacies was conducted according to World Health Organization and Health Action International Manual (WHO/HAI). Hundred medicines were selected from the global core list(n = 14), regional core list(n = 16) and the Sri Lanka Essential Medicine List (SL-EML) (n = 70) based on healthcare needs. Number of registered products in 2015 and 2021 were compared. FINDINGS Average availability was 85.4%(± 12.31) and availability was lowest in the Northern province (69.38 ± 21.18%)(p = 0.008). Availability between the state owned, franchise and privately owned pharmacies was not significantly different (p > 0.05). 89.4% medicines were affordable except for amiodarone, hydroxychloroquine, sitagliptin, soluble insulin, isophane insulin, losartan, levodopa carbidopa combination, clonazepam and ceftriaxone. The median price ratio (MPR) of 33.7% of medicines was less than 1 and MPR of 37.1% originator brands (OB) was over 3. Median number of generic brands in the market was 8(range 2-44), 9% of medicines had 20 or more products in the market and 72.7% medicines had more products available than the number registered in 2015. The average number of registered products were similar in 2015 (8.27) and 2021(7.59) (p = 0.15). CONCLUSION The overall availability of EMs in Sri Lanka was high in all categories of community pharmacies. Medicines were largely affordable and reasonably priced in 2015, although OBs were generally more expensive. Majority of medicines had more products in the market than the number of registered products.
Collapse
Affiliation(s)
- Chiranthi Kongala Liyanage
- Department of Pharmacology, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo, 00800, Sri Lanka.
| | - Mekala Gunawardane
- Department of Pharmacology, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo, 00800, Sri Lanka
| | | | - Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo, 00800, Sri Lanka
| | - Raveendra Laal Jayakody
- Department of Pharmacology, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo, 00800, Sri Lanka
| | - Priyadarshani Galappatthy
- Department of Pharmacology, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo, 00800, Sri Lanka
| |
Collapse
|
27
|
Baker J, Lenz K, Masood M, Rahman MA, Begg S. Tobacco retailer density and smoking behaviour: how are exposure and outcome measures classified? A systematic review. BMC Public Health 2023; 23:2038. [PMID: 37853379 PMCID: PMC10585801 DOI: 10.1186/s12889-023-16914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION To date only a limited number of reviews have focused on how exposure and outcome measures are defined in the existing literature on associations between tobacco retailer density ('density') and smoking behaviour ('smoking'). Therefore this systematic review classified and summarised how both density and smoking variables are operationalised in the existing literature, and provides several methodological recommendations for future density and smoking research. METHODS Two literature searches between March and April 2018 and April 2022 were conducted across 10 databases. Inclusion and exclusion criteria were developed and keyword database searches were undertaken. Studies were imported into Covidence. Cross-sectional studies that met the inclusion criteria were extracted and a quality assessment was undertaken. Studies were categorised according to the density measure used, and smoking was re-categorised using a modified classification tool. RESULTS Large heterogeneity was found in the operationalisation of both measures in the 47 studies included for analysis. Density was most commonly measured directly from geocoded locations using circular buffers at various distances (n = 14). After smoking was reclassified using a smoking classification tool, past-month smoking was the most common smoking type reported (n = 26). CONCLUSIONS It is recommended that density is measured through length-distance and travel time using the street network and weighted (e.g. by the size of an area), or by using Kernel Density Estimates as these methods provide a more accurate measure of geographical to tobacco and e-cigarette retailer density. The consistent application of a smoking measures classification tool, such as the one developed for this systematic review, would enable better comparisons between studies. Future research should measure exposure and outcome measures in a way that makes them comparable with other studies. IMPLICATIONS This systematic review provides a strong case for improving data collection and analysis methodologies in studies assessing tobacco retailer density and smoking behaviour to ensure that both exposure and outcome measures are clearly defined and captured. As large heterogeneity was found in the operationalisation of both density and smoking behaviour measures in the studies included for analysis, there is a need for future studies to capture, measure and classify exposure measures accurately, and to define outcome measures in a manner that makes them comparable with other studies.
Collapse
Affiliation(s)
- John Baker
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia.
| | - Katrin Lenz
- Violet Vines Marshman Centre For Rural Health Research, La Trobe Rural Health School, Melbourne, VIC, Australia
| | - Mohd Masood
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Institute of Dentistry, University of Turku, Turku, Finland
| | - Muhammad Aziz Rahman
- School of Health, Federation University, Berwick, Australia
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia
| | - Stephen Begg
- Violet Vines Marshman Centre For Rural Health Research, La Trobe Rural Health School, Melbourne, VIC, Australia
| |
Collapse
|
28
|
Singh S, Vemireddy V. Transitioning diets: a mixed methods study on factors affecting inclusion of millets in the urban population. BMC Public Health 2023; 23:2003. [PMID: 37833667 PMCID: PMC10576316 DOI: 10.1186/s12889-023-16872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The increasing health challenge in urban India has led to consumers to change their diet preferences by shifting away from staple cereals and making way for healthier foods such as nutri-cereals like millets and other diverse food groups. Taking the case of millets, this study seeks to uncover the exact drivers for this shift of consumers away from a traditional cereal dense diet to a nutritionally more diverse diet that includes nutri-cereal. We also look at deterrents that dissuade consumers from shifting to millets. METHOD We use primary data by surveying respondents through interviews and focused group discussions and online questionnaires. A total of 20 personal consumer interviews and 4 focus group discussions having 8-12 members each were conducted to arrive at the measures for the study. We use logistic regression and Structural Equation Modeling for data analysis. Responses were obtained across major metropolitan cities and tier 2 cities of India thus ensuring representation of geographical, cultural and diet diversity. 875 participants' responses were analysed for results. RESULTS Health reasons and social networks are the major drivers for shift to millets while lack of awareness, lack of easy availability, high prices, lack of branded products, family being averse to switching to millets and lack of attractive promotional cashbacks and discounts are major deterrents to trying out millets. CONCLUSIONS Diet focussed interventions are urgently needed to curb rising diet related non communicable diseases. Government policies aimed at greater production of millets, running awareness campaigns on mass media and private sector initiatives aimed at generating better value added market offerings could lead the way.
Collapse
Affiliation(s)
- Suruchi Singh
- Centre for Management in Agriculture, Indian Institute of Management Ahmedabad, Ahmedabad, India.
| | - Vidya Vemireddy
- Centre for Management in Agriculture, Indian Institute of Management Ahmedabad, Ahmedabad, India
| |
Collapse
|
29
|
Rehm J, Badaras R, Ferreira-Borges C, Galkus L, Gostautaite Midttun N, Gobiņa I, Janik-Koncewicz K, Jasilionis D, Jiang H, Kim KV, Lange S, Liutkutė-Gumarov V, Manthey J, Miščikienė L, Neufeld M, Petkevičienė J, Radišauskas R, Reile R, Room R, Stoppel R, Tamutienė I, Tran A, Trišauskė J, Zatoński M, Zatoński WA, Zurlytė I, Štelemėkas M. Impact of the WHO "best buys" for alcohol policy on consumption and health in the Baltic countries and Poland 2000-2020. Lancet Reg Health Eur 2023; 33:100704. [PMID: 37953993 PMCID: PMC10636269 DOI: 10.1016/j.lanepe.2023.100704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 11/12/2023]
Abstract
Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time-series analyses suggest improved health, measured as reductions in all-cause and alcohol-attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol-attributable deaths. The natural experiment in this region of high-income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.
Collapse
Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- World Health Organization/Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
- Faculty of Medicine, Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg 20246, Germany
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada
- Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada
- Program on Substance Abuse & WHO CC, Public Health Agency of Catalonia, 81-95 Roc Boronat St., Barcelona 08005, Spain
| | - Robertas Badaras
- Faculty of Medicine, Clinic of Anaesthesiology and Intensive Care, Centre of Toxicology, Vilnius University, M. K. Čiurlionio g. 21, Vilnius LT-03101, Lithuania
| | - Carina Ferreira-Borges
- World Health Organization, Regional Office for Europe, UN City, Marmorvej 5, Copenhagen DK-2100, Denmark
| | - Lukas Galkus
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Nijole Gostautaite Midttun
- Lithuanian Tobacco and Alcohol Control Coalition, Stikliu 8, Vilnius 01131, Lithuania
- Mental Health Initiative, Teatro 3-10, Vilnius 03107, Lithuania
| | - Inese Gobiņa
- Department of Public Health and Epidemiology, Riga Stradiņš University, Kronvalda Boulevard 9, Riga LV-1010, Latvia
- Institute of Public Health, Riga Stradiņš University, Kronvalda Boulevard 9, Riga LV-1010, Latvia
| | - Kinga Janik-Koncewicz
- Institute – European Observatory of Health Inequalities, Calisia University, Nowy Swiat 4, Kalisz 62-800, Poland
- Health Promotion Foundation, Mszczonowska 51, Nadarzyn 05-830, Poland
| | - Domantas Jasilionis
- Max Planck Institute for Demographic Research, Laboratory of Demographic Data, Konrad-Zuse-Str. 1, Rostock 18057, Germany
- Vytautas Magnus University, Demographic Research Centre, Jonavos g. 66, Kaunas 44191, Lithuania
| | - Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada
| | - Kawon Victoria Kim
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada
| | - Vaida Liutkutė-Gumarov
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Jakob Manthey
- Faculty of Medicine, Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg 20246, Germany
- Medical Faculty, Department of Psychiatry, University of Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany
| | - Laura Miščikienė
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Maria Neufeld
- World Health Organization, Regional Office for Europe, UN City, Marmorvej 5, Copenhagen DK-2100, Denmark
| | - Janina Petkevičienė
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Faculty of Public Health, Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Ričardas Radišauskas
- Faculty of Public Health, Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu Ave. 15, Kaunas 50162, Lithuania
| | - Rainer Reile
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Department for Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, Tallinn 11619, Estonia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria 3086, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm 106 91, Sweden
| | - Relika Stoppel
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Ilona Tamutienė
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Department of Public Administration, Faculty of Political Science and Diplomacy at Vytautas Magnus University, V.Putvinskio Str 23, Kaunas LT-44243, Lithuania
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Justina Trišauskė
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Mateusz Zatoński
- Institute – European Observatory of Health Inequalities, Calisia University, Nowy Swiat 4, Kalisz 62-800, Poland
| | - Witold A. Zatoński
- Institute – European Observatory of Health Inequalities, Calisia University, Nowy Swiat 4, Kalisz 62-800, Poland
- Health Promotion Foundation, Mszczonowska 51, Nadarzyn 05-830, Poland
| | - Ingrida Zurlytė
- WHO Country Office Lithuania, A. Jakšto g. 12, LT-01105 Vilnius, Lithuania
| | - Mindaugas Štelemėkas
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Faculty of Public Health, Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| |
Collapse
|
30
|
Endehabtu BF, Angaw DA, Gonete TZ, Jisso M, Abera N, Alemayehu A, Fikre R, Abdissa B, Umer A, Kebede M, Mohammed H, Yazie B, Dessie K, Tamiso A, Sime H, Yesuf EA, Gurmu KK, Tilahun B. Availability of Maternal, Newborn care and Child Health Services at Primary Health Care Unit during COVID-19 Outbreak in Ethiopia. Ethiop J Health Sci 2023; 33:117-126. [PMID: 38352671 PMCID: PMC10859739 DOI: 10.4314/ejhs.v33i2.5s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/09/2023] [Indexed: 02/16/2024] Open
Abstract
Background The COVID-19 pandemic is putting a pressure on global health systems. The disruption of essential health services (EHS) has an impact on the health of mothers, neonate and children in developing countries. Therefore, the main aim of this study was assessing the availability of Maternal, Newborn care and Child health (MNCHS) services at primary health care unit during COVID-19 outbreak. Methods A cross-sectional survey was conducted in five regions of Ethiopia in 2021. Descriptive analyses were undertaken using STATA 16 software and the results presented using tables and different graphs. A continuity of EHS assessment tool adopted from WHO was used for data collection. Result During COVID -19 pandemic, 30 (69.8%) of woreda health offices, 52 (56.5%) of health centers (HCs), 7 (44.4%) of hospitals, and 165 (48%) of health posts (HPs) had a defined list of EHS. In comparison with other EHS, family planning is the least available service in all regions. At HPs level care for sick children and antenatal care (ANC) were available at 59.1 and 58.82% respectively. Except immunization services at SNNP, all other maternal, newborn, and child health EHS were not available to all HPs at full scale. Conclusion Immunization services were most available, while ANC and care for sick children were least available during COVID-19 at the HPs level. There was regional variation in MNCH EHS service availability at all levels.
Collapse
Affiliation(s)
- Berhanu Fikadie Endehabtu
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
- eHealthLab Ethiopia, University of Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Tajebew Zayede Gonete
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Meskerem Jisso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Netsanet Abera
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | | | - Rekiku Fikre
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Biru Abdissa
- Jimma University, Institute of Health, Jimma, Ethiopia
| | - Abdurezak Umer
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Mesfin Kebede
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Hussen Mohammed
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Bekele Yazie
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Kassahun Dessie
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Alemu Tamiso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Habtamu Sime
- Jimma University, Institute of Health, Jimma, Ethiopia
| | | | - Kassu Ketema Gurmu
- World Health Organization Country Office for Ethiopia, Universal Health Coverage/Life Course, Health System Strengthening Team, Ethiopia
| | - Binyam Tilahun
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
- eHealthLab Ethiopia, University of Gondar, Ethiopia
| |
Collapse
|
31
|
Li X, Wang XS, Huang H, Liu M, Wu Y, Qiu J, Zhang B, Cui L, Hui D. National survey on the availability of oncology palliative care services at tertiary general and cancer hospitals in China. BMC Palliat Care 2023; 22:144. [PMID: 37770965 PMCID: PMC10536755 DOI: 10.1186/s12904-023-01259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND This nationwide survey studied the level of palliative care (PC) access for Chinese patients with cancer among cancer care providers either in tertiary general hospitals or cancer hospitals in China. METHODS Using a probability-proportionate-to-size method, we identified local tertiary general hospitals with oncology departments to match cancer hospitals at the same geographic area. A PC program leader or a designee at each hospital reported available PC services, including staffing, inpatient and outpatient services, education, and research, with most questions adapted from a previous national survey on PC. The primary outcome was availability of a PC service. RESULTS Most responders reported that some type of PC service (possibly called "comprehensive cancer care," "pain and symptom management," or "supportive care") was available at their institution (84.3% of tertiary general hospitals, 82.8% of cancer hospitals). However, cancer hospitals were significantly more likely than tertiary general hospitals to have a PC department or specialist (34.1% vs. 15.5%, p < 0.001). The most popular services were pain consultation (> 92%), symptom management (> 77%), comprehensive care plans (~ 60%), obtaining advanced directives and do-not-resuscitate orders (~ 45%), referrals to hospice (> 32%), and psychiatric assessment (> 25%). Cancer hospitals were also more likely than tertiary general hospitals to report having inpatient beds for PC (46.3% vs. 30.5%; p = 0.010), outpatient PC clinics (28.0% vs. 16.8%; p = 0.029), educational programs (18.2% vs. 9.0%, p = 0.014), and research programs (17.2% vs. 9.3%, p < 0.001). CONCLUSIONS Cancer hospitals are more likely to offer PC than are tertiary general hospitals in China. Our findings highlight opportunities to further increase the PC capacity in Chinese hospitals.
Collapse
Affiliation(s)
- Xiaomei Li
- Department of Geriatric Medicine, The Second Medical Center, Chinese PLA General Hospital, Haidian District, 28Th, Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Haili Huang
- Department of Medical Oncology, The Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Miao Liu
- Graduate School, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yinan Wu
- Publicity Department, Beijing Hospital, Beijing, People's Republic of China
| | - Jiaojiao Qiu
- Department of Geriatric Medicine, The Second Medical Center, Chinese PLA General Hospital, Haidian District, 28Th, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Boran Zhang
- Department of Geriatric Medicine, The Second Medical Center, Chinese PLA General Hospital, Haidian District, 28Th, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Linhong Cui
- Department of Geriatric Medicine, The Second Medical Center, Chinese PLA General Hospital, Haidian District, 28Th, Fuxing Road, Beijing, 100853, People's Republic of China
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
32
|
Nsengimana A, Isimbi J, Uwizeyimana T, Biracyaza E, Hategekimana JC, Uwambajimana C, Gwira O, Kagisha V, Asingizwe D, Adedeji A, Nyandwi JB. Malaria rapid diagnostic tests in community pharmacies in Rwanda: availability, knowledge of community pharmacists, advantages, and disadvantages of licensing their use. Glob Health Res Policy 2023; 8:40. [PMID: 37700374 PMCID: PMC10496312 DOI: 10.1186/s41256-023-00324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Presumptive treatment of malaria is often practiced in community pharmacies across sub-Saharan Africa (SSA).To address this issue, the World Health Organization (WHO) recommends that malaria Rapid Diagnostic Tests (m-RDTs) be used in these settings, as they are used in the public sector. However, their use remains unlicensed in the community pharmacies in Rwanda. This can lessen their availability and foster presumptive treatment. Therefore, this study investigated the availability of m-RDTs, knowledge of community pharmacists on the use of m-RDTs, and explored Pharmacists' perceptions of the advantages and disadvantages of licensing the use of m-RDTs in community pharmacies. METHODS This was a cross-sectional study among 200 licensed community pharmacists who were purposefully sampled nationwide from 11th February to 12th April 2022. Data was collected using an online data collection instrument composed of open-ended and closed-ended questions. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 25.0. The chi-square test was used to evaluate the association between the availability of m-RDTs and independent variables of interest. Content analysis was used for qualitative data. RESULTS Although 59% were consulted by clients requesting to purchase m-RDTs, only 27% of the participants had m-RDTs in stock, 66.5% had no training on the use of m-RDTs, and 18.5% were not at all familiar with using the m-RDTs. Most of the participants (91.5%) agreed that licensing the use of m-RDTs in community pharmacies could promote the rational use of antimalarials. The chi-square test indicated that being requested to sell m-RDTs (x2 = 6.95, p = 0.008), being requested to perform m-RDTs (x2 = 5.39, p = 0.02),familiarity using m-RDTs (x2 = 17.24, p = 0.002), availability of a nurse in the Pharmacy (x2 = 11.68, p < 0.001), and location of the pharmacy (x2 = 9.13, p = 0.048) were all significantly associated with the availability of m-RDTs in the pharmacy. CONCLUSIONS The availability of m-RDTs remains low in community pharmacies in Rwanda, and less training is provided to community pharmacists regarding the use of m-RDTs. Nevertheless, community pharmacists had positive perceptions of the advantages of licensing the use of m-RDTs. Thus, licensing the use of m-RDTs is believed to be the first step toward promoting the rational use of antimalarial medicines in Rwanda.
Collapse
Affiliation(s)
- Amon Nsengimana
- USAID Global Health Supply Chain Program-Procurement and Supply Management, Kigali, Rwanda.
| | - Joyce Isimbi
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | - Emmanuel Biracyaza
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montréal, QC, Canada
| | | | - Charles Uwambajimana
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Olivia Gwira
- USAID Global Health Supply Chain Program-Procurement and Supply Management, Kigali, Rwanda
| | - Vedaste Kagisha
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Domina Asingizwe
- Department of Physiotherapy, School of Health Sciences, University of Rwanda, Kigali, Rwanda
- East African Community Regional Center of Excellence for Vaccines, Immunization and Health Supply Chain Management, Kigali, Rwanda
| | - Ahmed Adedeji
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Jean Baptiste Nyandwi
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
- East African Community Regional Center of Excellence for Vaccines, Immunization and Health Supply Chain Management, Kigali, Rwanda
| |
Collapse
|
33
|
Ezezew M, Yehualaw A, Demsie DG. Assessment of availability and challenges of WHO recommended priority life-saving medicines for under five-year children in primary public health facilities of Amhara region. BMC Pediatr 2023; 23:395. [PMID: 37558993 PMCID: PMC10413804 DOI: 10.1186/s12887-023-04216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The world health organization (WHO) priority lifesaving medicines are medicines recommended for the prevention and treatment of leading causes of under-five morbidity and mortality. They should be available in all health systems and at all times. However, the availability of these medicines and its determinants is not well studied in Ethiopia in general and in primary public health facilities Amhara region in particular. OBJECTIVE The study aimed to assess the availability and challenges of the WHO-recommended priority lifesaving medicines for under-five children in primary public health facilities of the Amhara region. METHODS A cross-sectional study design was conducted from February to December 2020 in 98 health centers and 22 primary hospitals in the Amhara region, Ethiopia. Facilities were selected with a simple random sampling technique. The data were collected through a pretested and structured questionnaire. Binary logistic regression was used to identify predictors associated with availability of WHO-recommended priority lifesaving medicines for under-five children. RESULTS The availability of oral rehydration salt was high (82.5%) and the availability of vitamin A (47.5%), morphine tablet (13.3%), and artesunate rectal suppository (7.5%) were within low and very low WHO range respectively. Budget adequacy (AOR = 12.9 CI= (2.1-78.2)), periodic review of stock level ((AOR = 13.4,CI=(1.9-92.0)), training on integrated pharmaceutical logistic system ((AOR = 4.5,CI=(1.0-20.5)), inclusion of WHO priority under five children facility specific medicine list (AOR = 12.4,CI=(2.3-66.4)), lead time for EPSA(Ethiopia Pharmaceutical Supply Agency) procurement (AOR = 7.9,CI=(1.3-44.8)) were significantly associated with availability of all WHO priority lifesaving medicines for under- five children. CONCLUSION The average availability of WHO-recommended priority lifesaving medicines for under-five children was low. The habit of updating bincard and adoption of the life-saving medicine list were the independent predictors of medication availability.
Collapse
Affiliation(s)
| | - Adane Yehualaw
- College of Medicine and Health Sciences, Department of Pharmacy, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desalegn Getnet Demsie
- College of Medicine and Health Sciences, Department of Pharmacy, Bahir Dar University, Bahir Dar, Ethiopia.
| |
Collapse
|
34
|
Fassinou LC, Hien H, Yombi JC, Nagot N, Kirakoya-Samadoulougou F. Availability and readiness of the health facilities to provide HIV counseling and testing and prevention of mother-to-child transmission services in Burkina Faso: a trend analysis from 2012 to 2018. BMC Health Serv Res 2023; 23:757. [PMID: 37452422 PMCID: PMC10347843 DOI: 10.1186/s12913-023-09757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Provider-Initiated HIV Testing and Counseling (PITC) and Prevention of Mother-To-Child Transmission (PMTCT) are key services for achieving the goal of complete elimination of HIV. However, there is limited evidence on the ability of health facilities to provide these services in Burkina Faso. Therefore, we aimed to assess the trends and disparities in the availability and readiness of health facilities to provide PITC and PMTCT services in Burkina Faso between 2012 and 2018. METHODS We performed a secondary analysis of facility-level data from the World Health Organization's Service Availability and Readiness Assessment (SARA) surveys conducted in 2012, 2014, 2016, and 2018 in Burkina Faso. The availability and readiness of health facilities were assessed using SARA's manual, and linear regressions were used to examine trends. RESULTS Between 2012 and 2018, the mean proportion of health facilities providing PITC services increased, but not significantly, from 82.9% to 83.4% (p = 0.11), with the mean readiness index significantly decreasing from 71.5% to 65.4% (p < 0.001). This decrease concerned the staff and guidelines (73.8% to 50.5%; p < 0.001), equipment (79.0% to 77.4%; p < 0.001), and medicines and commodities (54.2% to 45.2%; p < 0.001) domains. Regarding the PMTCT services, the mean proportion of health facilities globally providing the service significantly decreased from 83.7% in 2012 to 67.7% (p = 0.030) in 2018, and the mean readiness significantly decreased from 53.2% in 2012 to 50.9% in 2018 (p = 0.004). This decreasing trend was related to the staff and training (80.3% to 57.6%; p < 0.001) and medicines and commodities (9.2% to 6.5%; p < 0.001) domains. The global significant negative trend of readiness was mainly observed at the primary level of healthcare (52.7% to 49.4%; p = 0.030). Four regions experienced a significant decrease in the readiness index of health facilities to provide PMTCT services: Cascades, Centre, Centre-Sud, and Sud-Ouest, while Haut-Bassins and Nord regions showed increasing trends. CONCLUSION Availability and readiness of health facilities to provide PITC and PMTCT remain suboptimal in Burkina Faso. Actions to strengthen the skills of professionals and enhance the availability of medicines and commodities while focusing more on health regions with significant decreasing trends are urgently needed to improve the quality of services for HIV.
Collapse
Affiliation(s)
- Lucresse Corine Fassinou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Hervé Hien
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Jean Cyr Yombi
- Department of Internal Medicine, Infectious and Tropical Diseases, AIDS Reference Centre, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Nagot
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, University of Antilles, Etablissement Français du Sang, Montpellier, France
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
| |
Collapse
|
35
|
Kuupiel D, Cheabu BSN, Yeboah P, Duah J, Addae JK, Ako-Nnubeng IT, Osei FA, Ziblim SD, Mchunu GG, Pillay JD, Bawontuo V. Geographic availability of and physical accessibility to tuberculosis diagnostic tests in Ghana: a cross-sectional survey. BMC Health Serv Res 2023; 23:755. [PMID: 37452305 PMCID: PMC10347710 DOI: 10.1186/s12913-023-09755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND In Ghana, tuberculosis (TB) case detection is low (< 34%). Existing scientific evidence suggest access to TB diagnostic tests play an essential role in TB case detection, yet little has been scientifically documented on it in Ghana. This study, therefore, sought to map TB diagnosis sites, and describe the geographic availability and physical accessibility to TB diagnosis in six regions of Ghana to inform scale-up and future placement of TB diagnostic tests. METHODS We assembled the geolocation and attribute data of all health facilities offering TB diagnosis in Upper West Region (UWR), Upper East Region (UER), Ahafo, North-East, Northern, and Savannah regions. QGIS was employed to estimate the distance and travel time to TB diagnosis sites within regions. Travel time estimates were based on assumed motorised tricycle speed of 20 km (km)/hour. RESULTS Of the total 1584 health facilities in the six regions, 86 (5.4%) facilities were providing TB diagnostic testing services. This 86 TB diagnosis sites comprised 56 (65%) microscopy sites, 23 (27%) both microscopy and GeneXpert sites, and 7 (8%) GeneXpert only sites (8%). Of the 86 diagnosis sites, 40 (46%) were in the UER, follow by Northern Region with 16 (19%), 12 (14%) in UWR, 9 (10%) in Ahafo Region, 5 (6%) in North East, and 4 (5%) in Savannah Region. The overall estimated mean distance and travel time to the nearest TB diagnosis site was 23.3 ± 13.8 km and 67.6 ± 42.6 min respectively. Savannah Region recorded the longest estimated mean distance and travel time with 36.1 ± 14.6 km and 108.3 ± 43.9 min, whilst UER recorded the shortest with 10.2 ± 5.8 km and 29.1 ± 17.4 min. Based on a 10 km buffer of settlement areas, an estimated 75 additional TB diagnosis sites will be needed to improve access to TB diagnosis services across the six regions. CONCLUSION This study highlights limited availability of TB diagnosis sites and poor physical accessibility to TB diagnosis sites across five out of the six regions. Targeted implementation of additional TB diagnosis sites is needed to reduce travel distances to ≤ 10 km.
Collapse
Affiliation(s)
- Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
- Faculty of Health Sciences, Durban University of Technology, Ritson Campus, Durban, 4001 South Africa
| | - Benjamin S. N. Cheabu
- Faculty of Health Sciences, Health Quality Programs, Queen’s University, Kingston, K7L3N6 Canada
- Christian Health Association of Ghana, # 21 Jubilee Wells Street Labadi, Accra, Ghana
| | - Peter Yeboah
- Christian Health Association of Ghana, # 21 Jubilee Wells Street Labadi, Accra, Ghana
| | - James Duah
- Christian Health Association of Ghana, # 21 Jubilee Wells Street Labadi, Accra, Ghana
| | - Joseph K. Addae
- Christian Health Association of Ghana, # 21 Jubilee Wells Street Labadi, Accra, Ghana
| | | | - Francis A. Osei
- Christian Health Association of Ghana, # 21 Jubilee Wells Street Labadi, Accra, Ghana
| | - Shamsu-Deen Ziblim
- Department of Population and Reproductive Health, School of Public Health, University of Development Studies, Tamale, Ghana
| | - Gugu G. Mchunu
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Julian D. Pillay
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Vitalis Bawontuo
- Department of Health Services Management and Administration, School of Business, SD Dombo University of Business and Integrated Development Studies (SDD-UBIDS), Wa, Ghana
| |
Collapse
|
36
|
Rurangwa C, Ndayisenga J, Sezirahiga J, Nyirimigabo E. Availability and affordability of anticancer medicines at cancer treating hospitals in Rwanda. BMC Health Serv Res 2023; 23:717. [PMID: 37391753 DOI: 10.1186/s12913-023-09706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Availability and accessibility of anti-cancer medicines is the pillar of cancer management, and it is one of the main concerns in low-income countries including Rwanda. The objective of this study was to assess the availability and affordability of anticancer medicines at cancer-treating hospitals in Rwanda. METHODOLOGY A descriptive cross-sectional study was conducted at 5 cancer-treating hospitals in Rwanda. Quantitative data were collected from stock cards and software that manage medicines and included the availability of anti-cancer medicines at the time of data collection, their stock status within the last two years, and the selling price. RESULTS The study found the availability of anti-cancer medicines at 41% in public hospitals at the time of data collection, and 45% within the last two years. We found the availability of anti-cancer medicines at 45% in private hospitals at the time of data collection, and 61% within the last two years. 80% of anti-cancer medicines in private hospitals were unaffordable while 20% were affordable. The public hospital that had most of the anti-cancer medicines in the public sector provided free services to the patients, and no cost was applied to the anti-cancer medicines. CONCLUSION The availability of anti-cancer medicines in cancer-treating hospitals is low in Rwanda, and most of them are unaffordable. There is a need to design strategies that can increase the availability and affordability of anti-cancer medicines, for the patients to get recommended cancer treatment options.
Collapse
Affiliation(s)
- Clement Rurangwa
- Immunization, Vaccines and Health Supply Chain Management, College of Medicines and Health Sciences, EAC Regional Centre of Excellence for Vaccines, University of Rwanda, Kigali, Rwanda.
| | - Jerome Ndayisenga
- African Research and Community Health Initiative (ARCH Initiative), Kigali, Rwanda
| | | | | |
Collapse
|
37
|
Shi Y, Chen Z, Zou K, Zhang M, Liu Z, Liu D, Zeng L, Li H, Jia ZJ, Cheng G, Tang Y, Zhao S, Jiang Y, Choonara I, Zhang L. Global, regional and national availability of essential medicines for children, 2009-2020: a systematic review and meta-analysis. BMC Public Health 2023; 23:1185. [PMID: 37340382 DOI: 10.1186/s12889-023-15820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/05/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Access to essential medicines is a vital component of universal health coverage. The low availability of essential medicines for children (EMC) has led the World Health Organization (WHO) to issue a number of resolutions calling on member states on its improvement. But its global progress has been unclear. We aimed to systematically evaluate the progress of availability of EMC over the past decade across economic regions and countries. METHODS We searched eight databases from inception to December 2021 and reference lists to identify included studies. Two reviewers independently conducted literature screening, data extraction and quality evaluation. This study was registered with PROSPERO, CRD42022314003. RESULTS Overall, 22 cross-sectional studies covering 17 countries, 4 income groups were included. Globally, the average availability rates of EMC were 39.0% (95%CI: 35.5-42.5%) in 2009-2015 and 43.1% (95%CI: 40.1-46.2%) in 2016-2020. Based on the World Bank classification of economic regions, income was not proportional to availability. Nationally, the availability rate of EMC was reasonable and high (> 50%) in only 4 countries, and low or very low for the rest 13 countries. The availability rates of EMC in primary healthcare centers had increased, while that for other levels of hospitals slightly declined. The availability of original medicines decreased while that of generic medicines was stable. All drug categories had not achieved the high availability rate. CONCLUSION The availability rate of EMC was low globally, with slight increase in the last decade. Continuous monitoring and timely reporting of the availability of EMC are also needed to facilitate targets setting and inform relevant policy making.
Collapse
Affiliation(s)
- Yuqing Shi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zhe Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Kun Zou
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
| | - Miao Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zheng Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Dan Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zhi-Jun Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Guo Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
| | - Yong Tang
- School of Economics, Sichuan University, Chengdu, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, China
| | - Yongmu Jiang
- School of Economics, Sichuan University, Chengdu, China
| | - Imti Choonara
- School of Medicine, University of Nottingham, Nottingham, DE22 3DT, UK
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
38
|
Huang ZY, Wu CY, Hseu ZY. Rare earth elements in tea garden soils and their bio availability to tea buds in Taiwan. Sci Total Environ 2023:164895. [PMID: 37321509 DOI: 10.1016/j.scitotenv.2023.164895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
Tea (Camellia sinensis) is a widespread beverage plant that prefers aluminum-enriched acidic soils. However, rare earth elements (REEs) might be highly phyto-available in these soils. With the increasing demands for REEs in high-technology industries, understanding the dynamics of REEs in the environment is essential. Thus, this study identified the total concentration of REEs in the root-zone soils and corresponding tea buds (n = 35) collected from tea gardens in Taiwan. Additionally, the labile REEs in the soils were extracted with 1 M KCl, 0.1 M HCl, and 0.05 M ethylenediaminetetraacetic acid (EDTA) to elucidate the fractionation tendency of REEs in the soil-plant system and the relationships between REEs and Al in the tea buds. The concentration of light REEs (LREEs) was higher than those of medium REEs (MREEs) and heavy REEs (HREEs) in all soil and tea bud samples. According to the upper continental crust (UCC) normalization, MREEs and HREEs were more abundant than LREEs in the tea buds. Furthermore, REEs remarkably increased with increasing Al in the tea buds, whereas the linear correlations between Al and MREEs and HREEs were stronger than between LREEs. Compared with LREEs, the extractabilities of MREEs and HREEs by all single extractants in the soils were higher, coinciding with their higher UCC-normalization-based enrichments in the tea buds. Moreover, the 0.1 M HCl- and 0.05 M EDTA-extractable REEs were affected by soil properties and significantly correlated with the total REEs in the tea buds. The concentration of REEs in the tea buds was successfully predicted by empirical equations of extractable REEs with 0.1 M HCl and 0.05 M EDTA, as well as general soil properties including pH, organic carbon, dithionite-citrate-bicarbonate-extractable iron, aluminum, and phosphorus. However, this prediction should be further verified using many soil and tea types in the future.
Collapse
Affiliation(s)
- Zzu-Ying Huang
- Department of Agricultural Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | - Cho-Yin Wu
- Department of Agricultural Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | - Zeng-Yei Hseu
- Department of Agricultural Chemistry, National Taiwan University, Taipei 10617, Taiwan.
| |
Collapse
|
39
|
Joosse IR, Wirtz VJ, van Mourik AT, Wagner BA, Mantel-Teeuwisse AK, Suleman F, van den Ham HA. SDG indicator 3.b.3 - an analysis of its robustness and challenges for measuring access to medicines for children. BMC Health Serv Res 2023; 23:574. [PMID: 37270535 DOI: 10.1186/s12913-023-09554-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/16/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Sustainable Development Goal (SDG) indicator 3.b.3 monitors progress in medicines' accessibility for adults and has significant limitations when applying to medicines for children. An adapted indicator methodology was developed to fill this gap, but no proof of its robustness exists. We provide this evidence through sensitivity analyses. METHODS Data on availability and prices of child medicines from ten historical datasets were combined to create datasets for analysis: Dataset 1 (medicines selected at random) and Dataset 2 (preference given to available medicines, to better capture affordability of medicines). A base case scenario and univariate sensitivity analyses were performed to test critical components of the methodology, including the new variable of number of units needed for treatment (NUNT), disease burden (DB) weighting, and the National Poverty Line (NPL) limits. Additional analyses were run on a continuously smaller basket of medicines to explore the minimum number of medicines required. Mean facility scores for access were calculated and compared. RESULTS The mean facility score for Dataset 1 and Dataset 2 within the base case scenario was 35.5% (range 8.0-58.8%) and 76.3% (range 57.2-90.6%). Different NUNT scenarios led to limited variations in mean facility scores of + 0.1% and -0.2%, or differences of + 4.4% and -2.1% at the more critical NPL of $5.50 (Dataset 1). For Dataset 2, variations to the NUNT generated differences of + 0.0% and -0.6%, at an NPL of $5.50 the differences were + 5.0 and -2.0%. Different approaches for weighting for DB induced considerable fluctuations of 9.0% and 11.2% respectively. Stable outcomes with less than 5% change in mean facility score were observed for a medicine basket down to 12 medicines. For smaller baskets, scores increased more rapidly with a widening range. CONCLUSION This study has confirmed that the proposed adaptations to make SDG indicator 3.b.3 appropriate for children are robust, indicating that they could be an important addition to the official Global Indicator Framework. At least 12 child-appropriate medicines should be surveyed to obtain meaningful outcomes. General concerns that remain about the weighting of medicines for DB and the NPL should be considered at the 2025 planned review of this framework.
Collapse
Affiliation(s)
- I R Joosse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands
| | - V J Wirtz
- WHO Collaborating Centre in Pharmaceutical Policy, Department of Global Health, Boston University School of Public Health, Boston, USA
| | - A T van Mourik
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands
| | - B A Wagner
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands
| | - A K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands
| | - F Suleman
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - H A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands.
| |
Collapse
|
40
|
Ma Y, Zhou F, Yu D, Zhang N, Qi M, Li Y, Wu F, Liang D. Irrigation leads to new Se-toxicity paddy fields in and around typical Se-toxicity area. Sci Total Environ 2023:164433. [PMID: 37245815 DOI: 10.1016/j.scitotenv.2023.164433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
Although the issue has been of much concern and has subsequently been controlled for years, the environmental risk of excess selenium (Se) in farmlands still has not been eliminated in Se-toxicity areas. Different types of farmland utilization can change Se behavior in soil. Thus, located field monitoring and surveys of various farmland soils in and around typical Se-toxicity areas spanning eight years were conducted in the tillage layer and deeper soils. The source of new Se contamination in farmlands was traced along the irrigation and natural waterway. This research indicated that 22 % of paddy fields increased to Se-toxicity in surface soil led by irrigation with high-Se river water. Selenate is the dominant Se species in rivers (90 %) originating from geological background areas with high Se. Both soil organic matter (SOM) and amorphous iron content played important roles in the fixation of input Se. Thus, available Se was increased by more than twofold in paddy fields. The release of residual Se and eventual bounding by organic matter is commonly observed, thus suggesting that stable soil Se availability seems sustainable for a long time. This study is the first report in China that shows how new soil Se-toxicity farmland is caused by high-Se water irrigation. This research warns that external attention should be paid to the selection of irrigation water in high-Se geological background areas to avoid new Se contamination.
Collapse
Affiliation(s)
- Yuanzhe Ma
- College of Natural Resources and Environment, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Fei Zhou
- College of Natural Resources and Environment, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Dasong Yu
- College of Natural Resources and Environment, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Nanchun Zhang
- College of Natural Resources and Environment, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Mingxing Qi
- College of Natural Resources and Environment, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Yanan Li
- College of Natural Resources and Environment, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Fuyong Wu
- College of Natural Resources and Environment, Northwest A&F University, Yangling, Shaanxi 712100, China; Key Laboratory of Plant Nutrition and the Agri-environment in Northwest China, Ministry of Agriculture, Yangling 712100, Shaanxi, China.
| | - Dongli Liang
- College of Natural Resources and Environment, Northwest A&F University, Yangling, Shaanxi 712100, China; Key Laboratory of Plant Nutrition and the Agri-environment in Northwest China, Ministry of Agriculture, Yangling 712100, Shaanxi, China.
| |
Collapse
|
41
|
Lungfiel G, Mandlmeier F, Kunow C, Langer B. Oral emergency contraception practices of community pharmacies: a mystery caller study in the capital of Germany, Berlin. J Pharm Policy Pract 2023; 16:68. [PMID: 37237301 DOI: 10.1186/s40545-023-00565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND In Germany, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is available as over-the-counter (OTC) medicine only from community pharmacies (CPs). Because of the window of effect, which is limited to only a few days, CPs have a great responsibility to provide rapid and unimpeded access, while also ensuring "adequate" counseling. The aim was-for the first time in Europe and thus also in Germany for the methodology used in this study-to investigate immediate availability, pricing, and aspects of counseling. METHODS Covert mystery calls were conducted in a random sample of CPs stratified by districts in the German capital Berlin. Each of the 263 CPs included was called once at random by one of two trained female student mystery callers. They simulated a product-based scenario for the UPA original ellaOne®, citing a contraceptive failure one day ago as the reason. RESULTS Of 257 successfully called CPs, UPA preparations were immediately available in 98.4% (253/257) and LNG preparations in 86.8% (184/212) of CPs. Prices for UPA preparations varied from €15.95 to €42.95 (∆ 169%; median €35.00 [interquartile range (IQR) €5.91]) and for LNG preparations from €10.60 to €32.49 (Δ 207%; median €22.00 [IQR €5.76]). Information about the correct different window of effect of UPA and LNG preparations was provided in 69.8% (127/182) of CPs. UPA preparations were recommended in 63.1% (111/176) and LNG preparations in 17.2% (30/174) of CPs. Information was provided on how to take them as soon as possible in 30.8% (44/143) of CPs and on how to use them after vomiting in 46.0% (64/139). CONCLUSIONS Berlin CPs support access through high immediate availability, especially to UPA preparations. However, access is hampered by high absolute price ranges of both UPA and LNG preparations, which could ideally be minimized by a comparison app. It is positive that CPs promote the benefits of UPA preparations by recommending them noticeably more often than LNG preparations. However, there are deficiencies in giving advice, so there is a need to raise awareness among pharmacy staff to ensure "adequate" counseling in advance over the phone.
Collapse
Affiliation(s)
- Gwenda Lungfiel
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Franca Mandlmeier
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Christian Kunow
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany.
| |
Collapse
|
42
|
Harrison MA, Marfo AFA, Annan A, Ankrah DNA. Access to cardiovascular medicines in low- and middle-income countries: a mini review. Glob Health Res Policy 2023; 8:17. [PMID: 37221559 DOI: 10.1186/s41256-023-00301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/07/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Many cardiovascular (CV) medicines are required for long term. However, with their limited resources, low- and middle-income countries (LMICs) may have challenges with access to cardiovascular medicines. The aim of this review was to provide a summary of available evidence on access to cardiovascular medicines in LMICs. METHODS We searched PubMed and Google scholar for English language articles on access to cardiovascular medicines for the period 2010-2022. We also searched for articles reporting measures for challenges in access to CV medicines from 2007 to 2022. Studies conducted in LMICs, and reporting availability and affordability were included for review. We also reviewed studies reporting affordability or availability using the World Health Organisation/Health Action International (WHO/HAI) method. Levels of affordability and availability were compared. RESULTS Eleven articles met the inclusion criteria for review on availability and affordability. Although availability appears to have improved, many countries did not meet the availability target of 80%. Between economies and within countries, there are equity gaps in access to CV medicines. Availability is lower in public health facilities than private facilities. Seven out of 11 studies reported availability less than 80%. Eight studies which investigated availability in the public sector reported less than 80% availability. Overall, CV medicines, especially combined treatments are not affordable in the majority of countries. Simultaneous achievement of availability and affordability target is low. In the studies reviewed, less than 1-53.5 days wages were required to purchase one month supply of CV medicines. Failure to meet affordability was 9-75%. Five studies showed that, on average 1.6 days' wages of the Lowest-Paid Government Worker (LPGW) was required to purchase generic CV medicines in the public sector. Efficient forecasting and procurement, increased public financing and policies to improve generic use, among others are measures for improving availability and affordability. CONCLUSIONS Significant gaps exist in access to cardiovascular medicines in LMICs, and in many low-and lower middle-income countries access to cardiovascular medicines is low. To improve access and achieve the Global Action Plan on non-communicable diseases in these countries, policy interventions must be urgently instituted.
Collapse
Affiliation(s)
- Mark Amankwa Harrison
- Pharmacy Department, Korle Bu Teaching Hospital, Korle Bu, P.O. Box 77, Accra, Ghana.
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustine Annan
- Pharmacy Department, Korle Bu Teaching Hospital, Korle Bu, P.O. Box 77, Accra, Ghana
| | | |
Collapse
|
43
|
Mekonnen Z, Melaku T, Tucho GT, Mecha M, Årdal C, Jahre M. The knock-on effects of COVID-19 pandemic on the supply and availability of generic medicines in Ethiopia: mixed methods study. BMC Health Serv Res 2023; 23:513. [PMID: 37210502 DOI: 10.1186/s12913-023-09535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/09/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND COVID-19 pandemic posed a major impact on the availability and affordability of essential medicines. This study aimed to assess the knock-on effects of the COVID-19 pandemic on the supply availability of non-communicable chronic disease (NCD) medicines and paracetamol products in Ethiopia. METHODS A mixed methods study was conducted to assess the supply and availability of twenty-four NCD drugs and four paracetamol products listed on the national essential medicines list for hospitals. Data were collected from twenty-six hospitals located in seven zones of Oromia region in the southwestern part of Ethiopia. We extracted data on drug availability, cost and stock out for these drugs between May 2019 and December 2020. The quantitative data were entered into Microsoft Excel and exported to statistical package software for social science (SPSS) version 22 (IBM Corporation, Armonk, NY, USA) software for analysis. RESULTS The overall mean availability of selected basket medicines was 63.4% (range 16.7% to 80.3%) during the pre-COVID-19 time. It was 46.3% (range 2.8% to 88.7) during the pandemic. There was a relative increase in the availability of two paracetamol products [paracetamol 500 mg tablet (67.5% versus 88.7%) and suppository (74.5% versus 88%)] during the pandemic. The average monthly orders fill rates for the selected products range from 43 to 85%. Pre-COVID-19, the average order fill rate was greater or equal to 70%. However, immediately after the COVID-19 case notification, the percentage of order(s) filled correctly in items and quantities began decreasing. Political instability, shortage of trained human resources, currency inflation, and limited drug financing were considered as the major challenges to medicine supply. CONCLUSION The overall stock out situation in the study area has worsened during COVID-19 compared to pre-COVID-19 time. None of the surveyed chronic disease basket medicines met the ideal availability benchmark of 80% in health facilities. However, availability of paracetamol 500 mg tablet surprisingly improved during the pandemic. A range of policy frameworks and options targeting inevitable outbreaks should exist to enable governments to ensure that medicines for chronic diseases are consistently available and affordable.
Collapse
Affiliation(s)
- Zeleke Mekonnen
- Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Tsegaye Melaku
- Institute of Health, Jimma University, Jimma, Oromia, Ethiopia.
| | | | - Mohammed Mecha
- Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Christine Årdal
- Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Marianne Jahre
- Department of Accounting and Operations Management, BI Norwegian Business School, Oslo, Norway
| |
Collapse
|
44
|
Manthey J, Kokole D, Riedel-Heller S, Rowlands G, Schäfer I, Schomerus G, Soellner R, Kilian C. Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany. Addict Sci Clin Pract 2023; 18:28. [PMID: 37161561 PMCID: PMC10169338 DOI: 10.1186/s13722-023-00383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Although the detrimental health effects of alcohol are well established, consumption levels are high in many high-income countries such as Germany. Improving alcohol health literacy presents an integrated approach to alcohol prevention and an important complement to alcohol policy. Our aim was to identify and prioritize measures to enhance alcohol health literacy and hence to reduce alcohol consumption, using Germany as an example. METHODS A series of recommendations for improving alcohol health literacy were derived from a review of the literature and subsequently rated by five experts. Recommendations were rated according to their likely impact on enhancing (a) alcohol health literacy and (b) reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC). RESULTS Eleven recommendations were established for three areas of action: (1) education and information, (2) health care system, and (3) alcohol control policy. Education and information measures were rated high to increase alcohol health literacy but low to their impact on alcohol consumption, while this pattern was reversed for alcohol control policies. The ratings showed good agreement (ICC: 0.85-0.88). CONCLUSIONS Improving alcohol health literacy and reducing alcohol consumption should be considered complementary and become part of a comprehensive alcohol strategy to curb the health, social, and economic burden of alcohol.
Collapse
Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Steffi Riedel-Heller
- Public Health Sciences Institute, Campus for Ageing & Vitality, Westgate Rd, Newcastle Upon Tyne, NE4 6BE, UK
| | - Gill Rowlands
- Institute of Social Medicine, Medical Faculty, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Georg Schomerus
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Renate Soellner
- Institute for Psychology, University of Hildesheim, Universitätsplatz 1, 34414, Hildesheim, Germany
| | - Carolin Kilian
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research (IMHPR), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| |
Collapse
|
45
|
Manthey J, Jacobsen B, Hayer T, Kalke J, López-Pelayo H, Pons-Cabrera MT, Verthein U, Rosenkranz M. The impact of legal cannabis availability on cannabis use and health outcomes: A systematic review. Int J Drug Policy 2023; 116:104039. [PMID: 37126997 DOI: 10.1016/j.drugpo.2023.104039] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND For alcohol, regulating availability is an effective way to reduce consumption and harm. Similarly, the higher availability of medical cannabis dispensaries has been linked to increased cannabis consumption and harm. For recreational cannabis markets, such a link is suspected but still poorly understood. METHODS A systematic literature review (PROSPERO registration number 342357) was conducted on 1 July 2022 in common libraries (Medline, Web of Science, PsycInfo, Psyndex, CINAHL, Embase, SCOPUS, Cochrane) for publications since 2012. Studies linking variations in the availability of legal cannabis products to behavioral outcomes (cannabis use or related health indicators) were included, while studies focusing solely on the legalization of medical cannabis were excluded. The risk of bias was assessed using an adapted version of the Newcastle-Ottawa-Scale. RESULTS After screening n = 6,253 studies, n = 136 were selected for full-text review, out of which n = 13 met the inclusion criteria, reporting on n = 333,550 study participants and n = 855,630 presentations to emergency departments. All studies were conducted in North America, with the majority from Western US states. Using longitudinal (n = 1), cross-sectional (n = 4), or repeated cross-sectional (n = 8) study designs, an increased availability of legal cannabis was linked to increased current cannabis use and health-related outcomes (vomiting, psychosis, or cannabis-involved pregnancies), regardless of the indicator employed to measure availability (proximity or density) among both adults and adolescents. The positive correlation between cannabis availability and consumption is most pronounced among those groups who have been less exposed to cannabis before legalization. The association between the availability of legal cannabis and risky use indicators was less consistent. CONCLUSIONS Groups who have been least exposed to cannabis before legalization may be most susceptible to increased availability. In jurisdictions with legal cannabis markets, restrictions on the number of legal cannabis retailers, especially in densely populated areas, appear warranted.
Collapse
Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany.
| | - Britta Jacobsen
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany
| | - Tobias Hayer
- University of Bremen, Institute of Public Health and Nursing Research, Department for Health and Society, Grazerstr. 2, 28359 Bremen, Germany
| | - Jens Kalke
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany
| | - Hugo López-Pelayo
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Unitat de Conductes Addictives, Servei de Psiquiatria Psicologia (ICN), Hospital Clínic de Barcelona, Barcelona, Spain; Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Spain
| | - Maria Teresa Pons-Cabrera
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Unitat de Conductes Addictives, Servei de Psiquiatria Psicologia (ICN), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Moritz Rosenkranz
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany
| |
Collapse
|
46
|
Calloway EE, Carpenter LR, Gargano T, Sharp JL, Yaroch AL. New measures to assess the "Other" three pillars of food security- availability, utilization, and stability. Int J Behav Nutr Phys Act 2023; 20:51. [PMID: 37101157 PMCID: PMC10134599 DOI: 10.1186/s12966-023-01451-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND In recent reviews of available measures, no existing measures assessed all four pillars of food security and most only assessed one or two pillars-predominantly the access pillar. The purpose of this study was to preliminarily develop novel measures of availability, utilization, and stability that are complementary to the USDA's household food security survey measure (HFSSM). METHODS A formative phase included an expert advisory group, literature scans, and interviews with individuals experiencing food insecurity. From April-June 2021, the new measures were piloted in five states (California, Florida, Maryland, North Carolina, and Washington). The cross-sectional pilot survey included the new measures (perceived limited availability, utilization barriers, and food insecurity stability), scales and items for validation (e.g., food security, and self-reported dietary and health outcomes), and demographic questions. Exploratory factor analysis was used to assess dimensionality, internal consistency was assessed using Kuder-Richardson formula 21 (KR21), and convergent and discriminant validity were assessed using Spearman's correlation coefficients. Also, a brief screener version was created for the utilization barriers measure that may be necessary for certain applications (e.g., clinical intake screening to inform referrals to assistance programs). RESULTS The analytic samples (perceived limited availability (n = 334); utilization barriers (n = 428); food insecurity stability (n = 445)) were around 45 years old on average, most households had children, over two-thirds were food insecure, over three-fourths were women, and the samples were racially/ethnically diverse. All items loaded highly and unambiguously to a factor (factor loadings range 0.525-0.903). Food insecurity stability showed a four-factor structure, utilization barriers showed a two-factor structure, and perceived limited availability showed a two-factor structure. KR21 metrics ranged from 0.72 to 0.84. Higher scores for the new measures were generally associated with increased food insecurity (rhos = 0.248-0.497), except for one of the food insecurity stability scores. Also, several of the measures were associated with statistically significantly worse health and dietary outcomes. CONCLUSIONS The findings support the reliability and construct validity of these new measures within a largely low-income and food insecure sample of households in the United States. Following further testing, such as Confirmatory Factor Analysis in future samples, these measures may be used in various applications to promote a more comprehensive understanding of the food insecurity experience. Such work can help inform novel intervention approaches to address food insecurity more fully.
Collapse
Affiliation(s)
- Eric E Calloway
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA.
| | - Leah R Carpenter
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
| | - Tony Gargano
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
| | | | - Amy L Yaroch
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
| |
Collapse
|
47
|
Chen CF, Lim YC, Ju YR, Albarico FPJB, Chen CW, Dong CD. A novel pollution index to assess the metal bio availability and ecological risks in sediments. Mar Pollut Bull 2023; 191:114926. [PMID: 37075561 DOI: 10.1016/j.marpolbul.2023.114926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
The chemical forms of metals in sediments of ports around Taiwan were investigated using sequential extraction. Based on the availability of different chemical forms, novel indices such as bioavailability, mobility, availability, and availability risk of metals in sediments were developed. The results showed that Co, Zn, Pb, Mn, and Cu were mainly present in available forms (49-84 %), and the proportion of oxidative or reductive fractionation was the highest. This suggests that the redox potential is a major factor for metal mobility in the sediments. The results from the proposed indexes showed that metals in sediments have low bioavailability but high to very high mobility and availability. Primarily, the proposed index is more appropriate, as the current index for assessing total metal content may overestimate the level of risk. The indexes established can comprehensively evaluate the bioavailability, mobility, availability, and ecological risk of metals in sediments.
Collapse
Affiliation(s)
- Chih-Feng Chen
- Department of Marine Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City 81157, Taiwan
| | - Yee Cheng Lim
- Department of Marine Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City 81157, Taiwan
| | - Yun-Ru Ju
- Department of Safety, Health and Environmental Engineering, National United University, Miaoli 36063, Taiwan
| | - Frank Paolo Jay B Albarico
- Department of Marine Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City 81157, Taiwan; Institute of Aquatic Science and Technology, National Kaohsiung University of Science and Technology, Kaohsiung City 81157, Taiwan
| | - Chiu-Wen Chen
- Department of Marine Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City 81157, Taiwan.
| | - Cheng-Di Dong
- Department of Marine Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City 81157, Taiwan.
| |
Collapse
|
48
|
Zhang Y, Wang X, Yang Y, Huang Y, Li X, Hu S, Liu K, Pang Y, Liu T, Li F. Retention and transformation of exogenous Hg in acidic paddy soil under alternating anoxic and oxic conditions: Kinetic and mechanistic insights. Environ Pollut 2023; 323:121335. [PMID: 36828356 DOI: 10.1016/j.envpol.2023.121335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
To estimate the risks and developing remediation strategies for the mercury (Hg)-contaminated soils, it is crucial to understand the mechanisms of Hg transformation and migration in the redox-changing paddy fields. In present study, a Hg-spiked acidic paddy soil (pH 4.52) was incubated under anoxic conditions for 40 d and then under oxic conditions for 20 d. During anoxic incubation, the water-soluble, exchangeable, specifically adsorbed, and fulvic acid-complexed Hg decreased sharply, whereas the humic acid-complexed Hg, organic, and sulfide-bound Hg gradually increased, which were mainly ascribed to the enhanced adsorption on the surface of soil minerals with an increase in soil pH, complexation by organic matters, precipitation as HgS, and absorption by soil colloids triggered by reductive dissolution of Fe(III) oxides. By contrast, after oxygen was introduced into the system, a gradual increase in available Hg occurred with decreasing soil pH, decomposition of organic matters and formation of Fe(III) oxides. A kinetic model was established based on the key elementary reactions to quantitatively estimate transformation processes of Hg fractions. The model matched well with the modified Tessier sequential extraction data, and suggested that large molecular organic matter and humic acid dominated Hg complexation and immobilization in acidic paddy soils. The content of methylmercury increased and reached its peak on anoxic 20 d. Sulfate-reducing bacteria Desulfovibrio and Desulfomicrobium were the major Hg methylating bacteria in the anoxic stage whereas demethylating microorganisms Clostridium_sensu_stricto_1 and Clostridium_sensu_stricto_12 began to grow after oxygen was introduced. These new dynamic results provided new insights into the exogenous Hg transformation processes and the model could be used to predict Hg availability in periodically flooded acidic paddy fields.
Collapse
Affiliation(s)
- Yufan Zhang
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China; School of Environment, South China Normal University, Guangzhou, 510006, China; National-Regional Joint Engineering Research Center for Soil Pollution Control and Remediation in South China, Guangdong Key Laboratory of Integrated Agro-environmental Pollution Control and Management, Institute of Eco-environmental and Soil Sciences, Guangdong Academy of Sciences, Guangzhou, 510650, China
| | - Xiangqin Wang
- National-Regional Joint Engineering Research Center for Soil Pollution Control and Remediation in South China, Guangdong Key Laboratory of Integrated Agro-environmental Pollution Control and Management, Institute of Eco-environmental and Soil Sciences, Guangdong Academy of Sciences, Guangzhou, 510650, China
| | - Yang Yang
- National-Regional Joint Engineering Research Center for Soil Pollution Control and Remediation in South China, Guangdong Key Laboratory of Integrated Agro-environmental Pollution Control and Management, Institute of Eco-environmental and Soil Sciences, Guangdong Academy of Sciences, Guangzhou, 510650, China
| | - Yingmei Huang
- National-Regional Joint Engineering Research Center for Soil Pollution Control and Remediation in South China, Guangdong Key Laboratory of Integrated Agro-environmental Pollution Control and Management, Institute of Eco-environmental and Soil Sciences, Guangdong Academy of Sciences, Guangzhou, 510650, China
| | - Xiaomin Li
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China; School of Environment, South China Normal University, Guangzhou, 510006, China
| | - Shiwen Hu
- National-Regional Joint Engineering Research Center for Soil Pollution Control and Remediation in South China, Guangdong Key Laboratory of Integrated Agro-environmental Pollution Control and Management, Institute of Eco-environmental and Soil Sciences, Guangdong Academy of Sciences, Guangzhou, 510650, China
| | - Kexue Liu
- School of Resources and Planning, Guangzhou Xinhua University, Guangzhou, 510310, China
| | - Yan Pang
- National-Regional Joint Engineering Research Center for Soil Pollution Control and Remediation in South China, Guangdong Key Laboratory of Integrated Agro-environmental Pollution Control and Management, Institute of Eco-environmental and Soil Sciences, Guangdong Academy of Sciences, Guangzhou, 510650, China
| | - Tongxu Liu
- National-Regional Joint Engineering Research Center for Soil Pollution Control and Remediation in South China, Guangdong Key Laboratory of Integrated Agro-environmental Pollution Control and Management, Institute of Eco-environmental and Soil Sciences, Guangdong Academy of Sciences, Guangzhou, 510650, China.
| | - Fangbai Li
- National-Regional Joint Engineering Research Center for Soil Pollution Control and Remediation in South China, Guangdong Key Laboratory of Integrated Agro-environmental Pollution Control and Management, Institute of Eco-environmental and Soil Sciences, Guangdong Academy of Sciences, Guangzhou, 510650, China
| |
Collapse
|
49
|
Ouédraogo AR, Boncoungou K, Ouédraogo JCRP, Ouédraogo GA, Kiendrebeogo JA, Sourabie A, Maiga S, Kafando S, Ouédraogo G, Badoum G, Ouédraogo M. [ Availability and affordability of diagnosis and treatment for asthma and COPD in Ouagadougou, Burkina Faso]. Rev Mal Respir 2023; 40:382-390. [PMID: 37062632 DOI: 10.1016/j.rmr.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Chronic respiratory diseases, particularly asthma and Chronic Obstructive Pulmonary Disease (COPD), pose a significant threat to public health. This study aims to determine the accessibility and affordability of means of diagnosis and treatment. METHODS This was a cross-sectional study covering the period from August to December 2021 in Ouagadougou, Burkina Faso. This study involved 107 health centers and 135 pharmacies. The World Health Organization/Health Action International definition was used as a benchmark for accessibility to medicines. RESULTS Out of 107 health centers, 29 (27.1%) had a spirometer. The average cost of spirometry represented 19.88 days of salary for a patient paid at the minimum wage. The most widely available drugs were salbutamol in a pressurized metered dose inhaler (pMDI) (88.1%) and prednisone 20mg tablet (87.4%). No disease-modifying drug was available in public pharmacies. Affordable drugs were salbutamol 4mg tablet and aminophylline 100mg tablet. CONCLUSION The means of diagnosis and treatment of asthma and COPD are insufficiently available, especially in the public sector, which is characterized by a nearly total absence of basic treatment.
Collapse
Affiliation(s)
- A R Ouédraogo
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Tengandogo, Ouagadougou, Burkina Faso.
| | - K Boncoungou
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - J C R P Ouédraogo
- Département MEPHATRA-PH, institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
| | - G A Ouédraogo
- Service de pneumologie, centre hospitalier universitaire régional de Ouahigouya, Ouagadougou, Burkina Faso
| | - J A Kiendrebeogo
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso
| | - A Sourabie
- Service de pneumologie, CHU de Souro-Sanou, Bobo-Dioulasso, Burkina Faso
| | - S Maiga
- Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - S Kafando
- Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - G Ouédraogo
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - G Badoum
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - M Ouédraogo
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| |
Collapse
|
50
|
Baraud F, Leleyter L, Poree S, Lecomte T. Environmental availability of trace metals in a fired brick elaborated from a marine dredged sediment. Environ Sci Pollut Res Int 2023; 30:54914-54926. [PMID: 36881230 DOI: 10.1007/s11356-023-26163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Each year, hundreds of millions of tons of sediments are dredged around the world. Alternatively to sea or land disposal, the reuse of these sediments as raw material in various civil engineering applications is developing. In this context, the French SEDIBRIC project (valorisation de SEDIments en BRIQues et tuiles) aims to replace, in the preparation of clay-fired bricks, a part of natural clays by harbor dredged sediments. The present study focuses on the fate of some potentially toxic elements (Cd, Cr, Cu, Ni, Pb, and Zn) that are initially present in the sediments. A fired brick is elaborated exclusively from one dredged sediment, after a desalination step. The total content of each element of interest is evaluated by ICP-AES, after a microwave-assisted acid (aqua regia) digestion, in the raw sediment and in the brick. Then, single extractions (H2O, HCl, or EDTA as reactant) and one sequential extraction procedure (according to Leleyter and Probst, Int J Environ Anal Chem 73(2): 109-128 1999) are applied to the raw sediment and to the brick, in order to assess the environmental availability of the elements of interest. For Cu, Ni, Pb, and Zn, the results obtained with the various extractions procedures applied are consistent and confirm that the firing process induces their stabilization in the brick. The availability however increases for Cr and remains unchanged for Cd.
Collapse
Affiliation(s)
- Fabienne Baraud
- Normandie Univ, UNICAEN, ABTE EA 4651, Boulevard du Maréchal Juin, Bât Sciences 2, 14032, Caen Cedex, France.
| | - Lydia Leleyter
- Normandie Univ, UNICAEN, ABTE EA 4651, Boulevard du Maréchal Juin, Bât Sciences 2, 14032, Caen Cedex, France
| | - Sandra Poree
- Normandie Univ, UNICAEN, ABTE EA 4651, Boulevard du Maréchal Juin, Bât Sciences 2, 14032, Caen Cedex, France
| | - Tristan Lecomte
- Normandie Univ, UNICAEN, ABTE EA 4651, Boulevard du Maréchal Juin, Bât Sciences 2, 14032, Caen Cedex, France
| |
Collapse
|