The knock-on effects of COVID-19 pandemic on the supply and availability of generic medicines in Ethiopia: mixed methods study

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.

Impact of COVID-19 pandemic on the availability of maternal and child health products and childhood vaccines

BACKGROUND

In many low- and middle-income countries, the 2019 novel coronavirus (COVID-19) has challenged efforts to ensure access to and availability of quality maternal, newborn, and child health (MCH) services and essential MCH commodities.

OBJECTIVES

This study evaluated the impact of COVID-19 pandemic on the availability of maternal and child health products and childhood vaccines at selected health facilities in Ethiopia.

METHODS

We have prospectively assessed 28 maternal-child health products and 14 childhood vaccines and accessories, which are listed in the Ethiopian national essential medicines list. Data were collected from 5 hospitals located in the Jimma zone of Oromia regional state in the southwestern part of Ethiopia. We extracted data on drug availability, and order fill rates for these pharmaceutical products between May 2019 and August 2020.

RESULTS

The overall mean availability of selected maternal and child health products was 43.2%. It was 52.9% (range 21.0-63.6%) prior COVID-19 and 42.6% (range 19-56.4) during COVID-19 time. The average monthly orders fill rates of hospitals for the selected products ranged from 39 to 79%. Before COVID-19 the average order fill rate was near 70% of total orders placed by the hospitals. However, immediately after the COVID-19 case notification in Ethiopia, the percentage of order filled correctly in items and quantities began decreasing.

CONCLUSION

This study illustrates that the availability of key essential medicines for maternal and child health in the study area was low. The overall stock-out situation of MCH products has worsened during COVID-19 compared to pre-COVID-19 pandemic. None of the surveyed MCH products met the ideal availability benchmark of 80% in the public hospitals. To allow governments to guarantee these products are constantly available and affordable, a variety of policy frameworks and choices addressing inevitable epidemics should exist.

The living marine resources in the Mediterranean Sea Large Marine Ecosystem

The Mediterranean Large Marine Ecosystem (Med-LME) is a heterogeneous system that, despite its oligotrophic nature, has high diversity of marine species and high rate of endemism, making it one of the world hotspots for marine biodiversity. The basin is also among the most impacted Large Marine Ecosystems in the world due to the combined multiple stressors, such as fishing pressure, habitat loss and degradation, climate change, pollution, eutrophication and the introduction of invasive species. The complexity of Med-LME in its structure/function and dynamics, combined with the socio-political framework of the region make management of its marine resources quite challenging. This contribution aims at highlighting the importance of the Med-LME, with an emphasis on the state of its food web and of its fish/fisheries using modelling tools and national/international reporting. The purpose is to demonstrate the importance of an holistic framework, based on stock assessments and ecosystem based modelling approaches, to be adopted in support of management and conservation measures for the preservation and sustainable use of the Med-LME resources.

Demographic structure and stock status of Lethrinus lentjan in Saudi coastal waters of the Red Sea

Fishes of the family Lethrinidae form a considerable portion of the catch from both the Red Sea and the Arabian Gulf in Saudi Arabia, and the species Lethrinus lentjan (Lacepède, 1802) is one of the most important among these fishes. This study was conducted to evaluate the demographic structure coefficients, survival rate, and stock status of L. lentjan from the Red Sea coast of Saudi Arabia. A total of 593 samples were collected on a monthly basis for a period of one year from the landing site for fishing boats operating in Red Sea waters off Jeddah. The results indicated that 88.87% of the specimens were female; the maximum total length recorded was 43.5 cm with the most frequent length (14.67%) being 23–23.9 cm. The maximum age recorded for both males and females was 6 year-plus, and the 1 year-plus age category represented the majority of the samples (57.67%). The total mortality coefficient, natural mortality coefficient, and fishing mortality coefficient were 1.538, 0.315, and 1.223, respectively; all mortality coefficients in the female fishes were higher than those in the male fishes. The survival rate of males was higher (0.617) than that of females (0.214). The results of the present study indicate that L. lentjan is subjected to overfishing and a new management strategy is necessary to improve the stock status of this fish species.