Integrating global and national knowledge to select medicines for children: the Ghana National Drugs Programme.
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ABSTRACT:
SUBMITTER: Sinclair D
PROVIDER: S-EPMC3660441 | biostudies-literature | 2013
REPOSITORIES: biostudies-literature
Publications
Integrating global and national knowledge to select medicines for children: the Ghana National Drugs Programme.
Sinclair David D Gyansa-Lutterodt Martha M Asare Brian B Koduah Augustina A Andrews Edith E Garner Paul P
PLoS medicine 20130521 5
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Project description:BackgroundIn Ghana, the government has integrated herbal medicine into the formal healthcare system in response to widespread use of traditional remedies. However, empirical evidence supporting the contribution of integrated healthcare to malaria control remains limited. This study employed a phenomenological qualitative research design to explore the experiences of medical doctors and pharmacists from the coastal, forest and savannah regions of Ghana regarding the integration of modern and herbal medicine in the treatment and control of malaria. Donabedian's framework for evaluating the quality of healthcare served as the foundational theoretical framework for this research.MethodsData were collected through individual in-depth interviews involving 26 participants and analysed using a framework analytical approach.ResultsThe findings revealed that inadequate political commitment to the practice of integration has led to several challenges, including the high cost of herbal anti-malaria medications, limited promotional activities surrounding integration, a shortage of qualified medical herbalists, inconsistent supply chains for herbal anti-malaria treatments, and a lack of standardisation in herbal medicine practices. Participants had divergent views regarding the impact of integration on malaria control; while medical doctors believed that the intervention has not significantly contributed to reducing malaria prevalence in Ghana, pharmacists viewed the presence of herbal clinics within government hospitals as an effective and sustainable alternative for treating malaria.ConclusionReflecting on these results, it is imperative for policymakers to explore strategies that could enhance the effectiveness of an integrated health system, thereby increasing the contribution of herbal medicine towards achieving a malaria free nation. Future research could benefit from including policymakers, heads of health directorates, and community members, regarding the role of public health interventions in addressing health inequities in Ghana.
| S-EPMC11665210 | biostudies-literature
Project description:BackgroundIn April 2011, the World Health Organization (WHO) published a list of "priority medicines" for maternal and child health based on 1) the global burden of disease and 2) evidence of efficacy and safety. The objective of this study was to examine the occurrence of these priority medicines on national essential medicines lists.Methods and findingsAll essential medicines lists published since 1999 were selected from the WHO website collection. The most-up-to date list for each country was then selected, resulting in 89 unique country lists. Each list was evaluated for inclusion of medicines (chemical entity, concentration, and dosage form) on the Priority Medicines List. There was global variation in the listing of the Priority Medicines. The most frequently listed medicine was paracetamol, on 94% (84/89) of lists. Sodium chloride, gentamicin and oral rehydration solution were on 93% (83/89) of lists. The least frequently listed medicine was the children's antimalarial rectal artesunate, on 8% of lists (7/89); artesunate injection was on 16% (14/89) of lists. Pediatric artemisinin combination therapy, as dispersible tablets or flexible oral solid dosage form, appeared on 36% (32/89) of lists. Procaine benzylpenicillin, for treatment of pediatric pneumonia and neonatal sepsis, was on 50% (45/89) of the lists. Zinc, for treatment of diarrhoea in children, was included on only 15% (13/89) of lists. For prevention and treatment of postpartum hemorrhage in women, oxytocin was more prevalent on the lists than misoprostol; they were included on 55 (62%) and 31 (35%) of lists, respectively. Cefixime, for treatment of uncomplicated anogenital gonococcal infection in woman was on 26% (23/89) of lists. Magnesium sulfate injection for treatment of severe pre-eclampsia and eclampsia was on 50% (45/89) of the lists.ConclusionsThe findings suggest that countries need to urgently amend their lists to provide all priority medicines as part of the efforts to improve maternal and child health.
| S-EPMC3365009 | biostudies-literature
Project description:BackgroundAccess 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.MethodsWe 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.ResultsOverall, 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.ConclusionThe 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.
| S-EPMC10280921 | biostudies-literature
Project description:Symptomatic testing programmes are crucial to the COVID-19 pandemic response. We sought to examine United Kingdom (UK) testing rates amongst individuals with test-qualifying symptoms, and factors associated with not testing. We analysed a cohort of untested symptomatic app users (N = 1,237), nested in the Zoe COVID Symptom Study (Zoe, N = 4,394,948); and symptomatic respondents who wanted, but did not have a test (N = 1,956), drawn from a University of Maryland survey administered to Facebook users (The Global COVID-19 Trends and Impact Survey [CTIS], N = 775,746). The proportion tested among individuals with incident test-qualifying symptoms rose from ~20% to ~75% from April to December 2020 in Zoe. Testing was lower with one vs more symptoms (72.9% vs 84.6% p<0.001), or short vs long symptom duration (69.9% vs 85.4% p<0.001). 40.4% of survey respondents did not identify all three test-qualifying symptoms. Symptom identification decreased for every decade older (OR = 0.908 [95% CI 0.883-0.933]). Amongst symptomatic UMD-CTIS respondents who wanted but did not have a test, not knowing where to go was the most cited factor (32.4%); this increased for each decade older (OR = 1.207 [1.129-1.292]) and for every 4-years fewer in education (OR = 0.685 [0.599-0.783]). Despite current UK messaging on COVID-19 testing, there is a knowledge gap about when and where to test, and this may be contributing to the ~25% testing gap. Risk factors, including older age and less education, highlight potential opportunities to tailor public health messages. The testing gap may be ever larger in countries that do not have extensive, free testing, as the UK does.
| S-EPMC10022193 | biostudies-literature
Project description:BackgroundAvailability of the opioid antagonist naloxone for lay administration has grown substantially since first proposed in 1996. Gaps remain, though, in our understanding of how people who inject drugs (PWID) engage with naloxone programmes over time.AimsThis paper aimed to address three specific evidence gaps: the extent of naloxone supply to PWID; supply-source (community or prisons); and the carriage of naloxone among PWID.Materials and methodsAnalysis of Scotland's Needle Exchange Surveillance Initiative (NESI) responses in 2011-2012 and 2013-2014 was undertaken with a specific focus on the extent of Scotland's naloxone supply to PWID; including by source (community or prisons); and on the carriage of naloxone. Differences in responses between the two surveys were measured using Chi-square tests together with 95% confidence intervals for rate-differences over time.ResultsThe proportion of NESI participants who reported that they had been prescribed naloxone within the last year increased significantly from 8% (175/2146; 95% CI: 7-9%) in 2011-2012 to 32% (745/2331; 95% CI: 30% to 34%) in 2013-2014. In contrast, the proportion of NESI participants who carried naloxone with them on the day they were interviewed decreased significantly from 16% (27/169; 95% CI: 10% to 22%) in 2011-2012 to 5% (39/741; 95% CI: 4% to 7%) in 2013-2014.ConclusionsThe supply of naloxone to PWID has increased significantly since the introduction of a National Naloxone Programme in Scotland in January 2011. In contrast, naloxone carriage is low and decreased between the two NESI surveys; this area requires further investigation.
| S-EPMC5854250 | biostudies-literature
Project description:BACKGROUND:Evidence of the context-specific challenges related to childhood cancer drug (CCD) access is vital to improving outcomes for children with cancer in low- and middle-income countries, such as Ghana. We sought to determine the availability and cost of essential CCD in Ghana and identify the underlying determinants of access. METHODS:Our study integrated quantitative data on drug prices and availability with qualitative insights into health system and sociopolitical determinants of CCD access in Ghana. We analysed retrospective monthly price and stock data for 41 cancer and supportive care drugs on the WHO Essential Medicines List (EML) from private retail and public institutional pharmacies. Non-parametric analyses evaluated relationships between drug price and availability, and impacts of drug class and formulation on availability and procurement efficiency. We assessed the determinants of drug access through thematic analysis of policy documents and semi-structured interviews (n=21) with key health system stakeholders. RESULTS:Ghana lists only 47% of essential CCD on its National EML, revealing gaps in domestic formulary inclusion. Stock-outs occurred for 88% of essential CCD, with a 70-day median stock-out duration; 32% had median price ratios above internationally-accepted efficiency thresholds. Drugs procured inefficiently were more susceptible to stock-outs (p=0.0003). Principal determinants of drug access included: (1) lack of sociopolitical priority afforded childhood cancer and (2) the impact of policy and regulatory environments on drug affordability, availability and quality. Establishment of a population-based cancer registry, a nationally-coordinated procurement strategy for CCD, public financing for childhood cancer care and policies to control drug costs emerged as priority interventions to improve drug access in Ghana. CONCLUSION:Our study provides context-specific evidence to enable responsive policy development for efficient drug procurement and supply management in Ghana and establishes a rigorous approach to the analysis of childhood cancer drug access in similar health system settings.
| S-EPMC7513566 | biostudies-literature
Project description:BackgroundApplying simulation-based education (SBE) into surgical curricula is challenging and exacerbated by the absence of guidance on implementation processes. Empirical studies evaluating implementation of SBE interventions focus primarily on outcomes. However, understanding the processes involved in organising, planning, and delivering SBE adds knowledge on how best to develop, implement, and sustain surgical SBE. This study used a reform of early years surgical training to explore the implementation of a new SBE programme in Scotland. It aimed to understand the processes that are involved in the relative success (or failure) when implementing surgical SBE interventions.MethodsThis qualitative case study, underpinned by social constructionism, used publicly available documents and the relevant surgical SBE literature to inform the research focus and contextualise data obtained from semi-structured interviews with core surgical trainees (n = 46), consultant surgeons (n = 25), and key leaders with roles in surgical training governance in Scotland (n = 7). Initial data coding and analysis were inductive. Secondary data analysis was then undertaken using Normalisation Process Theory (NPT). NPTs' four constructs (coherence, cognitive participation, collective action, reflexive monitoring) provided an explanatory framework for scrutinising how interventions are implemented, embedded, and integrated into practice, i.e. the "normalisation" process.ResultsDistributed leadership (individual SBE initiatives assigned to faculty but overall programme overseen by a single leader) and the quality improvement practise of iterative refinement were identified as key novel processes promoting successful normalisation of the new SBE programme. Other processes widely described in the literature were also identified: stakeholder collaboration, personal contacts/relational processes, effective communication, faculty development, effective leadership, and tight programme management. The study also identified that learners valued SBE activities in group- or team-based social environments over isolated deliberate practice.ConclusionsSBE is most effective when designed as a comprehensive programme aligned to the curriculum. Programmes incorporating both group-based and isolated SBE activities promote deliberate practice. Distributed leadership amongst faculty attracts wide engagement integral to SBE programme implementation, while iterative programme refinement through regular evaluation and action on feedback encourages integration into practice. The knowledge contributed by critically analysing SBE programme implementation processes can support development of much needed guidance in this area.
| S-EPMC10436455 | biostudies-literature
Project description:Prenatal exposure to recreational drugs impairs motor and cognitive development; however it is currently unknown whether visual brain areas are affected. To address this question, we investigated the effect of prenatal drug exposure on global motion perception, a behavioural measure of processing within the dorsal extrastriate visual cortex that is thought to be particularly vulnerable to abnormal neurodevelopment. Global motion perception was measured in one hundred and forty-five 4.5-year-old children who had been exposed to different combinations of methamphetamine, alcohol, nicotine and marijuana prior to birth and 25 unexposed children. Self-reported drug use by the mothers was verified by meconium analysis. We found that global motion perception was impaired by prenatal exposure to alcohol and improved significantly by exposure to marijuana. Exposure to both drugs prenatally had no effect. Other visual functions such as habitual visual acuity and stereoacuity were not affected by drug exposure. Prenatal exposure to methamphetamine did not influence visual function. Our results demonstrate that prenatal drug exposure can influence a behavioural measure of visual development, but that the effects are dependent on the specific drugs used during pregnancy.
| S-EPMC4652269 | biostudies-other
Project description:Ready-made spectacles are low-cost spectacles for correcting refractive errors in children who would otherwise have their refractive errors uncorrected due to lack of availability and affordability of conventional, expensive custom-made spectacles. Thus, this study seeks to estimate the proportion of children with uncorrected refractive errors eligible for ready-made spectacles in a school-based programme. A school-based descriptive cross-sectional study was employed to screen children aged 12-15 years in eighteen public junior high schools within the Bongo district of Ghana. Children who failed the 6/9 acuity test were refracted and given spectacles. Ready-made spectacle was prescribed when visual acuity improved by ≥2 lines in at least one eye with full correction (astigmatism of ≤0.75D); spherical equivalent corrected visual acuity to ≤1 line worse than best corrected visual acuity with full correction in the better eye; and there was ≤1.00D difference between the two eyes. A total of 1,705 school children were examined. Of this number, 30 (1.8%; 95% CI: 1.2-2.5%) met the criteria for refractive correction but none had any. Twenty-six (86.7%; 95% CI: 69.7-95.3%) were found to be eligible for ready-made spectacles (power range: -1.50D to +1.00D, mean spherical equivalent ± SD = -0.27D ± 0.79D) while 4 (13.3%; 95% CI: 4.7-30.3%) were not, hence, given custom-made spectacles. A binary logistic regression analysis revealed that the odds of being eligible for one type of spectacles was similar between males and females (OR: 1.1; 95% CI: 0.1-12.7; p = 0.93). A large proportion of students who met the criteria for spectacle correction could be corrected with ready-made spectacles. There is, therefore, the need for these spectacles to be considered an appropriate alternative for refractive error correction during school eye health programmes.
| S-EPMC10021990 | biostudies-literature
Project description:BackgroundAdverse effects of antileishmanial drugs can affect patients' quality of life and adherence to therapy for visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL). In Bangladesh, there are 26 treatment centers that manage leishmaniasis cases coming from 100 endemic upazilas (subdistricts) of 26 districts (these include VL, PKDL, treatment failure, and relapse VL and cutaneous leishmaniasis cases). This study aimed to investigate the feasibility of using focused pharmacovigilance for VL (VLPV) in Bangladesh's National Kala-azar Elimination Programme for the early detection and prevention of expected and unexpected adverse drug reactions (ADRs).MethodsThis activity has been going on since December 2014. Activity area includes secondary public hospital or Upazila health complex (UHC) in hundred sub districts and Surya Kanta Kala-azar Research Center (SKKRC) in Mymensingh District, a specialized center for management of complicated VL and PKDL cases. Communicable Disease Control (CDC) of the Directorate General of Health Services (DGHS) assigned twenty five of hundred UHCs and SKKRC (total 26) as treatment centers depending on their suitable geographical location. This was implemented for better management of VL cases with Liposomal Amphotericin B (AmBisome®) to ensure patient convenience and proper utilization of this expensive donated drug. A VLPV expert committee and a UHC VLPV team were established, an operational manual and pharmacovigilance report forms were developed, training and refresher training of health personnel took place at UHCs and at the central level, collected information such as patient data including demographics, treatment history and response, adverse events were analyzed. This report includes information for the period from December 2014 to December 2016.ResultsFrom December 2014 to December 2016, 1327 leishmaniasis patients were treated and 1066 (80%) were available for VLPV. Out of these, 57, 33, 9, and 1% were new VL, PKDL, VL relapse, and other cases, respectively. Liposomal amphotericin B was mostly used (82%) for case management, followed by miltefosine (20%) and paromomycin (3%). Out of the 1066 patients, 26% experienced ADRs. The most frequent ADR was fever (17%, 176/1066), followed by vomiting (5%, 51/1066). Thirteen serious adverse events (SAEs) (eight deaths and five unexpected SAEs) were observed. The expert committee assessed that three of the deaths and all unexpected SAEs were possibly related to treatment. Out of the five unexpected SAEs, four were miltefosine-induced ophthalmic complications and the other was an AmBisome®-induced avascular necrosis of the nasal alae. The Directorate General of the Drug Administration entered the ADRs into the World Health Organization Uppsala Monitoring Centre (WHO-UMC) VigiFlow database.ConclusionsThis study found that VLPV through NKEP is feasible and should be continued as a routine activity into the public health system of Bangladesh to ensure patient safety against anti-leishmanial drugs.
| S-EPMC6088425 | biostudies-literature