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Objective To analyse sales of fixed-dose combination and single antibiotics In India In relation to World Health Organization (WHO) recommendations and national regulatory efforts to control antibiotic sales. Methods We extracted data on sales volumes of systemic antibiotics in India from a market research company sales database. We compared the market share of antibiotic sales in 2020 by WHO AWaRe (Access, Watch and Reserve) category and for those under additional national regulatory controls. We also analysed sales of fixed-dose combinations that were: formally approved for marketing or had a no-objection certificate; on the national essential medicines list; and on the WHO list of not-recommended antibiotics. Findings There were 78 single and 112 fixed-dose combination antibiotics marketed in India, accounting for 7.6 and 4.5 billion standard units of total sales, respectively. Access, Watch and Reserve antibiotics comprised 5.8, 5.6 and 0.1 billion standard units of total market sales, respectively. All additionally controlled antibiotics were Watch and Reserve antibiotics (23.6%; 2.9 billion standard units of total sales). Fixed-dose combinations on the WHO not-recommended list were marketed in 229 formulations, with 114 formulations (49.8%) having no record of formal approval or no-objection certificate. While there were no not-recommended fixed-dose combinations on the national list of essential medicines, 13 of the top-20 selling antibiotic fixed-dose combinations were WHO not-recommended. Conclusion The sale of Watch group drugs, and antibiotics banned or not approved, needs active investigation and enforcement in India. The evidence base underpinning formal approvals and no-objection certificates for not-recommended fixed-dose combinations should be audited. Objectif Analyser les ventes d'antibiotiques en association fixe et a dose unique en Inde, a la lumiere des recommandations de l'Organisation mondiale de la Sante (OMS) et des efforts de reglementation a l'echelle nationale visant a controler la vente d'antibiotiques. Methodes Nous avons preleve des donnees relatives aux volumes de vente d'antibiotiques systemiques en Inde dans la base de donnees commerciales d'une societe d'etudes de marche. Nous avons ensuite compare la part de marche qu'occupe, en 2020, la vente d'antibiotiques appartenant a chaque categorie AWaRe (Access, Watch and Reserve) etablie par l'OMS, mais aussi de ceux cibles par des mesures nationales de controle supplementaires. Enfin, nous avons examine les ventes d'associations fixes: dont la commercialisation a ete officiellement approuvee ou qui ont fait l'objet d'un certificat de non-objection; figurant sur la liste nationale de medicaments essentiels; et reprises dans la liste des antibiotiques non recommandes par l'OMS. Resultats Nous avons comptabilise 78 antibiotiques a dose unique et 112 antibiotiques en association fixe sur le marche indien, representant respectivement 7,6 et 4,5 milliards d'unites standard sur l'ensemble des ventes. Les antibiotiques des categories Access (dont l'accessibilite est essentielle), Watch (a utiliser selectivement) et Reserve (de reserve, non recommandes) equivalaient a 5,8 milliards, 5,6 milliards et 0,1 milliard d'unites standard sur le total des transactions. Tous les antibiotiques soumis a des controles supplementaires faisaient partie des categories Watch et Reserve (23,6%; 2,9 milliards d'unites standard sur l'ensemble des ventes). Des associations fixes deconseillees par l'OMS etaient commercialisees dans 229 formulations, dont 114 (49,8%) ne possedaient ni attestation d'approbation officielle, ni certificat de non-objection. Bien qu'aucune association fixe deconseillee ne soit mentionnee sur la liste nationale de medicaments essentiels, 13 des 20 antibiotiques en association fixe les plus vendus n'etaient pas recommandes par l'OMS. Conclusion Il est necessaire de mener une enquete approfondie en Inde sur la vente de medicaments appartenant a la categorie Watch et d'antibiotiques interdits ou non approuves, et de prendre des mesures concretes. Les preuves sur lesquelles reposent les autorisations officielles et les certificats de non-objection pour les associations fixes non recommandees doivent etre verifiees. Objetivo Analizar las ventas de los antibioticos combinados en dosis fijas y en dosis unicas en la India en relacion con las recomendaciones de la Organizacion Mundial de la Salud (OMS) y los esfuerzos nacionales de regulacion para controlar las ventas de los antibioticos. Metodos Se extrajeron datos sobre los volumenes de ventas de antibioticos sistemicos en la India de una base de datos de ventas de empresas de investigacion de mercado. Se comparo la cuota de mercado de las ventas de antibioticos en 2020 por categoria AWaRe (Access, Watch and Reserve) de la OMS y para los que estaban sometidos a controles regulatorios nacionales adicionales. Tambien se analizaron las ventas de combinaciones en dosis fijas que estaban: formalmente aprobadas para su comercializacion o tenian un certificado de no objecion; en la lista nacional de medicamentos esenciales; y en la lista de antibioticos no recomendados de la OMS. Resultados En la India se comercializaron 78 antibioticos en dosis unica y 112 antibioticos combinados en dosis fijas, que representaron 7,6 y 4,5 mil millones de unidades estandar de ventas totales, respectivamente. Los antibioticos de acceso, vigilancia y reserva supusieron 5,8, 5,6 y 0,1 mil millones de unidades estandar de las ventas totales del mercado, respectivamente. Todos los antibioticos controlados adicionalmente fueron antibioticos de vigilancia y reserva (23,6 %; 2,9 mil millones de unidades estandar de las ventas totales). Las combinaciones en dosis fijas incluidas en la lista no recomendada de la OMS se comercializaron en 229 formulaciones, de las que 114 (49,8 %) no tenian registro de aprobacion formal ni certificado de no objecion. Mientras que no habia combinaciones en dosis fijas no recomendadas en la lista nacional de medicamentos esenciales, 13 de las 20 combinaciones en dosis fijas de antibioticos mas vendidas no estaban recomendadas por la OMS. Conclusion Se debe investigar y controlar activamente la venta de medicamentos del grupo Watch y de antibioticos prohibidos o no aprobados en la India. Asimismo, se debe auditar la base de pruebas que sustenta las aprobaciones formales y los certificados de no objecion para las combinaciones en dosis fijas no recomendadas., Introduction The overuse and misuse of antibiotics contribute to the development of antimicrobial resistance, eroding the drugs' effectiveness. (1) Consequently, efforts continue to be made to improve antibiotic stewardship internationally [...]

Objectives: (a) To critically appraise the quality of data submitted by sub-Saharan African (SSA) cancer registries to GLOBOCAN 2020 and (b) compare the quality of data of the registries common to GLOBOCAN 2008 and 2020. Design: Critical appraisal of cancer registry data quality using the Parkin and Bray framework. Setting and Participants: GLOBOCAN 2020 cancer registry estimates for 46 countries in SSA. Forty-three registries in 31 (SSA) countries were identified from the GLOBCAN 2020 supplementary documents, of which data from 28 registries in 23 sub-Saharan African countries were publicly available. Main outcomes measures: Data quality for 15 variables in four domains (comparability, validity, timeliness and completeness) were appraised using the Parkin and Bray framework. Results from the appraisal of GLOBOCAN 2020 sources were compared with previous findings for GLOBOCAN 2008. Results: Compared with GLOBOCAN 2008, GLOBOCAN 2020 country coverage had increased from 21 to 31 countries with 15 countries having no established registries. Out of a total possible score of 15 for data quality, 18 of the 28 publicly available GLOBOCAN 2020 registries fulfilled a score of 5 or more compared with seven registries in GLOBOCAN 2008. Of the 17 registries common to GLOBOCAN 2008 and 2020, nine showed an improvement in data quality. Conclusion: Country coverage and data quality have improved since GLOBOCAN 2008, however, overall data quality and coverage remain poor. GLOBOCAN 2020 estimates should be used with caution when allocating resources. [ABSTRACT FROM AUTHOR]

In Scotland, in 2002, the National Waiting Times Unit was launched to reduce NHS waiting times. This was accompanied by a series of waiting time targets across the NHS in Scotland. The purpose of this study is to analyse changes in equality of access to treatment by socioeconomic deprivation associated with this initiative. Trends in annual cataract rates were calculated using secondary care admissions' Scottish Morbidity Record (SMR01) data on NHS funded elective cataract procedures for patients treated in Scotland from 01 April 1997 to 31 March 2019. An interrupted time series model was used to analyse socioeconomic differences in waiting times by deprivation quintile over three time periods; pre and post waiting time initiative, and post austerity. Cataract Surgical Rates more than doubled from 3,723 per million population in 1997/1998 to 7,896 per million population in 2018/2019. Mean waiting time fell from 129.5 days in 1997/1998 to 87.7 days in 2018/2019. Inequality in mean waiting time between most and least deprived cataract patients increased by 1.34 days per quarter between 01 April 1997 and 30 June 2002 and following the waiting time initiative fell by 0.41 days per quarter through to 31 March 2010; and then decreased by 0.002 days per quarter between 01 April 2010 and 31 March 2019. The waiting time initiative had a major impact on reducing inequality in waiting times between socioeconomic groups. The onset of austerity in 2010 was associated with a very small and insignificant increase in inequality. [ABSTRACT FROM AUTHOR]

Objective To investigate equity in the geographical distribution of community pharmacies in South Africa and assess whether regulatory reforms have furthered such equity. Methods Data on community pharmacies from the national department of health and the South African pharmacy council were used to analyse the change in community pharmacy ownership and density (number per 10000 residents) between 1994 and 2012 in all nine provinces and 15 selected districts. In addition, the density of public clinics, alone and with community pharmacies, was calculated and compared with a national benchmark of one clinic per 10000 residents. Interviews were conducted with nine national experts from the pharmacy sector. Findings Community pharmacies increased In number by 13% between 1994 and 2012--less than the 25% population growth. In 2012, community pharmacy density was higher in urban provinces and was eight times higher in the least deprived districts than in the most deprived ones. Maldistribution persisted despite the growth of corporate community pharmacies. In 2012, only two provinces met the 1 per 10000 benchmark, although all provinces achieved it when community pharmacies and clinics were combined. Experts expressed concerns that a lack of rural incentives, inappropriate licensing criteria and a shortage of pharmacy workers could undermine access to pharmaceutical services, especially in rural areas. Conclusion To reduce inequity in the distribution of pharmaceutical services, new policies and legislation are needed to increase the staffing and presence of pharmacies. Objectif Etudier l'equite dans la distribution geographique des pharmacies communautaires en Afrlquedu Sud et evaluersi les reformes de la reglementatlon ont promu cette equite. Methodes Les donnees sur les pharmacies communautaires provenant du ministere national de la sante et de l'ordre des pharmaciens en Afriquedu Sud ont ete utilisees pour analyser les variations en matiere de proprlete et de densite (nombre pour 10 000 habitants) des pharmacies communautaires entre 1994 et 2012 dans (ensemble des 9 provinces et dans 15 districts selectionnes. En outre, la densite des cliniques publiques, seules et avec les pharmacies communautaires, a ete calculee etcompareea une reference natlonale d'une (1) clinique pour 10 000 habitants. Des entretiens ont ete menes avec neuf experts nationaux du secteur pharmaceutique. Resultats Le nombre de pharmacies communautaires a augmente de 13% entre 1994 et 2012--inferieur a la croissance de la population de 25%. En 2012, la densite des pharmacies communautaires etait superieure dans les provinces urbaines et etait 8 fois plus elevee dans les quartiers les moins defavorises que dans les quartiers les plus defavorises. La mauvaise distribution a persiste malgre la croissance des groupes de pharmacies communautaires. En 2012, seules 2 provinces ont atteint le taux de reference de 1 pour 10000 habitants, bien que toutes les provinces aient realise cet objectif lorsque les pharmacies et les cliniques ont ete combinees. Les experts craignent que l'absence d'indtations rurales, les criteres inappropries d'octroi de licence et une penurie de personnel qualifie dans les pharmacies puissent nuire a l'acces a des services pharmaceutiques, en particulier dans les zones rurales. Conclusion Pour reduire les inlquites dans la distribution des services pharmaceutiques, de nouvelles politiques et legislations sont necessaires pour augmenter les effectifs et la presence des pharmacies Objetivo Investigar la equidad en la distribucion geografica de las farmacias comunitarias en Sudafrica y evaluar si los cambios legislativos han promovido dicha equidad. Metodos Se utilizaron datos sobre las farmacias comunitarias del departamento nacional de salud y del consejo farmaceutico de Sudafrica para analizar el cambio en la propiedad y la densidad de las farmacias comunitarias (numero porcada 10 000 habitantes) entre 1994y 2012 en las nueve provincias y los 15 distritos seleccionados. Ademas, se calculo y comparo la densidad de las clinicas publicas, por separado y con farmacias comunitarias, con un punto de referencia nacional de una clinica por cada 10 000 habitantes, y se entrevistaron a nueve expertos nacionales del sector farmaceutico. Resultados El numero de farmacias comunitarias aumento en un 13% entre 1994 y 2012--un crecimiento inferior al de la poblacion, que fue del 25 %. En 2012, la densidad de las farmacias comunitarias era mas alta en las provincias urbanas, y era ocho veces mayor en los distritos menos desfavorecidos que en los mas desfavorecidos. La mala distribucion persistio a pesar del crecimiento de las farmacias comunitarias colectivas. En 2012, solo dos provincias cumplieron el punto de referencia de una farmacia por cada 10 000 habitantes a pesar de que todas las provincias lo lograron cuando se combinaron las farmacias comunitarias con las clinicas. Los expertos expresaron su preocupacion ya que la falta de incentivos rurales, los criterios inadecuados para la concesion de licencias y la escasez de trabajadores farmaceuticos podrian debilitar el acceso a servicios farmaceuticos, especialmente en las zonas rurales. Conclusion Con objeto de reducir la desigualdad en la distribucion de los servicios farmaceuticos, es necesario desarrollar una legislacion y politicas nuevas para aumentar la dotacion de personal y la presencia de las farmacias., La evaluacion de la equidad en la distribucion geografica de las farmacias comunitarias en Sudafrica para preparar un plan de seguro medico nacional Introduction Inequities in health and health-care are [...]