1. Availability, affordability, and quality of essential anti‐seizure medication in Cambodia
- Author
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Hanh Dufat, Sina Ros, Farid Boumediene, Noudy Sengxeu, Chanraksmey Aon, Jeremy Jost, Samleng Chan, Voa Ratsimbazafy, Pierre-Marie Preux, Grelier, Elisabeth, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Cibles Thérapeutiques et conception de médicaments (CiTCoM - UMR 8038), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Service de l'Information Médicale et de l'Évaluation [CHU Limoges] (SIME), CHU Limoges, Laboratoire de Biostatistique et d'Informatique Médicale, Université de Limoges (UNILIM), Service de Pharmacie Centrale [CHU Limoges], and Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)
- Subjects
Asia ,Seizure medication ,media_common.quotation_subject ,030231 tropical medicine ,Pharmacy ,Poor quality ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Environmental health ,medicine ,Humans ,Quality (business) ,RC346-429 ,media_common ,anti‐seizure medication ,treatment gap ,Medical treatment ,business.industry ,anti-seizure medication ,Carbamazepine ,respiratory system ,medicine.disease ,musculoskeletal system ,3. Good health ,respiratory tract diseases ,accessibility ,Cross-Sectional Studies ,Neurology ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Costs and Cost Analysis ,Full‐length Original Research ,epilepsy ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Neurology (clinical) ,Neurology. Diseases of the nervous system ,Rural area ,Cambodia ,Drugs, Essential ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
International audience; Objective: Epilepsy is a major neurological disorder that requires long-term medical treatment. Once epilepsy is diagnosed, people with epilepsy face many difficulties in accessing treatment (treatment gap). Our objective was to assess the situation regarding the availability, price, affordability, and quality of anti-seizure medication (ASM), which are major determinants of access to treatment. Method: A cross-sectional study was performed in provincial/district hospitals and private pharmacies in urban and rural areas in Cambodia. Data on ASM availability and price were obtained through drug suppliers. Affordability was estimated as the number of day wages the lowest-paid government employee must work to purchase a monthly treatment. Samples of ASM were collected, and the quality of ASM was assessed through Medicine Quality Assessment Reporting Guidelines. Results: Out of 138 outlets visited, only 72 outlets (52.2% [95% CI 43.5-60.7]) had at least one ASM available. Phenobarbital 100 mg was the most available (35.5%), followed by carbamazepine 200 mg (21.7%), phenobarbital 50 mg (11.6%), sodium valproate 500 mg (9.4%), and phenytoin 100 mg (9.4%). In provincial/district hospitals, ASM was provided free of charge. In private pharmacies, affordability for phenobarbital 50 mg and 100 mg was the best, with 0.6 and 0.5 days, respectively, compared to phenytoin 100 mg (1.8 days), and other ASM. No counterfeit ASM was found in this study. Phenytoin sample presented the worst quality (33.0%) compared to carbamazepine (27.8%), and other ASM. Significance: A lack of access to affordable and effective ASM due to low availability and poor quality of ASM was identified. Our research highlights the need for future policy efforts to ensure the quality of ASM and improve their availability. This can be achieved by involving the calculation of their annual needs for these drugs and increasing the national production of ASM.
- Published
- 2021
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