Abstract
BackgroundEquitable access to affordable medicines and diagnostic tests is an integral component of optimal clinical care of patients with asthma and chronic obstructive pulmonary disease (COPD). In Uganda, we lack contemporary data about the availability, cost and affordability of medicines and diagnostic tests essential in asthma and COPD management.MethodsData on the availability, cost and affordability of 17 medicines and 2 diagnostic tests essential in asthma and COPD management were collected from 22 public hospitals, 23 private and 85 private pharmacies. The percentage of the available medicines and diagnostic tests, the median retail price of the lowest priced generic brand and affordability in terms of the number of days’ wages it would cost the least paid public servant were analysed.ResultsThe availability of inhaled short acting beta agonists (SABA), oral leukotriene receptor antagonists (LTRA), inhaled LABA-ICS combinations and inhaled corticosteroids (ICS) in all the study sites was 75%, 60.8%, 46.9% and 45.4% respectively. None of the study sites had inhaled long acting anti muscarinic agents (LAMA) and inhaled long acting beta agonist (LABA)-LAMA combinations. Spirometry and peak flow-metry as diagnostic tests were available in 24.4% and 6.7% of the study sites respectively. Affordability ranged from 2.2 days’ wages for inhaled salbutamol to 17.1 days’ wages for formoterol/budesonide inhalers and 27.8 days’ wages for spirometry.ConclusionMedicines and diagnostic tests essential in asthma and COPD care are not widely available in Uganda and remain largely unaffordable. Strategies to improve access to affordable asthma and COPD medicines and diagnostic tests should be implemented in Uganda.
Highlights
Equitable access to affordable medicines and diagnostic tests is an integral component of optimal clinical care of patients with asthma and chronic obstructive pulmonary disease (COPD)
Availability of the medicines and diagnostic tests The availability of the selected medicines ranged from 0% for inhaled long acting anti muscarinic agents (LAMA) and inhaled LAMA-long acting beta agonist (LABA) combinations to 75% for short acting beta agonists (SABA)
The only available medicines in the public hospitals were: inhaled SABA in 26.1% compared to 77.3% and 88.2% in private hospitals and pharmacies respectively (p < 0.001), inhaled corticosteroids (ICS) in 4.4% compared to 50% and 55.3% in private hospitals and pharmacies respectively (p < 0.001) and oral methylxanthines in 4.4% compared to 18.2% and 20% in private hospitals and pharmacies respectively (p = 0.203)
Summary
Equitable access to affordable medicines and diagnostic tests is an integral component of optimal clinical care of patients with asthma and chronic obstructive pulmonary disease (COPD). In hospital mortality among the patients admitted with asthma and COPD was 8.3% and 9.3% respectively [2] Another population based prospective cross sectional study performed in rural Masindi, a district in Western Uganda in 2012 reported the burden of COPD of 16.2% especially among participants of both gender aged 30–39 years [3]. This highlights that the COPD in Uganda primarily occurs among the young and this could probably be due to effects of environmental factors like increased use of biomass fuel for cooking and early infections like tuberculosis and recurrent childhood pneumonia. The first and recently concluded nationwide population survey to determine the burden and predictors of asthma in Uganda, the Uganda National Asthma Survey (UNAS) has documented a prevalence of 9.8% with a higher prevalence of asthma reported in urban areas compared to rural areas (Kirenga B et al Unpublished data, 2016)
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