Availability and affordability of essential medicines and diagnostic tests for diabetes mellitus in Africa

Abstract

To investigate the current status of the availability and affordability of specific essential medicines and diagnostics for diabetes in Africa. Systematic review and meta-analysis. Studies conducted in Africa that reported any information on the availability and affordability of short-acting, intermediate-acting, and premixed insulin, glibenclamide, metformin, blood glucose, glycated haemoglobin or HbA1c, and lipid profile tests were included. Random-effect model meta-analysis and descriptive statistics were performed to determine the pooled availability and affordability, respectively. A total of 21 studies were included. The pooled availability of each drug was as follows: short-acting insulin 33.5% (95% CI: 17.8%-49.2%, I2 = 95.02%), intermediate-acting insulin 23.1% (95% CI: 6.3%-39.9%, I2 = 91.6%), premixed insulin 49.4% (95% CI: 24.9%-73.9%, I2 = 90.57%), glibenclamide 55.9% (95% CI: 43.8%-68.0%, I2 = 96.7%), and metformin 47.0% (95% CI: 34.6%-59.4%, I2 = 97.54%). Regarding diagnostic tests, for glucometers the pooled availability was 49.5% (95% CI: 37.9%-61.1%, I2 = 97.43%), for HbA1c 24.6% (95% CI: 3.1%-46.1%, I2 = 91.64), and for lipid profile tests 35.7% (95% CI: 19.4%-51.9%, I2 = 83.77%). The median (IQR) affordability in days' wages was 7 (4.7-7.5) for short-acting insulin, 4.4 (3.9-4.9) for intermediate-acting insulin, 7.1 (5.8-16.7) for premixed insulin, 0.7 (0.7-0.7) for glibenclamide, and 2.1 (1.8-2.8) for metformin. The availability of the five essential medicines and three diagnostic tests for diabetes in Africa is suboptimal. The relatively high cost of insulin, HbA1c, and lipid profile tests is a significant barrier to optimal diabetes care. Pragmatic country-specific strategies are urgently needed to address these inequities in access and cost.