Abstract
BackgroundEarly accurate diagnosis and sustainable availability of affordable medicines and diagnostic tests is fundamental in optimal management of asthma and chronic obstructive pulmonary disease (COPD). We systematically reviewed original research articles about availability and affordability of medicines and diagnostic tests recommended for management of asthma and COPD in sub-Saharan Africa (SSA).MethodsWe searched PubMed, Scopus and African Journal Online for original research articles conducted in SSA between 2000 and March 2018 containing information about availability and affordability of any recommended medicine and diagnostic test for asthma and COPD.ResultsThe search yielded 9 eligible research articles. Availability of short-acting beta agonists (SABA), inhaled corticosteroids (ICS) and short acting anti-muscarinic agents (SAMA) ranged between 19.9–100%, 0–45.5% and 0–14.3% respectively. Combination of ICS-long acting beta agonists (LABA) were available in 0–14.3% of facilities surveyed. There was absence of inhaled long acting anti-muscarinic agents (LAMA) and LAMA/LABA combinations. Spirometry and peak expiratory flow devices were available in 24.4–29.4% and 6.7–53.6% respectively. Affordability of SABA and ICS varied greatly, ranging from < 2 to 107 days’ wages while ICS–LABA combinations, SAMA and oral theophylline plus leukotriene receptor antagonists cost 6.4–17.1, 13.7 and 6.9 days’ wages respectively.ConclusionAvailability and affordability of medicines and diagnostics recommended for the management of asthma and COPD is a big challenge in SSA. Research about this subject in this region is still limited. More robustly performed studies are required to further understand the magnitude of inequity in access to these medicines and diagnostic tests in SSA and also to formulate simple pragmatic solutions to address this challenge.
Highlights
Availability and affordability of medicines and diagnostic tests recommended for the management of asthma and chronic obstructive pulmonary disease (COPD) in sub-Saharan Africa (SSA) has not been systematically studied to-date
A comprehensive literature search of PubMed, Scopus and African Journal Online was performed for original research articles in English language performed between 2000 and March 2018 with an objective of determining the scope of availability and affordability of key medicines and diagnostic tests recommended in the management of asthma and COPD in SSA
A better understanding of the magnitude and reasons to explain the challenge of poor availability and high cost of these medicines and diagnostic tests in SSA is important to guide better implementation of pragmatic solutions and guidelines
Summary
The 2015 Global Burden of Diseases, Injuries and Risk Factors (GBD) study reported an increase in the prevalence of asthma and COPD by 12.6% and 44.2% respectively from 1990 to 2015. This was associated with an increased rate of mortality due to COPD [2]. In 2015, 3.2 million people and 0.4 million people died from COPD and asthma worldwide respectively This represents an 11.6% increase in COPD-related deaths and a 26.7% decrease in asthmarelated deaths when compared to estimates in 1990 [2]. Smoking (both active and passive), ambient particulate matter, household pollution and occupational triggers were identified as the key risk factors and contributors to DALYS for both asthma and COPD [2]
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