Medicine Outlets Research Articles

Non-prescription sale and dispensing of antibiotics for prophylaxis in broiler chickens in Lusaka District, Zambia: findings and implications on one health.

The irrational use of antibiotics in humans and livestock has contributed to the emergence of antimicrobial resistance (AMR). This study investigated the commonly sold and dispensed antibiotics for prophylaxis in broiler chickens in pharmacy and agro-veterinary shop personnel in the Lusaka District of Zambia. This cross-sectional study was conducted from August 2023 to October 2023 among 200 veterinary medicine dispensers in the Lusaka District of Zambia using a simulated farmer or mystery shopper approach. Data analysis was performed using IBM Statistical Package for Social Sciences version 23.0. Out of the 200 medicine outlets investigated, 23 (11.5%) were agro-veterinary shops, while 177 (88.5%) were community pharmacies. A total of 165 community pharmacies and agro-veterinary shops provided veterinary services in the Lusaka District and sold medicines without prescription giving a 100% non-prescription sale. Of the 178 medicines dispensed for prophylaxis, 88.5% were antibiotics, while 13.5% were vitamins. The most dispensed antibiotic drug for prophylaxis in broiler chickens was oxytetracycline (30.34%), amoxicillin (17.98%) and gentamicin/doxycycline (10.67%). This study revealed a high sale and dispensing of antibiotics for prophylaxis in broiler chickens of which oxytetracycline, amoxicillin and gentamicin/doxycycline were commonly dispensed. There is a need for increased regulatory enforcement of selling antibiotics without a prescription as this may predispose poultry to the development of AMR and possible transmission of superbugs to humans and the environment. Educational interventions should be provided to community pharmacy and agro-veterinary personnel on adhering to antimicrobial stewardship practices when dispensing poultry antibiotics.

Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia

BackgroundDiabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia’s public and private medicine outlets with respect to availability and affordability parameters. MethodsA cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days’ wages required by the lowest paid government worker (LPGW) to purchase a one month’s supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices.ResultsAcross all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO’s target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month’s supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively.ConclusionsThere are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya.

ACTs are responsible for a substantial proportion of the global reduction in malaria mortality over the last ten years, made possible by publicly-funded subsidies making these drugs accessible and affordable in the private sector. However, inexpensive ACTs available in retail outlets have contributed substantially to overconsumption. We test an innovative, scalable strategy to target ACT-subsidies to clients with a confirmatory diagnosis. We supported malaria testing(mRDTs) in 39 medicine outlets in western Kenya, randomized to three study arms; control arm offering subsidized mRDT testing (0.4USD), client-directed intervention where all clients who received a positive RDT at the outlet were eligible for a free (fully-subsidized) ACT, and a combined client and provider directed intervention where clients with a positive RDT were eligible for free ACT and outlets received 0.1USD for every RDT performed. Our primary outcome was the proportion of ACT dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients tested at the outlet and adherence to diagnostic test results. 43% of clients chose to test at the outlet. Test results informed treatment decisions, resulting in targeting of ACTs to confirmed malaria cases- 25.3% of test-negative clients purchased an ACT compared to 75% of untested clients. Client-directed and client+provider-directed interventions did not offer further improvements, compared to the control arm, in testing rates(RD = 0.09, 95%CI:-0.08,0.26) or dispensing of ACTs to test-positive clients(RD = 0.01,95% CI:-0.14, 0.16). Clients were often unaware of the price they paid for the ACT leading to uncertainty in whether the ACT subsidy was passed on to the client. This uncertainty undermines our ability to definitively conclude that client-directed subsidies are not effective for improving testing and appropriate treatment. We conclude that mRDTs could reduce ACT overconsumption in the private retail sector, but incentive structures are difficult to scale and their value to private providers is uncertain. Trial registration: ClinicalTrials.gov NCT04428307.

The Trade of Porcupines in Malaysia With International Trade Links

Background and Research Aims Porcupines are frequently traded in Asia but evidence of this remains undocumented. This study was undertaken to address the dearth of information on porcupine trade dynamics using Malaysia as a case study. Methods To accomplish this, traditional Chinese medicine (TCM) outlets throughout the country were surveyed, the existence of porcupine farms were determined and porcupine seizures in Malaysia from 2011 – 2019 were analysed. Results The data revealed that porcupines are coveted predominantly for bezoars used in TCM and for breeding stock. Porcupine bezoars were found in 90% of TCM outlets surveyed though it is likely that the market consists of genuine and fake products. Porcupine farming appears to be gaining popularity and predominantly caters to a demand for breeding pairs. There were 47 seizures amounting to 110 porcupines of at least three species. Seizures included mostly live animals but also meat and quills. Conclusion The harvesting and consumption of porcupines is legally permitted in Malaysia. However, it is evident that illegal hunting of porcupines is also occurring. Captive breeding is unlikely to reduce poaching of porcupines considering the high value associated with wild-sourced bezoars. Local use is also driving international trade of bezoars particularly from Indonesia. Implications for Conservation Research on porcupine trade dynamics in Southeast Asia is limited. This is a conservation concern particularly as porcupines are valued as commercial commodities. As Asian porcupines face a multitude of synergistic threats ( i.e., habitat loss, human conflict and illegal hunting), understanding these cumulative impacts on wild populations is a conservation priority. More research on international trade dynamics is also warranted as it is currently occurring without any regulation or monitoring. Listing porcupines in the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) could potentially mitigate this.

Antimalarial procurement in private-sector pharmaceutical outlets: decision-making complexities and implications for medicine quality in Tanzania

Poor-quality medicines are a major threat to healthcare provision in low-income countries. The problem exacerbates disease vulnerabilities of already disadvantaged populations including children, women, and the elderly. However, while the...

Knowledge, attitudes, and practices toward emergency contraceptive pills among community pharmacists and pharmacy customers: A cross-sectional study in urban Vietnam

ObjectivesThis study aimed to investigate Vietnamese community pharmacists and pharmacy customers' knowledge, attitudes, and practices about emergency contraceptive pills (ECPs). Study designWe recruited 400 pharmacists and 396 customers via a nonprobability convenience sampling technique. We used univariate and multivariate linear regression models to determine factors associated with the knowledge and attitudes toward ECPs among pharmacists and customers. We selected variables in the multivariate models through the Bayesian Model Averaging method using R software (version 4.2.3). ResultsIn medicine outlets, levonorgestrel and mifepristone (ECPs) were highly available. The average knowledge scores on ECPs among pharmacists and customers were 9.98 ± 2.00 and 6.24 ± 2.33, respectively. Many pharmacists did not have adequate knowledge of ECPs’ mechanism of action, dosage, and contraindications. Customers lacked knowledge about their legislation, effectiveness, and side effects. The attitudes toward ECPs among participants were relatively positive. Reliable information sources about ECPs (such as the package leaflet, courses, and books) played an essential role in increasing ECP knowledge and attitudes (p < 0.001). The availability of ECPs (p < 0.001), being educated (p < 0.01 and 0.01), and daily sales (p < 0.001) were significantly associated with pharmacists’ knowledge/attitudes. Age, education level, marital status, and occupation were significantly associated with customers’ knowledge. Participants’ knowledge of was significantly associated with their attitude toward ECPs (p = 0.02 and p < 0.001, respectively). ConclusionsThe knowledge of ECPs among pharmacists was relatively good, while that of customers was poor. There is a need to have policies and interventions to enhance the knowledge and attitudes toward ECPs for both pharmacists and customers. ImplicationsCommunity pharmacies are ideal settings to dispense contraceptive methods, especially over-the-counter ECPs. Community pharmacists can help ensure the availability of ECPs in medicine outlets, increase women’s access to ECPs, and counsel customers on up-to-date and comprehensive knowledge about these medications, thereby guaranteeing rational ECP use.

Access to essential psychotropic medicines in Addis Ababa: A cross-sectional study.

Mental disorders are becoming a growing public health problem worldwide, especially in low- and middle-income countries. Regular and adequate supplies of appropriate, safe, and affordable medications are required to provide quality mental health services. However, significant proportions of the population with severe mental disorders are not getting access to treatment. Among others, the availability and affordability of psychotropic medicines are significant barriers for many patients in meeting their medication needs. This study aimed to assess the availability, prices, and affordability of essential psychotropic medicines in the private and public health sectors of Addis Ababa, the capital city of Ethiopia. A cross-sectional study design was used in 60 retail medicine outlets from the public and private sectors. Stratified random and quota sampling were applied to select the retail outlets. Data was entered and analyzed using the preprogrammed WHO/HAI workbook and SPSS V.25. The mean availability of Lower Priced Generic (LPG) psychotropic medicines was 24.33% in Addis Ababa (28.7% in the public sector and 19.80% in the private sector). The Patient prices for the LPG ranged from 0.52-6.43 MPRs in public and 1.08-24.28 MPRs in private sectors. Standard treatment costs varied from 0.1-7.8 days' wages in public and 0.8-25 days' wages in private sectors for the lowest-paid government worker to purchase a month's supply. Essential psychotropic medicines were poorly available, with high prices and low affordability in Addis Ababa. An efficient supply across all levels of care and financial protection for essential medicines should be in place to ensure access.

Perceived antimicrobial dispensing practices in medicine outlets in Ghana: A maximum difference experiment design.

Antimicrobials are consumed among patients globally, but in developing and middle-income countries, these drugs can be obtained without a prescription from pharmacies and licensed drug stores due to inadequate regulation in the pharmaceutical sector. This study aimed to assess antimicrobial dispensing practices in medicine sales outlets (i.e., pharmacies and licensed drug stores) to provide quantitative evidence for policy discussions to enhance patient safety and care quality in Ghana's pharmaceutical industry. The data for this study were obtained from a cross-sectional survey conducted in the Greater Accra region between July and August 2022. The survey was conducted through interviewer-administered questionnaires, and 200 staff members from medicine sales outlets were randomly selected using a two-stage cluster and random sampling technique. The maximum difference experiment model, rooted in random utility theory, was used to analyze their antimicrobial dispensing practices. We found that medicine sales outlet staffs were highly concerned about following the drug act and not dispensing antimicrobials without a prescription, and usually refer a patient to get a prescription from a doctor if the patient has complications (like high fever, generalized malaise, fatigue as symptoms, sinusitis). Stronger concerns were also observed for medicine outlet staff not dispensing antimicrobials without a prescription if the patient is pediatric or geriatric with a severe infection. They also evaluated patients and dispensed antimicrobials based on symptoms, not their age or gender. However, they tended not to dispense antibiotics if the patient had a mild fever and requested it without a prescription. Our results provide insight into the need for a national surveillance system for monitoring antimicrobial prescribing and dispensing practices at medicine sales outlets. Therefore, the selection of antimicrobials for treating infectious diseases may be informed by evidence-based antimicrobial prescribing and dispensing surveillance data and will help policymakers to know the pattern of commonly consumed antimicrobials in the medicine sales outlets.

Compliance of good storage practices of pharmacies and medicine outlets: a scoping review

AbstractEnsuring good storage practices (GSPs) of medicine outlets is important to maintain and ensure the safety, quality, and efficacy of dispensed medicines. The objective of this scoping review was to determine the most common GSP compliance issues within pharmacies and medicine outlets. PRISMA extension for scoping reviews guidelines were followed, and PubMed and Google Scholar were searched to identify the relevant primary literature from January 2016 and February 2022. All study designs in English were eligible for inclusion as long as they reported quantitative data for the fulfilment of individual GSP activities. Duplicate independent screening of the search results was undertaken. Quality assessment was performed on studies for final inclusion. Data extraction was performed by one reviewer, and the observed aggregate percentage compliance (% compliance), along with 95% confidence interval for the root GSP operation, was calculated. Of the 380 records identified, 15 articles were included. The studies were conducted in 10 countries and the majority were participatory research studies. Fire safety had the lowest aggregate % compliance (0.9%). Controlled substance, climate, light, ventilation and temperature and stock and bookkeeping operations all had overall aggregate % compliance levels below 50%. Despite evidence of basic controls and measures, we identified low compliance for many GSP operations. To ensure the integrity of medicines, it is important to increase the enforcement of security measures, invest resources in personnel training, account for informal vendor practices, and facilitate sharing global data publicly from external and governing body inspections and reviews of storage practices.

Open science in health psychology and behavioral medicine: A statement from the Behavioral Medicine Research Council.

Open Science practices include some combination of registering and publishing study protocols (including hypotheses, primary and secondary outcome variables, and analysis plans) and making available preprints of manuscripts, study materials, de-identified data sets, and analytic codes. This statement from the Behavioral Medicine Research Council (BMRC) provides an overview of these methods, including preregistration; registered reports; preprints; and open research. We focus on rationales for engaging in Open Science and how to address shortcomings and possible objections. Additional resources for researchers are provided. Research on Open Science largely supports positive consequences for the reproducibility and reliability of empirical science. There is no solution that will encompass all Open Science needs in health psychology and behavioral medicine's diverse research products and outlets, but the BMRC supports increased use of Open Science practices where possible. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Open Science in Health Psychology and Behavioral Medicine: A Statement From the Behavioral Medicine Research Council.

Open Science practices include some combination of registering and publishing study protocols (including hypotheses, primary and secondary outcome variables, and analysis plans) and making available preprints of manuscripts, study materials, de-identified data sets, and analytic codes. This statement from the Behavioral Medicine Research Council (BMRC) provides an overview of these methods, including preregistration; registered reports; preprints; and open research. We focus on rationales for engaging in Open Science and how to address shortcomings and possible objections. Additional resources for researchers are provided. Research on Open Science largely supports positive consequences for the reproducibility and reliability of empirical science. There is no solution that will encompass all Open Science needs in health psychology and behavioral medicine's diverse research products and outlets, but the BMRC supports increased use of Open Science practices where possible.

ACCESS TO MEDICINE

Availability and access to the health care facility is a fundamental right of human, it is the timely used of services according to the needs. It is included in International treaties and is recognized by authorities and various Governments throughout the world. What does it means the access to medicine? According to WHO (World Health Organization) access to medicines is “having medicines continuously available and affordable at public or private health facilities or medicine outlets that are within one hour’s walk from the homes of the population”. The affordability and availability of medicines is directly related to the strength of health care system, but the high prices of the medicines, prevalence of Non-communicable diseases (diabetes, hypertension) and increasing demand of patients are the major obstacles in this regard. According to Forbes “at least 2 billion people don’t have access to medicines and 1 billion people live in extreme poverty (less than $1.25 per day) and 2.2 billion live on less than $2 per day which is quite disturbing situation”. The World Health Organization (WHO) analyzed the global production of pharmaceutical products and it was concluded that 15% of the world’s population consumes over 90% of them. And by World Health Organization it is also estimated that one-third of the developing world population is unable to receive or purchase essential medicine on a regular basis, especially those which are on high demand. The situation is even worst in the under-privileged countries like Africa and Asia, where approximately 50% of the total population does not have sufficient medicines access and healthcare resources and the remaining 50% are using medication incorrectly. However about 10 million lives a year could be saved out of which 4 million in Africa and South-East Asia alone, if we improve the availability, balanced distribution and rational use of medicines. The overall situation of global access to essential medicines is still considered critical. In the privileged countries the budget for healthcare facilities corresponds to 24-66% of National health expenses, which indicates that there is need to monitor the availability and affordability of medicines in these countries. National policies, economical cost of medicine and strategies of procurement are required to ensure the availability of medicines cost-effectively. The people with low income and in-equal health can’t afford costly services of healthcare system. The policies for the improvement of infrastructure, financing of medical system and the rational use of medicines are formulated and followed on primarily basis. And Governments need reliable information in order to evaluate the impact of policy implementation. In addition to the cost and availability of medicines, it is mandatory to assess the quality of use and various aspects, such as rational medicine use, adherence of patients and appropriate prescription practices. Thus the access to healthcare system can be made effective, by the assessment of practices in facilities like record reviews and National expert reports. That’s why we are providing healthcare facilities to each person with the help of balanced geographical distribution. The 2016 Index showed that there is moderate progress by the pharmaceutical industries to improve medicines access. Besides these Pharmaceutical industries should play their role to perk up the medicines access. There is not any particular strategy that suits all systems, but all systems need to promote the provision of new medicinal products, by ensuring medical advancement, improving communication barriers and affordable treatment. And a Reliable Health and Supply system must provide all aspects of health system like procurement, supply and regulation of the medicines.

Barriers and motivation for presumptive tuberculosis case referral: qualitative analysis among operators of community medicine outlets in Ghana

BackgroundCommunity medicine outlets (CMOs) are the first point of call for individuals presenting with cough in Ghana. Although operators of CMOs comprising pharmacists and over-the-counter (OTC) medicine sellers largely support the public–private mix strategy which seeks to engage pharmacies in tuberculosis (TB) case detection, a significant proportion is not involved in TB referral services. The study explores the barriers to and motivation for presumptive TB case referral among CMO operators.MethodsWe used open- and close-ended questions nested in a telephone survey which assessed factors associated with presumptive TB case referral among CMO operators (n = 465). We interviewed participants using computer assisted telephone interviews and analysed the qualitative data using adjusted Mayring’s structured qualitative content analysis.ResultsBased on participants’ own experiences, non-referral was attributed to negative attitudes of presumed cases (48.2%) and inability to meet the financial demands of referred presumed cases (26.3%). Regarding their perception of barriers to TB referral for their professional colleagues, an assumed lack of TB training (44.5%) and an assumed negative attitude of operators (43.6%) were mentioned. From close-ended questions, most chosen barriers to referral were: the assumption of not having seen a presumptive TB case yet (31.8%), lack of TB training (22.2%) and no monetary motivation for operators (10.5%). Most operators (81.6%) view TB referral services as their social responsibility and feel self-motivated to refer cases in order to control the spread of TB in their communities. Of 152 further comments extracted as recommendations to improve referral, 101 (66.4%) of respondents would only refer with the availability of support systems in the form of TB training and making TB diagnostic testing more accessible.ConclusionOperators of CMOs are predominantly self-motivated to refer presumptive TB cases. Barriers to referral might be mitigated by providing more training to operators and specific financial support such as reimbursement of travel costs to presumptive cases.

Measuring Medicine Prices and Availability of Commonly used Essential Medicines using WHO/HAI Methodology in Hyderabad, India

Objectives: Access to health care is a basic right of population. Essential medicines are those which satisfy the priority of health care needs and intended to be available at all times. Hence prices and availability need to assess periodically. The objective of the study was to measure the variation in prices of selected medicines, to measure the availability of some selected medicines used for treating common diseases/ailments and to compare the prices and availability of medicines among the sectors. The present survey is conducted for 20 essential medicines in Hyderabad, Telangana. Methods: Medicines were selected based on the criteria of WHO/HAI methodology. Data was collected during October 2019 to March 2020 for originator brands and lowest priced generics in 60 medicine outlets. Prices were compared to international reference prices and expressed as median price ratio. Percent availability computed only on the day of data collection. Results: Median MPRs for originator brands and lowest priced generics were 2.20 and 1.53 in independent outlets, 2.20 and 1.61 in chain pharmacies respectively. Median MPR for generics in Jan Aushadhi Kendra was 0.38 i.e., all available medicines were priced less than international reference prices. Availability was 95.8%, 95.4% and 67.5% for generics and 12% and 13.3% for originator brands respectively. Conclusion: The survey revealed reasonable prices and high availability in private sectors but in JanAushadhi Kendra, prices are flattened with good availability. The maximum applicable Goods and Services Tax rate is 12% for medicines under price control and life-saving drugs resulted in 2.3% increase in tax rate ultimately causing burden to patients. Government should ensure certain policies about importance of generic drugs and their availability in Jan Aushadhi Kendra.

The trade of Saiga Antelope horn for traditional medicine in Thailand

Demand for Saiga Antelope Saiga tatarica horn products in Southeast Asia, due to their perceived medicinal value, has drastically impacted the conservation of this species. At the same time, poor understanding of the dynamics of this trade in parts of Southeast Asia continues to impede regulation and conservation efforts. Here we examine the trade of Saiga horn products in Thailand through a rapid physical and online market survey, and via an analysis of Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) trade data. We found an active local trade in Saiga horn products in Thailand, with both physical market surveys and online surveys showing predominantly two forms of Saiga horn products in the market, i.e., cooling water and horn shavings (mostly sold as pre-packaged boiling kits). These products are commercially marketed as staple household medicines. Greater scrutiny, monitoring and research is urgently needed to understand how the use of Saiga horn is being regulated in Thailand including the number of licensed traders, potential stockpiles and management of these. Traditional medicine outlets and online sales of commercial Saiga horn products also requires attention. As a non-native species, the Saiga Antelope is not protected in Thailand which makes it difficult for enforcement authorities to prevent illegal trade of Saiga horn products within the country. Thailand is currently revising its wildlife laws with the intention of addressing the protection of non-native and CITES-listed species. Considering the widespread use of Saiga horn in Thailand, we recommend that Saiga Antelope be included in the revised species protection lists to enable enforcement action against trade in illegally sourced Saiga horn products.

Access to Insulin Products in Pakistan: A National Scale Cross-Sectional Survey on Prices, Availability, and Affordability.

Background: Diabetes is among the top ten most prevalent diseases in Pakistan, and the availability of medicines to treat the disease is vital for a great percentage of the country’s population. Insulin was discovered a century ago; however, its access in several parts of the globe remains an issue. This study aims to evaluate prices, availability, and affordability (access components) of insulin and five comparator medicine access in Pakistan. Methods: A nationwide cross-sectional survey was conducted to evaluate the access to insulin and some comparator medicines in eight cities of Pakistan, using a modified WHO/HAI methodology. The survey included 80 medicine outlets, i.e., 40 private pharmacies and 40 public hospitals. Data for every unique insulin product available in the Pakistani market were obtained, including five comparator medicines. Percentage availability, median unit prices (MUPs), and affordability (the number of days’ wages (NDWs) required for a month’s course by the lowest-paid unskilled government worker) of all products were calculated, including originator brands (OBs) and biosimilar (BS) products. Results: Of all insulin products surveyed (n = 320), 87.5% were manufactured by foreign multinational companies (MNCs). None of the insulin products had an ideal availability of 80% in any of the surveyed health facilities. In the public sector, none of the insulin products had an availability of more than 50%. In the public sector, the overall availability of human insulin was 70% (including OB and BS). While in the private sector, the overall availability of human insulin was 90% and that of analog insulin was 62.5%. The analog insulin products were 72.8% costlier than the human insulin products. The median prices of BS insulin were 25.4% lower than the OB products, indicating that almost one-fourth of the cost could be saved by switching to BS human insulin from OB human insulin. All oral anti-diabetic medicines were found to be affordable, whereas none of the insulin was affordable. The NDWs for human and analog insulin were 1.38 and 5.06. Conclusion: In Pakistan, the insulin availability falls short of the WHO’s benchmark of 80%. Insulin continues to be unaffordable in both private and government sectors. To increase insulin access, the government should optimize insulin procurement at all levels, promote local production, enforce biosimilar prescribing, and provide financial subsidies for these products.

Patients Access to Medicines - A Critical Review of the Healthcare System in Kenya.

Access to affordable, safe, effective, and quality-assured medicines by a patient is important for good health outcomes. Unfortunately, there is sparse literature published on the pharmaceutical enablers that may increase the sale of a substandard and falsified (SF) medicine to a patient in Kenya. The review highlights some of the factors that may facilitate the entry of SF medicines into the legitimate pharmaceutical supply chain and discusses their impact on patient access to medicines. Lack of essential medicines in public health facilities is an important factor that may contribute to increased demand for medicine-related out-of-pocket expenses from private health facilities, thus a likelihood for a patient purchasing SF medicine from unlicensed and illegal medicine outlets or unregulated websites. The need to increase medicine availability in the public sector by the Ministry of Health (MOH) is emphasized in addition to the strengthening of public procurement to cushion it from corruption and mismanagement. In addition, the MOH should promote local pharmaceutical manufacturing and implement a medicine pricing containment policy to avoid abuse and prevent overexploitation of patients, increase medicine price transparency, and reduce pharmaceutical supply chain distortion. Recommended regulatory reviews include accreditation of unlicensed illegal medicine outlets to facilitate accountability, regulatory oversight, and active surveillance. The national post-market surveillance regulatory capacity should be strengthened to improve rational medicine use. A 3-year diploma course should be replaced with a shorter 1- or 2-year pharmaceutical support staff training not eligible to superintend a pharmacy. The recommended legislative review includes a mandatory clause to enforce generic prescribing and the implementation of generic substitution by health workers. Unethical manipulative pharmaceutical marketing practices should carry stiffer penalties to deter malpractice. Future research areas include investigation of medicine prescribing and dispensing practices, medicine consumption studies, medicine price differences within different health sub-sectors, and between licensed pharmacies and unlicensed illegal medicine outlets.

Accessibility of Essential Medicines for Children in Sichuan Province of China: A Cross-Sectional Study.

Background: Essential medicines for children are those medicines that satisfy the priority health care needs of children. Access to essential medicines for children is a big challenge, particularly in low- and middle-income countries. Our study aimed to assess the accessibility of essential medicines for children in public sector in Sichuan Province of China, based on availability, affordability, and price. Methods: We adopted the modified World Health Organization/Health Action International (WHO/HAI) standardization methodology to measure the availability, affordability, and prices of 30 essential medicines for children in 20 public hospitals in nine regions of the Sichuan Province, China. Availability was expressed as the percentage of public medicine outlets that stocked surveyed medicines on the day of data collection, and prices were expressed as median price ratio (MPR). Affordability was assessed as the number of Sichuan Province’s daily wages required for the lowest-paid government unskilled worker (11.03 USD per day) to purchase one standard treatment of an acute disease or treatment for chronic disease for a month. Results: The mean availability of originator brands (OBs) and lowest priced generics (LPGs) were 9.7 and 46.5% in public sector. MPRs of only 3 OBs could be calculated, ranging from 0.55 to 13.37. MPRs of 18 LPGs ranged from 0.07 to 25.05. Among them, 2 OBs and 11 LPGs were priced at more than 1.5 times their international reference prices (IRPs) in public sector, most of which were injections. Except for cefazolin injection and ceftriaxone injection, most LPGs were affordable for the treatment of childhood diseases in public sector, as they each cost one or less than the daily wage for the lowest-paid unskilled government worker. Conclusions: Although the availability of LPGs for children was higher than OBs in public sector, the availability of children’s essential medicines was low in surveyed public sector in Sichuan Province, which was similar to previous studies in other provinces of China. The price of most medicines surveyed was higher than their IRPs in surveyed public sector, especially for some injections. The affordability of most surveyed LPGs was reasonable in surveyed public sector, except for ceftriaxone injection and cefazolin injection.

IDENTIFICATION OF PUBLIC MEDICINE STORAGE PROFILE IN THE COMMUNITY PHARMACY: A SYSTEMATIC REVIEW

Background: Drug is the most common form of therapy and an integral part of almost all levels of care. The conditions and proper way of storing medicines at home are important aspects of safe and effective drug treatment. Information about the knowledge of patients with appropriate storage conditions, rational drug use, appropriate drug use and management of various drugs is essential in helping pharmacists identify which medicinal products and aspects of home storage require more attention when counselling patients. Objective: The aim of this systematic review is to identify and characterize the mode of storage associated with home-stored pharmaceuticals. Methods: This systematic review analyzes the storage methods for medicines to identify and characterize the storage methods associated with medicines stored at home. The limitation of publication used, namely English and Indonesian in the last 10 years, and obtained through literature that can be considered relevant. Results: This systematic review was conducted in the period July, August, September 2020 - February 2021. As many as 20 journals were obtained. Those who met the inclusion criteria were 10 journals. Of the 10 journals that had met the inclusion criteria, 3 journals were excluded so that only 7 journals were used in the literature review / systematic review. The storage of medicines in the household is based on the presence of family members who have certain diseases so that they have to consume drugs in the long term, the presence of health workers, and the education level of family members. Problems that can arise with drug storage conditions are impaired drug stability and can accelerate drug degradation prematurely. Storage of medicines in the medicine cabinet and out of reach of children is highly recommended. Placement of drugs in one place without being separated and a lack of awareness in administering specific markings can increase drug administration errors and lead to non-compliance with over-the-counter drug use. The application of drug management in the family can improve the quality of life and avoid the adverse effects of drug misuse. Conclusion: This study raises relation to medicines stored inside homes that warrant addressing that need pharmacists regarding public education in relation to drug therapy that goes beyond the dispensing process. They were judging by the finding that pharmacists were not considered primary sources of drug-related information. Good practices should be encouraged through continued health education at health institutions and retail medicine outlets.&#x0D; Keywords: Drugs, Storage, Household

Referral of presumptive TB among operators of community medicine outlets.

BACKGROUND: Case detection is an important part of TB control programmes. In 2007, the TB programme in Ghana join the WHO´s public-private partnership with community medicine outlet operators to increase referral of persons with presumptive TB for laboratory investigation. Information on factors likely to influence referral is scarce in Ghana. We assessed these factors among pharmacists and over-the-counter (OTC) medicine sellers.METHODS: In 2019-2020, we conducted computer-assisted telephone interviews among community pharmacists and OTC medicine sellers in the Eastern Region of Ghana. We used a structured questionnaire and collected data on respondents´ sociodemographics and professional characteristics. We used logistic regression to investigate characteristics associated with self-reported referral of presumptive TB cases.RESULTS: Of all respondents who completed the interviews, 68.7% (321/467) reported having ever referred a presumptive TB case and 72.1% (336/466) had received specific training. Associated factors of presumptive TB referral were having received specific training (OR 2.7, 95% CI 1.5-4.9); performing both dispensing and managerial functions (OR 2.8, 95% CI 1.4-5.5); operating from OTC shop (OR 6.2, 95% CI 1.6-23.4) and the availability of a TB laboratory within walking distance (OR 3.3, 95% CI 1.2-9.5).CONCLUSION: Interviewees largely support TB referral. However, a significant proportion does not follow the strategy closely. We recommend more specific TB training courses.