Access to medicines and diagnostic tests integral in the management of diabetes mellitus and cardiovascular diseases in Uganda: insights from the ACCODAD study

Abstract

BackgroundDespite the burgeoning burden of diabetes mellitus (DM) and cardiovascular diseases (CVD) in low and middle income countries (LMIC), access to affordable essential medicines and diagnostic tests for DM and CVD still remain a challenge in clinical practice. The Access to Cardiovascular diseases, Chronic Obstructive pulmonary disease, Diabetes mellitus and Asthma Drugs and diagnostics (ACCODAD) study aimed at providing contemporary information about the availability, cost and affordability of medicines and diagnostic tests integral in the management of DM and CVD in Uganda.MethodsThe study assessed the availability, cost and affordability of 37 medicines and 19 diagnostic tests in 22 public hospitals, 23 private hospitals and 100 private pharmacies in Uganda. Availability expressed as a percentage, median cost of the available lowest priced generic medicine and the diagnostic tests and affordability in terms of the number of days’ wages it would cost the least paid public servant to pay for one month of treatment and the diagnostic tests were calculated.ResultsThe availability of the medicines and diagnostic tests in all the study sites ranged from 20.1% for unfractionated heparin (UFH) to 100% for oral hypoglycaemic agents (OHA) and from 6.8% for microalbuminuria to 100% for urinalysis respectively. The only affordable tests were blood glucose, urinalysis and serum ketone, urea, creatinine and uric acid. Parenteral benzathine penicillin, oral furosemide, glibenclamide, bendrofluazide, atenolol, cardiac aspirin, digoxin, metformin, captopril and nifedipine were the only affordable drugs.ConclusionThis study demonstrates that the majority of medicines and diagnostic tests essential in the management of DM and CVD are generally unavailable and unaffordable in Uganda. National strategies promoting improved access to affordable medicines and diagnostic tests and primary prevention measures of DM and CVD should be prioritised in Uganda.

Availability and affordability of essential medicines and diagnostic tests for diabetes mellitus in sub-Saharan Africa: A systematic review.

“…There was an observed heterogeneity of the study ndings. Among the 19 studies conducted in one region of SSA, the majority were from the Eastern region (n = 11, 58%) [11][12][13][14][15][16][17][18][19][20][21]. About 26% (n = 5) [22][23][24][25][26]and 16% (n = 3) [27][28][29] of the remaining studies were conducted in the Southern and Western region respectively.…”

“…Aspirin cost less than a days' wages in the two studies [11,27]. The cost of captopril and statins greatly varied among the countries.…”

“…Five studies reported about the availability of statins ranging from 0% in public facilities in Malawi [23] and Eritrea [31] to 84% in Uganda [11]. The documented availability in other studies was 3.1% in another study conducted in Uganda (simvastatin) [15], 8.3% in Benin (simvastatin) [31], 10% in Cameroon (simvastatin) [27], 35.7% in Sudan (simvastatin) [31] and 56% in private health facilities in Malawi (lovastatin) [23].…”

“…A total of 14 studies (66.7%) investigated the availability of at least one diagnostic test for DM. Among the recommended diagnostic tests for DM in the WHO PEN, availability of blood glucose tests was the most investigated (13 studies, 92.9%) [11, 13, 14, 17-22, 26-29, 31] while microalbuminuria tests were the least investigated (2 studies, 14.3%) [11,20].…”

“…Affordability of any of the three classes of essential medicines above was investigated by four studies [11,23,25,27]. Only two studies assessed affordability of all the three classes of essential medicines above [11,27].…”