Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

Abstract

Background: Access to essential medicines in pediatric endocrinology and diabetes is limited in resource-limited countries. The World Health Organization (WHO) maintains two non-binding lists of essential medicines (EMLs) which are often used as a template for developing national EMLs. Methods: We compared a previously published master list of medicines for pediatric endocrinology and diabetes with the WHO EMLs and national EMLs for countries within the WHO African region. To better understand actual access to medicines by patients, we focused on diabetes and surveyed pediatric endocrinologists from 5 countries and assessed availability and true cost for insulin and glucagon. Results: Most medicines that are essential in pediatric endocrinology and diabetes were included in the national EMLs. However, essential medicines, such as fludrocortisone, were present in less than 30% of the national EMLs despite being recommended by the WHO. Pediatric endocrinologists from the 5 focus countries reported significant variation in terms of availability and public access to insulin, as well as differences between urban and rural areas. Except for Botswana, glucagon was rarely available. There was no significant relationship between Gross National Income and the number of medicines included in the national EMLs. Conclusions: Governments in resource-limited countries could take further steps to improve EMLs and access to medicines such as improved collaboration between health authorities, the pharmaceutical industry, patient groups, health professionals, and capacity-building programs such as Paediatric Endocrinology Training Centres for Africa.

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

“…Optimally in this tier, glucagon would also be available; however, it is rarely provided by government health services in less‐resourced countries, and the out‐of‐pocket cost, if it can be purchased at all in these countries, is unaffordable for many.…”

“…Interestingly, these levels are even similar to those seen in some high-income countries with substantially more resources. 3,29,43 Optimally in this tier, glucagon would also be available; however, it is rarely provided by government health services in less-resourced countries, 2,44 and the out-of-pocket cost, if it can be purchased at all in these countries, is unaffordable for many.…”

Incidence of disorders of sexual development in neonates in Ghana: prospective study

“…Unfortunately, essential medicines such as hydrocortisone and fludrocortisone were mostly unavailable despite being included in WHO model list of essential medicines 7. This highlights the need to adapt the therapeutic guidelines, usually written for and by health professionals working in high-resource settings, to low-resource settings 6.…”

Structurally Based Design of Glucagon Mutants That Inhibit Fibril Formation

“…Their integral roles in controlling blood sugar levels have led to their long history of use as pharmaceutical compounds. , Insulin is prescribed to treat hyperglycemia in diabetic patients, who either cannot produce their own insulin or have resistance to insulin. , Conversely, glucagon is prescribed to treat hypoglycemia, which is most common in diabetic patients whose insulin dose is too large for their activity level or food intake. Although glucagon has been prescribed for six decades, its pharmaceutical formulation remains a challenge. Due to its near-neutral isoelectric point, the peptide has very low solubility at physiological pH and is thus typically prepared for use at an acidic pH of 2–3 .…”

“…5,6 Conversely, glucagon is prescribed to treat hypoglycemia, which is most common in diabetic patients whose insulin dose is too large for their activity level or food intake. Although glucagon has been prescribed for six decades, 7 its pharmaceutical formulation remains a challenge. Due to its near-neutral isoelectric point, the peptide has very low solubility at physiological pH 8 and is thus typically prepared for use at an acidic pH of 2−3.…”