Overview of accessibility and quality of antiepileptic drugs in Madagascar

Nizard, Mandy; Jost, Jérémy; Tanamasoandro, Rakotovao; Andriambololona, Rindra; Megherbi, Mehdi; Solofomalala, Gaëtan Duval; Marquet, Pierre; Preux, Pierre‐Marie; Ratsimbazafy, Voa

doi:10.1016/j.seizure.2016.07.015

Cited by 8 publications

(4 citation statements)

References 16 publications

(15 reference statements)

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“…Our result regarding the availability of each AED (<15.0%) in health facilities was lower than previous studies in Vietnam (>30.0%) 40 , Thailand (>80.0%), 41,42 and Madagascar 43 (>80.0%). We observed better affordability of carbamazepine (2.3 day wages) and phenytoin (1.0 day wages) in Lao PDR compared to Malawi 44 which reported more than 5.0 day wages required for these two drugs.…”

Section: Discussioncontrasting

confidence: 92%

Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR

et al. 2020

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Objective Epilepsy is a chronic condition treatable by cost‐effective antiepileptic drugs (AEDs), but limited access to treatment was documented. The availability and affordability of good quality of AEDs play a significant role in access to good health care. This study aimed to assess the availability, affordability, and quality of long‐term AEDs in Lao PDR. Method A cross‐sectional study was performed in both public and private drug supply chains in urban and rural areas in Lao PDR. Data on AEDs availability and price were obtained through drug suppliers. Affordability was estimated as the number of day wages the lowest‐paid government employee must work to purchase a monthly treatment. Samples of AEDs were collected, and the quality of AEDs was assessed through Medicine Quality Assessment Reporting Guidelines. Results Out of 237 outlets visited, only 50 outlets (21.1% [95% CI 16.1‐26.8]) had at least one AED available. The availability was significantly different between urban (24.9%) and rural areas (10.0%), P = .017. Phenobarbital 100 mg was the most available (14.3%); followed by sodium valproate 200 mg (9.7%), phenytoin 100 mg (9.7%), and carbamazepine 200 mg (8.9%). In provincial/district hospitals and health centers, AEDs were provided free of charge. In other healthcare facilities, phenytoin 100 mg and phenobarbital 100 mg showed the best affordability (1.0 and 1.2 day wages, respectively) compared to carbamazepine 200 mg (2.3 days) and other AEDs. No sample was identified as counterfeit, but 15.0% [95% CI 7.1‐26.6] of samples were classified as of poor quality. Significance We quantified and qualified the various factors contributing to the high treatment gap in Lao PDR, adding to diagnostic issues (not assessed here). Availability remains very low and phenobarbital which is the most available and affordable AED was the worst in terms of quality. A drug policy addressing epilepsy treatment gap would reduce these barriers.

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Section: Discussioncontrasting

confidence: 92%

Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR

et al. 2020

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“…Duas pessoas alteraram os níveis plasmáticos entre os encontros, sendo que uma passou de nível terapêutico a subterapia e outra de subterapia a nível terapêutico. Contudo, não houve diferença significativa entre as concentrações antes (mediana (AIQ)=7,03 (11,22)) e após a troca de marca (mediana (AIQ)=6,80 (13,12); p=0,688).…”

Section: Resultsunclassified

“…Tamizi et al (2012) 21 encontraram resultados semelhantes em um dos produtos de fenobarbital por eles testados, porém a comprovação de que ele não era uniforme foi entre comprimidos de um mesmo lote. Nizard et al (2016) 22 também demonstraram uma amostra do medicamento genérico fora dos limites, entretanto apenas o primeiro estágio do teste foi realizado, devido à falta de comprimidos suficientes. Segundo Couto & Tavares (2011) 23 , a análise da uniformidade de conteúdo é extremamente importante, uma vez que assegura a quantidade de princípio ativo presente na formulação que será administrada.…”

Section: Discussionunclassified

Phenobarbital: effect of interchangeability on the profile of adverse effect, on quality of life and on plasma concentrations - a pilot study

Frade¹,

Paiva²,

Sakakibara³

et al. 2020

Rev Bras Farm Hosp Serv Saude

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Introduction: Phenobarbital is one of the drugs most used in the treatment of epilepsy, with different formulations available on the market today. Objectives: The objective of this study was to evaluate the effect of interchangeability on the profile of the adverse effect, on quality of life and on plasma concentrations before and after the exchange of phenobarbital formulations in patients with epilepsy. Methods: This is a before and after study, in which adult patients with a diagnosis of epilepsy were included in outpatient treatment with phenobarbital. The Adverse Events Profile (AEP) and Quality of Life in Epilepsy-31 (QOLIE) questionnaires were applied before and after the brand change in phenobarbital, as well as the determination of the plasma concentration of phenobarbital. In the first meeting, the “Interchangeable Pharmaceutical Product in the Treatment of Epilepsy” questionnaire was also applied. Physical-chemical tests to evaluate the quality of the tablets were performed according to the parameters of the Brazilian pharmacopoeia. Results: The population was composed of eight patients; six were females, with a mean age of 51.4 (SD=5.4) years old and four did not have a full first degree. Of the interviewees, six had no knowledge of the three types of existing antiepileptic formulations. Significant differences were found for the “Emotional wellbeing” domain of quality of life before and after the formulation change (p=0.016) and no significant difference between frequencies of adverse effects and plasma concentrations. Conclusion: The results suggest the importance of pharmacovigilance, in addition to being able to subsidize new clinical studies regarding the interchangeability between antiepileptics. In addition, the physical-chemical tests point to the need to strengthen health surveillance actions.

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“…These misconceptions about epilepsy are also prevalent among Lao health-care providers, as 1/3 of physicians treating children had never prescribed ASM. 76 Similar challenges, including population misbeliefs regarding epilepsy, financial barriers, and disparities in health infrastructures in remote districts, were also present in Madagascar 77 and Cambodia. 78 …”

Section: Treatmentmentioning

confidence: 95%

Neonatal Seizures in Low- and Middle-Income Countries: A Review of the Literature and Recommendations for the Management

Spenard,

Salazar Cerda,

Nevzat Çizmeci

2024

Turkish Archives of Pediatrics

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Neonatal seizures are a common cause of neonatal intensive care unit (NICU) admission and a significant source of morbidity and mortality worldwide. Over the recent decades, there have been significant improvements in perinatal and neonatal medicine and electroencephalographic monitoring that have enhanced the diagnosis and treatment of neonatal seizures in high-income countries. However, the management of neonatal seizures remains a major challenge in low- to middle-income countries, where the availabilityof resources is limited. The purpose of this article is to present a comprehensive review of the current evidence on the etiology, pathophysiology, diagnosis, and treatment of neonatal seizures and to offer practical management recommendations that could be implemented in resource-limited settings.

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Overview of accessibility and quality of antiepileptic drugs in Madagascar

Abstract: The AEDs collected in Haute Matsiatra were globally of good quality. The main limiting elements were a lack of knowledge among PWE that epilepsy is a disease, and the cost of traditional treatments.

Cited by 8 publications

References 16 publications

Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR

Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR

Phenobarbital: effect of interchangeability on the profile of adverse effect, on quality of life and on plasma concentrations - a pilot study

Neonatal Seizures in Low- and Middle-Income Countries: A Review of the Literature and Recommendations for the Management

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