Quality of antiepileptic drugs in sub‐Saharan Africa: A study in Gabon, Kenya, and Madagascar

Jost, Jérémy; Ratsimbazafy, Voa; Nguyen, Thu Trang; Nguyễn, Thùy Linh; Dufat, Hanh; Dugay, Annabelle; Ba, Alassane; Sivadier, Guilhem; Mafilaza, Yattussia; Jousse, Cyril; Traı̈kia, Mounir; Leremboure, Martin; Auditeau, Emilie; RAHARIVELO, Adeline; Ngoungou, Edgard Brice; Kariuki, Symon M.; Newton, Charles R.; Preux, Pierre‐Marie

doi:10.1111/epi.14445

Cited by 10 publications

(14 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our result on affordability was similar to a previous multicenter study conducted in 46 countries which reported the day wage patient price of generic carbamazepine was less than 5.0 day in all healthcare facilities, although this study pulled data from developing and developed countries 7 . The proportion of poor‐quality AEDs found in our study (15.0%) was lower than that observed in a study performed in sub‐Saharan Africa 8 which reported 32.3% of poor quality. In that study, carbamazepine and sodium valproate were the poorest in terms of quality, probably due to high sensitivity to humidity and heat under tropical conditions, whereas our study found poor quality only for phenobarbital samples.…”

Section: Discussionsupporting

confidence: 84%

“…Endpoints, sampling methodology, and analytical testing were adapted from those used in another project performed in sub‐Saharan Africa and published in 2018 8 . A degree of quality scale was designed based on type of issue(s) observed (active ingredient assay, impurities screening, pharmacotechnical features) (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…Despite that, several studies have documented low availability and low affordability of AEDs in many LMICs both in the public and private sectors 6,7 . Besides, a recent study in African countries has reported a high proportion of poor‐quality AEDs with 32.3% of substandard drugs 8 . Few studies have addressed this topic in Southeast Asia 9,10 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2020

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Endpoints, sampling methodology, and analytical testing were adapted from those used in another project performed in sub‐Saharan Africa and published in 2018 11 . A degree of the quality scale was designed based on the type of issue(s) observed (active ingredient assay, impurities screening, pharmacotechnical features) (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…Similarly, in Lao PDR, approximatively half of the sample of phenobarbital collected in 2018, which was the most available and affordable ASM, was of poor quality 8 . Besides, a study performed in sub‐Saharan Africa shown that tropical environmental factors (temperature, relative humidity, light) have a strong influence on the quality of carbamazepine, phenytoin, and sodium valproate tablets 11 …”

Section: Introductionmentioning

confidence: 99%

Availability, affordability, and quality of essential anti‐seizure medication in Cambodia

et al. 2021

Self Cite

View full text Add to dashboard Cite

Objective Epilepsy is a major neurological disorder that requires long‐term medical treatment. Once epilepsy is diagnosed, people with epilepsy face many difficulties in accessing treatment (treatment gap). Our objective was to assess the situation regarding the availability, price, affordability, and quality of anti‐seizure medication (ASM), which are major determinants of access to treatment. Method A cross‐sectional study was performed in provincial/district hospitals and private pharmacies in urban and rural areas in Cambodia. Data on ASM 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 ASM were collected, and the quality of ASM was assessed through Medicine Quality Assessment Reporting Guidelines. Results Out of 138 outlets visited, only 72 outlets (52.2% [95% CI 43.5‐60.7]) had at least one ASM available. Phenobarbital 100 mg was the most available (35.5%), followed by carbamazepine 200 mg (21.7%), phenobarbital 50 mg (11.6%), sodium valproate 500 mg (9.4%), and phenytoin 100 mg (9.4%). In provincial/district hospitals, ASM was provided free of charge. In private pharmacies, affordability for phenobarbital 50 mg and 100 mg was the best, with 0.6 and 0.5 days, respectively, compared to phenytoin 100 mg (1.8 days), and other ASM. No counterfeit ASM was found in this study. Phenytoin sample presented the worst quality (33.0%) compared to carbamazepine (27.8%), and other ASM. Significance A lack of access to affordable and effective ASM due to low availability and poor quality of ASM was identified. Our research highlights the need for future policy efforts to ensure the quality of ASM and improve their availability. This can be achieved by involving the calculation of their annual needs for these drugs and increasing the national production of ASM.

show abstract

Willingness to pay brand premiums for generic medicines in Kenya: A bidding game experiment

Rockers

Kiragu

Onyango

et al. 2023

Health Planning & Management

View full text Add to dashboard Cite

BackgroundRecent growth in the market share of higher priced branded generic medicines in low‐ and middle‐income countries (LMICs) has raised concerns around affordability and access. We examined consumer willingness to pay (WTP) for branded versus unbranded generic non‐communicable disease (NCD) medicines in Kenya.MethodsWe randomly assigned NCD patients to receive a hypothetical offer for either a Novartis Access‐branded medicine or for an unbranded generic equivalent. We then analysed WTP data captured using a bidding game methodology.ResultsWe found that WTP for Novartis Access medicines was on average 23% higher than for unbranded generic equivalents (p = 0.009). The WTP brand premium was driven almost entirely by wealthier patients.ConclusionsOur findings suggest that the dominance of branded generics in LMICs like Kenya reflect in part consumer preferences for these medicines. Governments and other health sector actors may be justified in intervening to improve access to these medicines and equivalent non‐branded generics, particularly for the poorest patients who appear to have no preference for branded medicines.

show abstract

Quality of antiepileptic drugs in sub‐Saharan Africa: A study in Gabon, Kenya, and Madagascar

Abstract: No counterfeiting was observed. However, inadequate AED storage conditions are likely to lead to ineffective and possibly dangerous AEDs, even when good-quality AEDs are initially imported.

Cited by 10 publications

References 15 publications

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

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

Availability, affordability, and quality of essential anti‐seizure medication in Cambodia

Willingness to pay brand premiums for generic medicines in Kenya: A bidding game experiment

Contact Info

Product

Resources

About