Date Published: March 7, 2019
Publisher: BioMed Central
Author(s): Davis Kibirige, Richard E. Sanya, Rebecca Nantanda, William Worodria, Bruce Kirenga.
Early accurate diagnosis and sustainable availability of affordable medicines and diagnostic tests is fundamental in optimal management of asthma and chronic obstructive pulmonary disease (COPD). We systematically reviewed original research articles about availability and affordability of medicines and diagnostic tests recommended for management of asthma and COPD in sub-Saharan Africa (SSA).
We searched PubMed, Scopus and African Journal Online for original research articles conducted in SSA between 2000 and March 2018 containing information about availability and affordability of any recommended medicine and diagnostic test for asthma and COPD.
The search yielded 9 eligible research articles. Availability of short-acting beta agonists (SABA), inhaled corticosteroids (ICS) and short acting anti-muscarinic agents (SAMA) ranged between 19.9–100%, 0–45.5% and 0–14.3% respectively. Combination of ICS-long acting beta agonists (LABA) were available in 0–14.3% of facilities surveyed. There was absence of inhaled long acting anti-muscarinic agents (LAMA) and LAMA/LABA combinations. Spirometry and peak expiratory flow devices were available in 24.4–29.4% and 6.7–53.6% respectively. Affordability of SABA and ICS varied greatly, ranging from < 2 to 107 days’ wages while ICS–LABA combinations, SAMA and oral theophylline plus leukotriene receptor antagonists cost 6.4–17.1, 13.7 and 6.9 days’ wages respectively. Availability and affordability of medicines and diagnostics recommended for the management of asthma and COPD is a big challenge in SSA. Research about this subject in this region is still limited. More robustly performed studies are required to further understand the magnitude of inequity in access to these medicines and diagnostic tests in SSA and also to formulate simple pragmatic solutions to address this challenge.
A comprehensive literature search of PubMed, Scopus and African Journal Online was performed for original research articles in English language performed between 2000 and March 2018 with an objective of determining the scope of availability and affordability of key medicines and diagnostic tests recommended in the management of asthma and COPD in SSA. References of the selected original research articles and published review articles were further searched for additional original research articles. We also searched the first 1000 Google scholar searches for original research articles.
A total of 796 published articles were identified after searching the 3 databases. Thirty-two duplicates were removed, leaving 764 articles. The titles and abstracts of 764 articles were screened. Of these, 737 articles were excluded because they lacked the information of interest. Full texts of 27 articles were assessed for eligibility and only 6 articles met the inclusion criteria. Three papers were added after searching Google Scholar, references of the eligible original articles and published review articles, making a total of 9 eligible original research articles which were included in the systematic review [15–23] (Fig. 1—Flow diagram summarizing the identification of eligible articles).Fig. 1Flow diagram for the systematic review
To our knowledge, this systematic review provides the first comprehensive assessment of availability and affordability of internationally recommended medicines and diagnostic tests in management of asthma and COPD in SSA. It also evidently demonstrates that studies investigating this key area in SSA are still limited and availability of affordable medicines and diagnostic tests still remains a substantial challenge in clinical practice in the region.
A better understanding of the magnitude and reasons to explain the challenge of poor availability and high cost of these medicines and diagnostic tests in SSA is important to guide better implementation of pragmatic solutions and guidelines. Poor availability and unaffordability of medicines and diagnostic tests recommended for the management of asthma and COPD in SSA could be addressed through increasing awareness about the burden of both conditions and their optimal management among healthcare practitioners, improving local manufacturing of cheap good quality generic medicines, updating national EML and treatment guidelines, improving supply chain and forecast and sustained and equitable government financing of health budgets. Implementation of health policies like national health insurance schemes, regulation of local retail prices of chronic diseases and introduction of preferential registration procedures for locally manufactured generic drugs by drug regulatory institutions can help address the challenge of high costs of medicines of asthma and COPD in SSA.