提格雷地区（埃塞俄比亚北部）卫生机构中 5 岁以下儿童优先救命药品的可及性和可负担性。
Availability and affordability of priority life-saving medicines for under-five children in health facilities of Tigray region, northern Ethiopia.
机构信息
Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
出版信息
BMC Pregnancy Childbirth. 2018 Nov 29;18(1):464. doi: 10.1186/s12884-018-2109-2.
BACKGROUND
In developing countries, child health outcomes are influenced by the non-availability of priority life-saving medicines at public sector health facilities and non-affordability of medicines at private medicine outlets. This study aimed to assess availability, price components and affordability of priority life-saving medicines for under-five children in Tigray region, Northern Ethiopia.
METHODS
A cross-sectional study was conducted in Tigray region from December 2015 to July 2016 using a standard method developed by the World Health Organization and Health Action International (WHO/HAI). Data on the availability and price of 27 priority life-saving medicines were collected from 31 public and 10 private sectors. Availability and prices were expressed in percent and median price ratios (MPRs), respectively. Affordability was reported in terms of the daily wage of the lowest-paid unskilled government worker.
RESULTS
The overall availability of priority life-saving drugs in this study was low (34.1%). The average availabilities of all surveyed medicines in public and private sectors were 41.9 and 31.5%, respectively. The overall availability of medicines for malaria was found to be poor with average values of 29.3% for artemisinin combination therapy tablet, 19.5% for artesunate injection and 0% for rectal artesunate. Whereas, the availability of oral rehydration salt (ORS) and zinc sulphate dispersible tablets for the treatment of diarrhea was moderately high (90% for ORS and 82% for zinc sulphate). Medicines for pneumonia showed an overall percent availability in the range of 0% (ampicillin 250 mg and 1 g powder for injection and oxygen medicinal gas) to 100% (amoxicillin 500 mg capsule). The MPRs of 12 lowest price generic medicines were 1.5 and 2.7 times higher than the international reference prices (IRPs) for the private and public sectors, respectively. About 30% of priority life-saving medicines in the public sector and 50% of them in the private sector demanded above a single daily wages to purchase the standard treatment of the prevalent diseases of children.
CONCLUSIONS
The lower availability, high price and low affordability of lowest price generic priority life-saving medicines in public and private sectors reflect a failure to implement the health policy on priority life-saving medicines in the region.
背景
在发展中国家，儿童健康状况受到公共部门卫生机构无法提供优先救命药品和私人药店药品价格过高的影响。本研究旨在评估提 供埃塞俄比亚北部提格雷地区五岁以下儿童优先救命药品的可及性、价格构成和负担能力。
方法
2015 年 12 月至 2016 年 7 月，采用世界卫生组织和国际健康行动（WHO/HAI）制定的标准方法在提格雷地区进行了横断面研究。从 31 家公立和 10 家私立部门收集了 27 种优先救命药品的供应和价格数据。供应情况以百分比表示，价格以中位数价格比（MPR）表示。负担能力以最低工资非熟练政府工人的日工资表示。
结果
本研究中优先救命药物的总体供应情况较低（34.1%）。所有调查药品在公立和私立部门的平均供应情况分别为 41.9%和 31.5%。抗疟药物的总体供应情况较差，青蒿素复方疗法片剂的平均供应值为 29.3%，青蒿琥酯注射液为 19.5%，直肠青蒿琥酯为 0%。而口服补液盐（ORS）和硫酸锌分散片治疗腹泻的供应情况适中，ORS 为 90%，硫酸锌为 82%。肺炎药物的总体供应百分比在 0%（注射用氨苄西林 250mg 和 1g 粉及医用氧气）到 100%（阿莫西林 500mg 胶囊）之间。12 种最低价格通用药品的 MPR 分别比私营和公共部门的国际参考价格（IRP）高出 1.5 倍和 2.7 倍。公立部门 30%左右、私立部门 50%左右的优先救命药品的价格超过了儿童常见疾病标准治疗的单一日工资。
结论
公立和私立部门最低价格通用优先救命药品的供应不足、价格高、负担能力低，反映了该地区优先救命药品卫生政策的实施失败。
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