Okubadejo Njideka U, Ojo Oluwadamilola O, Wahab Kolawole W, Abubakar Sani A, Obiabo Olugbo Y, Salawu Fatai K, Nwazor Ernest O, Agabi Osigwe P, Oshinaike Olajumoke O
Neurology Unit, Department of Medicine, College of Medicine University of Lagos & Lagos University Teaching Hospital Idi Araba Lagos State Nigeria.
University of Ilorin Teaching Hospital Ilorin Kwara State Nigeria.
Mov Disord Clin Pract. 2018 Nov 16;6(1):27-33. doi: 10.1002/mdc3.12682. eCollection 2019 Jan.
Limited access to medicines can impact negatively on outcomes in people with Parkinson's disease (PD). The study objectives were to determine the availability and assess the affordability of antiparkinsonian medications in pharmacies across Nigeria.
This was a cross-sectional nationwide study utilizing the World Health Organization/Health Action Initiative methodology. Strategically selected private- and public-sector pharmacies in the six geopolitical zones of Nigeria were surveyed for availability of medicines for management of early and advanced PD. The nine categories were: levodopa/peripheral decarboxylase inhibitors, dopamine receptor agonists, monoamine oxidase type B inhibitors, anticholinergics, catechol-o-methyl transferase inhibitors, atypical antipsychotics, antidepressants, antidementia drugs, and miscellaneous (e.g., drugs for orthostatism, urinary incontinence, and sleep disturbance). Unaffordability was defined as paying more than 1 days' wages (>N600 or > US$1.67) for a standard 30-day supply.
One hundred twenty-three pharmacies were surveyed (62 private [50.4%] and 61 public sector [49.6%]; range of 15-25 pharmacies in each geopolitical zone). Private exceeded public-sector availability across all nine categories of PD medicines ( < 0.05). The most available medicines were dopamine receptor agonists (68.3%; predominantly ergot-derived bromocriptine), anticholinergics (56.1%; mainly trihexyphenidyl), and l-dopa formulations (48%; mainly 250/25 l-dopa/carbidopa). Only two medications (trihexyphenidyl tablets and biperiden injection) were affordable. The average number of day's minimum wages for a 30-day supply of PD medicines was 41.3 days (range, 1-371).
PD medicines access is limited in Nigeria. Strategies, including engagement of stakeholders to consider interventions to improve and prioritize PD medicines access, are urgently warranted.
药品可及性受限会对帕金森病（PD）患者的治疗结局产生负面影响。本研究的目的是确定尼日利亚各地药店抗帕金森药物的可及性，并评估其可负担性。
这是一项采用世界卫生组织/健康行动倡议方法的全国性横断面研究。对尼日利亚六个地理政治区域中经策略性选择的私营和公共部门药店进行调查，以了解用于治疗早期和晚期PD的药物的可及性。这九类药物分别为：左旋多巴/外周脱羧酶抑制剂、多巴胺受体激动剂、单胺氧化酶B型抑制剂、抗胆碱能药物、儿茶酚-O-甲基转移酶抑制剂、非典型抗精神病药物、抗抑郁药物、抗痴呆药物以及其他药物（如用于体位性低血压、尿失禁和睡眠障碍的药物）。可负担性定义为购买标准30天供应量的药物花费超过1天的工资（>600尼日利亚奈拉或>1.67美元）。
共调查了123家药店（62家私营药店[50.4%]和61家公共部门药店[49.6%]；每个地理政治区域有15 - 25家药店）。在所有九类PD药物中，私营药店的可及性均超过公共部门药店（<0.05）。可及性最高的药物是多巴胺受体激动剂（68.3%；主要是麦角衍生的溴隐亭）、抗胆碱能药物（56.1%；主要是苯海索）和左旋多巴制剂（48%；主要是250/25左旋多巴/卡比多巴）。只有两种药物（苯海索片和安坦注射液）价格可负担。PD药物30天供应量的平均最低工资天数为41.3天（范围为1 - 371天）。
在尼日利亚，PD药物的可及性有限。迫切需要采取策略，包括让利益相关者参与，以考虑采取干预措施来改善并优先保障PD药物的可及性。
