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Introduction. Inadequate control of cancer pain represents an escalating public health concern in Africa, particularly within francophone regions, amidst a concurrent surge in cancer incidence. This study aims to enhance comprehension of the impediments to effective cancer pain management utilizing opioid analgesics in francophone Africa which is sparsely documented in the scientific literature compared to the rest of the world, particularly in the English-speaking countries. Methods. A double phased Survey engaged experts and field clinicians specialized in cancer pain management: 1) Expert questionnaire: a contemporary assessment of the organizational, legislative, and societal landscape at the national or regional scale; 2) Clinician questionnaire: an exploration of practices, identified needs, perceived barriers, and strategies to improve Pain management at local level. Results. A cohort of twelve experts and sixty clinicians from 15 countries diligently completed the surveys. A robust consensus emerged delineating four primary barriers: insufficient human resources with requisite competencies and dedicated facilities, constraints entailing opioid analgesic prescription, limited drug availability compounded by challenges in accessibility, and the economic burden borne by patients. Conclusion. Remedying the often-dire scenario in francophone Africa necessitates a multidimensional endeavour. Critical components encompass training in pain management and palliative care and safe opioids prescription, optimizing drug availability, affordability, and distribution networks, formulating clinical recommendations tailored to the specifics of francophone Africa taking in consideration local contexts and socio-cultural aspects, mitigating prescription constraints, and fostering heightened awareness across all pertinent stakeholders while always minimizing the risks related to opioids. [ABSTRACT FROM AUTHOR]

For the past 15 years, trials of combination therapy options for visceral leishmaniasis have been conducted with the aim of identifying effective, and safe treatment regimens that were shorter than existing monotherapy regimens and could also prevent or delay the emergence of drug resistance. Although first-line treatment currently relies on combination therapy in east Africa, this is not true in Latin America owing to disappointing trial results, with lower than expected efficacy seen for the combination treatment group. By contrast, several effective combination therapy regimens have been identified through trials on the Indian subcontinent; yet, first-line therapy is still AmBisome monotherapy as the drug is part of a free donation programme and is highly effective in this region. Achieving a short all-oral combination treatment will require new chemical entities, several of which are currently under evaluation. Future studies should systematically include pharmacological substudies to ensure optimal dosing for all patient groups. To achieve maximal impact of new combination treatments, mechanisms to ensure drug availability and access after trials should be established. Enhancing the longevity of current and novel treatments will require effective systems for early detection of emerging drug resistance. [ABSTRACT FROM AUTHOR]

Low‐ and middle‐income countries (LMIC) face unique challenges with regard to the establishment of robust pharmacovigilance systems capable of generating data to inform healthcare policy and practice. These include the limited integration and reliability of pharmacovigilance systems across LMIC despite recent efforts to harmonize pharmacovigilance rules and regulations in several regional economic communities. There are particular challenges relating to the need to translate reporting tools into numerous local languages and the low numbers of healthcare providers relative to number of patients, with very short consultation times. Additional factors frequent in LMIC include high uptake of herbal and traditional medication, mostly by self‐medication; disruptive political conflicts jeopardizing fragile systems; and little or no access to drug utilization data, which makes it difficult to reliably estimate the true risks of medicines use. Pharmacovigilance activities are hindered by the scarcity of well‐trained personnel with little or no budgetary support from national governments; high turnover of pharmacovigilance staff whose training involves a substantial amount of resources; and little awareness of pharmacovigilance among healthcare workers, decision makers and consumers. Furthermore, little collaboration between public health programmes and national medicines regulatory authorities coupled with limited investment in pharmacovigilance activities, especially during mass drug administration for neglected tropical diseases and mass vaccinations, produces major challenges in establishing a culture where pharmacovigilance is systematically embedded. Very low spontaneous reporting rates with poor quality reports hinders robust signal detection analyses. This review summarises the specific challenges and areas of progress in pharmacovigilance in LMIC with special focus on the situation in Africa. [ABSTRACT FROM AUTHOR]

Objective: To investigate the current status of the availability and affordability of specific essential medicines and diagnostics for diabetes in Africa. Methods: Systematic review and meta‐analysis. Studies conducted in Africa that reported any information on the availability and affordability of short‐acting, intermediate‐acting, and premixed insulin, glibenclamide, metformin, blood glucose, glycated haemoglobin or HbA1c, and lipid profile tests were included. Random‐effect model meta‐analysis and descriptive statistics were performed to determine the pooled availability and affordability, respectively. Results: A total of 21 studies were included. The pooled availability of each drug was as follows: short‐acting insulin 33.5% (95% CI: 17.8%–49.2%, I2 = 95.02%), intermediate‐acting insulin 23.1% (95% CI: 6.3%–39.9%, I2 = 91.6%), premixed insulin 49.4% (95% CI: 24.9%–73.9%, I2 = 90.57%), glibenclamide 55.9% (95% CI: 43.8%–68.0%, I2 = 96.7%), and metformin 47.0% (95% CI: 34.6%–59.4%, I2 = 97.54%). Regarding diagnostic tests, for glucometers the pooled availability was 49.5% (95% CI: 37.9%–61.1%, I2 = 97.43%), for HbA1c 24.6% (95% CI: 3.1%–46.1%, I2 = 91.64), and for lipid profile tests 35.7% (95% CI: 19.4%–51.9%, I2 = 83.77%). The median (IQR) affordability in days' wages was 7 (4.7–7.5) for short‐acting insulin, 4.4 (3.9–4.9) for intermediate‐acting insulin, 7.1 (5.8–16.7) for premixed insulin, 0.7 (0.7–0.7) for glibenclamide, and 2.1 (1.8–2.8) for metformin. Conclusion: The availability of the five essential medicines and three diagnostic tests for diabetes in Africa is suboptimal. The relatively high cost of insulin, HbA1c, and lipid profile tests is a significant barrier to optimal diabetes care. Pragmatic country‐specific strategies are urgently needed to address these inequities in access and cost. [ABSTRACT FROM AUTHOR]

Although currently available data indicate that Africa has the lowest usage of antimicrobials in animals in the world (adjusted by animal biomass), data show a high prevalence of antimicrobial resistance in foodborne pathogens isolated from animals and animal products. Apart from the lack of solid data on antimicrobial use in many countries in Africa, different hypotheses could explain this situation. Qualitative interviews of farmers show a lack of knowledge and uninformed use of antimicrobials. Considering the development of animal farming to meet an increasing demand for proteins, this deficiency represents a serious public health issue. We advocate for policies that consider the specific challenges faced by family farmers in Africa, to simultaneously improve access to veterinary drugs while strengthening the regulation of their use. We propose a global approach targeting the agri-food system, offering innovative social and technical interventions on antimicrobial usage, adapted to family farmers. [ABSTRACT FROM AUTHOR]

Standard treatment guidelines (STGs) are an important tool for ensuring high quality clinical care and prudent antimicrobial use (AMU) and stewardship (AMS). In 2018, African Union (AU) member state representatives recognized the lack of STGs as a barrier to AMS at national and facility levels. Previous research reported that only 17 of 55 (31%) member states had STGs that provided disease- or pathogen-specific antimicrobial treatment recommendations, excluding those that covered only treatment of HIV, malaria, and tuberculosis). The Africa Centres for Disease Control and Prevention convened expert panels to develop first edition antibiotic treatment guidelines for priority infectious diseases and clinical syndromes for pediatric and adult patient populations in Africa. The purpose of the guidelines is to provide healthcare workers with treatment guidance by harmonising existing national STGs, filling gaps where existing STGs are not available, and serving as a model for future guidelines. Two expert panels of 28 total clinicians, pharmacists, and other relevant stakeholders from 14 AU member states representing each continental region convened to develop consensus treatment recommendations for select priority bacterial infections and clinical syndromes. In developing recommendations, the panels considered treatment recommendations from existing STGs, drug availability, clinical experience, and available antimicrobial resistance data. The guidelines underwent an external review process where clinical stakeholders who did not serve on either panel were invited to submit feedback prior to their publication. The guidelines provide empiric antibiotic therapy guidelines - including drug selection, route of administration, formulation, dosage, and therapy duration - and principles of stewardship for 28 bacterial infections or clinical syndromes. The first edition guidelines for the treatment of common infectious diseases and clinical syndromes in Africa aims to improve clinical treatment and antimicrobial stewardship and will serve as a template for future regional guidelines. [ABSTRACT FROM AUTHOR]

Background: There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was to assess the severity of post cesarean section pain. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction.Methods: We prospectively followed 333 women who underwent cesarean section under spinal anesthesia. Subjective assessment of the participants' pain was done using the Visual Analogue Scale (0 to 100) at 0, 6 and 24 h after surgery. Satisfaction with pain control was ascertained at 24 h after surgery using a 2-point scale (yes/no). Participants' charts were reviewed for records of analgesics administered.Results: Pain control medications used in the first 24 h following cesarean section at this hospital included diclofenac only, pethidine only, tramadol only and multiple pain medications. There were mothers who did not receive any analgesic medication. The highest pain scores were reported at 6 h (median: 37; (IQR:37.5). 68% of participants reported they were satisfied with their pain control.Conclusion: Adequate management of post-cesarean section pain remains a challenge at Mulago hospital. Greater inter-professional collaboration, self-administered analgesia, scheduled prescription orders and increasing availability of analgesic drugs may contribute to improved treatment of postoperative pain with better pain scores. [ABSTRACT FROM AUTHOR]

Background: Barely a decade after introduction of Ghana's National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services. However, sustainability of the scheme is increasingly threatened by concerns on quality of health service delivery in NHIS-accredited health facilities coupled with stakeholders' discontentment with the operational and administrative challenges confronting the NHIS. The study sought to ascertain whether or not Systematic Community Engagement (SCE) interventions have a significant effect on frontline health workers' perspectives on the NHIS and its impact on quality health service delivery.Methods: The study is a randomized cluster trial involving clinical and non-clinical frontline health workers (n = 234) interviewed at baseline and follow-up in the Greater Accra and Western regions of Ghana. Individual respondents were chosen from within each intervention and control groupings. Difference-in-difference estimations and propensity score matching were performed to determine impact of SCE on staff perceptions of the NHIS. The main outcome measure of interest was staff perception of the NHIS based on eight (8) factor-analyzed quality service parameters.Results: Staff interviewed in intervention facilities appeared to perceive the NHIS more positively in terms of its impact on "availability and quality of drugs (p < 0.05)" and "workload on health staff/infrastructure" than those interviewed in control facilities (p < 0.1). Delayed reimbursement of service providers remained a key concern to over 70 % of respondents in control and intervention health facilities.Conclusion: Community engagement in quality service assessment is a potential useful strategy towards empowering communities while promoting frontline health workers' interest, goodwill and active participation in Ghana's NHIS. [ABSTRACT FROM AUTHOR]

Objective: To examine trends in equity in contraceptive use, and in contraceptive-prevalence rates in six East African countries.Methods: In this repeated cross-sectional study, Demographic and Health Surveys Program data from women aged 15-49 years in Ethiopia, Kenya, Malawi, Rwanda, Tanzania, and Uganda between 2000 and 2010 were analyzed. Individuals were ranked according to wealth quintile, stratified urban/rural populations, and calculated concentration index-a statistic integrating information from all wealth quintiles to analyze disparities.Results: Equity and contraceptive-prevalence rates increased in most country regions over the study period. Notably, in rural Rwanda, contraceptive-prevalence rates increased from 3.9 to 44.0, and urban Kenya became the most equitable country region, with a concentration index of 0.02. The Pearson correlation coefficient between improvements in concentration index and contraceptive-prevalence rates was 0.52 (P=0.011).Conclusion: The results indicate that countries seeking to increase contraceptive use should prioritize equity in access to services and contraceptives. [ABSTRACT FROM AUTHOR]

The role played by properly functioning regulatory systems towards enhancing access to essential medicines for patients is crucial. This is especially the case in Africa which has seen progressive growth in the regulatory environment. At the center of this growth has been the African Medicines Regulatory Harmonization (AMRH) initiative. This initiative seeks to strengthen regulatory capacity and encourage harmonization of regulatory requirements - with the ultimate aim of expanding access to quality, safe, and effective medicines for patients in need in Africa. A lot of progress has been made during the last years, with initial focus on the East African Community, where harmonization related regulations have already been implemented. The same is now being rolled out in other regions such as West Africa and the Southern African Development Community. Removing bottlenecks and reducing redundancies in regulatory processes that slow access to medicines for patients in need today is critical. In this sense, collaboration between the World Health Organization and relevant stakeholders, including the research-based pharmaceutical industry, on collaborative registration procedures that support fast and efficient review and approval of essential medicines in Africa is essential. African regulatory harmonization offers many benefits to regulatory authorities, patients in Africa and industry alike - and most critically for the protection of public health. [ABSTRACT FROM AUTHOR]

The article discusses how free trade can enhance the importation of patented pharmaceuticals and the development of Africa's pharmaceutical manufacturing capacity, and it mentions issues related to regionalism and access to medicines in Africa, as well as the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Compulsory licenses and an African regional trade agreement are mentioned in relation to the promotion of African interests in the World Trade Organization (WTO).

This article examines challenges faced by the national health systems of African countries emerging from conflict in the provision of antiretroviral (ARV) medication and HIV/AIDS-related healthcare. It analyses resource profiles, the unmet need for antiretroviral medication, and progress in the provision of HIV/AIDS-related healthcare in Burundi, Liberia, Mozambique, Rwanda, Sierra Leone and Uganda, using data from the Global AIDS Response Progress Reports (GARPR) of 2011. Findings indicate that challenges to the health systems in post-conflict countries are immense and should not be underestimated, particularly in the context of HIV/AIDS. Policy recommendations for bolstering the performance of national health systems of post-conflict countries in the context of HIV/AIDS are proposed. [ABSTRACT FROM PUBLISHER]

Abstract: Context: Although pain and burdensome symptoms among HIV-infected persons can be effectively managed, the availability of opioids and other symptom-controlling drugs is a particular challenge in sub-Saharan Africa. Objectives: This study aimed to identify current drug availability and prescribing practices in 12 sub-Saharan African countries and to examine the barriers and potential facilitators for use of opioids and other key HIV/AIDS symptom-controlling drugs. Methods: This was a cross-sectional survey, integrating data from palliative care facilities and competent authorities within ministries of health in 12 African countries. Results: Of 62 responding facilities, problems were reported in accessing named nonopioids, with a small number of facilities unable to dispense them. Less than half the facilities were currently prescribing opioids of any strength. Further problems were identified in terms of the availability and supply continuity of named antiemetics and anxiolytics. The data identified a number of systemic problems, suggesting that opioid supply issues are similar to less controlled drugs, such as antiemetics. Among competent authorities, there was no agreement on whether further opioid expansion was possible. Integration of data from care facilities and competent authorities highlighted a disparity in the understanding of the availability of specific drugs, with competent authorities naming drugs that were not listed by any responding facility in their respective country. Conclusion: This study shows that opioid expansion needs to balance supply and skills: Currently there are insufficient trained clinical personnel to prescribe, and supply is unreliable. Efforts to expand supply should ensure that they do not weaken current systems. [Copyright &y& Elsevier]

Abstract: International health and drug regulatory authorities acknowledge that analgesics (especially opioids) are insufficiently available for pain management in many countries. In Africa, reported morphine consumption is far below the global mean, with multiple factors hampering opioid supply. Since 2006, the African Palliative Care Association has hosted three regional drug availability workshops across the continent to address this issue. Using an interactive format, the workshops have identified country-specific barriers to opioid and other essential medication accessibility before supporting participants to develop action plans to address recognized impediments. Despite multiple challenges, a number of successes have arisen from the implementation of the plans. However, key issues remain, including the introduction of supportive policy environments, effective educational initiatives, and measures to address supply-chain obstacles impeding drug availability. [Copyright &y& Elsevier]

During the last quarter century, much of the scholarship and discussion on pharmaceuticals in Africa has centered on consumer access to generic drugs such as HIV antiretrovirals and malaria treatments. Recently, issues such as Africa's role in global health security have begun to attract more interest. This article examines the conditions that propel Senegal's illegal pharmaceutical trade, the institutions and individuals that are implicated, and the impact on legal, biomedically trained pharmacy owners. Based on fieldwork in the Senegalese cities of Dakar, Thiaroye, Guédiwaye, and Diourbel, this article also examines Senegal's illicit connections to a larger trade of drugs, goods, and bodies and demonstrates how events in West Africa are connected to global developments in public health. [ABSTRACT FROM AUTHOR]

The article examines the potential benefits of African ambitions to establish a strong domestic pharmaceutical sector to improve desperately needed local access to drugs. A study produced by the Council on Health Research for Development has identified several initiatives and institutions involved in researching and developing treatments for neglected diseases. It is noted that an increasing political momentum exists in Africa behind the idea of a domestic pharmaceutical sector solely managed by Africans.

It is the right of all humans to have access to safe, quality and effective medicines. This article seeks to expound on the problems of drug manufacturing and challenges of accessing medicines in West Africa, and evaluate the strategies being adopted by international developmental partners and the governments to address them. West Africa is uniquely diverse in culture (having English, French and Portuguese speaking people) but generally affected by the same diseases (e.g., malaria, HIV/AIDS, and Tuberculosis). In this developmentally beleaguered region, drug development and manufacturing are still stuck in their embryonic stages where medicine distribution is chaotic and insufficiently regulated. An enduring question is why investment in research and development in medicines for neglected tropical diseases and manufacturing is still very low in Africa and in particular West Africa. In this article, we look at how these vulnerabilities are exploited by unscrupulous merchants, leading to massive influx of fake and substandard medicines to the supply chain, making it difficult for the rural, voiceless poor to access quality safe medication. Through an examination of current research and published works by the World Health Organization (WHO), the United States Pharmacopeia (USP) and other international development partners in Africa, first hand interactions with manufacturers, medicine regulators, regulatory consultants, and the patients, as well as from personal observations, the article crystallizes the major issues and challenges to drug manufacturing and access to quality, safe, and effective essential medicines in West Africa. This article also examines the strategies and policies being implemented to salvage the situation. It is irrevocably clear that solving the challenges of providing safe medication to West Africa is a collective responsibility - the government (through legislation, strategic regulations and policies), medicines manufacturers (adoption of Good Manufacturing Practices and ethics), regulators (through persuasion and enforcement of rules), regulatory consultants, the patients (empowered, informed about their rights and courage and willingness to report drug reactions and discernible counterfeiting), the international development partners and all other stake holders in the health care sector have roles to play in ensuring that the public has access to quality safe and efficacious medicines. [ABSTRACT FROM AUTHOR]

The article compares the mortality rates of people with sickle-cell disease in African nations to that of Western countries, and discusses stem-cell transplantation reversing the disease, and better diagnosis and drug availability to overcome sickle-cell disease.

Opioid analgesics are critical to the effective relief of cancer pain. Effective treatment is predicated on sound assessments, individually tailored analgesic therapy, and the availability and accessibility of the required medications. In some countries, pain relief is hampered by the lack of availability or barriers to the accessibility of opioid analgesics. As the follow-up to a successful project to evaluate the availability and accessibility of opioids and regulatory barriers in Europe, the European Society for Medical Oncology (ESMO) and the European Association for Palliative Care (EAPC) undertook to expand their research to those parts of the world where data were lacking regarding these aspects of care, in particular Africa, Asia, the Middle East, Latin America and the Caribbean, and the states of India. This project has been undertaken in collaboration with the Union for International Cancer Control (UICC), the Pain and Policy Studies Group (PPSG) of the University of Wisconsin, and the World Health Organization (WHO), together with a consortium of 17 international oncology and palliative care societies. This article describes the study methodology. [ABSTRACT FROM AUTHOR]

The nations of the Caribbean, Central America and South America form a heterogeneous region with substantial variability in economic, social and palliative care development. Palliative care provision is at varied stages of development throughout the region. The consumption of opioids in Latin America and the Caribbean is variable with moderate levels of consumption by international standards (1–10 mg morphine equivalents/capita/year) observed in Argentine, Brazil, Chile, Colombia, Cuba, Mexico, Costa Rica, Uruguay and most of the Caribbean but relatively low levels of consumption in other countries particularly Guatemala, Honduras and Bolivia. Data for Latin American and Caribbean is reported on the availability and accessibility of opioids for the management of cancer pain in 24 of the 33 countries surveyed. The results of this survey are relevant to 560 million of the region's 595 million people (94%). Opioid availability continues to be low throughout most of Latin America and the Caribbean. While formularies in this region generally include all recommended morphine formulations, access is significantly impaired by widespread over-regulation that continues to be pervasive across the region. [ABSTRACT FROM AUTHOR]

The reports of the Global Opioid Policy Initiative (GOPI) project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Caribbean, and the Middle East, together with the previous 2010 European Society for Medical Oncology (ESMO)/European Association for Palliative Care (EAPC) report from Europe, have provided critical data in demonstrating the deficiencies in many countries throughout the world. Formulary deficiencies and over-regulation are pandemic and must be addressed. This process is challenging and will require concerted and sustained efforts by clinical leaders and advocacy groups partnering with international and regional organizations and, of course, with national governments and their competent authorities. There is a growing international expertise and infrastructure to coordinate advocacy and strategic planning based on the World Health Organization (WHO) Model of Education, Policy Reform and Medication Availability. [ABSTRACT FROM AUTHOR]