Availability of two essential medicines for mental health in Bangladesh, the Democratic Republic of Congo, Haiti, Nepal, Malawi, Senegal, and Tanzania: Evidence from nationally representative samples of 7958 health facilities

Abstract

Background Access to effective mental health services in low- and- middle income countries (LMICs) is limited, leading to a substantial global treatment gap. Amitriptyline, an anti-depressant, and diazepam, an anxiolytic drug, are classified as essential medications by the World Health Organization (WHO). They are the only psychotropic medications whose availability in health facilities is documented as part of Service Provision Assessment surveys. Our objective was to characterize the availability of these medicines in seven countries. Methods We pooled nationally representative data from Service Provision Assessment surveys of health facilities conducted in Bangladesh, Democratic Republic of Congo (DRC), Haiti, Malawi, Nepal, Senegal, and Tanzania, from 2012 to 2018. We estimated the distribution and determinants of facility-level amitriptyline and diazepam availability in each country. Results We analysed data from 7958 health facilities. An estimated 8.2% of facilities had amitriptyline and 46.1% had diazepam on the day of assessment. There was significant heterogeneity in both amitriptyline and diazepam availability across countries and within countries across facility characteristics. Multivariable models indicated that hospitals, faith-based and private-for-profit facilities, facilities with more staff, and facilities with more technological resources were more likely to have each medicine, relative to primary care facilities, public sector facilities, facilities with fewer staff, and facilities with fewer technological resources, respectively. Conclusion Our results indicate limited availability of amitriptyline in health facilities in these seven LMICs. Diazepam is much more commonly available than amitriptyline. Efforts to narrow the global treatment gap for mental health – and especially to integrate mental health services into primary care in LMICs – will be limited without the availability of essential medicines like amitriptyline. Efforts to expand purchasing, distribution, and capacity-building in the appropriate use of essential mental health medicines in LMICs are warranted.

Health facility readiness to screen, diagnose and manage substance use disorders in Mbale district, Uganda

“…Other studies have shown that individuals often prefer seeking care from traditional healers, even though they seek treatment for conditions such as epilepsy in healthcare facilities [ 1 , 30 ]. The availability of medicines like diazepam in our study contrasts with reports of low availability in other low- and middle-income countries (LMICs), highlighting the slow progress some countries are making in integrating mental health services into primary care in LMICs [ 31 , 32 ].…”

Availability, price, and affordability of antiseizure medicines in Addis Ababa, Ethiopia

“…20 The availability of Diazepam 5 mg tablet was higher than in seven low-and lower-middle-income countries 25 and also other countries like Gambia, 23 Jordan, 24 and China. [26][27][28] Generally, the availability of sodium valproate, carbamazepine, phenytoin, phenobarbitone, and diazepam in this study was higher than availability in 46 countries with different income levels. 29 Addis Ababa is the capital city of Ethiopia, where many health facilities and specialized health services are provided.…”

“…This was higher than the average availability of all WHO regions of the world 22 and also higher than the average availability in each different income‐level categorized countries, 22 Zambia, 16 Madagascar, 17 Jordan, 24 and Cambodia 20 . The availability of Diazepam 5 mg tablet was higher than in seven low‐ and lower‐middle‐income countries 25 and also other countries like Gambia, 23 Jordan, 24 and China 26–28 . Generally, the availability of sodium valproate, carbamazepine, phenytoin, phenobarbitone, and diazepam in this study was higher than availability in 46 countries with different income levels 29 …”

Availability, Price and Affordability of Psychotropic Medicines in Addis Ababa, Ethiopia

“…24 The problem arises when there is a need to switch medication in each group, since the availability of the second chosen medicine was mostly very low. The availability of Amitriptyline 25 mg tablet and Diazepam 5 mg tablet was higher than seven low and lower-middle income countries, 25 and also other countries like Gambia 23 and China. [26][27][28] The overall availability of LPG fluoxetine 20 mg capsules was 53.2%, with 42.9% in the public sector and 80% in the private sector.…”