Drug procurement, the Global Fund and misguided competition policies

Tren, Richard; Hess, Kimberly; Bate, Roger

doi:10.1186/1475-2875-8-305

Cited by 25 publications

(18 citation statements)

References 2 publications

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“…Although the new antimalarial policy was adopted in 2004, it was not fully implemented until 2006, and non-recommended regimens continue to be used frequently in Uganda due to stock-outs of artemether-lumefantrine [27].…”

Section: Methodsmentioning

confidence: 99%

Efficacy, Safety, and Tolerability of Three Regimens for Prevention of Malaria: A Randomized, Placebo-Controlled Trial in Ugandan Schoolchildren

et al. 2010

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BackgroundIntermittent preventive treatment (IPT) is a promising malaria control strategy; however, the optimal regimen remains unclear. We conducted a randomized, single-blinded, placebo-controlled trial to evaluate the efficacy, safety, and tolerability of a single course of sulfadoxine-pyrimethamine (SP), amodiaquine + SP (AQ+SP) or dihydroartemisinin-piperaquine (DP) among schoolchildren to inform IPT.MethodsAsymptomatic girls aged 8 to 12 years and boys aged 8 to 14 years enrolled in two primary schools in Tororo, Uganda were randomized to receive one of the study regimens or placebo, regardless of presence of parasitemia at enrollment, and followed for 42 days. The primary outcome was risk of parasitemia at 42 days. Survival analysis was used to assess differences between regimens.ResultsOf 780 enrolled participants, 769 (98.6%) completed follow-up and were assigned a treatment outcome. The risk of parasitemia at 42 days varied significantly between DP (11.7% [95% confidence interval (CI): 7.9, 17.1]), AQ+SP (44.3% [37.6, 51.5]), and SP (79.7% [95% CI: 73.6, 85.2], p<0.001). The risk of parasitemia in SP-treated children was no different than in those receiving placebo (84.6% [95% CI: 79.1, 89.3], p = 0.22). No serious adverse events occurred, but AQ+SP was associated with increased risk of vomiting compared to placebo (13.0% [95% CI: 9.1, 18.5] vs. 4.7% [95% CI: 2.5, 8.8], respectively, p = 0.003).ConclusionsDP was the most efficacious and well-tolerated regimen tested, although AQ+SP appears to be a suitable alternative for IPT in schoolchildren. Use of SP for IPT may not be appropriate in areas with high-level SP resistance in Africa.Trial RegistrationClinicalTrials.gov NCT00852371

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Section: Methodsmentioning

confidence: 99%

Efficacy, Safety, and Tolerability of Three Regimens for Prevention of Malaria: A Randomized, Placebo-Controlled Trial in Ugandan Schoolchildren

et al. 2010

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“…Notably, AL stock-outs were not particular to Nyanza Province, being documented nationwide in 2008. 25,26 The increase in malaria prevalence and mortality occurred despite high ITN use, a worrisome finding that indicates that ITNs alone are not sufficient to prevent increases in malaria.…”

Section: Antimalarial Drug Stock-outs After Its Introduction Inmentioning

confidence: 99%

A Reversal in Reductions of Child Mortality in Western Kenya, 2003–2009

Hamel

Adazu²,

Obor

et al. 2011

The American Society of Tropical Medicine and Hygiene

101

126

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We report and explore changes in child mortality in a rural area of Kenya during 2003–2009, when major public health interventions were scaled-up. Mortality ratios and rates were calculated by using the Kenya Medical Research Institute/Centers for Disease Control and Prevention Demographic Surveillance System. Inpatient and outpatient morbidity and mortality, and verbal autopsy data were analyzed. Mortality ratios for children less than five years of age decreased from 241 to 137 deaths/1,000 live-births in 2003 and 2007 respectively. In 2008, they increased to 212 deaths/1,000 live-births. Mortality remained elevated during the first 8 months of 2009 compared with 2006 and 2007. Malaria and/or anemia accounted for the greatest increases in child mortality. Stock-outs of essential antimalarial drugs during a time of increased malaria transmission and disruption of services during civil unrest may have contributed to increased mortality in 2008–2009. To maintain gains in child survival, implementation of good policies and effective interventions must be complemented by reliable supply and access to clinical services and essential drugs.

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“…Shortages of essential medications and supplies stem from lack of foreign exchange reserves to pay for imports, limited government health budgets, and weak procurement, supply chain, and management information systems. 27,28 Each of these problems needs to be addressed in its own right, but the far more fragile supply chains present in many low-income countries mean that these countries could experience far worse shortages of basic medical and public health supplies as fossil fuel costs drive prices higher.…”

Section: Medical Supplies and Equipmentmentioning

confidence: 99%

“…56---58 Many low-income countries, particularly the 58 countries in the bottom billion, rely heavily on development aid and associated technical assistance provided through donors such as the Global Fund for AIDS, Tuberculosis and Malaria to set affordable prices for essential drugs, 59 establish and maintain procurement and supply management systems, 27,60 and to pay for the drugs and supplies themselves. 27,28 The end of cheap fossil fuels could greatly increase the cost of procuring and importing drugs and supplies, particularly in the landlocked countries of sub-Saharan Africa. 3 In 2006, a review of 17 lowincome countries found that 87% of all spending on HIV/AIDS came from international donors.…”

Section: Aid Dependencementioning

confidence: 99%