ESPE Abstracts (2016) 86 P-P1-692

Access to Medicines in Pediatric Endocrinology and Diabetes in Africa: Insights from the WHO and National Lists of Essential Medicines

Amanda Rowlandsa,b, Renson Mukhwanad, Joel Dipesalemab,c & Jean-Pierre Chanoinea,b

aBritish Columbia Children’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada; bGlobal Pediatric Endocrinology and Diabetes (GPED), Vancouver, British Columbia, Canada; cPrincess Marina Hospital and University of Botswana, Gaborone, Botswana; dGertrudes Childrens Hospital, Nairobi, Kenya

Background: Access to essential medicines remains suboptimal in Africa. The World Health Organisation (WHO) maintains two non-binding essential medicine lists (EML) (for children and for adults). Individual countries refer to these lists to prepare national EMLs.

Objective and hypotheses: To determine which medicines commonly used in pediatric endocrinology and diabetes are included in the WHO and national EMLs in the WHO African region. We hypothesize that significant differences are present between countries, reflecting at least in part differences in Gross National Income (GNI).

Method: We compared a master list of medicines with i) the WHO EML for children and adults and ii) The national EML for countries included in the WHO African region. National EMLs were obtained from the WHO website and GNI data from the World Bank.

Results: Data from 40 of the 47 countries included in the WHO African region was collected. Four countries (=10%) had separate adult and child EMLs and 33 countries (=83%) were classified as low income. Overall, the WHO EMLs included medicines for contraception, Vitamin D deficiency, Type 1 and Type 2 diabetes and diseases of the adrenals, the thyroid and puberty. Calcitriol, diazoxide, growth hormone and bisphosphonates were not included. In African EMLs, all countries included at least one glucocorticoid and 96% included a short and/or long acting insulin. In contrast, fludrocortisone was only present in 11 (=25%) and glucagon in 10 (=23%) of the national EMLs, despite being suggested by WHO. Calcitriol was included by 7% of the countries. Diazoxide was not included in any of the lists. Overall, richer countries had more medicines listed than poorer countries.

Conclusion: There are significant discrepancies between the content of the WHO and National EMLs. Future research will determine the extent to which the national EMLs reflect availability of the medicines in the country.

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