Determinants of Access to essential Antiepileptic Drugs in Southeast Asia
Author: Sengxeu, Noudy
Under the direction of: Voahirana Ratsimbazafy and Jérémy Jost
Limoges University
Texte français
Keywords: Epidemiology, Southeast Asia, Epilepsy, Therapeutic deficit, Accessibility, Knowledge, Antiepileptics, Asia, Access to medicines.
Abstract
Epilepsy is a neurological disorder that affects approximately 70 million people worldwide, 70% of whom do not have access to appropriate treatment. A proportion of 70% could live seizure-free with appropriate use of antiepileptic drugs (AEDs). However, access to AEDs remains insufficient in developing countries with a high treatment gap, above 75%. The aim of this study was to evaluate the availability, accessibility, quality of end-of-dispensing chain AEDs, and the knowledge and qualifications of pharmacy-dispensing workers to patients in Southeast Asia. Overall, 21.1% of the outlets visited in Lao and 52.2% in Cambodia had at least one AED. Phenobarbital 100 mg was the most available (14.3% in Lao and 35.5% in Cambodia). In Lao, phenytoin 100 mg and phenobarbital 100 mg were the most affordable (1.0 and 1.2 working days to purchase one month of treatment, respectively). In Cambodia, phenobarbital 50 mg and 100 mg were the most affordable (0.6 and 0.5 days of salary, respectively). No counterfeit drug was identified. The proportion of poor-quality AEDs was 15.0% in Lao and 23.9% in Cambodia. Regarding knowledge and skills, 40.8% of respondents in Cambodia and 38.5% in Lao were pharmacists. A total of 87.0% of respondents in Cambodia knew at least one AED, compared to 67.3% in Lao (p=0.003). Knowledge of the interactions between AEDs and oral contraception was almost never known. The same study in Thailand is currently in progress. This study has quantified and qualified various factors that contribute to the treatment gap in both Lao and Cambodia. The availability of treatment remains low, with poor quality AEDs in both countries. A drug policy aimed at improving the parameters studied would reduce the treatment gap for epilepsy.
