Displaying publications 41 - 60 of 656 in total

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  1. Fulltext Identifying causes of Under Five mortality for better planning
    Nur Syakirah Awai, Aminah Bee Mohd Kassim
    Malaysian Journal of Medicine and Health Sciences, 2019;15(104):20-20.
    MyJurnal
    Introduction: Under 5 mortality is a leading indicator of the level of child health and overall development of a coun-try. In Malaysia, progressive reduction has been observed from 1990 however since 2000 progress has been static. Further understanding about this trend is crucial. The objective of this study was to identify causes of mortality for better policy development in order to further reduce this rate. Methods: Analysis of mortality trends was done using data from Department of Statistics and causes of mortality using data collected through the Stillbirth and Under 5 Mortality Reporting System (SU5MR) in 2016. Results: The trend for Under 5 mortality rate between 2006 till 2016 is still plateaued and hovered between 8 to 9 per 1000 live births at the national level. High percentage of death is seen among the neonatal group (51%), followed by children 28 days to 1year (31%) and toddlers 1-4 years (18%). Percentage of preventable deaths increased with age i.e. 21% among neonates, 41% among children 28 days to 1year and 48% among toddlers. The leading causes of death are conditions from perinatal period (34.4%), congen-ital malformation (30%), injuries and external causes (6.4%), respiratory (5.6%) and certain infectious and parasitic disease (5.1%). Conclusion: To further reduce under -5 mortality focus needs to be on preventable deaths; to reduce neonatal deaths will require political commitment to ensure adequate resources; interagency collaboration is needed to reduce toddler mortality and family and community awareness on prevention of injury and infection.
    Matched MeSH terms: Policy Making
  2. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide
    Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, et al.
    Lancet Oncol, 2023 Dec;24(12):e472-e518.
    PMID: 37924819 DOI: 10.1016/S1470-2045(23)00412-6
    The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
    Matched MeSH terms: Health Policy
  3. The global three: A Malaysian lens on the challenges and opportunities facing restorative justice planning and implementation
    Mohammad T, Azman A, Anderstone B
    Eval Program Plann, 2019 02;72:1-7.
    PMID: 30245370 DOI: 10.1016/j.evalprogplan.2018.09.007
    From the rise of restorative justice to evidence-based approaches to reducing recidivism, the intellectual landscape of criminal justice has seen considerable change in recent decades. The result is that an increasing number of countries have tackled the task of shifting preexisting political institutions to confirm with these new understandings. This is, of course, no easy feat. A great number of challenges confront willing policymakers, a reality that often puts philosophy at loggerheads with practicality. Moreover, the political process of change is subject to the influence of cultural and institutional norms. In this paper, we look at one particular case study - that of Malaysia's juvenile justice system - to understand the challenges faced in changing criminal justice policy. We identify three primary categories of challenges and elucidate their shape and impact through the Malaysian example. We also briefly analyze potential opportunities to mitigate and overcome these challenges. Furthermore, we also conclude with several implications for future research that we deem are important to be taken place. In sum, we argue that criminal justice reform must be undertaken with an eye toward important societal and institutional norms, each requiring thoughtful analysis of complex local cases.
    Matched MeSH terms: Policy
  4. The Heath government and British defence policy in Southeast Asia at the end of empire (1970-71)
    Andrea B
    20 Century Br Hist, 2009;20(1):53-73.
    PMID: 19569309
    This article examines the rationale behind the Heath government's 1970 decision to negotiate a Five Power Defence agreement with Australia, New Zealand, Singapore and Malaysia and to maintain a small British military contingent in Southeast Asia as a part of this new politico-military framework. It argues that while its overriding foreign policy concern was to end Britain's problematic relationship with the European Economic Community and to make membership of this grouping the cornerstone of its foreign policy, the Heath government was careful not to cast Britain's post-imperial future in purely European terms. The successful negotiation of the Five Power Defence Arrangements in 1970-71 was instrumental in achieving this by ensuring that London would maintain close links with key Commonwealth partners in the Asian region. In what was not only an attempt to neutralize potential domestic opposition to Britain's entry into the EEC, but also a lingering reluctance to do away with the rhetoric of Britain as a leading power with extra-European interests, Heath was eager to show that by making a contribution to the stability of Southeast Asia, Britain still had a role to play outside Europe.
    Matched MeSH terms: Public Policy*
  5. The end of the line: who is most at risk from the crisis in global fisheries?
    Hall SJ, Dugan P, Allison EH, Andrew NL
    Ambio, 2010 Feb;39(1):78-80.
    PMID: 20496655
    Matched MeSH terms: Public Policy*
  6. Fulltext Cost of type 2 diabetes mellitus in selected developing countries
    Wan Norlida Ibrahim, Syed Aljunid, Aniza Ismail
    Malaysian Journal of Public Health Medicine, 2010;10(2):68-71.
    MyJurnal
    Increasing prevalence of chronic diseases is a major contributor for rapid rise in healthcare cost in developing countries since the last decade. It was estimated that around 54% of deaths in developing countries are due to chronic non-communicable diseases which is predicted to rise by 65% by 2030. Diabetes mellitus is among the most prevalent chronic diseases suffered by more than 180 million people worldwide. By 2030 it is estimated that around 400 million people in the world will be afflicted with diabetes. Annual deaths attributable to diabetes are probably as high as 3 million with more than 80% occur in developing countries. India, China and Indonesia are three countries in the Asian region with most number of people with diabetes. The total number of cases in these three countries is expected to increase more than double from 61 million in 2000 to 163 million in 2030. China and India will suffer cumulative GDP loss of 13.8% and 16.7% respectively, over the next ten year period. Assessing economic burden of diabetes is a challenging task for researchers because identification of direct and indirect cost of the disease is often complex since patients with diabetes also suffers from other complications and co-morbidities. In conclusion, the heavy economic burden of diabetes pose major challenges to health policy makers in developing countries to assess the current approach in managing this chronic disease. Serious efforts should be made on focusing and up-scaling activities on health promotion and prevention of diabetes so that to provide a more cost-effective solution to this condition with huge and increasing economic loss.
    Matched MeSH terms: Health Policy
  7. Fulltext Corporate culture and health care organization
    Izamin, I., Jamsiah, M., Aniza, I.
    Malaysian Journal of Community Health, 2007;13(1):44-54.
    MyJurnal
    Each organization has a particular culture, due to personal interactions, with certain values shared by its members. Corporate culture is defined as ‘the set of shared, taken-for-granted implicit assumptions that a group holds and that determines how it perceives, thinks about, and reacts to its various environments’. Positive corporate culture is linked to increased staff alignment, advanced level of employee commitment, increased employee productivity, enhanced organizational effectiveness and increased profitability. Researchers claimed that most studies suggesting the associations between culture and performance are methodologically weak. Cultural transformation has been a big part of NHS reforms and health system redesign in United States to deliver improvements in quality and performance. Environment, market competition, technology advancement, information age and government policies will influence the cultural change within the organization. Undesirable culture might emerge if the organization does not act appropriately to manage its corporate culture. There are six critical success factors for the implementation of corporate culture changes: committed and effective leadership, clear definition of the desired goals, rigorous implementation of a change management model, effective mitigation of change resistance, active governance structure and a design model, and effective communication. Among the issues in implementing corporate culture within healthcare organizations are middle managers dilemma, cultural diversity and subcultures within the organization, size of healthcare organization and critical mass.
    Matched MeSH terms: Policy
  8. Moving towards sustainability: how do natural resources, financial development, and economic growth interact with the ecological footprint in Malaysia? A dynamic ARDL approach
    Khan MK, Abbas F, Godil DI, Sharif A, Ahmed Z, Anser MK
    Environ Sci Pollut Res Int, 2021 Oct;28(39):55579-55591.
    PMID: 34138439 DOI: 10.1007/s11356-021-14686-9
    Without enhancing the quality of the environment, the goals of sustainable development remain unachievable. In order to minimize the damage to the planet, sustainable practices need to be considered. This study is conducted to identify some of the drivers behind the increasing sustainability issues and tried to investigate the impact of natural resources, financial development, and economic growth on the ecological footprint in Malaysia from the year 1980-2019 by utilizing the dynamic simulated autoregressive distribution lag approach. It was identified that financial development, economic growth, and natural resources are the determinants behind the upsurge of the ecological footprint as all three show a positive and significant effect on ecological footprint. However, in the long run, the presence of the Environmental Kuznets Curve hypothesis was also validated in Malaysia. Therefore, it is recommended to increase awareness among the public regarding the adoption of sustainable practices in everyday life and to use green technologies that offer maximum efficiency and minimum damage to the environment in commercial and domestic activities. Finally, based on the research results, a comprehensive policy framework was proposed which could allow the Malaysian economy to attain the objectives of Sustainable Development Goals (SDGs) 7, 8, and 13.
    Matched MeSH terms: Policy
  9. A global strategy for road building
    Laurance WF, Clements GR, Sloan S, O'Connell CS, Mueller ND, Goosem M, et al.
    Nature, 2014 Sep 11;513(7517):229-32.
    PMID: 25162528 DOI: 10.1038/nature13717
    The number and extent of roads will expand dramatically this century. Globally, at least 25 million kilometres of new roads are anticipated by 2050; a 60% increase in the total length of roads over that in 2010. Nine-tenths of all road construction is expected to occur in developing nations, including many regions that sustain exceptional biodiversity and vital ecosystem services. Roads penetrating into wilderness or frontier areas are a major proximate driver of habitat loss and fragmentation, wildfires, overhunting and other environmental degradation, often with irreversible impacts on ecosystems. Unfortunately, much road proliferation is chaotic or poorly planned, and the rate of expansion is so great that it often overwhelms the capacity of environmental planners and managers. Here we present a global scheme for prioritizing road building. This large-scale zoning plan seeks to limit the environmental costs of road expansion while maximizing its benefits for human development, by helping to increase agricultural production, which is an urgent priority given that global food demand could double by mid-century. Our analysis identifies areas with high environmental values where future road building should be avoided if possible, areas where strategic road improvements could promote agricultural development with relatively modest environmental costs, and 'conflict areas' where road building could have sizeable benefits for agriculture but with serious environmental damage. Our plan provides a template for proactively zoning and prioritizing roads during the most explosive era of road expansion in human history.
    Matched MeSH terms: Environmental Policy*
  10. Fulltext Parental perception of their children's weight status, and its association with their nutrition and obesity knowledge
    Muhammad NA, Omar K, Shah SA, Muthupalaniappen L, Arshad F
    Asia Pac J Clin Nutr, 2008;17(4):597-602.
    PMID: 19114396
    BACKGROUND: Worldwide the prevalence of overweight and obesity in children is escalating. Parents’ recognition of overweight or obesity in their own children is very important for a successful intervention in these children. This study examined parental perception of their children’s weight status, and its association with their knowledge on nutrition and obesity.
    MATERIALS AND METHODS: This was a cross sectional study of parents with children aged 9 to 12 years, in a primary school of Kuala Lumpur. Parents responded to a self-administered questionnaire which contains parental perception of their child weight status as well as knowledge on nutrition and obesity. The parents’ perception of the children’s weight status was then compared with the actual measured weight status.
    RESULTS: There were 204 parents who participated in the study. Parents were found to underestimate their child weight status and 38.2% were inaccurate in their perception. The mean score of knowledge on nutrition and obesity was 78.5±14.4; and this did not associate with the accuracy of their perception on the child weight status. Parents showed inadequate knowledge in food pyramid and preparation of low fat meals.
    CONCLUSION: The Malaysian Health Campaigns had resulted in overall good knowledge on nutrition and obesity in the parents except in few domains. However, this was insufficient to make the parents recognize the growing overweight and obesity problem in their children.
    Key Words: overweight, obesity, children, parental perception, knowledge
    Matched MeSH terms: Nutrition Policy*
  11. Fulltext Public awareness and support for environmental protection-A focus on air pollution in peninsular Malaysia
    Chin YSJ, De Pretto L, Thuppil V, Ashfold MJ
    PLoS One, 2019;14(3):e0212206.
    PMID: 30870439 DOI: 10.1371/journal.pone.0212206
    As in many nations, air pollution linked to rapid industrialization is a public health and environmental concern in Malaysia, especially in cities. Understanding awareness of air pollution and support for environmental protection from the general public is essential for informing governmental approaches to dealing with this problem. This study presents a cross-sectional survey conducted in the Klang Valley and Iskandar conurbations to examine urban Malaysians' perception, awareness and opinions of air pollution. The survey was conducted in two languages, English and Malay, and administered through the online survey research software, Qualtrics. The survey consisted of three sections, where we collected sociodemographic information, information on the public perception of air quality and the causes of air pollution, information on public awareness of air pollution and its related impacts, and information on attitudes towards environmental protection. Of 214 respondents, over 60% were positive towards the air quality at both study sites despite the presence of harmful levels of air pollution. The air in the Klang Valley was perceived to be slightly more polluted and causing greater health issues. Overall, the majority of respondents were aware that motor vehicles represent the primary pollution source, yet private transport was still the preferred choice of transportation mode. A generally positive approach towards environmental protection emerged from the data. However, participants showed stronger agreement with protection actions that do not involve individual effort. Nonetheless, we found that certain segments of the sample (people owning more than three vehicles per household and those with relatives who suffered from respiratory diseases) were significantly more willing to personally pay for environmental protection compared to others. Implications point to the need for actions for spreading awareness of air pollution to the overall population, especially with regards to its health risks, as well as strategies for increasing the perception of behavioural control, especially with regards to motor vehicles' usage.
    Matched MeSH terms: Environmental Policy
  12. Fulltext Ethical issues related to epilepsy care in the developing world
    Tan CT, Avanzini G
    Epilepsia, 2009 May;50(5):975-7.
    PMID: 19170738 DOI: 10.1111/j.1528-1167.2008.01934.x
    There are three major issues of ethical concern related to epilepsy care in the developing world. First, is it ethical for a developing country to channel its limited resources from direct epilepsy care to research? The main considerations in addressing this question are the particular research questions to be addressed and whether such research will bring direct benefits to the local community. Second, in a country with limited resources, when does ignoring the high treatment gap become an ethical issue? This question is of particular concern when the community has enough resources to afford treatment for its poor, yet is not providing such care because of gross wastage and misallocation of the national resources. Third, do countries with plentiful resources have an ethical responsibility to help relieve the high epilepsy treatment gap of poor countries? Indeed, we believe that reasonable health care is a basic human right, and that human rights transcend national boundaries. Although health care is usually the responsibility of the nation-state, many modern states in the developing world are arbitrary creations of colonization. There is often a long process from the establishment of a political-legal state to a mature functional nation. During the long process of nation building, help from neighboring countries is often required.
    Matched MeSH terms: Health Policy
  13. Fulltext Muslim female healthcare personnel dress code: a proposed guideline
    Saidun, S., Akhmetova, E., Awang Abd Rahman, A.
    International Medical Journal Malaysia, 2018;17(2):57-70.
    MyJurnal
    Introduction: The struggle of Muslim women to comply with Islamic teaching while working in the healthcare sector has been a long-standing issue. Following the case of a Muslim nurse who was allegedly fired for non-adherence to the short-sleeve uniform rule, the Malaysian Muslim Consumers Association highlighted the need for a uniform guideline to prevent similar instances. Yet, no guideline has been issued to date. Materials and Methods: This conceptual study employed library research method to gather relevant materials. Library research was able to retrieve guidelines from seven Muslim-minority countries but none from Muslim-majority countries. Document analysis of the materials gathered was undertaken. The different guidelines were compared, with special reference to awrah-related issues. Results: Several major issues that healthcare personnel dress code considers are the safety, health, cleanliness, and comfort for both patients and healthcare personnel. Islamic dressing requirement is not only in line with clinical practice but Islam also highly promotes maintenance of safety, health, cleanliness, and comfort. The widely adopted ‘bare below the elbows (BBE) policy is the only practice that may contradict Islamic rules. However, some healthcare institutions in Muslim-minority countries allow modifications of uniform rules on religious grounds; some of the modifications are not observed in Muslim-majority countries. When providing direct patient care that requires BBE, the use of disposable over-sleeves is a good alternative to adhere to both clinical and Islamic standards. Conclusion: Healthcare personnel dress code policy that is concordant to both clinical and Islamic standards is possible although it may require greater resources.
    Matched MeSH terms: Health Policy
  14. Fulltext The role of partnership in capacity building in public health nutrition - experience of Malaysia
    Awin N
    Malays J Nutr, 2002 Mar;8(1):99-107.
    PMID: 22692442 MyJurnal
    Public Health emphasizes the plurality of the determinants of health of individuals, families and communities. Nutrition, as a major determinant of health, is itself influenced by a multitude of determinants that are under the purview of several agencies. Thus, inter-sectoral collaboration among the relevant agencies is imperative for promoting optimal health and nutrition such a partnership is manifested in the development and implementation of the National Plan of Nutrition (NPAN) of Malaysia pursuant to the International Conference on Nutrition (ICN) held in 1992. While the overall coordination of NPAN is at the Family Development Division in the Ministry of Health, the body that sees to the coordination is again a multi-agency group in the form of the National Coordinating Committee for Food and Nutrition (NCCFN). The NCCFN has representation for the nine thrust areas of NPAN that cut across various sectors including health, agriculture, education, community development and economic planning. Capacity building is a central strategy in the NPAN through the creation of positions and special budgetary allocations, and the implementation of activities including research, training, development of dietary guidelines and the National Nutrition Policy. This policy will be a major driving force for strengthening and building of capacity for nutrition-related activities, and more importantly it will facilitate a coordinated and coherent approach to capacity building, including sharing of resources.
    Matched MeSH terms: Nutrition Policy
  15. Fulltext Reducing the stigma of mental health disorders with a focus on low- and middle-income countries
    Javed A, Lee C, Zakaria H, Buenaventura RD, Cetkovich-Bakmas M, Duailibi K, et al.
    Asian J Psychiatr, 2021 Apr;58:102601.
    PMID: 33611083 DOI: 10.1016/j.ajp.2021.102601
    Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.
    Matched MeSH terms: Health Policy
  16. Fulltext Towards sustainable transport policy framework: A rail-based transit system in Klang Valley, Malaysia
    Yusoff I, Ng BK, Azizan SA
    PLoS One, 2021;16(3):e0248519.
    PMID: 33711053 DOI: 10.1371/journal.pone.0248519
    This study examines the sustainable transport policy framework in the case of railway development in Klang Valley, Malaysia. It is guided by the main principle that sustainable transport policy is a result of the integration of broad policy instruments that range from infrastructure provision and management, technological improvements, regulation, information, awareness, education, and pricing and taxation. Although this study is mainly qualitative, performance data available at the ASEAN Statistics Division, World Bank Open Data and Global Competitiveness Reports. This is followed by in-person interviews with experts who have vast knowledge, experience, and direct participation in sustainable railway development in Malaysia, especially those related to the Klang Valley development. The main findings have indicated that the current framework in Malaysia meets the criteria of sustainable development policy framework, which are essentially constituted within environmental protection. It also constitutes the pursuance of long-term growth in terms of economic and societal needs. Nonetheless, the rail-based transit system in Malaysia is highly driven by the Government and there is no clear sign indicating that the public is shifting from the road and private transport to rail-based services.
    Matched MeSH terms: Policy*
  17. Dynamics of Social Enterprises in Health Care Delivery: Contexts, Models, and Policy Insights From Malaysia
    Ng BK, Chin TY, Abu Shamsi N, Azizan SA
    Asia Pac J Public Health, 2023 May;35(4):257-266.
    PMID: 37029545 DOI: 10.1177/10105395231164441
    This qualitative article explores the potential role of health care social enterprises (SEs) as disruptive innovators in improving the availability, accessibility, and affordability of health care delivery. It focuses on the context and mechanisms that enable SEs to produce positive health outcomes. Findings from an in-depth interview with the representatives of SEs and stakeholders in Malaysia reveal that strategies to balance the elements of social and enterprise (business) are the key for SEs to sustain in the market. This is supported with several inclusive business models such as inclusive employment model, cross-subsidization, and flexible fees payment mechanism, as well as collaborative engagement with multiple stakeholders, expert domains, and social workers. This article also highlights several main challenges in health care SEs, namely financial sustainability, impact measurement, scaling up of project, and political influence. This article ends with a few salient policies that focus on nurturing and strengthening health care SEs.
    Matched MeSH terms: Health Policy; Policy
  18. Fulltext National Cancer Patient Registry--a patient registry/clinical database to evaluate the health outcomes of patients undergoing treatment for cancers in Malaysia
    Lim GC, Azura D
    Med J Malaysia, 2008 Sep;63 Suppl C:55-6.
    PMID: 19230247
    Cancer burden in Malaysia is increasing. Although there have been improvements in cancer treatment, these new therapies may potentially cause an exponential increase in the cost of cancer treatment. Therefore, justification for the use of these treatments is mandated. Availability of local data will enable us to evaluate and compare the outcome of our patients. This will help to support our clinical decision making and local policy, improve access to treatment and improve the provision and delivery of oncology services in Malaysia. The National Cancer Patient Registry was proposed as a database for cancer patients who seek treatment in Malaysia. It will be a valuable tool to provide timely and robust data on the actual setting in oncology practice, safety and cost effectiveness of treatment and most importantly the outcome of these patients.
    Matched MeSH terms: Health Policy/trends
  19. Effects of agricultural development policies on migration in peninsular Malaysia
    Baydar N, White MJ, Simkins C, Babakol O
    Demography, 1990 Feb;27(1):97-109.
    PMID: 2303144
    State planning plays a central role in Malaysia's social and economic development. The government's rural development policies are designed to promote agricultural incomes and help counterbalance ethnic inequalities. The Federal Land Development Authority (FELDA) implements one of the internationally most successful land development and resettlement programs. In this article, we quantify the impact of FELDA settlements on local out-migration rates, linking macro and micro approaches and using data from the Malaysian Family Life Survey, national censuses, and other sources. A model of instantaneous migration rates specifies an individual's migration rate as a function of individual-level sociodemographic characteristics, the level of urbanization of the origin and destination, and the extent of rural development at the district of current residence. Our results show that in the late 1960s and early 1970s, the existence of rural development centers in a district reduced the levels of out-migration to pre-1965 levels.
    Matched MeSH terms: Public Policy*
  20. Fulltext WHO key access antibiotics price, availability and affordability in private sector pharmacies in Pakistan
    Saleem Z, Saeed H, Akbar Z, Saeed A, Khalid S, Farrukh L, et al.
    Cost Eff Resour Alloc, 2021 Feb 16;19(1):10.
    PMID: 33593366 DOI: 10.1186/s12962-021-00263-x
    BACKGROUND: Poor availability and unaffordability of key access antibiotics may increase antimicrobial resistance in the community by promoting inappropriate antibiotic selection and abridged therapy compliance.

    OBJECTIVE: To check the prices, availability, and affordability of the World Health Organization (WHO) key access antibiotics in private sector pharmacies of Lahore, Pakistan.

    METHODOLOGY: A survey of WHO key access antibiotics from WHO essential medicine list 2017 was conducted in private sector pharmacies of 4 different regions of Lahore employing adapted WHO/HAI methodology. The comparison of prices and availability between originator brands (OB) and lowest price generics (LPG) were conducted followed by the effect of medicine price differences on patient's affordability. The data were analyzed using a preprogrammed WHO Microsoft excel workbook.

    RESULTS: The mean availability of OB products was 45.20% and the availability of LPGs was 40.40%. The OBs of co-amoxiclav, clarithromycin and metronidazole and LPGs of azithromycin and ciprofloxacin were easily available (100%) in all private sector pharmacies. Whereas, antibiotics like chloramphenicol, cloxacillin, nitrofurantoin, spectinomycin, and cefazolin were totally unavailable in all the surveyed pharmacies. The OBs and LPGs with high MPRs were ceftriaxone (OB; 15.31, LPG; 6.38) and ciprofloxacin (OB; 12.42, LPG; 5.77). The median of brand premium obtained was 38.7%, which varied between the lowest brand premium of 3.97% for metronidazole and highest for ceftriaxone i.e. 140%. The cost of standard treatment was 0.5 day's wage (median) if using OB and 0.4 day's wage (median) for LPG, for a lowest paid unskilled government worker. Treatment with OB and LPG was unaffordable for ciprofloxacin (OB; 2.4, LPG; 1.1) & cefotaxime (OB; 12.7, LPG; 8.1).

    CONCLUSION: There is dire need to properly implement price control policies to better regulate fragile antibiotic supply system so that the availability of both OB and LPG of key access antibiotics should be increased. The prices could be reduced by improving purchasing efficiency, excluding taxes and regulating mark-ups. This could increase the affordability of patients to complete their antibiotic therapy with subsequent reduction in antimicrobial resistance.

    Matched MeSH terms: Policy
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