Browsing by Author "Marume, Amos."

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A price and availability survey of essential medicines in Harare Province, Zimbabwe.
(2015) Marume, Amos.; Bangalee, Varsha.
Access to essential medicines is both a fundamental basic right and necessity for everyone, thus governments should make concerted efforts to ensure that all have access to safe, quality and comparative cost-effective medicines. Efforts aimed at identifying factors hindering full access are key in informing relevant policy makers. Thus in pursuant of making significant contributions to the above, a survey was carried-out in Harare metropolitan province of Zimbabwe to determine prices, price components, pricing policies, source and availability of essential medicines (their innovator and/or generic equivalents) in both private and public retail sectors. Comparisons with 36 other low to middle-income countries in the rest of Africa, Americas, Eastern Mediterranean, Europe, Southeast Asia and Western Pacific were also conducted. A standardized methodology developed by World Health Organization and Health Action International (WHO/HAI) was used to survey a selected basket of 40 medicines. The selection was based on the WHO/HAI core medicines list and the latest version of the essential drug list of Zimbabwe. The survey was conducted in 110 private pharmacies, of which 55 were from the central business district, 33 from the high density and 22 from the low density suburbs. In both private and public sectors, availability of the selected essential medicines (low priced generics) was quite high (>80%). Fewer innovator brands were found for the selected medicines. Median price ratios (MPR) of the lowest priced generics revealed that many people still might be having their accesses to essential medicines compromised by high prices, particularly in the private sector (4.52). The public sector showed significant progress towards procurement efficiency (MPR of 1.5). More than 70% of the surveyed medicines were from manufacturers outside Zimbabwe with more than 60% being produced by Indian generic manufacturers. Zimbabwe still needs to do more on pricing, particularly in the private sector as well as promoting local production among other efforts in its quest to ensure all its people have access to quality, safe and effective medicines.
Price, availability and affordability of antineoplastic medicines in Harare’s public and private institutions: implications for access.
(2020) Mutyavaviri, Sly Ngoni.; Bangalee, Varsha.; Marume, Amos.
Background: Antineoplastic medicines are increasingly becoming more vital in many public health setups. There has been significant progress made in terms of newer molecules since the advent of chemotherapy. Despite the importance of antineoplastic medicines and advent of these molecules, there are still issues of limited availability and affordability in Zimbabwe. Currently the country has no government initiated policies on pricing and accessibility of antineoplastic medicines in public and private institutions, placing health care consumers at risk. A study was therefore designed to assess the price, availability and affordability of antineoplastic medicines in Harare Province, Zimbabwe. Methods: The study was based on the standardised method recommended by the World Health Organisation (WHO) and Health Action International (HAI). A data collection form-based cross-sectional survey was conducted in public and private medicine outlets. A total of 153 facilities were surveyed. The facilities consisted of three (3) public institutions and one hundred and fifty (150) private pharmacies in Harare and surrounding towns. The percentage availability, median price ratio using International Reference Prices, mark-ups, price and affordability of antineoplastic medicines were determined. Affordability was determined by using the wage of the lowest paid government worker which was USD296 per month. Median price ratios were calculated for twenty-two (22) of the antineoplastic medicines that were imported into the country from the import records at the Medicines Control Authority and also appearing on the medicines register for private pharmacies and seven (7) medicines for the public hospital pharmacies. The WHO’s International Reference Prices were used for calculation of median price ratios. Range, mode and average mark-up percentages for the antineoplastic medicines were also determined. Availability and price in the public sector was compared to availability in the private sector. Affordability was calculated as the out-of-pocket day’s wages to buy a monthly cycle of the antineoplastic medicine. Results: The percentage availability of the antineoplastic medicines at the government institutions was 25%, whilst the percentage availability of the antineoplastic medicines in the private sector ranged from 1% to 42.7%. Fifty percent of the twenty-two (22) medicines in the private sector had a median price ratio of lower than 4. The median price ratio in the private sector ranged from 0.60 to 11. Median price ratios were calculated for seven (7) medicines in the public sector. The median price ratio in the public sector ranged from 0.73 to 2.25. Eleven (11) of the medicines in the private sector were affordable with ten (10) days wage and below. Eight of the medicines were slightly affordable with wage days more than 10 days wage but less than 20 days wage. Wage days in private sector ranged from 1 day to 490 days. Affordability of the medicines in the public sector ranged from 1 to 10 days wage. Average percentage mark-up was 51.3% in the private sector and 34% in the public sector for the medicines that were available. Conclusion: Medicines were generally more available in the private sector than in the public sector. The government needs to continue supporting the National Pharmaceutical Company’s procurement of antineoplastic medicines. Generally medicines were more affordable in the public sector than in the private sector. The high percentage mark-ups calculated in the private sector compared to the public sector are as a result of the overhead expenses in private pharmacies which have to be borne from the actual sales of the medicines unlike in the public sector were the services are subsidised by the government. The low availability of antineoplastic medicines coupled with a very high unemployment rate means there is a huge burden on accessibility of antineoplastic medicines in Harare. Most patients cannot afford antineoplastic medicines which can result in increased mortality. There is a need to subsidise the medicines to improve accessibility. This will reduce the out-of-pocket expenses made by patients. There is a need to also ensure that medical insurance in Zimbabwe allow all pharmacies to retail antineoplastic medicines instead of the selective incorporation of pharmacies into their health insurance schemes. The calculated median price ratios range showed that the prices of the medicines are varied and there is need to have medicine procurement and pricing policies that minimise the median price ratio to lower than 5 for all antineoplastic medicines.
Roles of single nucleotide polymorphisms in the promoter regions of tumour necrosis factor-α and interleukine-1o genes in Schistosoma haematobium infection susceptibility.
(2020) Marume, Amos.; Mduluza, Takafira.; Mann, Jaclyn Kelly.
Background: Schistosomiasis remains a public health threat in sub-Saharan Africa which carries 85% of the global burden. With effective vaccines a distant future away, and no one allround intervention, research is still required to ensure that only effective programmes are introduced and implemented as well as evaluated and/or monitored. It is therefore key for researchers, policy makers and implementers to understand the epidemiology, immunology, immunopathology, immunogenetics, chemotherapy, management and control of Schistosoma haematobium for optimal elimination strategies to be implemented. A research study was therefore instituted to determine the prevalence, risk factors and host immunogenetic factors in S. haematobium infections among pre- and school going children living in endemic regions of Manicaland and Mashonaland central provinces in rural Zimbabwe. The relationship between single nucleotide polymorphisms (SNPs) of the promoter regions of tumor necrosis factor alpha (TNF-α or rs1800629) and interleukin- 10 (IL-10 or rs1800871) and susceptibility to Schistosoma haematobium was investigated. In addition, the relationship between these SNPs and cytokine levels, as well as the relationship between actual cytokine levels and susceptibility to Schistosoma haematobium was assessed. Methods: In this cross-sectional immune-epidemiological study Schistosoma haematobium was diagnosed by the microscopic examination of urine specimens for the presence of parasite eggs using the urine filtration technique. DNA for the genotyping was extracted from approximately 300μl whole blood using the QiagenFlexiGene DNA extraction kit, following the manufacturer’s protocol. IL-10 and TNF-α promoter region single nucleotide polymorphisms were genotyped using amplification refractory mutation system-polymerase chain reaction (ARMS-PCR).The allele frequencies and genotype distribution of S. haematobium infected and uninfected participants were then analysed using the chi-square test. All analyses were performed using SPSS (version 21) and p-values <0.05 were considered statistically significant. The levels of the cytokines (IL-10 and TNF-α) were measured by indirect enzyme linked immunosorbent assay (ELISA) using MABTECH, 3510-1H-6 kits, according to the manufacturer’s instruction. Results: The overall prevalence of S. haematobium among children in endemic rural and farming communities of the two provinces of Zimbabwe assessed was 17.1% (158/924). Gender specific prevalences were similar (17.5% in girls and 16.7% in boys; p = 0.735). Age and location were significant risk factors for schistosomiasis in children living in endemic regions surveyed. The older the child the higher the risk of getting infected by S. haematobium xvii (10.5% in 0-5 year olds; 24.0% in 6-10 year olds and 30.7% in 11-15 year olds; p < 0.001). IL-10 -1082 G/A, IL-10 -819 C/T and TNF-α -308 G/A single nucleotide polymorphisms were not significantly associated with susceptibility to S. haematobium infection. TNF- α genotypes AA, GA and GG were associated with high, moderate to high and low production of TNF-α respectively. IL-10 TT, CT and CC genotypes were associated with low, moderate and high IL-10 plasma levels respectively. Higher TNF-α and lower IL-10 serum levels were negatively associated with schistosomiasis infection. Praziquantel treatment reduced prevalence among the study participants as reinfections were only recorded in 6 of the 59 (10.2%) who were infected at baseline of children. Discussion and Conclusion: The determined schistosomiasis prevalence puts the regions of Zimbabwe studied within the moderate range as described by the World Health Organisation (10 – 49% prevalence), hence more concerted efforts are required to fight schistosomiasis. Although cytokine genotypes were associated as expected with cytokine levels, genotypes did not directly correlate with schistosomiasis infection while cytokine levels did. This indicates that circulating TNF-α and IL-10 levels are a result of many factors apart from genotypes. Taken together with previous work, this study suggests that high TNF-α and low IL-10 serum levels confer protection against schistosomiasis infection. Since schistosomiasis prevalence was similar between boys and girls and prevalence was high in all age groups (increasing with age), all programmes aimed at eliminating schistosomiasis should include both genders and children of all age groups. Specific locations could be targeted in resource limited settings as location was a significant risk factor for infection. Praziquantel is effective, with few reinfections observed, and therefore remains central in schistosomiasis management. To clearly understand the role host genetic factors in infection and to inform effective control, elimination and eradication programmes, more research on risk factors and host immunogenetics is necessary