Global recommendations on child medicines should show supporting evidence

News article 22 May 2013
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Transparent information on the evidence supporting global recommendations on paediatric medicines should be easily accessible in order to help policy groups make decisions about what drugs to include in their national drug lists, according to international experts from Ghana and the UK writing in this week’s PLOS Medicine.

The authors, led by Dr David Sinclair from LSTM, working with a team from the Ghana National Drugs Programme, Accra, Ghana, report their experience reviewing the international evidence base for five priority paediatric medicines in order to decide whether or not to include them in Ghana’s essential drug list.

According to the authors, applying the global recommendations to Ghana was not straightforward for any of the five medicines*, despite high quality evidence of important clinical benefits, because of the unproven effect of the drugs in African settings and the scant information on cost effectiveness and the supply chain.

After the authors did their own review of the evidence on the effectiveness of these drugs to the situation and context of Ghana, they decided to include only four out of the five drugs in the national drug list.

According to the authors: “This project demonstrates why global recommendations should be presented alongside transparent descriptions of the evidence base, allowing policy groups to identify where, when, and how the interventions have been evaluated, and any factors limiting wider applicability.”

The authors argue: “In addition, for interventions where feasibility and affordability are likely to vary from setting to setting, the [World Health Organization] could further assist national decision-makers by providing implementation guidance on the assessment of health system implications, training and education requirements, and country level cost analyses.”

“As many policy questions are relevant across sub-Saharan Africa, and policy makers are likely to encounter recurrent problems, we encourage regional collaboration on health technology assessment, and sharing of information and resources”, the authors conclude.

*These medicines are:

1) Oral zinc sulphate for acute diarrhoea,

2) Injectable artesunate for severe malaria,

3) Topical chlorhexidine for preventing neonatal cord sepsis,

4) Dispersible oral amoxicillin for community acquired pneumonia,

5) Oral and injectable caffeine citrate for neonatal apnoea