Access to fludrocortisone and to hydrocortisone in children with congenital adrenal hyperplasia in the WHO Eastern Mediterranean Region: it takes a village

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dc.contributor.authorAmanda Rowlands
dc.contributor.authorAsma Deeb
dc.contributor.authorAsmahane Ladjouze
dc.contributor.authorRasha T Hamza
dc.contributor.authorSalwa A Musa
dc.contributor.authorJamal Raza
dc.contributor.authorFarida Jennane
dc.contributor.authorAbdulsalam Abu-Libdeh
dc.contributor.authorJean-Pierre Chanoine
dc.contributor.authorGPED CAH Working
dc.date.accessioned2023-01-23T12:57:05Z
dc.date.available2023-01-23T12:57:05Z
dc.date.issued2021-10-20
dc.description.abstractCongenital adrenal hyperplasia (CAH), if untreated, carries high morbidity and mortality. A higher incidence of CAH is expected in countries where consanguinity is common, such as in the countries of the WHO Eastern Mediterranean Region (EMRO). CAH is managed through lifelong treatment with fludrocortisone and hydrocortisone. In this analysis, performed in the 22 EMRO countries and territories plus Algeria, we review which countries offer a neonatal screening programme for CAH and describe the barriers and opportunities to access oral fludrocortisone and oral and injectable hydrocortisone. Neonatal CAH screening was only available nationally in Qatar, Kuwait and partially in Lebanon and Saudi Arabia. We reviewed the national lists of essential medicines (NEMLs) and found that 13/23 (57%) countries included fludrocortisone and 18/23 (78%) included oral hydrocortisone. Fludrocortisone was not included by any of the low-income countries and oral hydrocortisone was only included by one low-income country. We then contacted paediatric endocrinologists in each country to assess perceived availability of these medicines. Overall, there was a relatively good consistency between inclusion of fludrocortisone and hydrocortisone in the NEML and their actual availability in a country. We propose several mechanisms to improve access, including prequalification by the WHO, a common registration process for groups of countries, pooled procurement, working with local pharmaceutical companies, special access status for medicines not yet registered in a country and compounding. We suggest that access to medicines requires a collaboration between health professionals, families of patients, health authorities, pharmaceutical companies and the WHO.
dc.identifier.citationRowlands A, Deeb A, Ladjouze A, et al. Access to fludrocortisone and to hydrocortisone in children with congenital adrenal hyperplasia in the WHO Eastern Mediterranean Region: it takes a village.... BMJ Global Health 2021;6:e007195. doi:10.1136/ bmjgh-2021-007195
dc.identifier.urihttps://dspace.alquds.edu/handle/20.500.12213/7692
dc.language.isoen
dc.titleAccess to fludrocortisone and to hydrocortisone in children with congenital adrenal hyperplasia in the WHO Eastern Mediterranean Region: it takes a village
dc.typeArticle
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