title: The current availability of antiepileptic drugs in Zambia: implications for the ILAE/WHO "out of the shadows" campaign.
abstract: Recent concerns regarding antiepileptic drug (AED) availability in Zambia led us to conduct a study in the Lusaka and Southern Provinces to quantify the availability and cost of AEDs and assess determinants. Among 111 pharmacies, almost one-half did not carry AEDs (N = 54; 49.1%). Available AEDs were phenobarbitone (21; 18.9%), carbamazepine (27; 24.3%), valproic acid (4; 3.6%), and phenytoin (3; 2.7%). Adult out-of-pocket monthly costs ranged from US $7 to $30. Pediatric syrups were universally unavailable. Interviews revealed several barriers to AED provision, including that handling phenobarbitone (historically the most affordable AED) has become increasingly difficult because of newly enforced regulatory requirements. Personal communications with epilepsy-care providers in other low income countries suggest that this problem may be widespread. Improved enforcement of existing drug regulations may be contributing to the AED shortage. Social programs aimed at encouraging people with epilepsy to come "out of the shadows" must be preceded by improved AED access.
authors.affiliation: Department of Paediatrics and Child Health, University of Zambia, Lusaka, Zambia. embewe2001@yahoo.com
authors.forename: Elwyn Nachanya
authors.initials: EN
authors.lastname: Chomba
authors.forename: Alan
authors.initials: A
authors.lastname: Haworth
authors.forename: Edward
authors.initials: E
authors.lastname: Mbewe
authors.forename: Masharip
authors.initials: M
authors.lastname: Atadzhanov
authors.forename: Philimon
authors.initials: P
authors.lastname: Ndubani
authors.forename: Henry
authors.initials: H
authors.lastname: Kansembe
authors.forename: Gretchen Lano
authors.initials: GL
authors.lastname: Birbeck
mesh_terms: D000927:Anticonvulsants / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use; D016527:Drug Costs; D004827:Epilepsy / Q000188:drug therapy; D006297:Health Services Accessibility; D006801:Humans; D015024:Zambia
chemical_list: D000927:Anticonvulsants
references.citation: Epilepsia. 2000 Mar;41(3):277-81
references.pmid: 10714398
references.citation: Soc Sci Med. 2002 Jun;54(12):1867-74
references.pmid: 12113441
references.citation: Arq Neuropsiquiatr. 2007 Jun;65 Suppl 1:5-13
references.pmid: 17581662
references.citation: Lancet. 2009 Jan 17;373(9659):240-9
references.pmid: 19042012
references.citation: Trop Med Int Health. 2009 Mar;14(3):362-72
references.pmid: 19207171
references.citation: Seizure. 2007 Oct;16(7):601-7
references.pmid: 17576079
references.citation: Epilepsia. 2009 Nov;50(11):2340-3
references.pmid: 19744112
references.citation: Epilepsia. 2005 May;46(5):751-9
references.pmid: 15857443
references.citation: Am J Trop Med Hyg. 2009 Nov;81(5):776-81
references.pmid: 19861610
references.citation: Epilepsia. 2001 Aug;42(8):1094-100
references.pmid: 11554901
references.citation: Lancet Neurol. 2007 Jan;6(1):39-44
references.pmid: 17166800
references.citation: Epilepsia. 2005;46 Suppl 1:61-2
references.pmid: 15816985
references.citation: Bull World Health Organ. 2010 Apr;88(4):260-6
references.pmid: 20431789
references.citation: Epilepsia. 2002 Aug;43(8):904-11
references.pmid: 12181010