[Assessment of the availability and use of antivenom in the district of Bamako, Mali, West Africa].
The aim of this study is to describe the difficulties related to problems of supply and use of antivenom serum (SAV) in the district of Bamako. A retrospective study over a span of five years (January 1998-December 2002) and an interview with the staff of various facilities were conducted. The study included 2 wholesalers of pharmaceuticals, 20 private pharmacies, and 2 hospital pharmacies as they were involved in antivenom trades. A market-driving ability survey of driving practice was conducted in 37 community health centers (CHCs) and 4 dispensaries because they performed antivenom treatments during the study period. A total of 3,318 doses of antivenom were bought, including 84.4% by the People Pharmacy of Mali (PPM), a public organization, and 15.6% by Laborex, a private company. These were out of stock in 1999. Three kinds of SAV were ordered: the polyvalent IPSER Africa (1,200 vials or 36.2%), FAV Africa (318 vials or 9.6%), and Sii anti-snake venom polyvalent serum (1,800 vials or 54.2%). Orders from PPM involved IPSER Africa (Pasteur Mérieux Serum & Vaccines) and Sii anti-snake venom polyvalent serum (Serum Institute of India), and those from Laborex involved IPSER Africa and FAVAfrica (Aventis Pasteur). Onehalf of private pharmacies (54.3%) had made at least one order of SAV. The PPM lost 50% of 2,000 vials of SAV in 1996 due to the expiration of vials that were bought. Private pharmacies lost 3.6% of stocks due to expiration. Prices varied depending on the type of service and the point of sale. Costs of vials were 19,440-35,000 CFA francs (29.6-53.4 euros) for Sii antivenom and 50,200-63,000 CFA francs (76.5-96.1 euros) for FAV Africa antivenom. In CHCs, 59.5% of prescribers were unaware of the indications and methods of proper administration of the SAV, 32.3% ignored the existence of SAV, and 30.9% were skeptical about its effectiveness in treatment of envenomation by snakebite.
CHU Hôpital du Mali, Missabougou, Bamako, Mali. bdrameml@yahoo.fr
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D000354:Africa, Western / Q000453:epidemiology; D000465:Algorithms; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D003151:Community Health Centers / Q000458:organization & administration / Q000706:statistics & numerical data / Q000600:supply & distribution; D004345:Drug Industry / Q000458:organization & administration / Q000706:statistics & numerical data; D004865:Equipment and Supplies, Hospital / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008302:Mali / Q000453:epidemiology; D010594:Pharmacies / Q000458:organization & administration / Q000600:supply & distribution; D055818:Public-Private Sector Partnerships / Q000458:organization & administration / Q000592:standards; D012909:Snake Bites / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D012910:Snake Venoms / Q000276:immunology
D000997:Antivenins; D012910:Snake Venoms