title: Overview of accessibility and quality of antiepileptic drugs in Madagascar.
abstract: OBJECTIVE
  To determine the accessibility of treatment and the quality of antiepileptic drugs (AEDs) in the Haute Matsiatra district of Madagascar.
  
  
  METHODS
  Cross-sectional descriptive study and interviews. Samples of 10 units of each available AED were collected, and the active ingredient was quantified by reversed-phase high-performance liquid chromatography (RP-HPLC) with photodiode-array UV detection. The quality of an AED was considered satisfactory if the quantity of active ingredient in each tablet was in the range ±15% of the average value according to the European Pharmacopeia (6th edition, 2008).
  
  
  RESULTS
  The area was well served with health infrastructure but rescue facilities were poorly distributed. Available AEDs were all first-generation, and 73% were generic formulations. People with epilepsy (PWE) surveyed consulted traditional healers and most were treated with plants. PWE did not consider themselves sick but believed they were "possessed"; they consulted a doctor only immediately after a seizure, following the advice of traditional healers. The most prescribed AED was phenobarbital, costing between 0.03 and 0.12 US Dollar (US$) per 100mg. The purchase of full treatment was difficult for 77% of PWE and as a result, 39% took nothing. The quality of AEDs were considered unsatisfactory in 2.8% of cases.
  
  
  CONCLUSIONS
  The AEDs collected in Haute Matsiatra were globally of good quality. The main limiting elements were a lack of knowledge among PWE that epilepsy is a disease, and the cost of traditional treatments.
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France. Electronic address: mandy.nizard@gmail.com.
authors.forename: Mandy
authors.initials: M
authors.lastname: Nizard
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France; CHU Limoges, Department of Pharmacy, F-87000 Limoges, France.
authors.forename: Jérémy
authors.initials: J
authors.lastname: Jost
authors.affiliation: CHU Fianarantsoa 301, Madagascar.
authors.forename: Rakotovao
authors.initials: R
authors.lastname: Tanamasoandro
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France.
authors.forename: Rindra
authors.initials: R
authors.lastname: Andriambololona
authors.affiliation: CHU, Department of Pharmacology Toxicology and Pharmacovigilance, Federation of Biology, Limoges, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Megherbi
authors.affiliation: CHU Fianarantsoa 301, Madagascar.
authors.forename: Gaetan Duval
authors.initials: GD
authors.lastname: Solofomalala
authors.affiliation: CHU, Department of Pharmacology Toxicology and Pharmacovigilance, Federation of Biology, Limoges, France; INSERM UMR850, CHU Limoges, Univ. Limoges, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Marquet
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France; CHU Limoges, Department of Pharmacy, F-87000 Limoges, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Preux
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France; CHU Limoges, Department of Pharmacy, F-87000 Limoges, France.
authors.forename: Voa
authors.initials: V
authors.lastname: Ratsimbazafy
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D010634:Phenobarbital / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D010634:Phenobarbital
keywords: Epilepsy; PWE; Religious camp; Treatment