Oral rehydration powders were available in most of pharmacy outlets in both sectors. However, dispersible tablets of Zinc as recommended in the EMLc, were available in only half of the surveyed sites Evidence based data suggest that zinc is beneficial for treatment of pediatric diarrhea for children aged 6 months or older [ 30 ].
Paracetamol acetaminophen has a unique role in children because it is the first-line choice for the treatment of both fever and pain. When used in the recommended doses, it has few side effects and is remarkably well tolerated [ 31 ]. However, the recommended pediatric dose tablet was not available in any of the surveyed pharmacies.
Clinical data proves that in overdose, paracetamol is hepatotoxic [ 31 ]. The affordability of lowest cost medicines was compared across the country. The pediatric essential medicines were generally less affordable in the private sector and costed more than the recommended international reference prices. Mongolia is country with seasonal variations, with winter being very long and harsh.
During this time, most pediatric conditions are associated with respiratory infections. Empiric treatment with appropriate antibiotics for respiratory infections, including pneumonia is crucial in the reduction of mortality from pneumonia [ 32 ].
When compared to other countries, this result is comparably low [ 29 ]. On the other hand, treatment cost reflects medicines cost only, excluding any additional consultation or diagnostic costs. Additionally, treatment was estimated only for one child, indicating that families with more children and their treatment would endure an overwhelming cost.
Similar to previous findings, essential medicines are often not affordable for many populations [ 13 , 16 , 27 , 33 ]. The study has several limitations that are consistent with previous surveys. The study results reflect the status of availability and cost based on the day of data collection. They do not necessarily reflect the monthly or yearly availability of essential pediatric medicines at the national level or individual pharmacy outlets.
In addition, the median cost ratio was estimated using the supplier cost. Although, when the supplier cost was not available, buyer costs were used to calculate the median international reference cost. Substituting the supplier with buyer cost could result in inaccurate prices and therefore influence the true median price [ 15 ].
On the other hand, the study has utilized a previously validated methodology using a standardized way to evaluate the availability and costs of essential pediatric medicines in the country [ 34 ]. Furthermore, training and using multiple checkpoints have improved the quality of data collection, data entry and interpretation. The findings of this study can serve as basic data to develop and revise the National Policy in order to improve the accessibility and availability of essential pediatric medicines in Mongolia.
Furthermore, control, monitoring and comparing pediatric medicines costs not just across the country but also at the international level would help to increase transparency of different tasks including registration, procurement and reimbursement decision making procedures. A detailed investigation regarding the prescribing of pediatric medicines should be completed to identify the challenges and barriers.
Finally, the procurement, supply and distribution of essential pediatric medicines needs to be examined in order to identify the lack of availability and higher costs of some essential pediatric medicines in Mongolia. National Statistics Office of Mongolia. World Bank. Poverty Rate in Mongolia Estimated at Health Development Centre of Mongolia. Health indicators of Mongolia Ministry of Health Mongolia. The drugs act of Mongolia National Drug Policy of Mongolia, Health Indicators of Mongolia Ulaanbaatar Mongolia Health Department of Mongolia. World Health Organization.
Priority life-saving medicines for women and children. Geneva: WHO; Can we achieve millennium development goal 4? New analysis of country trends and forecasts of under-5 mortality to Make medicines child size, Promoting rational use of medicines: Core components, Ministry of Health and Sports Mongolia. Pharmaceutical sector indicators of Mongolia, Munkhdelger Ch.
Health Action International.
Medicine prices: a new approach to measurement. Working draft for field testing and revision. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries.
Access to Essential Medicines for Children: The World Health Organization's Global Response
Bull World Health Organ. Overview of methods for medicines availability and pricing surveys: better medicines for children project. Management Sciences for Health.
International drug price Indicator State Bank of Mongolia. Currency exchange rate Meassuring medicine prices, availability, affordability and price components. Availability of pediatric medicines and their perception among prescribers at a tertiary care teaching hospital. Available; Availability and use of essential medicines in China: manufacturing, supply, and prescribing in Shandong and Gansu provinces. Chisholm D, David B. Improving health system e ciency as a means of moving towards universal coverage, What essential medicines for children are on the shelf?
Glob Health. The availability and affordability of selected essential medicines for chronic diseases in six low-and middle-income countries. BMC Cardiovasc Disord. Lazzerini M, Ronfani L.www.maquinarias-reunidas.com/libraries/series/york-murder-crime.php
Promoting Safety of Medicines for Children
Oral zinc for treating diarrhoea in children. The Cochrane Library. Cranswick N, Coghlan D. Paracetamol efficacy and safety in children: the first 40 years. Am J Ther. Technical bases for the WHO recommendations on the management of pneumonia in children at first-level health facilities. Quantifying the impoverishing effects of purchasing medicines: a cross-country comparison of the affordability of medicines in the developing world. PLoS Med. Rev Panam Salud Publica. Download references. Authors would like to acknowledge all pharmacists consenting to participate as well as Dr.
Marg Ewen, Health Action International, who provided necessary materials for data collection and analysis. All authors have read and approved the manuscript. Correspondence to Gereltuya Dorj. All participants were informed about the study protocol including objectives, methodology and expected outcomes prior the study. A verbal informed consent was obtained from all participants. We declare that there was no funding for publication of this manuscript and we have no financial or non-financial competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Methods A standardized methodology developed by the WHO and Health Action International HAI was employed to conduct a study on the availability, costs and affordability of pediatric medicines in Mongolia. Results Availability of individual essential pediatric medicines varied across the country. The climate is changing, with temperatures in Canada rising at twice the global average. The work of federal scientists is essential to support the health, security, and well-being of To date, over 1, expert volunteers have made contributions to the important work of the CCA as expert panelists, peer reviewers, and members of our Board of Directors, and Scientific Advisory Committee.
Their commitment of knowledge, expertise, leadership, and time in support of evidence-based decision-making is vital to the work of the CCA. Convening experts. Assessing evidence. Informing decisions.