(63) The Availability of Essential Medicines for Cardiovascular Diseases in Low- and Middle-Income Countries: A Case Study of Bangladesh

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 394

Presenting Author(s)

Md Jamal Uddin, PhD
– Biostatistician and Epidemiologist, Shahjalal University of Science & Technology, Sylhet, Sylhet, Bangladesh

Co-Author(s)

Shariful Hakim
– Department of Statistics, Shahjalal University and Science and Technology, Bangladesh
Muhammad Abdul Baker Chowdhury
– Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL, FL, United States

Background: Long-term, often lifelong care for cardiovascular disease (CVD) patients require consistent usages medication, hence the availability of essential medicines is vital for treatment, survival, and quality of life. However, research on the availability of essential medicines in low- and middle-income countries is scarce.

Objectives: Our objective was to assess the availability of essential medicines for CVD (EM-CVD), and to explore facility characteristics associated with availability of those medicines in Bangladesh.

Methods: We used publicly available cross-sectional data from two waves of Bangladesh Health Facilities Survey (BHFS) that were conducted in 2014 and 2017. A total of 128 (56 from 2014, and 72 from 2017) facilities were included in the analysis for availability of EM-CVD. The outcome variable ‘EM-CVD availability’ was calculated as a count score of the tracer medicines: (angiotensin-converting enzyme (ACE) inhibitors (enalapril), thiazide, beta blockers (atenolol), calcium channel blockers (amlodipine/nifedipine), aspirin). Several potential facility characteristics were considered, including managing authority, location, administrative division, external supervision, routine user fee, 24-hour duty schedule of medical specialists, medical officers, nurses, and paramedics, inpatient capability, diagnostic capacity score, and guideline for disease diagnosis and management. Multivariable Poisson regression model was used to identify the health facility characteristics associated with EM-CVD availability.

Results: Between 2014 and 2017, there has been an increase in the availability of calcium channel blockers (from 54.7% to 61.9%) and aspirin (from 37.4% to 46.0%), while there has been a decrease in the availability of ACE inhibitors (enalapril) (from 18.8% to 10.7%), thiazide (from 23.5% to 18.2%), beta blockers (from 57.9% to 51.9%). In both surveys, The likelihood of EM-CVD availability was higher (relative risk (RR): 1.88, 95% confidence interval (CI): 1.33-2.65, p-value: < 0.01 and 1.97 (1.49 -2.61), p-value: < 0.01, respectively) among the private for-profit facilities compared to public facilities. Moreover, the chance for EM-CVD availability was higher among the facilities which had high diagnostic capacity score compared to those facilities which had low diagnostic capacity score.

Conclusions: Our findings show that facility management authority (public, private not-for-profit, or private for-profit) and diagnostic capacity are significantly associated to EM-CVD availability. Government officials should consider a variety of policy issues, such as the importance of public facilities and the diagnostic capacity of facilities, in order to increase EM-CVD availability.