Availability and affordability of essential medicines: exploring the health seeking behaviours and health service utilisation for children under-5 years living in squatter settlement of Karachi, Pakistan

Child health outcomes in the poor communities are largely affected by the nonavailability of essential medicines at government health facilities and non-affordability of prescribed medicines at private retail pharmacies. This phenomenon largely defines health seeking behaviours and health service utilisation patterns of the families of the children. Using observational visits, we examined the shelf-availability of medicines for children less than 5 years of age at a rural health centre and conducted focus group discussions with the mothers to explore the effects of nonavailability and non-affordability of medicines. We also validated all information by interviewing the health care providers of the area. We found that erratic and insufficient supply of essential medicines at the government health facility and a limited purchasing power to buy medicines from a retail pharmacy, led to considerable 'financial burden' on the poor people, non-compliance with the treatment, health care seeking from informal health providers and healer shopping. This trend has a serious repercussion on the health seeking behaviours and of course the health outcomes, especially among children. On the users' side, health education and health promotion campaign must be instituted to explain the adverse effects on child health ensure appropriate health care seeking behaviours. For the supply side, the health care authorities must ensure the availability of essential medicines for the children at the government facilities. Local community representatives must be involved in the matters related to medicines stock management at the facility.

Gastrograffin use in distal intestinal obstruction syndrome of cystic fibrosis

Meconium ileus equivalent or the Distal Intestinal Obstruction Syndome [DIOS] is an entity that is frequently seen in patients with cystic fibrosis [CF]. In the gastrointestinal tract cyst fibrosis may produces symptoms of malabsorption and constipation. The latter may be associated with complications such as impaction and intestinal perforation. Meconium ileus and DIOS are an emergency and requires to be treated aggressively to ensure that consequences such as perforation do not occur. Traditional modes of management of DIOS have included the use of laxatives, Acetylcysteine and Gastrograffin enemas. We are describing the use of oral gastrograffin in our patient seen at the Aga Khan University Hospital where small bowel obstruction was refractory to treatment. Oral gastrograffin was used once diluted in 4 times the volume of water or fruit juice with half doses given on day 2 and 3. Oral gastrograffin use was followed by relief of obstruction in this patient. Gastrograffin use orally or rectally may be helpful in the treatment of refractions distal intestinal obstruction syndrome in cystic fibrosis