Nationwide survey of the availability and affordability of asthma and COPD medicines in Nigeria.

OBJECTIVE(S): To determine the availability and affordability of asthma and COPD medicines across Nigeria. METHODS: This was a cross-sectional survey conducted in 128 pharmacies (51 in public sector hospitals, 51 private sector community pharmacies and 26 charity or big private hospitals) across the six geopolitical zones of Nigeria using the WHO/Health Action Initiative method. The proportion of pharmacies where medicines were available, the median retail prices of originator and generics and affordability were analysed. A medicine was available if found in ≥ 80% of surveyed pharmacies. Unaffordability was defined as paying> 1 day's wage (> US$1.68) for a standard 30-day supply of the medicine. RESULTS: The available medicines were oral corticosteroids and oral salbutamol which are not on the WHO Essential Medicine List. Medicines were found more frequently in private than public pharmacies and in the southern than northern zones. Inhalable corticosteroid was not available at any public pharmacy nationwide. None of the EML medicines were affordable. The least number of days' wages for a 30-day supply of any inhalable corticosteroid-containing medication was 3.5 days. CONCLUSIONS: There are very limited availability and affordability of recommended asthma and COPD medicines across Nigeria with disparity across regions. Medicines that were available and affordable are not recommended and are harmful for long-term use. This underpins the need for engagement of all stakeholders for the review of existing policies regarding access to asthma and COPD medicines to improve availability and affordability.

Ecthyma gangrenosum on the face of a malnourished child with Pseudomonas sepsis: Simulating Cancrum oris.

INTRODUCTION: Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by Pseudomonas aeruginosa that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children. CASE PRESENTATION: This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek. She was febrile, pale, wasted with bilateral pitting pedal oedema. She had a solitary circumscribed round necrotic lesion, with surrounding hyperaemia on the right malar area which extended to destroy the right ala nasi. No intra-oral rashes but she had left ear discharge. She received blood transfusion, antibiotics, antiseptic wound care and nutritional rehabilitation. MANAGEMENT AND OUTCOME: Swabs of the lesion and ear discharge both revealed Gram-negative bacilli and culture yielded P. aeruginosa. Retroviral, Mantoux and Gene Xpert tests were negative. She had moderate anaemia, normal white blood cell count, and neutropaenia. Parenteral ceftriazone was changed to ciprofloxacin based on sensitivity results and lack of clinical response. The wound healed with residual scarring and partial destruction of right ala nasi. DISCUSSION: Although this patient had facial necrosis to suggest Noma, she did not have initial oral involvement, and clinical features such as Pseudomonas sepsis and neutropaenia suggested EG. Facial necrosis in malnourished children may be due to EG.