Stakeholder perspectives on the demand and supply factors driving substandard and falsified blood pressure lowering medications in Nigeria: a qualitative study.
Stakeholder perspectives on the demand and supply factors driving substandard and falsified blood pressure lowering medications in Nigeria: a qualitative study.
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利益相关者对驱动不合标准和伪造血压降低药物的需求和供应因素的观点：一项定性研究。
DOI：
10.1136/bmjopen-2022-063433
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发表时间：
2022-12-22
期刊：
影响因子：
2.9
通讯作者：
中科院分区：
文献类型：
--
作者：
尽管不合格和伪造的降血压药物是一个全球性问题，但在尼日利亚探索导致这一问题的因素的定性研究尚未报道。本研究提供了驱动尼日利亚低质量降压药物需求和供应的因素以及解决这些因素的潜在策略的信息。这是一项横断面定性研究。在2020年8月至2020年9月期间，我们与卫生设施管理人员、降血压药物的主要制造商和分销商、药剂师、药品监管机构、患者和初级保健医生进行了11次深度访谈和7次焦点小组讨论，有目的地从尼日利亚联邦首都地区取样。在Dedoose的帮助下，使用定向含量分析来分析数据。我们发现，尼日利亚降低SF血压药物的需求是由高自付支出和有质量保证的降低血压药物的库存驱动的。国内生产能力有限、未遵守良好生产和分销规范、药物监管系统资源不足、医疗设施运营效率低下、分销规范不佳、训练有素的药剂师数量有限以及COVID-19大流行导致药品缺货，这些因素推动了低质量降压药物的供应。中央药店采购程序、有效药物成分质量检查和培训药师的可用性是降低SF - BP降血压药物供需风险的现有策略。我们的研究结果表明，尼日利亚降低SF血压药物的需求和供应是由多层次的、相互关联的因素驱动的。多管齐下的战略需要针对涉及药物生产、分销、处方、消费、监管和定价的利益攸关方和系统。
Although substandard and falsified (SF) blood pressure (BP) lowering medications are a global problem, qualitative research exploring factors driving this in Nigeria has not been reported. This study provides information on factors driving demand for and supply of low-quality BP lowering medications in Nigeria and potential strategies to address these factors. This was a cross-sectional qualitative study. Between August 2020 and September 2020, we conducted 11 in-depth interviews and 7 focus group discussions with administrators of health facilities, major manufacturers and distributors of BP lowering medications, pharmacists, drug regulators, patients and primary care physicians purposively sampled from the Federal Capital Territory, Nigeria. Data were analysed using directed content analysis, with the aid of Dedoose. We found that demand for SF BP lowering medications in Nigeria was driven by high out-of-pocket expenditure and stockouts of quality-assured BP lowering medications. Supply of low-quality BP lowering medications was driven by limited in-country manufacturing capacity, non-adherence to good manufacturing and distribution practices, under-resourced drug regulatory systems, ineffective healthcare facility operations, poor distribution practices, limited number of trained pharmacists and the COVID-19 pandemic which led to stockouts. Central medicine store procurement procedures, active pharmaceutical ingredient quality check and availability of trained pharmacists were existing strategies perceived to lower the risk of supply and demand of SF BP lowering medications. Our findings suggest that demand for and supply of SF BP lowering medications in Nigeria are driven by multi-level, interrelated factors. Multi-pronged strategies need to target stakeholders and systems involved in drug production, distribution, prescription, consumption, regulation and pricing.
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DOI：
10.1038/s41581-019-0244-2
发表时间：
2020-04
期刊：
Nature reviews. Nephrology
影响因子：
--
作者：
Mills KT;Stefanescu A;He J
通讯作者：
He J
影响因子：
3.3
作者：
Attaran, Amir
通讯作者：
Attaran, Amir
影响因子：
168.9
作者：
Lim, Stephen S.;Vos, Theo;Flaxman, Abraham D.;Danaei, Goodarz;Shibuya, Kenji;Adair-Rohani, Heather;Amann, Markus;Anderson, H. Ross;Andrews, Kathryn G.;Aryee, Martin;Atkinson, Charles;Bacchus, Loraine J.;Bahalim, Adil N.;Balakrishnan, Kalpana;Balmes, John;Barker-Collo, Suzanne;Baxter, Amanda;Bell, Michelle L.;Blore, Jed D.;Blyth, Fiona;Bonner, Carissa;Borges, Guilherme;Bourne, Rupert;Boussinesq, Michel;Brauer, Michael;Brooks, Peter;Bruce, Nigel G.;Brunekreef, Bert;Bryan-Hancock, Claire;Bucello, Chiara;Buchbinder, Rachelle;Bull, Fiona;Burnett, Richard T.;Byers, Tim E.;Calabria, Bianca;Carapetis, Jonathan;Carnahan, Emily;Chafe, Zoe;Charlson, Fiona;Chen, Honglei;Chen, Jian Shen;Cheng, Andrew Tai-Ann;Child, Jennifer Christine;Cohen, Aaron;Colson, K. Ellicott;Cowie, Benjamin C.;Darby, Sarah;Darling, Susan;Davis, Adrian;Degenhardt, Louisa;Dentener, Frank;Des Jarlais, Don C.;Devries, Karen;Dherani, Mukesh;Ding, Eric L.;Dorsey, E. Ray;Driscoll, Tim;Edmond, Karen;Ali, Suad Eltahir;Engell, Rebecca E.;Erwin, Patricia J.;Fahimi, Saman;Falder, Gail;Farzadfar, Farshad;Ferrari, Alize;Finucane, Mariel M.;Flaxman, Seth;Fowkes, Francis Gerry R.;Freedman, Greg;Freeman, Michael K.;Gakidou, Emmanuela;Ghosh, Santu;Giovannucci, Edward;Gmel, Gerhard;Graham, Kathryn;Grainger, Rebecca;Grant, Bridget;Gunnell, David;Gutierrez, Hialy R.;Hall, Wayne;Hoek, Hans W.;Hogan, Anthony;Hosgood, H. Dean, III;Hoy, Damian;Hu, Howard;Hubbell, Bryan J.;Hutchings, Sally J.;Ibeanusi, Sydney E.;Jacklyn, Gemma L.;Jasrasaria, Rashmi;Jonas, Jost B.;Kan, Haidong;Kanis, John A.;Kassebaum, Nicholas;Kawakami, Norito;Khang, Young-Ho;Khatibzadeh, Shahab;Khoo, Jon-Paul;Kok, Cindy;Laden, Francine;Lalloo, Ratilal;Lan, Qing;Lathlean, Tim;Leasher, Janet L.;Leigh, James;Li, Yang;Lin, John Kent;Lipshultz, Steven E.;London, Stephanie;Lozano, Rafael;Lu, Yuan;Mak, Joelle;Malekzadeh, Reza;Mallinger, Leslie;Marcenes, Wagner;March, Lyn;Marks, Robin;Martin, Randall;McGale, Paul;McGrath, John;Mehta, Sumi;Mensah, George A.;Merriman, Tony R.;Micha, Renata;Michaud, Catherine;Mishra, Vinod;Hanafiah, Khayriyyah Mohd;Mokdad, Ali A.;Morawska, Lidia;Mozaffarian, Dariush;Murphy, Tasha;Naghavi, Mohsen;Neal, Bruce;Nelson, Paul K.;Miquel Nolla, Joan;Norman, Rosana;Olives, Casey;Omer, Saad B.;Orchard, Jessica;Osborne, Richard;Ostro, Bart;Page, Andrew;Pandey, Kiran D.;Parry, Charles D. H.;Passmore, Erin;Patra, Jayadeep;Pearce, Neil;Pelizzari, Pamela M.;Petzold, Max;Phillips, Michael R.;Pope, Dan;Pope, C. Arden, III;Powles, John;Rao, Mayuree;Razavi, Homie;Rehfuess, Eva A.;Rehm, Juergen T.;Ritz, Beate;Rivara, Frederick P.;Roberts, Thomas;Robinson, Carolyn;Rodriguez-Portales, Jose A.;Romieu, Isabelle;Room, Robin;Rosenfeld, Lisa C.;Roy, Ananya;Rushton, Lesley;Salomon, Joshua A.;Sampson, Uchechukwu;Sanchez-Riera, Lidia;Sanman, Ella;Sapkota, Amir;Seedat, Soraya;Shi, Peilin;Shield, Kevin;Shivakoti, Rupak;Singh, Gitanjali M.;Sleet, David A.;Smith, Emma;Smith, Kirk R.;Stapelberg, Nicolas J. C.;Steenland, Kyle;Stoeckl, Heidi;Stovner, Lars Jacob;Straif, Kurt;Straney, Lahn;Thurston, George D.;Tran, Jimmy H.;Van Dingenen, Rita;van Donkelaar, Aaron;Veerman, J. Lennert;Vijayakumar, Lakshmi;Weintraub, Robert;Weissman, Myrna M.;White, Richard A.;Whiteford, Harvey;Wiersma, Steven T.;Wilkinson, James D.;Williams, Hywel C.;Williams, Warwick;Wilson, Nicholas;Woolf, Anthony D.;Yip, Paul;Zielinski, Jan M.;Lopez, Alan D.;Murray, Christopher J. L.;Ezzati, Majid
通讯作者：
Ezzati, Majid
影响因子：
0.7
作者：
Dzudie A;Rayner B;Ojji D;Schutte AE;Twagirumukiza M;Damasceno A;Ba SA;Kane A;Kramoh E;Kacou JB;Onwubere B;Cornick R;Sliwa K;Anisiuba B;Mocumbi AO;Ogola E;Awad M;Nel G;Otieno H;Toure AI;Kingue S;Kengne AP;Perel P;Adler A;Poulter N;Mayosi B;PASCAR task force on hypertension
通讯作者：
PASCAR task force on hypertension
影响因子：
4.9
作者：
de Terline, Diane Macquart;Diop, Bara I.;Antignac, Marie
通讯作者：
Antignac, Marie