Access to Essential Medicines and Diagnostic Tests for Cardiovascular Diseases in Maputo City, Mozambique

Neusa Jessen; Abhishek Sharma; Jennifer Jones; Tangeni Auala; Sainimere Boladuadua; Ahmadou Jingi; Jose Ferrer; Ana Olga Mocumbi

doi:10.5334/gh.1186

Access to Essential Medicines and Diagnostic Tests for Cardiovascular Diseases in Maputo City, Mozambique

Volume 18 (2023): Issue 1

By: Neusa Jessen , Abhishek Sharma , Jennifer Jones , Tangeni Auala , Sainimere Boladuadua , Ahmadou Jingi, Jose Ferrer and Ana Olga Mocumbi

Open Access

|Feb 2023

Figures & Tables

Map of the survey area and location of the surveyed facilities in Maputo city, Mozambique.

Table 1

Availability of surveyed essential medicines in Maputo city, Mozambique.

		PRIVATE-SECTOR		PUBLIC-SECTOR HOSPITAL PHARMACIES [N = 6]
		RETAIL PHARMACIES [N = 30]	HOSPITAL PHARMACIES [N=6]	PUBLIC-SECTOR HOSPITAL PHARMACIES [N = 6]
Core Essential Medicines
1	Amitriptyline 25 mg	36.7% (n = 11)	83.3%	83.3% (n = 5)
2	Amoxicillin 500 mg	100.0% (n = 30)	100.0%	100.0% (n = 6)
3	Atenolol 50 mg	70.0% (n = 21)	33.3%	16.7% (n = 1)
4	Captopril 25 mg	20.0% (n = 6)	0.0%	0.0% (n = 0)
5	Ceftriaxone Inj 1 g/via	46.7% (n = 14)	50.0%	50.0% (n = 3)
6	Ciprofloxacin 500 mg	80.0% (n = 24)	66.7%	66.7% (n = 4)
7	Co-trimoxazole suspension 8+40 mg/ml	50.0% (n = 15)	66.7%	66.7% (n = 4)
8	Diazepam 5 mg	3.3% (n = 1)	33.3%	33.3% (n = 2)
9	Diclofenac 50 mg	100.0% (n = 30)	83.3%	83.3% (n = 5)
10	Glibenclamide 5 mg	90.0% (n = 27)	66.7%	66.7% (n = 4)
11	Omeprazole 20 mg	60.0% (n = 18)	16.7%	**
12	Paracetamol suspension 24 mg/ml	56.7% (n = 17)	16.7%	33.3% (n = 2)
13	Salbutamol inhaler 100 mcg/dose	56.7% (n = 17)	33.3%	33.3% (n = 2)
14	Simvastatin 20 mg	70.0% (n = 21)	50.0%	50.0% (n = 3)
CVD Essential Medicines
1	Bisoprolol 5mg Tab/cap	43.3% (n = 13)	16.7%	16.7% (n = 1)
2	Glyceryl trinitrate (sublingual) 0.5 mg Tab/cap	0.0% (n = 0)	0.0%	0.0% (n = 0)
3	Isosorbid dinitrate (sublingual) 5 mg Tab/cap	0.0% (n = 0)	0.0% (n = 0)	0.0% (n = 0)
4	Digoxin 0.05 mg/ml solution	0.0% (n = 0)	0.0% (n = 0)	0.0% (n = 0)
5	Lidocaine 200 mg/ml in 5 ml vial	3.3% (n = 1)	0.0% (n = 0)	0.0% (n = 0)
6	Verapamil (hydrochloride) 40 mg Tab/cap	0.0% (n = 0)	0.0% (n = 0)	0.0% (n = 0)
7.a	Amiodarone 100 mg Tab/cap	0.0% (n = 0)	0.0% (n = 0)	0.0% (n = 0)
7.b	Amiodarone 50 mg/ml in 3 ml Ampoule	0.0% (n = 0)	16.7% (n = 1)	16.7% (n = 1)
8	Amlodipine maleate 5 mg Tab/cap	70.0% (n = 21)	33.3% (n = 2)	16.7% (n = 1)
9	Enalapril (as hydrogen maleate) 5 mg Tab/cap	56.7% (n = 17)	33.3% (n = 2)	16.7% (n = 1)
10.a	Hydralazine, powder for injection 20 mg Ampoule	0.0% (n = 0)	33.3% (n = 2)	33.3% (n = 2)
10.b	Hydralazine 25 mg Tab/cap	0.0% (n = 0)	50.0% (n = 3)	50.0% (n = 3)
11	Hydrochlorothiazide 25 mg Tab/cap	3.3% (n = 1)	16.7% (n = 1)	16.7% (n = 1)
12	Methyldopa 250 mg Tab/cap	90.0% (n = 27)	50.0% (n = 3)	50.0% (n = 3)
13	Losartan 50 mg Tab/cap	36.7% (n = 11)	0.0% (n = 0)	0.0% (n = 0)
14.a	Furosemide 40 mg Tab/cap	90.0% (n = 27)	100.0% (n = 6)	100.0% (n = 6)
14.b	Furosemide 10 mg/ml in 2ml ampoule	0.0% (n = 0)	50.0% (n = 3)	50.0% (n = 3)
14.c	Furosemide 20 mg/5ml vial	0.0% (n = 0)	16.7% (n = 1)	16.7% (n = 1)
15	Spironolactone Tab/cap	70.0% (n = 21)	33.3% (n = 2)	33.3% (n = 2)
16	Dopamine vial	0.0% (n = 0)	0.0% (n = 0)	0.0% (n = 0)
17	Acetylsalicylic acid Tab/cap	40.0% (n = 12)	50.0% (n = 3)	50.0% (n = 3)
18	Clopidogrel Tab/cap	26.7% (n = 8)	16.7% (n = 1)	16.7% (n = 1)
19	Streptokinase vial	0.0% (n = 0)	0.0% (n = 0)	0.0% (n = 0)
20	Gliclazide (controlled release) Tab/cap	20.0% (n = 6)	16.7% (n = 1)	16.7% (n = 1)
21	Glucagon injection	0.0% (n = 0)	0.0% (n = 0)	0.0% (n = 0)
22	Metformin (hydrochloride) Tab/cap	90.0% (n = 27)	16.7% (n = 1)	16.7% (n = 1)
23	Benzathine benzyl penicillin vial	33.3% (n = 10)	50.0% (n = 3)	50.0% (n = 3)
24	Heparin vial	0.0% (n = 0)	0.0% (n = 0)	0.0% (n = 0)
25	Warfarin Tab/cap	30.0% (n = 1)	33.3% (n = 2)	33.3% (n = 2)
26	Morphine ampoule	0.0% (n = 0)	16.7% (n = 1)	33.3% (n = 2)
27	Phenoxymethyl penicillin 250 mg Tab/cap	0.0% (n = 0)	33.3% (n = 2)	0.0% (n = 0)
28	Erythromycin Tab/cap	0.0% (n = 0)	50.0% (n = 3)	50.0% (n = 3)
29	Nifedipine retard Tab/cap	70.0% (n = 21)	83.3% (n = 5)	83.3% (n = 5)
30	Soluble insulin vial 100 IU/ml	0.0% (n = 0)	0.0% (n = 0)	83.3% (n = 5)
31	Adrenaline vial	0.0% (n = 0)	16.7% (n = 1)	33.3% (n = 2)
32	Sodium Nitroprusside, powder for infusion ampoule	0.0% (n = 0)	0.0% (n = 0)	0.0% (n = 0)
33.a	Metoclopramide (hydrochloride) ampoule	6.7% (n = 2)	33.3% (n = 2)	16.7% (n=1)
33.b	Metoclopramide, Oral liquid: 5 mg/5 mL	3.3% (n = 1)	0.0% (n = 0)	16.7% (n=1)
33.c	Metoclopramide, Solid oral: 10 mg (hydrochloride)	36.7% (n = 11)	0.0% (n = 0)	0.0% (n= 0)
34	Digoxin Tab/cap	46.7% (n = 14)	**	**
35	Phenoxymethyl penicillin 500 mg Tab/cap	33.3% (n = 10)	**	**
	Overall availability of Core Essential Medicines
	• Mean (SD)	59.8% (28.2%)	50.0% (29.2%)	52.6% (28.7%)
	• Median (IQR)	56.7% (47.5%, 77.5%)	50.0% (33.3%, 66.7%)	50.0% (33.3%, 66.7%)
	• [min, max]	[3.3%, 100.0%]	[0.0%, 100.0%]	[0.0%, 100.0%]
	Overall availability of CVD Medicines
	• Mean availability	21.5% (29.3%)	22.2% (24.6%)	20.7% (25.8%)
	• Median (IQR)	3.3% (0.0%, 36.7%)	16.7% (0.0%, 33.3%)	16.7% (0.0%, 33.3%)
	• [min, max]	[0.0%, 90.0%]	[0.0%, 33.3%]	[0.0%, 100.0%]
	ALL Medicines	30.6% (33.2%)	29.6% (28.4%)	28.4% (29.6%)
		20.0% (0.0%, 56.7%)	16.7% (0.0%, 50.0%)	16.7% (0.0%, 100.0%)
		[0.0%, 100.0%]	[0.0%, 100.0%]	[0.0%, 100.0%]

[i] ** Missing data (medicines not surveyed because they were included in the survey list after the data collection in those facilities was completed).

Table 2

Availability and price of CVD diagnostics in Maputo city, Mozambique.

	AVAILABILITY (%)				PRICE (MTN\|USD)
	PUBLIC-SECTOR HOSPITALS		PRIVATE-SECTOR HOSPITALS		PRIVATE SECTOR
	IN GENERAL	AT THE TIME OF SURVEY	IN GENERAL	AT THE TIME OF SURVEY	PRIVATE SECTOR
Diagnostic tests
Glycaemia	100%	100%	100.0%	100.0%	304.5\|4.99
Creatinine	100%	100%	100.0%	100.0%	300.0\|4.92
Urea	100%	83.3%	100.0%	83.3%	266.0\|4.36
Total cholesterol	83.3%	50.0%	100.0%	100.0%	437.5\|7.17
HDL cholesterol	66.7%	50.0%	100.0%	100.0%	684.0\|11.21
LDL cholesterol	50.0%	0.0%	100.0%	100.0%	671.0\|11.00
Triglyceride	83.3%	83.3%	100.0%	100.0%	657.0\|10.77
Proteinuria	83.3%	83.3%	83.3%	83.3%	349.5\|5.73
Natremia	50.3%	33.3%	100.0%	100.0%	336.0\|5.51
Kalemia	100.0%	33.3%	100.0%	100.0%	336.0\|5.51
HbA1c	16.7%	0.0%	83.3%	83.3%	1373.0\|22.51
Uric acid	83.3%	83.3%	100.0%	83.3%	336.0\|5.51
Full blood count	100.0%	100.0%	100.0%	100.0%	730.0\|11.97
ESR	100.0%	83.3%	83.3%	83.3%	230.0\|3.77
Troponin	16.7%	16.7%	50.0%	50.0%	1496.0\|24.52
ASO	66.7%	33.3%	66.7%	66.7%	496.0\|8.13
Electrocardiogram	33.3%	33.3%	100.0%	100.0%	900.0\|14.75
Echodiogram	33.3%	33.3%	66.7%	66.7%	3500.0\|57.38
Chest X-ray (radiography facility)	83.3%	83.3%	100.0%	100.0%	1416.0\|23.21
Mean	73.7%	55.6%	91.2%	89.5%
Median [min, max]	83.3% [16.7%, 100.0%]	50.0% [0.0%, 100.0%]	100.0% [50.0%, 100.0%]	100.0% [50.0%, 100.0%]
Diagnostic devices
Thermometer	100.0%	100.0%	100.0%	100.0%
Electrocardiograph	33.3%	33.3%	100.0%	100.0%
Weighing scale/machine	100.0%	100.0%	100.0%	100.0%
Sphygmomanometer	83.3%	66.7%	100.0%	100.0%
Stethoscope	100.0%	100.0%	100.0%	100.0%
Pulse oximeter	66.7%	66.7%	100.0%	100.0%
Spacer for inhalers	83.3%	83.3%	100.0%	100.0%
Glucometer	100.0%	83.3%	100.0%	100.0%
Peak flow meter	0.0%	0.0%	66.7%	66.7%
Blood glucose test strips	50.0%	50.0%	100.0%	100.0%
Urine protein test strips	16.7%	16.7%	66.7%	66.7%
Urine ketone test strips	0.0%	0.0%	66.7%	66.7%
Mean availability	61.1%	58.3%	91.7%	91.7%
Median [min, max]	75.0% [0.0%, 100%]	66.7% [0.0%, 100.0%]	100.0% [66.7%, 100.0%]	100.0% [66.7%, 100.0%]
Additional diagnostic and treatment devices
Nebulizer	66.7%	66.7%	100.0%	100.0%
Troponin test strips	0.0%	0.0%	50.0%	50.0%
Urine albuminuria test strips	0.0%	0.0%	50.0%	50.0%
Tuning fork	0.0%	0.0%	0.0%	0.0%
Defibrillator	50.0%	50.0%	100.0%	100.0%
Mean availability	23.3%	23.3%	60.0%	60.0%
Median [min, max]	0.0% [0.0%, 66.7%]	0.0% [0.0%, 66.7%]	50.0% [0.0%, 100.0%]	50.0% [0.0%, 100.0%]

[i] CVD, cardiovascular disease; ESR, Erythrocyte sedimentation rate; ASO, antistreptolysin O titer.

Table 3

Summary of median price ratios (MPRs) for Core and CVD essential medicines in the private retail sector in Maputo region, Mozambique.

	PRIVATE-SECTOR RETAIL PHARMACIES
	LOWEST PRICED GENERIC	MOST SOLD GENERIC
Core Essential medicines
Median MPR	2.93	2.93
Minimum, Maximum MPR	1.67, 11.01	1.67, 13.02
CVD Essential Medicines
Median MPR	4.51	5.37
Minimum, Maximum MPR	0.98, 58.09	2.05, 58.09
Overall (All medicines)
Median MPR	4.43	3.20
Minimum, Maximum MPR	0.98, 58.09	1.67, 58.09

Availability and affordability of selected essential medicines in the private sector.

Table 4

Estimated monthly costs of managing cardiovascular risk profile in Mozambique’s private sector.

PREVENTION	RISK	INTERVENTION	COST OF MEDICINES (USD \| NO. OF DAYS’ WAGES)	COST OF TESTS (USD \| NO. OF DAYS’ WAGES)	TOTAL COST (USD \| NO. OF DAYS’ WAGES)
Primary	<10%	Lifestyle changes + 12-monthly risk monitoring	N/A	4.44 \| 2.00	4.44 \| 2.00
	10–20%	Lifestyle changes + 6-monthly risk monitoring	N/A	8.88 \| 4.00	8.88 \| 4.00
	20–30%	Statin^a + one antihypertensive^b + 6-monthly risk monitoring	7.32–12.79 \| 3.3–5.8	8.88 \| 4.00	16.2–21.67 \| 7.30–9.76
	≥30%	Statin^a + one antihypertensive^b + aspirin + 3-monthly risk monitoring	10.98–16.45 \| 5.0–7.4	17.78 \| 8.01	28.76–34.23 \| 12.95–15.42
Secondary		ß-blocker^c + ACE Inhibitor^d + statin ^a + aspirin + 3-monthly risk monitoring	13.44–21.79 \| 6.1–9.8	17.78 \| 8.01	31.22–39.57 \| 14.06–17.82

[i] Risk monitoring (lipid profile, fasting blood sugar and proteinuria) would cost USD 53.3, that is, 24.01 days’ wages. From these values, we calculated 12-monthly, 6-monthly and 3-monthly risk monitoring costs. Lowest daily wage for unskilled workers in Mozambique at the time of survey was USD 2.22.

^a Includes simvastatin; ^b Includes amlodipine, nifedipine, hydrochlorothiazide, captopril and enalapril; ^c Includes atenolol and bisoprolol; ^d Includes captopril and enalapril.

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DOI: https://doi.org/10.5334/gh.1186 | Journal eISSN: 2211-8179

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Language: English

Submitted on: Jul 31, 2022

Accepted on: Jan 23, 2023

Published on: Feb 28, 2023

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

essential medicines,

cardiovascular medicines,

cardiovascular diagnostics,

Maputo,

Mozambique

© 2023 Neusa Jessen, Abhishek Sharma, Jennifer Jones, Tangeni Auala, Sainimere Boladuadua, Ahmadou Jingi, Jose Ferrer, Ana Olga Mocumbi, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 18 (2023): Issue 1

Access to Essential Medicines and Diagnostic Tests for Cardiovascular Diseases in Maputo City, Mozambique

Figures & Tables

Figure 1

Table 1

Table 2

Table 3

Figure 2

Table 4

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