1. Meeting the information needs of prescribers and users of medicine in LMICs Sarah Cavanagh Sarah Cavanagh and Lynn Martin EAMIS Ipswich Hospital and Addenbrookes Hospital Cambridge

4. Aim Establish if providing a UK based MI Service would be beneficial and appropriate Establish if providing a UK based MI Service would be beneficial and appropriate Establish the requirements and logistics of providing such a service Establish the requirements and logistics of providing such a service

5. Objectives Identify potential users of the service Identify potential users of the service Establish means of communication Establish means of communication Provide a service Provide a service Evaluate and quantify the service Evaluate and quantify the service

6. Method Potential users approached by email Potential users approached by email Questionnaire sent out Questionnaire sent out Free MI service offered for 6 months Free MI service offered for 6 months Data collated and evaluated Data collated and evaluated

7. Results… 10 centres contacted of which 5 responded, all in Africa 10 centres contacted of which 5 responded, all in Africa

10. Most centres had some books although usually several editions out of date and only 2 centres had a qualified pharmacist. Most also had access to email although comments received on this included… ‘yes I can access email and the internet when I can get to a functioning telephone which involves an 80 mile round trip on dirt roads’ and ‘please no files or pictures the country server will clog’

11. …results 11 enquiries received from 3 centres 11 enquiries received from 3 centres MadagascarMadagascar SudanSudan The GambiaThe Gambia

13. Enquiry Categories

14. … results Average time taken < 30 minutes Average time taken < 30 minutes Cost £150 year to provide a service to 5 centres for 1 year Cost £150 year to provide a service to 5 centres for 1 year £1500 a year to every country in Africa £1500 a year to every country in Africa

15. …in context Annual UK aid budget £4,823 million Annual UK aid budget £4,823 million OXFAM pa £133 million OXFAM pa £133 million Cost of treating HIV £500 per month Cost of treating HIV £500 per month 44% of Sub-Saharan Africa <$1 a day 44% of Sub-Saharan Africa <$1 a day Annual Marketing Spend by Pharmaceutical Companies in Europe is… Annual Marketing Spend by Pharmaceutical Companies in Europe is…

16. £60 Billion

17. Example Questions Antimalarials in liver impairment Antimalarials in liver impairment artesunateartesunate lumefantrinelumefantrine quininequinine

18. ‘we have a Hepatitis E out break in Dafur and as it is the rainy season malaria is prevalent. Is there a problem using artesunate, lumefantrine or quinine in liver impairment? ‘we have a Hepatitis E out break in Dafur and as it is the rainy season malaria is prevalent. Is there a problem using artesunate, lumefantrine or quinine in liver impairment?

20. ‘ a container of donated drugs has been embargoed by customs and is stuck on the runway for 6 weeks. Temperatures uncertain but likely to be in xs of 50 o C. Do we need to reorder the lot or can some be used (total cost of drugs 50,000 Euros)?’

22. We have 30 of that. I think it is an antibiotic. What is it? What infections does it treat? Is it enough for a course? Or should I throw it away?

23. Conclusions Users perceived a benefit Users perceived a benefit Time taken minimal Time taken minimal Simple methods of communication worked best Simple methods of communication worked best Potential benefit to providers Potential benefit to providers Potential for more research Potential for more research

26. and finally… Why should we do this? Why should we do this? Why NOT?

27. Discussion Large quantities of donated drugs could be left in store rooms across Africa because the information required for their use is lacking. Large quantities of donated drugs could be left in store rooms across Africa because the information required for their use is lacking. We could help ensure these drugs are used safely and effectively which would in turn preserve limited budgets for other much needed areas including… We could help ensure these drugs are used safely and effectively which would in turn preserve limited budgets for other much needed areas including… vaccination programmes, vaccination programmes, water filters so that antibiotics can be reconstituted with clean water, water filters so that antibiotics can be reconstituted with clean water, Diesel for the generator to run an operating theatre, Diesel for the generator to run an operating theatre, the purchase of anti-retroviral agents…. the purchase of anti-retroviral agents…. The list is endless. The list is endless. Showing an interest in the working lives of others overseas can only increase our awareness and understanding of other peoples lives and cultures which are invariably very different from our own. Surely this can only be a good thing? Showing an interest in the working lives of others overseas can only increase our awareness and understanding of other peoples lives and cultures which are invariably very different from our own. Surely this can only be a good thing?

28. … vaccination programmes, water filters for antibiotics reconstitution with clean water, diesel for the generator, the purchase of anti- retroviral agents…. the list is endless. … vaccination programmes, water filters for antibiotics reconstitution with clean water, diesel for the generator, the purchase of anti- retroviral agents…. the list is endless. Showing an interest in the working lives of others overseas can only increase our awareness and understanding of other peoples lives and cultures which are invariably very different from our own. Surely this can only be a good thing? Showing an interest in the working lives of others overseas can only increase our awareness and understanding of other peoples lives and cultures which are invariably very different from our own. Surely this can only be a good thing?

30. What next, come and ask me! References: Pakenham-Walsh N. Eddleston M. Kaur M. Developing world needs access to low cost pharmaceutical information from reliable sources. Br Med J. 1999;319:1265 Kasilo O. and Nhachi C. Recommendations for establishing a drug and toxicology information centre in a developing country. DICP, The Annals of Pharmacotherapy 1991;25:1379 – 1383 Joshi M. University hospital based drug information service in a developing country. European Journal of Clinical Pharmacology 1997;53 (2):89 – 94