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Table 2 Summary of the eligible studies included in the systematic review

From: Availability and affordability of medicines and diagnostic tests recommended for management of asthma and chronic obstructive pulmonary disease in sub-Saharan Africa: a systematic review

Study, year and reference

Country (ies) where study was done

No. of health facilities surveyed

No. of essential medicines and diagnostic tests studied

Key study findings about availability and affordability

Method quality score

1. Mendis et al. [15]

6 LMIC (Only one African country included-Malawi).

20 public and 16 private facilities.

2 essential medicines (Salbutamol and Beclometasone inhalers)

Availability of beclometasone: 0% in public sector and 38% in private sector

Affordability of salbutamol and beclometasone combination: 9.2 days’ wages


2. Kibirige et al. [16]


23 public and 22 private facilities and 85 private pharmacies

17 essential medicines and 2 diagnostic tests (Spirometry and peak flow-metry)

Availability of inhaled SABA, oral LTRA, ICS–LABA combinations, ICS, oral theophylline, inhaled SAMA, inhaled SAMA and SABA combination and inhaled LAMA monotherapy or with LABA: 75, 60.8, 46.9, 45.4, 16.9, 12.3, 10.8 and 0% respectively

Availability of spirometry and peak flow-metry: 24.4% and 6.7% respectively

Affordability: inhaled salbutamol-2.2 days’ wages, inhaled beclometasone-5.3 days’ wages, inhaled formeterol-beclometasone-6.4 days’ wages, oral montelukast-6.9 days’ wages, inhaled salmeterol-fluticasone propionate-10.2 days’ wages, inhaled salbutamol-ipratropium-10.7 days’ wages and 17.1 days’ wages for formoterol/budesonide

Affordability of spirometry: 27.8 days’ wages


3. Desalu et al. [17]


68 tertiary public hospitals

6 classes of essential medicines and 2 diagnostic tests (Spirometry and peak flow-metry)

Availability of inhaled anti-cholinergics, oral LTRA, ICS, SABA nebules, ICS–LABA combinations, inhaled SABA and oral theophylline was 2.9%, 5.9%, 23.5%, 35.3%, 50%, 76.5%, 76.5% respectively

Availability of spirometry and peak flow-metry was 29.4% and 38% respectively


4. Babar et al. [18]

52 LMICs (21 SSA countries)

2 private retail pharmacies, 1 national procurement centre and 1 public hospital for each participating country

3 essential medicines (Salbutamol, Beclometasone and Budesonide)

Availability of beclometasone and budesonide: 0% in the surveyed sites in Burundi, Cameroon, Democratic Republic of Congo (DRC), Djibouti, Nigeria, Tanzania and Togo

Affordability of innovator budesonide in Burkina Faso, Mozambique and Republic of Guinea was 48 days’ wages, 51 days’ wages and 107 days’ wages respectively

Affordability of the lowest priced generic beclometasone was < 2 days’ wages in Kenya, South Africa, Uganda and Zambia and > 2 days’ wages in Ethiopia, Madagascar, Malawi, Sudan and Zimbabwe

Affordability of the lowest priced generic salbutamol was < 2 days’ wages in Burkina Faso, DRC, Kenya, South Africa, Tanzania, Uganda, Zambia and Zimbabwe and ≥ 2 days’ wages in Benin, Burundi, Cameroon, Ethiopia, Republic of Guinea, Madagascar, Malawi, Mali, Mozambique and Togo


5. Nyarko et al. [19]


23 health facilities (92%-public and 8%-private)

3 essential medicines (Salbutamol inhaler, Ipratropium bromide and beclometasone inhaler) and 1 diagnostic test (peak flow-metry)

Availability of ipratropium bromide, beclometasone inhaler and salbutamol inhaler was 4.5, 17.4 and 39.1% respectively

Availability of peak flow-metry was 13%


6. Armstrong-Hough et al. [20]


196 health facilities

2 essential medicines (Beclometasone and salbutamol inhalers)

Availability of beclometasone and salbutamol inhalers was 1.5% and 19.9% respectively


7. Cameron et al. [21]

36 LMICs (11 SSA countries)

1 main public hospital, 4 randomly-selected public medicine outlets and 1 private facility for each participating country

1 essential medicine (Salbutamol inhaler)

Mean availability of lowest priced generic salbutamol in 8 SSA countries was 14% (0–55.9%) and 47% (0–95%) in the public and private sector respectively

Affordability of lowest priced generic salbutamol in the public sector was a mean of 1.6 days’ wages. In the private sector, the lowest priced generic and innovator salbutamol cost a mean of 2.5 and 4.4 days’ wages respectively


8. Mendis et al. [22]

8 LMICs (3 SSA countries-Benin, Eriteria and Sudan)

30 health facilities.

3 essential medicines (beclometasone, salbutamol and ipratropium bromide inhalers)

Availability of beclometasone inhaler in Benin, Sudan and Eriteria was 16.7, 21.4 and 33.3% respectively

Availability of salbutamol inhaler in Benin, Sudan and Eriteria was 33.3, 71.4 and 100% respectively

Availability of ipratropium bromide was 0% in Benin and Eriteria and 14.3% in Sudan


9. Mash et al. [23]

South Africa

46 primary care facilities

1 diagnostic test (peak flow-metry)

Details of essential medicines studied were not given

Availability of peak flow-metry was 53.6%


  1. LMIC Low-and middle-income countries, SSA sub-Saharan Africa, SABA short acting beta agonists, SAMA short acting anti muscarinic agents, LAMA long acting anti muscarinic agents, LABA long acting beta agonists, ICS inhaled corticosteroid, LTRA leukotriene receptor antagonists