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Home / Equine Research Bank / PLoS One / Striving towards access to essential medicines for human and...
PloS one2023; 18(3); e0278964; doi: 10.1371/journal.pone.0278964

Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia.

Abstract: Antifungal medications are vital in combatting fungal diseases that affect over a billion people annually. Antifungal medications for people and equids are scarce in Ethiopia, where lack of resources to treat fungal infection, in particular histoplasmosis, is a major health challenge. Histoplasmosis is endemic within the equine population in Ethiopia, where it is estimated that one in five horses are infected. This disease has far reaching impacts on equine welfare and the socio-economic wellbeing of families. The burden of histoplasmosis in people in Ethiopia is currently unknown, representing a blind spot in public health surveillance. Previous research has identified contact with wildlife, and domestic animal species as possible transmission pathways for histoplasmosis however, questions remain about the role of equids in human histoplasmosis. Given the close proximity of people and animals in this setting, the high level of endemic disease among equids, and the common sources of anti-fungals in Ethiopia, our study adopted a One-Health approach to examine how systemic issues affect access to, and use of antifungals to treat histoplasmosis among people and equids. A qualitative study was conducted in 6 urban regions of Oromia, Ethiopia in December 2018, incorporating semi-structured face-to-face interviews and focus group discussions. Twenty-seven individual interviews were held with doctors (n = 7), pharmacists (n = 12), veterinarians (n = 5), para-veterinarians (n = 2) and an equid owner (n = 1). Eleven focus groups were conducted with equid owners (n = 42), 3 with veterinarians (n = 6), 1 with para-veterinarians (n = 2) and 1 with pharmacists (n = 2). Transcripts were analysed using thematic analysis, and dimensions of key themes conceptualised and compared. Two overarching themes namely, 'Structural', and 'Human factors', summarised the main limitations to access to antifungal medications. 'Structural factors' included the national reliance on importation of medicines or pharmaceutical ingredients, inaccurate demand forecasting due to poor recording of the shortfall within the pharmaceutical supply chain, deficiencies in diagnostic capacity for fungal disease and, a healthcare system funded with a significant component of out-of-pocket expenditure. 'Human factors' that influenced access to antifungals included the perception of the expense of antifungals compared with competing needs such as food and education, the social stigma attached to histoplasmosis that could lead to delays in treatment seeking and, readily available home remedies or alternative treatment options. Furthermore, it was reported that trust in healthcare and veterinary provisions was undermined by a perceived lack of efficacious medications. Access to antifungals remains an urgent public health and animal welfare concern in Ethiopia. Key points within the supply and distribution chain that affect access to anti-fungals are identified, and policies that facilitate anti-fungal procurement and distribution should be reviewed. This paper highlights the structural, socio-economic and cultural factors influencing the management of infection with histoplasmosis, including how it is understood, identified and treated. This study identifies areas where further cross-sectorial work is needed to address these factors to improve disease control and clinical outcomes observed in human and animal histoplasmosis within Ethiopia.
Copyright: © 2023 Robertson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Publication Date: 2023-03-09 PubMed ID: 36893127PubMed Central: PMC9997978DOI: 10.1371/journal.pone.0278964Google Scholar: Lookup
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  • Non-U.S. Gov't

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research report presents an investigation into the scarce availability of antifungal medications for treating histoplasmosis in both human and animal populations in Ethiopia, with the aim to identify the challenges and propose strategic policy changes.

Research Methodology

  • The study was conducted in a qualitative manner in 6 urban regions of Oromia, Ethiopia in December 2018.
  • Data were collected through semi-structured face-to-face interviews and focus group discussions providing a diverse sample of participants including doctors, pharmacists, veterinarians, para-veterinarians, and equid owners.
  • The collected transcripts were examined using thematic analysis.
  • Different aspects of the identified themes were evaluated and compared to understand the bigger picture of the issues associated with scarcity and access of antifungal therapies.

Key Findings

  • Two primary themes emerged as barriers to antifungal medications access are ‘Structural’, and ‘Human factors’.
  • ‘Structural factors’ comprised a reliance on imported medicines, poor demand forecasting due to inaccuracies in the pharmaceutical supply chain, lack of diagnostic capabilities, and a healthcare system that significantly depends on out-of-pocket expenditure.
  • ‘Human factors’ included the perception of the high cost of antifungals, the social stigma attached to histoplasmosis, and the availability of home remedies which are often the preferred treatment option. There was also a reported mistrust in healthcare and veterinary guidelines due to the perceived lack of effective medications.

Implications

  • Access to antifungal medicines is a pressing public health and animal welfare matter in Ethiopia.
  • The study identifies points within the supply and distribution chain that affect access to antifungal treatments, suggesting an urgent need to review policies that facilitate these processes.
  • The research underscores the roles of structural, socio-economic, and cultural factors that influence how histoplasmosis is understood, detected, and treated.
  • The study advocates for further intersectoral work to address these issues to improve disease management and clinical outcomes in both human and animal histoplasmosis within Ethiopia.

Cite This Article

APA
Robertson E, Abera C, Wood K, Deressa K, Mesfin S, Scantlebury C. (2023). Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia. PLoS One, 18(3), e0278964. https://doi.org/10.1371/journal.pone.0278964

Publication

PloS one
ISSN: 1932-6203
NlmUniqueID: 101285081
Country: United States
Language: English
Volume: 18
Issue: 3
Pages: e0278964
PII: e0278964

Researcher Affiliations

Robertson, Eleanor
  • Department of Livestock and One Health, Institute of Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
Abera, Cherinet
  • Histoplasmosis Research Group, Care of SPANA Bishoftu, Brooke Addis Ababa, Addis Ababa, Ethiopia.
Wood, Kelly
  • Department of Livestock and One Health, Institute of Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
Deressa, Kabeba
  • Histoplasmosis Research Group, Care of SPANA Bishoftu, Brooke Addis Ababa, Addis Ababa, Ethiopia.
Mesfin, Samuel
  • Independent Researcher, Addis Ababa, Ethiopia.
Scantlebury, Claire
  • Department of Livestock and One Health, Institute of Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.

MeSH Terms

  • Humans
  • Horses
  • Animals
  • Antifungal Agents / therapeutic use
  • Histoplasmosis / drug therapy
  • Histoplasmosis / epidemiology
  • Histoplasmosis / veterinary
  • Ethiopia / epidemiology
  • Animals, Domestic
  • Drugs, Essential

Grant Funding

  • Wellcome Trust

Conflict of Interest Statement

The authors have declared that no competing interests exist.

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Citations

This article has been cited 1 times.
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