Drugmakers are being urged to develop medicines to prevent and treat tuberculosis in children, particularly those who are HIV-infected, and for newborn care.
The call comes in the World Health Organisation (WHO)'s first-ever list of 30 priority medicines for maternal and child health, which "tells manufacturers exactly what they should be producing to meet countries' needs," according to Hans Hogerzeil, director of WHO's Department for Essential Medicines and Pharmaceutical Policies.
Every year, more than eight million children aged under five die from conditions such as pneumonia, diarrhea and malaria, and an estimated 1,000 women die every day due to complications during pregnancy and childbirth, says WHO. Almost all these deaths occur in developing countries and the vast majority can be prevented when the right medicines are available in the right formulations and are prescribed and used correctly, it adds.
Haemorrhage is the leading cause of maternal death, but an injection of oxytocin immediately after delivery can stop the bleeding and make the difference between life and death, says WHO. Other drugs on the list for mothers include treatments for infection, high blood pressure and sexually-transmitted infections, as well as drugs to prevent preterm birth.
An estimated1.6 million children aged under five die each year from pneumonia, but treatment with simple antibiotics could save as many as 600,000, while improving access to oral rehydration salts (ORS) and zinc tablets would save many of the 1.3 million children who die each year from diarrhea.
And appropriate doses of the right combinations of antimalarials and antiretrovirals are critical to reducing child deaths and suffering from malaria and HIV/AIDS-related illness, says WHO.
Surveys conducted in 14 African countries show that children's medicines are available in only 35%-50% of public and private pharmacies and drug stores. The availability of medicines in developing countries for maternal and child health is compromised by poor supply and distribution systems, insufficient health facilities and staff, low levels of investment in health and high costs of medicines, the agency notes.
"We know that basic, cheap ORS and zinc stop children from dying from diarrhea, and we recommend that all countries make them accessible. But our surveys show that, at present, ORS is available in less than half of pharmacies and kiosks in African countries and zinc is not available at all in many places," says Elizabeth Mason, director of WHO's Department of Maternal, Newborn, Child and Adolescent Health.
Moreover, child-appropriate medicines are often not available, partly because of a lack of awareness that children need different drugs from adults. As a result, health workers are forced to adapt adult medicines, crushing them into imprecise portions and dissolving them into unpalatable drinks that are difficult for children to swallow and potentially ineffective, toxic or harmful.
However, examples of child-appropriate medicines include a newly-developed artemesinin combination tablet for malaria that is dissolved in liquid and tastes sweet, making it easier for children to swallow and ensuring that they receive correct and effective doses.
The top 30 priorities list also features urgently-needed tuberculosis medicines that do not currently exist. The recommended dosage in WHO's recently-developed treatment guide for tuberculosis in children requires a child to take many tablets a day over a long period, while combining the essential ingredients into one tablet results in a pill that is too large for a child to swallow. Therefore, WHO is calling for more research to develop appropriate, palatable formulations for children.