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Patterns of paediatric analgesic use in Africa: a systematic review
Parvaz Madadi1, Ehijie F O Enato, Shir Fulga
1Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada. parvaz.madadi@sickkids.ca
Insights
Pain management for African children often falls short of World Health Organization (WHO) standards. A review found limited use of essential medicines like morphine, despite widespread paracetamol and ibuprofen use.
Area of Science:
- Pediatric pharmacology
- Global health
- Systematic reviews
Background:
- Effective pain management is crucial for children.
- The World Health Organization's Essential Medicines List for Children (EMLc) provides guidelines for essential analgesics.
- Understanding current analgesic use patterns in African children is vital for improving care.
Purpose of the Study:
- To review analgesic use patterns in African children.
- To compare these patterns with EMLc recommendations.
- To summarize outcomes of analgesic use, including effectiveness, adverse events, cost, and accessibility.
Main Methods:
- Systematic literature review of 34 peer-reviewed observational studies.
- Included 7772 children (≤12 years) from 12 African countries.
- Analyzed data on analgesic types, pain indications, and reported outcomes.
Main Results:
- Paracetamol and ibuprofen comprised approximately 60% of analgesics used.
- Morphine, an EMLc essential medicine, was used in only 0.2% (20 children).
- 455 suspected adverse drug reactions were reported, including 17 deaths.
Conclusions:
- Current analgesic use in African children does not consistently meet WHO standards.
- There is a significant underutilization of essential analgesics like morphine.
- Further research and policy interventions are needed to improve pediatric pain management in Africa.
Abstract:
We conducted a systematic literature review with two objectives: (1) to assess reported patterns of analgesic use in African children and compare these observed patterns to the analgesics given in the WHO Essential Medicines List for Children (EMLc); and (2) to summarise outcomes related to effectiveness, adverse events, cost and accessibility of these analgesics. Eligible participants were children (≤12 years) living in any African country who received an analgesic administered with the intention of relieving pain in any setting. Thirty-four peer-reviewed, observational studies representing 7772 African children were accepted. Studies were conducted in 25 different regions of 12 countries. Pain was attributed to surgery, burns, sickle cell anaemia and conditions requiring palliation in 32% of children, and was unspecified in the other 68%. Of the three EMLc analgesics, paracetamol and ibuprofen were widely employed, constituting ∼60% of all analgesics, while morphine was used in 20 children (0.2%). There were 455 suspected adverse drug reactions which included 17 deaths. Analgesic use reported in African children appears to fall short of WHO standards.
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