Clinton Health Access Initiative in Kenya secures a special access price for Caffeine Citrate -a lifesaving drug, which helps premature infants with immature breathing patterns to breathe.
The special access price deal will now enable Kenya to buy- caffeine citrate -the drug used to keep pre-term babies breathing- at a heavily subsidized price following price negotiation between Clinton Health Access Initiative (CHAI) and the drug manufacturer Ethypharm, through the support of the Ministry of Health.
In the deal, Kenya will be able to access the commodity at an access price of Ksh 400 compared to the previous price of Ksh1,500.
CHAI Deputy Director Rosemary Kihoto noted that the new price for the drug negotiated with the support of her organization, represented over 70 per cent reduction in access price.
“The drug which was initially stocked at Ksh 1,500 will now be accessed with only Sh400 per ampoule. Initially, the price of caffeine citrate was a barrier, with only 19percent of facilities managing small and sick newborns in the public sector procuring it in Kenya. Now more facilities will afford to buy enough quantities,” said Kihoto.
Caffeine citrate is essential in the management of apnoea of prematurity, a condition where pre-term babies stop breathing for more than 20 seconds or have a slow heart rate accompanied by low oxygen levels. The more premature the baby, the greater the chances of apnoea. Apnoea of prematurity is mainly caused by immaturity of the brain, while factors like infections, temperature problems can result in apnoea. Babies who develop apnoea of prematurity are at risk for complications and death.
The Ministry of Health cites prematurity complications as leading cause of neonatal deaths in Kenya.
Caffeine Citrate is recommended by the Ministry of Health in Kenya and World Health Organization (WHO) for the prevention and treatment of apnoea of prematurity in infants between 28 and less than 33 weeks gestational age.
According to Ethypharm General manger -Middle East and North Africa, Rob Bruchet the opportunity in Kenya will help in increasing access to caffeine Citrate, a core medication in treatment of Apnoea of Prematurity and helping in the implementation of WHO recommendations.
Caffeine Citrate will make a huge difference in management of Apnoea and the partnership in Kenya through CHAI’s engagement, will make a difference with Ethypharm special access pricing. Ethypharm is willing to get into similar partnerships with other governments in Africa, he said.
“Ethypharm will work with our local distributor Laborex Kenya to ensure that products are distributed with highest quality and standards to ensure that people of Kenya benefit.”
CHAI together with Ethypharm donated Kshs 13.5 million worth of Caffeine Citrate to strengthen immediate access of the commodity in the public sector. CHAI donated 20,000 ampoules of caffeine citrate, which will be channeled through Kenya Medical Supplies Authority (KEMSA). Ethypharm donated 10,000 ampoules of caffeine citrate along with essential equipment for use in newborn units.
Regional Manager, Northern Sub- Saharan Africa, Dr Rueben Kiptoo Sigey , said the use of evidence based, cost-effective, and low technology therapeutics, like caffeine citrate, is desirable to augment the limited respiratory support in our settings.
“Caffeine citrate is safer and easier to administer and has better therapeutic properties. It is therefore the preferred for the treatment of apnea of prematurity.”
CHAI’s Associate Director for Maternal Newborn & Child Health Betty Wariari said that the commodity donation goes hand in hand with the timely launch of the national guideline on Management of Apnoea of Prematurity in Kenya. The guideline will enable health care workers to effectively prevent and treat apnoea of prematurity using caffeine citrate, as well as use bubble Continuous Positive Airway Pressure (bCPAP) and monitor oxygen levels using pulse oximetry.
“With the guideline launched, a strong foundation has been laid to increase demand and investments towards the procurement of caffeine citrate– a lifesaving commodity.”
She explained that programmatic investments in strengthening quality of care for preterms are necessary for Kenya to achieve Sustainable Development Goal of reducing neonatal mortality to 12 deaths per 1,000 live births by 2030. CHAI will support the Ministry of Health to have a strong pool of trained health care workers in all the 47 counties in order for preterms to survive and thrive, she said.
According to Ethypharm Key account manager Kenya, Dr Kirkland Dingli Magwilu, the beneficial effects of caffeine citrate are fewer ventilator days, reduced incidence of bronchopulmonary dysplasia, and improved neurodevelopmental outcomes.
Makueni County Governor, Mutula Kilonzo Junior was grateful for CHAI’s effort in negotiating for affordable caffeine citrate since prohibitive cost of commodities and medical equipment hinders quality neonatal care and urged the national government to subsidize the cost of the neonatal unit’s equipment and machines.
“As a country, we must change how we treat newborn units by allocating enough space for the unit, when you visit any public hospital, you will find only a small room is considered for neonatal units after setting aside other big spaces for other departments,” said Mutula.
On her part, The Health Cabinet Secretary Susan Nakhumicha called upon all counties to prioritize investment in new-born support equipment, commodities, and trained personnel to effectively manage babies in the New-born Units.
Even with the launch of the guidelines, strong community involvement and the use of community health promoters in creating awareness on prevention of prematurity and the importance of family involvement was emphasized.
According to Head of Division on Neonatal, Dr Janette Karimi, Preterm birth is the highest cause of children under five years deaths.
She said that “if we have to reduce the under five deaths, we must reduce the neonatal deaths because neonatal deaths are about half of all the under five deaths.”
According to Kenya Demographic Health Survey (KDHS) 2022 data for every 1,000 live births at least 21 dies between the age of zero to 28 days.
The challenges accompanying the birth of an infant weighing less than 1,000 grams are numerous and include such things as respiratory failure due to surfactant insufficiency, patent ductus arteriosus, intraventricular hemorrhage, renal failure, apnea of prematurity, necrotizing enterocolitis, sepsis, and death.
Treatment for apnea of prematurity includes pharmacological and non-pharmacological modalities such as tactile stimulation, positioning, Kangaroo mother care, use of caffeine citrate, bubble Continuous Positive Airway Pressure (bCPAP), oxygen administration and mechanical ventilation.
However, there is scarcity of specialists and equipment to support interventions that improves premature infants’ survival rates with most hospitals including referral hospitals, lacking neonatal nurses. Additionally, hospitals lack continuous positive airway pressure (CPAP) machines, ventilators, surfactant, or the ability to provide thermoregulation resulting in early neonatal deaths.
High drug prices and lack of drug availability for purchase have been cited as the primary barrier of access to caffeine Citrate – a core medication listed in the guideline used in the prevention and treatment of apnoea of prematurity, coupled with low staff rates and only 3 Neonatal intensive care units (NICU) in the whole country public hospitals.
According to Kenya Pediatric association membership data, there are 907 active pediatricians. The country also has 30 neonatologists mostly domiciled in Nairobi, Eldoret, Nyeri and Mombasa.
