Diseases causing high mortality in children under 5 years of age in resource limited settings (RLS) could be treated if children in these countries had access to existing medicines. It took 30 years before the WHO Essential Medicines List (EML) considered the issue of medicines for children, with the first EML for children being published in 2007. Recent data indicate that less than half of the key paediatric essential medicines are available in countries of sub-Saharan Africa. Problems include substandard medicines, irrational use of medicines, inefficiency and even possible corruption in pharmaceutical management systems. These are global issues which affect RLS most. Clinical trials in developing countries for the benefit of children are needed but challenging in several ways. In this review, the authors will consider the following areas where progress could improve paediatric pharmacotherapy in RLS: registration and regulation of medicines, rational use of medicines, clinical trials in children and restriction of corruption in pharmaceutical management systems.
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Competing interests KH has been a member of the WHO Expert Panel on the Selection and Use of Essential Medicines since 2007. He has served on two Expert Committees (2007, 2009) and two Paediatric Subcommittees of the Expert Committee on the Selection and Use of Essential Medicines (2007, 2008) and has been a temporary adviser to WHO programmes. SSR has served on WHO's Paediatric Subcommittee of the Expert Committee on the Selection and Use of Essential Medicines (2007) and also as temporary adviser to two (Essential Medicine and Pharmacovigilance) WHO–South East Asian Region programmes (WHO-SEARO). ANOD has been a member of the WHO Expert Panel on Drug Evaluation since 2007 and the WHO Advisory Committee on the Safety of Medicinal Products since 2008. He is also the Director of the WHO Collaborating Centre for Advocacy and Training in Pharmacovigilance. He has served on one Expert Committee on the Selection and Use of Essential Medicines (2009) and been a temporary adviser to several WHO programmes.
Provenance and peer review Commissioned; externally peer reviewed.