Availability and Stock Levels of Essential Medicines in Government Healthcare Institutions of Different Settings in a Rural District in Sri Lanka: a multicentre cross-sectional study

Availability and Stock Levels of Essential Medicines in Government Healthcare Institutions of Different Settings in a Rural District in Sri Lanka: a multicentre cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Availability and Stock Levels of Essential Medicines in Government Healthcare Institutions of Different Settings in a Rural District in Sri Lanka: a multicentre cross-sectional study Janani Buddhika Rathnaweera Bopage, Anura Abeysinghe Jayawardhana Yapa, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5051616/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The availability of essential medicines (EMs) is an important aspect of quality healthcare services. This study aimed to assess the availability, stock-out periods, record-keeping, presence of expired medicines, and conservation and handling of selected EMs across different levels of Government Healthcare Institutions (GHCIs) in Monaragala, one of the rural districts in Sri Lanka. Methods: A descriptive, cross-sectional study was conducted, with retrospective data collection methods where necessary. Six GHCIs representing four different levels of care were selected in Monaragala District, Sri Lanka. EMs for 23 diseases were selected from the National Essential Medicine List (EML) of Sri Lanka. Data was collected using survey forms adapted from the WHO operational package for assessing, monitoring, and evaluating country pharmaceutical situations (WHO-OP). Ethics review approval was obtained from the Ethics Review Committee, the Open University of Sri Lanka, and institutional permissions were obtained from the relevant authorities. Results: The average availability of selected EMs was fairly high (77.1%) in the Monaragala district, while the “highest” availability (80.49%) was recorded by divisional hospitals type B. The highest average stock-out days (66 days) were reported from the Divisional Hospital- Type C. Only Divisional Hospital- Type A reported having expired medicines on shelves (2.43%). All six GHCIs reported more than 80.49% for record-keeping on medicines. Divisional Hospital Type-A reported having the lowest score for warehouse management. Conclusions: The availability of EMs at the GHCIs of the Monaragala district was fairly high. Record keeping of EMs was high while the average number of stock-out days varied per institution. Conservation and handling practices of the store rooms and dispensing areas of the GHCIs in the Monaragala district should be further improved. Essential medicines availability stock-out storage facilities record keeping Background Access to essential medicines (EMs) is a vital component of ensuring the right to health for all individuals, regardless of their socioeconomic status or geographical location. According to the World Health Organization (WHO), EMs are medicines designed to meet the top health requirements of the population. They should always be accessible in functional health systems, in appropriate dosage forms and quantities, with assured quality, and at a cost that people in the community and individuals can afford. The WHO updates and publishes Model Lists of EMs and EMs for Children biannually. These lists act as resources for countries or regional organizations to adopt or modify their EM lists to comply with regional treatment recommendations and priorities for health [1]. There are 137 national lists of EMs available worldwide, each containing between 44 and 983 medicines, which is partly explained by differences in the characteristics of the country [2]. The National Essential Medicines List (EML) of Sri Lanka, 5 th edition [3], classifies government healthcare institutions (GHCIs) of Sri Lanka into 4 categories: level 1 (primary medical care units), level 2 (divisional hospitals), level 3 (district base hospitals and district general hospitals) and level 4 (provincial general hospitals and teaching hospitals). The national EML of Sri Lanka has listed 318 medicines for 29 major disease categories. The medicine information includes the medication name, strength, dosage forms, and the international non-proprietary name of the active ingredient, together with the recommended level of care [3]. One of the most essential elements of quality healthcare services is the availability of EMs, since their continuous availability guarantees that patients have access to health services without interruption [4]. Even a slight shortage of EMs can significantly affect the delivery of high-quality health care. Stockouts are an important indicator of the preparedness of healthcare services since clinics cannot operate continually without dependable and adequate access to critical medications [5]. Effective record-keeping of pharmaceuticals ensures efficient management of stock status and consumption data. The logistics management information system (LMIS) is crucial in effective record keeping. Hospitals maintain either manual or electronic records of pharmaceuticals [6]. Most medicines lose efficacy after their expiry date, and some may develop different adverse reactions. All expired pharmaceuticals should always be considered pharmaceutical waste and should never be used as expired medicines become unsafe for use [7]. The presence of expired medicines on pharmacy shelves, the appropriateness of handling, and conservation conditions are used as indicators of the quality usage of medicines [8]. The Sri Lankan government provides free health care to all citizens at the point of delivery. However, certain expensive medical supplies might be purchased by patients when they are unavailable in government hospitals, which creates a financial burden for low–income patients [9]. Monitoring and evaluating the pharmaceutical sector is vital for determining whether the main pharmaceutical aims are met. The WHO operational package for assessing, monitoring, and evaluating country pharmaceutical situations (WHO-OP) [8] provides a standard method to analyse and track progress over time and compare pharmaceutical situations in different facilities, districts, and nations. A few studies have been carried out on the accessibility and cost of medicines in Sri Lanka, focusing on specific demographic areas or particular categories of medicines[10–12]. To our knowledge, this is one of the first studies to evaluate different pharmaceutical parameters at different levels of GHCIs in Sri Lanka. This study was conducted to assess the availability, stock-out periods, record-keeping, presence of expired medicines, and conservation and handling of selected EMs across different levels of GHCIs in Monaragala, a rural district in Sri Lanka. Methods Study design and study setting A descriptive, cross-sectional study was conducted from May to June 2023 in Monaragala District, Sri Lanka. Retrospective data were used whenever necessary. Monaragala district is situated in the east and southeast directions of Uva province, Sri Lanka. The total area is 5959 km 2 , and it is the second-largest district in Sri Lanka [13]. Agriculture is the main type of employment for 51.4% of the population [14]. All GHCIs in Monaragala district in Sri Lanka were considered as the population. The Monaragala district has 6 different types of GHCIs belonging to 4 levels of care as defined by the National EML. One government healthcare institution of each type was selected conveniently. The selected GHCIs are shown in Table 01. The identities of all the selected GHCIs were kept confidential. The outpatient department (OPD) dispensaries and the clinic pharmacies of the selected GHCIs were visited once for data collection. The presence of expired medicines at GHCIs was determined by randomly examining the expiration dates of each of the 44 medicines investigated in this study. To determine the one-year stock-out period, stock registers were checked for the last 12 months (from the 01 st of May 2022 to the 30 th of April 2023). Indoor pharmacies supplying medicines to wards and the Emergency Treatment Units (ETUs) of selected GHCIs, private sector healthcare facilities, retail pharmacies, and polyclinics were excluded from the study. Table 1 Classification of selected GHCIs according to the National EML-Sri Lanka Levels of care as per National EML Total No. of GHCIs available in the district Type selected of GHCI for the study No. of Beds at the selected GHCI Level 1 10 Primary Medical Care Unit (PMCU) 0 Level 2 1 Divisional Hospital -Type A (DH -A) 56 5 Divisional Hospital -Type B (DH -B) 38 8 Divisional Hospital -Type C (DH -C) 110 Level 3 3 Base Hospital -Type B (BH -B) 80 Level 4 1 District General Hospital (DGH) 579 Study instrument Data were collected via survey forms adapted from the WHO Operational Package for assessing, monitoring, and evaluating country pharmaceutical situations (WHO-OP) on the basis of availability, average stock-out duration, adequacy of conservation conditions (level of storage facilities), and adequacy of record-keeping of the selected EMs. The WHO-OP recommends the selection of 15 key medicines for the assessment. The National EML Sri Lanka has been prescribed to make more than one dosage form or different strengths of the same medicine for EMs available. In this study, 44 EMs used to treat 23 diseases, including both communicable diseases (CDs) and noncommunicable diseases (NCDs), were selected from the National EML 5 th edition published in 2014. Each dosage form of medicine was considered as a separate entity. Data analysis The data were analysed according to the WHO-OP [8]. The data were presented as percentages and averages. The number of medicines entitled to be available at particular GHCIs was taken as the denominator when analysing the data. The availability of the selected EMs was reported based on previous national and international surveys; 80%: high [10, 15]. Results Availability of EMs The overall availability of selected EMs in the GHCIs in Monaragala district was “fairly high” (77.1%), which varied from “fairly high” (75%) at DH-B to “high” (80.49%) (Table 2). Only DH-A was reported to have expired medicines on the shelves during the survey period, and the product was “iron drops 100 mg/5 mL, in 15 mL droppers”. All the selected EMs were available at all GHCIs for the disease categories of gastritis/gastric ulcers, nausea/vomiting, skin infection, eye infection, vertigo, diabetes, and angina. Beclomethasone, which is prescribed for the management of asthma, is prioritized to be available at all levels of care (levels 1, 2, 3, and 4) in the dosage forms of dry powder capsules (DPCs) (200 mcg) and metered dose inhalers (MDIs) (50 mcg, 100 mcg, and 250 mcg). However, the mentioned dosage forms or strength were not available at DGH on the day of the visit. This may be due to the high number of patients attending the DGH. Table 2 Summary of the availability of EMs on the day of the visit, record keeping, and percentage of expired medicines at GHCIs in the Monaragala district DGH BH -B DH -A DH -B DH -C PMCU Number of entitled medicines in selected list 44 44 41 41 41 38 Number of entitled medicines at the time of visit 34 34 33 33 30 29 Number of entitled medicines with adequate records 43 44 41 41 41 38 Percentage (%) of availability for entitled medicines 77.27% 77.27% 78.05% 80.49% 73.17% 76.32% Percentage (%) of medicines expired on shelves (entitled mediciness) 0.00% 0.00% 2.43% 0.00% 0.00% 0.00% Percentage (%) of record keeping for entitled medicines 97.73% 100.0% 80.49% 100.0% 100.0% 100.0% Average number of stock-out days for entitled medicines 56.82 23.52 46.93 27.88 65.51 54.89 DGH District General Hospital; BH-B Base Hospital-Type B; DH-A Divisional Hospital-Type A; DH-B Divisional Hospital-Type B ; DH-C Divisional Hospital-Type C ; PMCU: Primary Medical Care Units Record-keeping All the GHCIs maintained record-keeping practices of more than 80%. Except for DGH and DH-A, all the other four GHCIs in this study reported 100% record keeping. DGH was reported for not keeping records for beclomethasone DPC 200 mg. DH-A was reported as not keeping records for 8 medicines; beclomethasone MDI 50 mcg 200 doses, beclomethasone MDI 250 mg 200 doses, domperidone tab. 10 mg, folic acid tab. 1 mg, ciprofloxacin eardrops 0.3%, fluoxetine tab. 5mg, olanzapine tab. 5 mg, and carbamazepine tab. 200 mg. Table 3 Availability of selected EMs during the day of visit at selected GHCIs in Monaragala district -2023 Key medicine to treat common conditions EMs entitled levels of GHCIs DGH BH -B DH -A DH -B DH -C PMCU Anti-thrombotic (NCD) Aspirin tab. 75 mg, 100 mg, 150 mg 1, 2, 3, 4 Yes No Yes Yes Yes Yes Rheumatoid diseases (NCD) Diclofenac sodium tab. 50 mg 1, 2, 3, 4 No Yes Yes Yes Yes Yes Paracetamol tab. 500 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Paracetamol oral liquid 120 mg/5 mL 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Worm infestation (CD) Mebendazole tab. 100 mg 1, 2, 3, 4 Yes No No Yes Yes No Respiratory tract infections (CD) Amoxicillin cap. 250 mg, 500 mg 1, 2, 3, 4 Yes Yes Yes No Yes No Amoxicillin oral susp. 125 mg/5 mL,100 mL bot. 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Common colds, rhinitis (CD) Chlorpheniramine maleate tab. 4 mg 1, 2, 3, 4 Yes Yes No Yes Yes Yes Chlorpheniramine oral solu. 2 mg/5 mL, 60 mL bot. 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Asthma (NCD) Salbutamol tab. 2 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Salbutamol MDI 100 mcg, 50 mcg per dose 1, 2, 3, 4 No Yes Yes Yes Yes Yes Ipratropium bromide MDI 20 mcg 3, 4 Yes Yes - - - - Ipratropium bromide DPC 20 mcg 3, 4 Yes Yes Yes* Yes* - Yes* Beclomethasone DPC 200 mcg 1, 2, 3, 4 No Yes Yes Yes No Yes Beclomethasone MDI 50 mcg, 200 doses 1, 2, 3, 4 No No No No No No Beclomethasone MDI 100 mcg, 200 doses 1, 2, 3, 4 No No No Yes No Yes Beclomethasone MDI 250 mcg, 200 doses 1, 2, 3, 4 No No No Yes No Yes Prednisolone tab. 5 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Diarrhoea (CD) Oral Rehydration Salt (ORS) 1, 2, 3, 4 Yes Yes Yes No Yes Yes Gastritis/GI ulcers (NCD) Omeprazole cap. 20 mg 2, 3, 4 Yes Yes Yes Yes Yes Yes Nausea, Vomiting (NCD) Domperidone tab. 10 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Domperidone syrup 5 mg/5 mL 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Urinary Tract Infection (CD) Nitrofurantoin tab. 50 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes No Skin infection (CD) Miconazole cream 2% 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Inflamation and pruritus (CD) Hydrocortisone cream or ointment 1% 1, 2, 3, 4 No Yes No No No No Anemia (NCD) Ferrous sulfate tab. 200 mg 1, 2, 3, 4 Yes No Yes Yes No Yes Folic acid tab. 1 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Iron drops 100 mg/5 mL, in 15 mL dropper 1, 2, 3, 4 Yes Yes Yes No No Yes Iron syr. 25 mg/mL bot. 1, 2, 3, 4 Yes No No No No No Eye infections (CD) Ciprofloxacin eye drops 0.3% 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Ear infections (CD) Ciprofloxacin ear drops 0.3% 1, 2, 3, 4 No No Yes Yes No Yes Vertigo (NCD) Prochlorperazine tab. 5 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Diabetics (NCD) Metformin tab. 500 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Hypertension (NCD) Nifedipine tab. 20 mg 1, 2, 3, 4 No Yes No No No No Enalapril tab. 5 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Hydrocholorothiazide tab. 25 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Angina (NCD) Glyceryl trinitrate tab. (sublingual) 500 mcg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Heart Failure (NCD) Spironolactone tab. 25 mg 1, 2, 3, 4 Yes No Yes Yes Yes No Anti-coagulant (NCD) Warfarin tab. 0.5 mg, 1 mg, 3 mg, 5 mg 3, 4 Yes Yes Yes* - - - Psychosis (NCD) Fluoxetine cap. 20 mg 1, 2, 3, 4 No Yes Yes Yes Yes No Olanzapine tab. 5 mg 2, 3, 4 Yes No Yes Yes Yes - Epilepsy (NCD) Sodium valproate tab. 100 mg, 200 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes Sodium valproate syrup 200 mg/5 mL 2, 3, 4 Yes Yes No No No - Carbamazepine tab. 200 mg 1, 2, 3, 4 Yes Yes Yes Yes Yes Yes The duplication of medicines in multiple disease categories of the national EML, Sri Lanka, was excluded from the calculation of availability (%). DGH District General Hospital, BH-B Base Hospital-Type B, DH-A Divisional Hospital-Type A, DH-B Divisional Hospital-Type B , DH-C Divisional Hospital-Type C , PMCU Primary Medical Care Units, CD Communicable Diseases, NCD Noncommunicable Diseases, MDI Metered Dose Inhaler, DPC Dry Powder Capsules Yes - Medicine was present on the day of the visit, No - Medicine was not present on the day of the visit * Available on the day of visit even though not entitled to present at the GHCIs as per the national EML. Table 4 Summary of scores for conservation conditions and the handling of medicines at GHCIs from Monaragala district-2023 DGH BH-B DH-A DH-B DH-C PMCU Average Adequacy of conservation conditions and good handling of medicines at storerooms (%) 60 90 50 100 90 60 75 Adequacy of conservation conditions and handling of medicines at dispensing facilities (%) 80 80 50 80 80 80 75 DGH District General Hospital, BH-B Base Hospital-Type B, DH-A Divisional Hospital-Type A, DH-B Divisional Hospital-Type B , DH-C Divisional Hospital-Type C , PMCU Primary Medical Care Units Stock-out duration Over the last 12 months, the highest average stock-out duration was reported as 66 days at DH-C, whereas DGH, PMCU, DH-A, DH-B, and BH-B were reported as 57, 55, 47, 28, and 24 days, respectively. Among the stock-out medicines at DH-C, beclomethasone MDI 50 mcg, iron drops 100 mg/5 mL, in a 15 mL dropper, iron syr. 25 mg/mL in bot., ciprofloxacin ear drops 0.3%, and sodium valproate syr. of 200 mg/5 mL were reported for the longest stockout period, with 365 days. At DH-A, sodium valproate syr. 200 mg/5 mL, iron syr. 25 mg/mL bot. and spironolactone (tab. 25 mg) were reported to have a stock-out duration of more than 320 days. At DGH, only the beclomethasone MDI 50 mcg, 200 dose was reported for a stock-out duration of more than 300 days, whereas the PMCU reported stock-out per year for the beclomethasone MDI 50 mcg, 200 dose, and iron syr. 25 mg/mL bot., spironolactone (tab. 25 mg), and a fluoxetine cap. 20 mg for 365 days. DH-B reported for nifedipine tab. 20 mg and beclomethasone MDI 50 mcg, 200 doses stocking out for more than 150 days. (Additional file 1: Table A1: Stock-out duration of the selected EMs in days within the last 12 months) Inventory management practices at GHCIs Except for DH-A, all the other GHCIs scored 80 marks for the conservation conditions at dispensing areas, whereas DH-A scored 50 marks. DH-B, BH-B, and DH-C scored 90, 90, and 100 marks, respectively, for conservation conditions at storage rooms in the GHCIs, whereas the other three GHCIs scored 60 or 50 scores. All the storerooms and dispensing areas were free from moisture, and no evidence of pests in the areas was found. Except for DH-A, in all the storage rooms and dispensing areas of the investigated GHCIs, medicines were stored first-expiry-first out (FEFO) principle, and windows or air vents were present. However, tablets/capsules were reported to be manipulated by the naked hand at the dispensing areas of all the GHCIs. Only the storerooms in DGH were reported to have direct sunlight in the room. Overall, the storage rooms and dispensing areas of the GHCIs scored 50 or more than 50 out of 100 for the conservation of medicines. Discussion Availability of medicines According to the WHO definition, EMs should exist within operating healthcare institutions at all times [1]. The availability of EMs mostly influences the quality of healthcare and patient satisfaction. The average availability of the selected EMs in Monaragala district was “fairly high” (77.1%), even though the country was facing an economic crisis. The availability was “high” at DH-B and “fairly high” at other GHCIs. A study conducted in another rural district in Sri Lanka revealed that “high” availability for EMs was reported only at the district hospital, whereas the base hospital and the PMCUs reported “fairly high” availability [16]. Another study conducted in Sri Lanka reported that the availability of selected EMs used for noncommunicable diseases were 36.4% and >50% for primary and secondary levels of care, respectively, with a mean availability of 58% (±0.32) in the public sector [10]. In this study, the availability of selected EMs for the secondary and tertiary care levels was reported as 77%. The secondary care level includes a few basic specialties, and the tertiary care level includes some subspecialties. The greater number of patients served by secondary- and tertiary-level healthcare facilities might be the reason for the unavailability of some of the EMs. However, 73% or greater availability of EMs in Monaragala district was reported for all the primary, secondary, and tertiary GHCIs considered in this study. Monaragala, a rural district with a high availability of EMs, is notable. Studies conducted in other lower-middle-income countries (LMICs), such as Nepal [17], Pakistan [18], Malawi, and Bangladesh [19], have reported poor availability of EMs of less than 50%. A study conducted at 6 healthcare centers in Adama Town, Ethiopia, on 11 EMs reported an overall average availability of 76.3% [20]. Another study conducted in Iran [4], an LMIC, reported that 97.5% of 15 key medications were available in various cities, as well as in state and commercial pharmacies, with no significant variation [21]. The WHO affirms that the appropriate level of availability for essential medications is at least 80% [22]. Monaragla district accounted for 77.1% of all districts, which is closer to the WHO recommended level. Record-keeping This study revealed higher percentages (> 80%) of record-keeping of EMs, possibly because almost all the GHCIs were supported by the computerized Medical Supplies Management Information System (MSMIS) provided by the Medical Supplies Division (MSD) of the Ministry of Health. A study conducted in six healthcare centers in Adama town in Ethiopia assessed the accuracy of record keeping via inventory management assessment tool (IMAT) indicators and reported low accuracy of records [20]. Stock-out duration Stock-outs arise from an inability to manage medical supplies, report shortages, and act swiftly and effectively to prevent their recurrence. The stock-out duration of essential medicines is an important measure for ensuring the availability of EMs [23]. The average stock-out durations assessed during the last 12 months in this study were reported as 65, 57, 55, 47, 28, and 24 days for DH-C, DGH, PMCU, DH-A, DH-B, and BH-B, respectively. A study conducted at two government healthcare centers in Northwest Ethiopia reported that the average stock-out durations in the last 6-month period were 38.8 days and 11.2 days [4]. Another study conducted in Adama Town, Ethiopia, reported that the average length of stock-out days for 11 EMs from 5 healthcare centers throughout the past 12 months was 40.6 days [20]. Paracetamol oral liquid 120 mg/5 mL), amoxicillin capsules (250 mg, 500 mg), amoxicillin oral suspension 125 mg/5 mL, 100 mL), beclomethasone MDI (100 mcg, 200 doses), hydrocortisone cream 1%; and ciprofloxacin eye drops 0.3% were stock out at the day of visit and in the last 12 months at all GHCIs. This may be due to the high consumption of these medicines at the GHCIs. Studies conducted in Ethiopia reported that ferrous salt + folic acid (150 mg + 0.5 mg), ORS, and amoxicillin syrup 125 mg/5 mL are the medicines most frequently stocked out [4, 20]. A shortage of EMs may increase the burden on healthcare staff, as patients may need to make additional visits and referrals. Patients might choose not to take medications that are out of stock owing to unavailability or financial constraints. These stockouts may result from long-distance transportation from suppliers during the procurement process, unavailability of medications from suppliers, or high consumption in the absence of an efficient supply system [4, 20]. A study conducted in 9831 primary healthcare centers in Indonesia reported a lack of necessity was the primary reason for stockouts accounting for 46% of the stock-outs, whereas 38% of the stock-outs were due to medicines not being supplied to healthcare facilities [24]. Presence of expired medicines Only iron drops of 100 mg/5 mL in 15 mL were reported to present as expired medicines on the shelves during the survey period, as reported by DH-A. A study conducted in Nepal assessing the availability, stockouts, and expiry of 17 EMs in 28 peripheral healthcare facilities (below the district level) reported an average of 3% for the presence of expired medicines at the levels of health posts and subhealth posts. At least 9 out of 17 medicines (52.9% of total medicines) included in that study were found to have expired in at least one health facility at the time of visit [17]. Iran reported only 1% for the presence of expired medicines among public health care facilities, which was reported only at one public pharmacy out of the 6 public pharmacies considered in the study [21]. A study conducted at 4 health facilities in the Awi zone, Amhara regional state, Ethiopia, reported that 8.1% of the medications out of 173 medications were reported as expired medicines [25]. The absence of expired medicines, adherence to the standard storage conditions at the dispensing facilities, proper conditions, and standard handling of medicines in storerooms are used as indicators to assess the quality use of the medicines as defined by the WHO [8]. Inventory management practices at GHCIs The average value for conservation conditions and good handling of medicines at both storerooms and dispensing facilities was reported as 75%. This percentage varied from 100% to 50% for storeroom conditions and 80% to 50% for the dispensing area, whereas DH-B reported the highest scores for both the storeroom area and the dispensing area. A study conducted in 5 cities in Iran reported scores of more than 75% by all 5 public health care centers for the adequacy of conservation conditions and the handling of medicines in the storeroom area and the dispensing area [21]. A study conducted in 62 government health facilities across 21 districts of Nepal reported that only 13% of health facilities followed medicine storage guidelines and reported that temperature and humidity levels exceeded recommended limits [26]. A study conducted in Nepal identified delays in the procurement process as the major barrier to the effective management of essential medicines [27]. Limitations of the study This study investigated only selected EMs, but examining all the EMs in the GHCIs would be of greater value. This study investigated only the availability, stock-out duration, and storage conditions at six GHCIs in the Monaragala district. Assessing the situation at other healthcare facilities in the district would be more representative. This research included only oral and topical medicines, and parenteral medications were excluded. Moreover, the study did not examine any of the factors that affect the availability of EMs in healthcare institutions. Conclusions Despite the economic crisis faced by Sri Lanka during 2023, the selected GHCIs in Monaragala district presented fairly high availability of selected EMs, indicating that free state health services were given priority when funds were allocated. However, certain areas, such as storage conditions, should be improved at all GHCIs. Even though this study revealed a minimal occurrence of expired medicines, consistent monitoring of healthcare facilities and enhancing the medicine supply system would ensure the availability of EMs and an uninterrupted supply of medicines to patients. Abbreviations EMs: Essential Medicine; WHO: World Health Organization; EML: Essential Medicine List; GHCIs: Government Healthcare Institutions; LMIS: Logistics Management Information System; OPD: Outpatient Department; ETUs: Emergency Treatment Units; WHO-OP: WHO Operational Package for assessing, monitoring, and evaluating country pharmaceutical situations; CD: Communicable Diseases; NCD: Non-Communicable Diseases; MDI: Metered Dose Inhaler; DPC: Dry Powder Capsules; DGH: District General Hospital; BH-B: Base Hospital-Type B; DH-A: Divisional Hospital-Type A; DH-B: Divisional Hospital-Type B; DH-C: Divisional Hospital-Type C; PMCU: Primary Medical Care Units; FEFO: First-Expiry-First Out; LMICs: Lower-Middle-Income Countries; ORS: Oral Rehydration Salt Declarations Informed consent: Since patient-related information was not collected in this study, informed consent was not applicable. Ethics approval and consent to participate The Ethics Review Committee of the Open University of Sri Lanka approved the study (FH/ERC/033). Administrative approval was obtained from the Provincial Director of Health Services, Uva Province; the Regional Director of Health Services, Monaragala District; and the heads of the relevant institutions. All methods were performed following relevant guidelines and regulations. The data were kept confidential and were only used for the intended purpose. Consent for publication: The consent to publish the information gathered from the GHCIs was obtained from the Provincial Director of Health Sciences. The data are reported in a way that it will not be possible to identify the individual institutions. Availability of data and materials The online version contains supplementary material available on the publishing website. Competing interests: The authors declare that they have no competing interests. Funding The study was self-funded. Authors’ contributions RBJB conceived the idea of the study, and all the authors participated in designing the study. AAJY was involved in the data collection. AAJY, RBJB, NDDW, CA, JCMT, and RF were involved in the analysis and interpretation of the data. RBJB, AAJY, and NDDW drafted the manuscript, and AAJY, RBJB, NDDW, CA, JCMT, and RF critically revised it. All the authors read and approved the final manuscript. Acknowledgments We would like to express our gratitude to health professionals working in GCHIs in Monaragala district for their cooperation during data collection. Authors' information 1 Department of Pharmacy, Faculty of Health Sciences, The Open University of Sri Lanka, Nugegoda, Sri Lanka, 2 District General Hospital, Monaragala, Sri Lanka, 3 The Pharmaceutical Society of Sri Lanka, Colombo, Sri Lanka, 4 Provincial Director of Health Services, Badulla, Uva Province, Sri Lanka, 5 Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka References World Health Organization (2023) WHO EML 23rd List (2023). Persaud N, Jiang M, Shaikh R, et al (2019) Comparison of essential medicines lists in 137 countries. Bull World Health Organ 97:394-404C Ministry of Health Sri Lanka (2014) National List of Essential Medicines Sri Lanka 2013-2014 Fifth Revision. 28 Tefera BB, Tafere C, Yehualaw A, Mebratu E, Chanie Y, Ayele S, Adane S (2022) Availability and stock-out duration of essential medicines in Shegaw Motta general hospital and Motta Health Centre, North West Ethiopia. PLoS One 17:1–10 Wagenaar BH, Gimbel S, Hoek R, et al (2014) Stock-outs of essential health products in Mozambique - longitudinal analyses from 2011 to 2013. Trop Med Int Health 19:791–801 Mekonnen BA, Worku MC, Tefera BB (2024) Evaluation of logistics management information system and availability of nonprogram tracer drugs in public health facilities in Bahir Dar City, Northwest Ethiopia. PLoS One. https://doi.org/10.1371/journal.pone.0302319 World Health Organization 1999 (1999) Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies. WHO (2007) WHO Operational Package for Assessing, Monitoring and Evaluating Country Pharmaceutical Situations. WHO Press, Geneva Ministry of Health Nutrition & Indigenous Medicine (2017) Sri Lanka National Health Policy. Sri Lanka Dabare PRL, Wanigatunge CA, Beneragama BH (2014) A national survey on availability, price and affordability of selected essential medicines for non communicable diseases in Sri Lanka. BMC Public Health. https://doi.org/10.1186/1471-2458-14-817 Ganga Senarathna SMDK, Mannapperuma U, Rohini Fernandopulle BM (2011) Medicine prices, availability and affordability in Sri Lanka. Indian J Pharmacol 43:60–63 Balasubramaniam R, Benaragama BVSH, Sri Ranganathan S (2014) A national survey of price and affordability of key essential medicines for children in Sri Lanka. Indian J Pediatr 81:362–367 District Secretariat- Monaragala (2022) Annual Performance Report- Monaragala District. Department of Census and Statistics, Ministry of Finance ES and NP (2022) Sri Lanka Labour Force Survey- Annual Bulletin. Gelders S, Ewen M, Noguchi N, Laing R (2006) Price, availability and affordability An international comparison of chronic disease medicines. Rathish D, Premarathna I, Jayathilake T, Kandegedara C, Punchihewa K, Ananda L, Bandara T, Jayasumana C, Siribaddana S (2017) Availability of essential medicines in selected public, primary and secondary health care institutions of a rural Sri Lankan district: A spot survey. BMC Health Serv Res 17:1–9 Shiva Raj Adhikari, Achyut Raj Pandey, Mamata Ghimire, Arjun Kumar Thapa, Dinesh Kumar Lamsal (2018) Universal Access to Essential Medicines: An Evaluation of Nepal’s Free Health Care Scheme. J Nepal Health Res Counc 16:36–42 Saeed A, Saeed H, Saleem Z, Fang Y, Babar ZUD (2019) Evaluation of prices, availability and affordability of essential medicines in Lahore Division, Pakistan: A cross-sectional survey using WHO/HAI methodology. PLoS One. https://doi.org/10.1371/journal.pone.0216122 Mendis S, Fukino K, Cameron A, Laing R, Filipe A, Khatib O, Leowski J, Ewen M (2007) The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull World Health Organ 85:279–288 Kefale AT, Shebo HH (2019) Availability of essential medicines and pharmaceutical inventory management practice at health centers of Adama town, Ethiopia. BMC Health Serv Res 19:1–7 Minaei H, Peikanpour M, Yousefi N, Peymani P, Peiravian F, Shobeiri N, Majd ZK, Shamsaee J (2019) Country pharmaceutical situation on access, quality, and rational use of medicines: An evidence from a middle-income country. Iranian Journal of Pharmaceutical Research 18:2191–2203 World Health Organization (2013) Global action plan for the prevention and control of noncommunicable diseases, 2013-2020. Hodes R, Price I, Bungane N, Toska E, Cluver L (2017) How front-line healthcare workers respond to stock-outs of essential medicines in the Eastern Cape Province of South Africa. South African Medical Journal 107:738–740 Biljers Fanda R, Probandari A, Yuniar Y, Hendarwan H, Trisnantoro L, Jongeneel N, Kok MO (2024) The availability of essential medicines in primary health centres in Indonesia: achievements and challenges across the archipelago. Ebrahim AJ, Teni FS, Yimenu DK (2019) Unused and Expired Medications: Are They a Threat? A Facility-Based Cross-Sectional Study. J Prim Care Community Health. https://doi.org/10.1177/2150132719847857 Dhakal N, Gyanwali P, Humagain B, Bc R, Jha N, Sah P, Pradhan A, Dhimal M, Jha AK (2023) Assessment of quality of essential medicines in public health care facilities of Nepal: Findings of nationwide study. PLOS Global Public Health. https://doi.org/10.1371/journal.pgph.0001841 Adhikari B, Ranabhat K, Khanal P, Poudel M, Marahatta SB, Khanal S, Paudyal V, Shrestha S (2024) Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal. PLOS Global Public Health. https://doi.org/10.1371/journal.pgph.0003128 Additional Declarations No competing interests reported. Supplementary Files Supplementarydata1.docx Additional file 1. Table A1: Stock-out duration of the selected EMs in days within the last 12 months. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5051616","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":357514086,"identity":"ecc8063b-4913-4f95-8d8b-a096bebff05b","order_by":0,"name":"Janani Buddhika Rathnaweera Bopage","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAApElEQVRIiWNgGAWjYDACCR4GBp4KKOfBAaK1nIFyEojWwttGihbz2b3HJN7Os0lsYD/8gCHhDGEdDDJ3zqVJzt2WltjAk2bAkHCDGHdJ5JhJ8247nNjAkAN02AeitcwBauF/Q5KWBqAWCZAtRDlM5lyy5ZxjacZtEs8MDhDlfQnp3oM33tTYyPbzJz988OEYEVrggA2ID5CiYRSMglEwCkYBHgAAUig0sDAtAWIAAAAASUVORK5CYII=","orcid":"","institution":"The Open University of Sri Lanka","correspondingAuthor":true,"prefix":"","firstName":"Janani","middleName":"Buddhika Rathnaweera","lastName":"Bopage","suffix":""},{"id":357514087,"identity":"8a7b3d40-b729-4abd-b51c-d033f5a7e75a","order_by":1,"name":"Anura Abeysinghe Jayawardhana Yapa","email":"","orcid":"","institution":"District General Hospital Monaragala","correspondingAuthor":false,"prefix":"","firstName":"Anura","middleName":"Abeysinghe Jayawardhana","lastName":"Yapa","suffix":""},{"id":357514090,"identity":"a518cb58-47a7-4e7b-8b12-54882e371401","order_by":2,"name":"Nadeesha Dilmi Dias Wickramasinghe","email":"","orcid":"","institution":"The Open University of Sri Lanka","correspondingAuthor":false,"prefix":"","firstName":"Nadeesha","middleName":"Dilmi Dias","lastName":"Wickramasinghe","suffix":""},{"id":357514092,"identity":"26584589-c403-4ca5-969f-4cf5abebdbe7","order_by":3,"name":"Chinta Abayawardana","email":"","orcid":"","institution":"The Pharmaceutical Society of Sri Lanka, Sri Lanka","correspondingAuthor":false,"prefix":"","firstName":"Chinta","middleName":"","lastName":"Abayawardana","suffix":""},{"id":357514095,"identity":"2eab007d-9525-4525-9b19-c3db0871f018","order_by":4,"name":"Janitha Chandanie Manike Tennekoon","email":"","orcid":"","institution":"Provincial Director of Health Services","correspondingAuthor":false,"prefix":"","firstName":"Janitha","middleName":"Chandanie Manike","lastName":"Tennekoon","suffix":""},{"id":357514097,"identity":"603fb9fa-b14c-48e6-8646-4514db4f8398","order_by":5,"name":"Rohini Fernandopulle","email":"","orcid":"","institution":"General Sir John Kotelawala Defence University","correspondingAuthor":false,"prefix":"","firstName":"Rohini","middleName":"","lastName":"Fernandopulle","suffix":""}],"badges":[],"createdAt":"2024-09-08 07:55:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5051616/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5051616/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88311799,"identity":"3c720d32-2c20-4685-87dd-d67575efc07b","added_by":"auto","created_at":"2025-08-05 07:02:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1328264,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5051616/v1/23040d65-6a87-4479-8ac5-ffb4b767fe51.pdf"},{"id":66303815,"identity":"edf5b6fa-5a01-4626-8679-9c66c9263efa","added_by":"auto","created_at":"2024-10-10 06:54:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23253,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAdditional file 1. \u003c/strong\u003eTable A1: Stock-out duration of the selected EMs in days within the last 12 months.\u003c/p\u003e","description":"","filename":"Supplementarydata1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5051616/v1/42e46fb20628c0811fdf479a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Availability and Stock Levels of Essential Medicines in Government Healthcare Institutions of Different Settings in a Rural District in Sri Lanka: a multicentre cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eAccess to essential medicines (EMs) is a vital component of ensuring the right to health for all individuals, regardless of their socioeconomic status or geographical location. According to the World Health Organization (WHO), EMs are medicines designed to meet the top health requirements of the population. They should always be accessible in functional health systems, in appropriate dosage forms and quantities, with assured quality, and at a cost that people in the community and individuals can afford. The WHO updates and publishes Model Lists of EMs and EMs for Children biannually. These lists act as resources for countries or regional organizations to adopt or modify their EM lists to comply with regional treatment recommendations and priorities for health [1]. There are 137 national lists of EMs available worldwide, each containing between 44 and 983 medicines, which is partly explained by differences in the characteristics of the country [2].\u003c/p\u003e\n\u003cp\u003eThe National Essential Medicines List (EML) of Sri Lanka, 5\u003csup\u003eth\u003c/sup\u003e edition [3], classifies government healthcare institutions (GHCIs) of Sri Lanka into 4 categories: level 1 (primary medical care units), level 2 (divisional hospitals), level 3 (district base hospitals and district general hospitals) and level 4 (provincial general hospitals and teaching hospitals).\u0026nbsp;The national EML of Sri Lanka has listed 318 medicines for 29 major disease categories. The medicine information includes the medication name, strength, dosage forms, and the international non-proprietary name of the active ingredient, together with the recommended level of care [3].\u003c/p\u003e\n\u003cp\u003eOne of the most essential elements of quality healthcare services is the availability of EMs, since their continuous availability guarantees that patients have access to health services without interruption [4]. Even a slight shortage of EMs can significantly affect the delivery of high-quality health care. Stockouts are an important indicator of the preparedness of healthcare services since clinics cannot operate continually without dependable and adequate access to critical medications [5]. Effective record-keeping of pharmaceuticals ensures efficient management of stock status and consumption data. The logistics management information system (LMIS) is crucial in effective record keeping. Hospitals maintain either manual or electronic records of pharmaceuticals [6].\u003c/p\u003e\n\u003cp\u003eMost medicines lose efficacy after their expiry date, and some may develop different adverse reactions. All expired pharmaceuticals should always be considered pharmaceutical waste and should never be used as expired medicines become unsafe for use [7]. The presence of expired medicines on pharmacy shelves, the appropriateness of handling, and conservation conditions are used as indicators of the quality usage of medicines [8].\u003c/p\u003e\n\u003cp\u003eThe Sri Lankan government provides free health care to all citizens at the point of delivery. However, certain expensive medical supplies might be purchased by patients when they are unavailable in government hospitals, which creates a financial burden for low–income patients [9]. Monitoring and evaluating the pharmaceutical sector is vital for determining whether the main pharmaceutical aims are met. The WHO operational package for assessing, monitoring, and evaluating country pharmaceutical situations\u0026nbsp;(WHO-OP) [8]\u0026nbsp;provides a standard method to analyse and track progress over time and compare pharmaceutical situations in different facilities, districts, and nations.\u003c/p\u003e\n\u003cp\u003eA few studies have been carried out on the accessibility and cost of medicines in Sri Lanka, focusing on specific demographic areas or particular categories of medicines[10–12]. To our knowledge, this is one of the first studies to evaluate different pharmaceutical parameters at different levels of GHCIs in Sri Lanka. This study was conducted to assess the availability, stock-out periods, record-keeping, presence of expired medicines, and conservation and handling of selected EMs across different levels of GHCIs in Monaragala, a rural district in Sri Lanka.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and study setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive, cross-sectional study was conducted from May to June 2023 in Monaragala District, Sri Lanka. Retrospective data\u0026nbsp;were\u0026nbsp;used whenever necessary. Monaragala district is situated in the\u0026nbsp;east\u0026nbsp;and\u0026nbsp;southeast\u0026nbsp;directions of Uva\u0026nbsp;province, Sri Lanka. The total area is 5959 km\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e and it is the second-largest district in Sri Lanka [13]. Agriculture is the main\u0026nbsp;type of\u0026nbsp;employment for 51.4% of the population [14].\u003c/p\u003e\n\u003cp\u003eAll\u0026nbsp;GHCIs\u0026nbsp;in Monaragala district in Sri Lanka were considered as the population. The\u0026nbsp;Monaragala district has 6 different types of GHCIs belonging to 4 levels of care as defined by\u0026nbsp;the National\u0026nbsp;EML. One government healthcare institution\u0026nbsp;of\u0026nbsp;each\u0026nbsp;type was selected conveniently.\u0026nbsp;The selected\u0026nbsp;GHCIs are shown in Table 01.\u0026nbsp;The identities\u0026nbsp;of all the selected GHCIs were kept confidential.\u0026nbsp;The outpatient department (OPD) dispensaries and the clinic pharmacies of the selected GHCIs were visited once for data collection. The presence of expired medicines at GHCIs was determined by randomly examining the expiration dates of each of the 44 medicines investigated in this study. To determine the one-year stock-out period, stock registers were checked for the last 12 months\u0026nbsp;(from\u0026nbsp;the\u0026nbsp;01\u003csup\u003est\u003c/sup\u003e of May 2022 to\u0026nbsp;the\u0026nbsp;30\u003csup\u003eth\u003c/sup\u003e of\u0026nbsp;April 2023).\u0026nbsp;Indoor pharmacies supplying medicines to wards and the Emergency Treatment Units (ETUs) of selected GHCIs, private sector healthcare facilities, retail pharmacies, and polyclinics were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Classification of selected GHCIs according to the National EML-Sri Lanka\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevels of care as per National EML\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No. of GHCIs available in the district\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType selected of GHCI for the study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of Beds at the selected GHCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eLevel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003ePrimary Medical Care Unit (PMCU)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eLevel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003eDivisional Hospital -Type A (DH -A)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003eDivisional Hospital -Type B (DH -B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003eDivisional Hospital -Type C (DH -C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eLevel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003eBase Hospital -Type B (BH -B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eLevel 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003eDistrict General Hospital (DGH)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e579\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eStudy\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einstrument\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected via survey forms adapted from the WHO Operational Package for assessing, monitoring, and evaluating country pharmaceutical situations (WHO-OP)\u0026nbsp;on\u0026nbsp;the basis of availability, average stock-out duration, adequacy of conservation conditions (level of storage facilities), and adequacy of record-keeping of the selected EMs. The\u0026nbsp;WHO-OP recommends\u0026nbsp;the selection of\u0026nbsp;15 key medicines for the assessment.\u0026nbsp;The National EML Sri Lanka has been prescribed to make more than one dosage form or different strengths of the same medicine for EMs available.\u0026nbsp;In this study, 44\u0026nbsp;EMs used to treat 23 diseases, including both communicable diseases (CDs) and noncommunicable diseases (NCDs), were selected from the National EML 5\u003csup\u003eth\u003c/sup\u003e edition published in 2014. Each dosage form of medicine was considered as a separate entity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analysed according to the WHO-OP [8]. The data were presented as percentages and averages. The number of medicines entitled to be available at particular GHCIs was taken as the denominator when analysing the data. The availability of the selected EMs was reported based on previous national and international surveys; \u0026lt;30%: very low; 30-49%: low; 50-80%: fairly high; and \u0026gt;80%: high [10, 15].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eAvailability of EMs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall\u0026nbsp;availability of selected EMs in the GHCIs in Monaragala district was \u0026ldquo;fairly high\u0026rdquo; (77.1%), which varied from \u0026ldquo;fairly high\u0026rdquo; (75%) at DH-B to \u0026ldquo;high\u0026rdquo; (80.49%) (Table 2).\u0026nbsp;Only DH-A was reported to have expired medicines on the shelves during the survey period, and the product was \u0026ldquo;iron drops 100 mg/5 mL, in 15 mL droppers\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eAll the selected EMs were available at all GHCIs for the disease categories of gastritis/gastric ulcers, nausea/vomiting, skin infection, eye infection, vertigo, diabetes, and angina. Beclomethasone, which is prescribed for the management of asthma, is prioritized to be available at all levels of care (levels 1, 2, 3, and 4) in the dosage forms of dry powder capsules (DPCs) (200 mcg) and metered dose inhalers (MDIs) (50 mcg, 100 mcg, and 250 mcg). However, \u0026nbsp; the mentioned dosage forms or strength were not available at DGH on the day of the visit. This may be due to the high number of patients attending the DGH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Summary of the availability of EMs on the day of the visit, record keeping, and percentage of expired medicines at GHCIs in the Monaragala district\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"670\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7313%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDGH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBH -B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDH -A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDH -B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDH -C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePMCU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7313%;\"\u003e\n \u003cp\u003eNumber of entitled medicines in selected list\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7313%;\"\u003e\n \u003cp\u003eNumber of entitled medicines at the time of visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7313%;\"\u003e\n \u003cp\u003eNumber of entitled medicines with adequate records\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7313%;\"\u003e\n \u003cp\u003ePercentage (%) of availability for entitled medicines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e77.27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e77.27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e78.05%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e80.49%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e73.17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e76.32%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7313%;\"\u003e\n \u003cp\u003ePercentage (%) of medicines expired on shelves (entitled mediciness)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e2.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7313%;\"\u003e\n \u003cp\u003ePercentage (%) of \u0026nbsp;record keeping for entitled medicines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e97.73%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e80.49%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7313%;\"\u003e\n \u003cp\u003eAverage number of stock-out days for entitled medicines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e56.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e23.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e46.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e27.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e65.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0448%;\"\u003e\n \u003cp\u003e54.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eDGH\u003c/em\u003e District General Hospital; \u003cem\u003eBH-B\u003c/em\u003e Base Hospital-Type B; \u003cem\u003eDH-A\u003c/em\u003e Divisional Hospital-Type A; \u003cem\u003eDH-B\u003c/em\u003e Divisional Hospital-Type B\u003cem\u003e; DH-C\u003c/em\u003e Divisional Hospital-Type C\u003cem\u003e;\u003c/em\u003e\u003cem\u003e\u0026nbsp;PMCU:\u0026nbsp;\u003c/em\u003ePrimary Medical Care Units\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecord-keeping\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the GHCIs maintained record-keeping practices of more than 80%. Except for DGH and DH-A, all the other four GHCIs in this study reported 100% record keeping. DGH was reported for not keeping records for beclomethasone DPC 200 mg. DH-A was reported as not keeping records for 8 medicines; beclomethasone MDI 50 mcg 200 doses, beclomethasone MDI 250 mg 200 doses, domperidone tab. 10 mg, folic acid tab. 1 mg, ciprofloxacin eardrops 0.3%, fluoxetine tab. 5mg, olanzapine tab. 5 mg, and carbamazepine tab. 200 mg.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Availability of selected EMs during the day of visit at selected GHCIs in Monaragala district -2023\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKey medicine to treat common conditions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEMs entitled levels of GHCIs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDGH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBH -B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDH -A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDH -B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDH -C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePMCU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col\u003e\n \u003cli\u003e\u003cstrong\u003eAnti-thrombotic (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eAspirin tab. 75 mg, 100 mg, 150 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"2\"\u003e\n \u003cli\u003e\u003cstrong\u003eRheumatoid diseases (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eDiclofenac sodium tab. 50 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eParacetamol tab. 500 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eParacetamol oral liquid 120 mg/5 mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"3\"\u003e\n \u003cli\u003e\u003cstrong\u003eWorm infestation (CD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eMebendazole tab. 100 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"4\"\u003e\n \u003cli\u003e\u003cstrong\u003eRespiratory tract infections (CD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eAmoxicillin cap. 250 mg, 500 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eAmoxicillin oral susp. 125 mg/5 mL,100 mL bot.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"5\"\u003e\n \u003cli\u003e\u003cstrong\u003eCommon colds, rhinitis (CD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eChlorpheniramine \u0026nbsp;maleate tab. 4 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eChlorpheniramine oral solu. 2 mg/5 mL, 60 mL bot.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"6\"\u003e\n \u003cli\u003e\u003cstrong\u003eAsthma (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eSalbutamol tab. 2 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eSalbutamol MDI 100 mcg, 50 mcg per dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eIpratropium bromide \u0026nbsp;MDI 20 mcg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eIpratropium bromide DPC 20 mcg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eBeclomethasone DPC 200 mcg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eBeclomethasone MDI 50 mcg, 200 doses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eBeclomethasone MDI 100 mcg, 200 doses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eBeclomethasone MDI 250 mcg, 200 doses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003ePrednisolone tab. 5 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"7\"\u003e\n \u003cli\u003e\u003cstrong\u003eDiarrhoea (CD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eOral Rehydration Salt (ORS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"8\"\u003e\n \u003cli\u003e\u003cstrong\u003eGastritis/GI ulcers (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eOmeprazole cap. 20 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"9\"\u003e\n \u003cli\u003e\u003cstrong\u003eNausea, Vomiting (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eDomperidone tab. 10 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eDomperidone syrup 5 mg/5 mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"10\"\u003e\n \u003cli\u003e\u003cstrong\u003eUrinary Tract Infection (CD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eNitrofurantoin tab. 50 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"11\"\u003e\n \u003cli\u003e\u003cstrong\u003eSkin infection (CD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eMiconazole cream 2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"12\"\u003e\n \u003cli\u003e\u003cstrong\u003eInflamation and pruritus (CD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eHydrocortisone cream or ointment 1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"13\"\u003e\n \u003cli\u003e\u003cstrong\u003eAnemia (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eFerrous sulfate tab. 200 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eFolic acid tab. 1 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eIron drops 100 mg/5 mL, in 15 mL dropper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eIron syr. 25 mg/mL bot.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"14\"\u003e\n \u003cli\u003e\u003cstrong\u003eEye infections (CD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eCiprofloxacin eye drops 0.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"15\"\u003e\n \u003cli\u003e\u003cstrong\u003eEar infections (CD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eCiprofloxacin ear drops 0.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"16\"\u003e\n \u003cli\u003e\u003cstrong\u003eVertigo (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eProchlorperazine tab. 5 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"17\"\u003e\n \u003cli\u003e\u003cstrong\u003eDiabetics (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eMetformin tab. 500 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"18\"\u003e\n \u003cli\u003e\u003cstrong\u003eHypertension (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eNifedipine tab. 20 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eEnalapril tab. 5 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eHydrocholorothiazide tab. 25 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"19\"\u003e\n \u003cli\u003e\u003cstrong\u003eAngina (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eGlyceryl trinitrate tab. (sublingual) 500 mcg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"20\"\u003e\n \u003cli\u003e\u003cstrong\u003eHeart Failure (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eSpironolactone tab. 25 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"21\"\u003e\n \u003cli\u003e\u003cstrong\u003eAnti-coagulant (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eWarfarin tab. 0.5 mg, 1 mg, 3 mg, 5 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"22\"\u003e\n \u003cli\u003e\u003cstrong\u003ePsychosis (NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eFluoxetine cap. 20 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eOlanzapine tab. 5 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003col start=\"23\"\u003e\n \u003cli\u003e\u003cstrong\u003eEpilepsy \u0026nbsp;(NCD)\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eSodium valproate tab. 100 mg, 200 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eSodium valproate syrup 200 mg/5 mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.0405%;\"\u003e\n \u003cp\u003eCarbamazepine tab. 200 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2399%;\"\u003e\n \u003cp\u003e1, 2, 3, 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.32087%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.85358%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78816%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.919%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe duplication of medicines in multiple disease categories of the national EML, Sri Lanka, was excluded from the calculation of availability (%). \u003cem\u003eDGH\u003c/em\u003e District General Hospital, \u003cem\u003eBH-B\u003c/em\u003e Base Hospital-Type B, \u003cem\u003eDH-A\u003c/em\u003e Divisional Hospital-Type A, \u003cem\u003eDH-B\u003c/em\u003e Divisional Hospital-Type B\u003cem\u003e, DH-C\u003c/em\u003e Divisional Hospital-Type C\u003cem\u003e, PMCU\u0026nbsp;\u003c/em\u003ePrimary Medical Care Units, \u003cem\u003eCD\u003c/em\u003e Communicable Diseases, \u003cem\u003eNCD\u003c/em\u003e Noncommunicable Diseases, \u003cem\u003eMDI\u003c/em\u003e Metered Dose Inhaler, \u003cem\u003eDPC\u003c/em\u003e Dry Powder Capsules\u003c/p\u003e\n\u003cp\u003eYes - \u003cem\u003eMedicine was present on the day of the visit,\u003c/em\u003e No - \u003cem\u003eMedicine was not present on the day of the visit\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e* Available on the day of visit even though not entitled to present at the GHCIs as per the national EML.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Summary of scores for conservation conditions and the handling of medicines at GHCIs from Monaragala district-2023\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"661\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDGH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBH-B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDH-A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDH-B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDH-C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.95475%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePMCU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eAdequacy of conservation conditions and good handling of medicines at storerooms (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.95475%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eAdequacy of conservation conditions and handling of medicines at dispensing facilities (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.95475%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59728%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eDGH\u003c/em\u003e District General Hospital, \u003cem\u003eBH-B\u003c/em\u003e Base Hospital-Type B, \u003cem\u003eDH-A\u003c/em\u003e Divisional Hospital-Type A, \u003cem\u003eDH-B\u003c/em\u003e Divisional Hospital-Type B\u003cem\u003e, DH-C\u003c/em\u003e Divisional Hospital-Type C\u003cem\u003e, PMCU\u0026nbsp;\u003c/em\u003ePrimary Medical Care Units\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStock-out duration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOver the last 12 months, the highest average stock-out duration was reported as 66 days at DH-C, whereas DGH, PMCU, DH-A, DH-B, and BH-B were reported as 57, 55, 47, 28, and 24 days, respectively. Among the stock-out medicines at DH-C, beclomethasone MDI 50 mcg, iron drops 100 mg/5 mL, in a 15 mL dropper, iron syr. 25 mg/mL in bot., ciprofloxacin ear drops 0.3%, and sodium valproate syr. of 200 mg/5 mL were reported for the longest stockout period, with 365 days. At DH-A, sodium valproate syr. 200 mg/5 mL, iron syr. 25 mg/mL bot. and spironolactone (tab. 25 mg) were reported to have a stock-out duration of more than 320 days. At DGH, only the beclomethasone MDI 50 mcg, 200 dose was reported for a stock-out duration of more than 300 days, whereas the PMCU reported stock-out per year for the beclomethasone MDI 50 mcg, 200 dose, and iron syr. 25 mg/mL bot., spironolactone (tab. 25 mg), and a fluoxetine cap. 20 mg for 365 days. DH-B reported for nifedipine tab. 20 mg and beclomethasone MDI 50 mcg, 200 doses stocking out for more than 150 days. (Additional file 1: Table A1: Stock-out duration of the selected EMs in days within the last 12 months)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInventory management practices at GHCIs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExcept for\u0026nbsp;DH-A, all\u0026nbsp;the\u0026nbsp;other GHCIs scored 80 marks for the conservation conditions at dispensing areas, whereas\u0026nbsp;DH-A scored 50 marks. DH-B, BH-B, and DH-C scored 90, 90, and 100 marks,\u0026nbsp;respectively,\u0026nbsp;for conservation conditions at\u0026nbsp;storage\u0026nbsp;rooms in the GHCIs,\u0026nbsp;whereas\u0026nbsp;the\u0026nbsp;other\u0026nbsp;three GHCIs scored 60 or 50 scores.\u003c/p\u003e\n\u003cp\u003eAll the storerooms and dispensing areas were free from moisture, and no evidence of pests in the areas was found. Except for DH-A, in all the storage rooms and dispensing areas of the investigated GHCIs, medicines were stored first-expiry-first out (FEFO) principle, and windows or air vents were present. However, tablets/capsules were reported to be manipulated by the naked hand at the dispensing areas of all the GHCIs. Only the storerooms in DGH were reported to have direct sunlight in the room. Overall, the storage rooms and dispensing areas of the GHCIs scored 50 or more than 50 out of 100 for the conservation of medicines.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eAvailability of medicines\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the WHO definition, EMs should exist within operating healthcare institutions at all times [1].\u0026nbsp;The availability of EMs mostly influences the quality of healthcare and patient satisfaction. The average availability of the selected EMs in Monaragala district was “fairly high” (77.1%), even though the country was facing an economic crisis. The availability was “high” at DH-B and “fairly high” at\u0026nbsp;other\u0026nbsp;GHCIs. A study conducted in another rural district in Sri Lanka revealed that “high” availability for EMs was reported only at the district hospital,\u0026nbsp;whereas\u0026nbsp;the base hospital and the PMCUs reported “fairly high” availability [16]. Another study conducted in Sri Lanka\u0026nbsp;reported\u0026nbsp;that the availability of selected EMs used\u0026nbsp;for noncommunicable\u0026nbsp;diseases were 36.4% and \u0026gt;50% for primary and secondary levels of care,\u0026nbsp;respectively,\u0026nbsp;with\u0026nbsp;a\u0026nbsp;mean availability\u0026nbsp;of\u0026nbsp;58% (±0.32) in the public sector [10]. In this study, the availability of selected EMs for the secondary and tertiary care levels was reported as 77%. The secondary care level includes a few basic specialties,\u0026nbsp;and the tertiary care level includes some\u0026nbsp;subspecialties. The\u0026nbsp;greater\u0026nbsp;number of patients served by secondary-\u0026nbsp;and tertiary-level healthcare facilities might be the reason for the unavailability of some of the EMs. However,\u0026nbsp;73% or greater availability of EMs in Monaragala district was reported for\u0026nbsp;all the primary, secondary, and tertiary GHCIs considered in this study. Monaragala,\u0026nbsp;a rural district with a high availability of EMs,\u0026nbsp;is notable.\u003c/p\u003e\n\u003cp\u003eStudies conducted in other lower-middle-income countries (LMICs),\u0026nbsp;such as Nepal [17], Pakistan [18], Malawi, and Bangladesh [19],\u0026nbsp;have reported poor availability of EMs of less than 50%. A study conducted at 6 healthcare centers in Adama Town, Ethiopia,\u0026nbsp;on 11 EMs reported an overall average availability of 76.3% [20].\u0026nbsp;Another\u0026nbsp;study conducted in Iran [4], an LMIC,\u0026nbsp;reported\u0026nbsp;that 97.5% of 15 key medications were available in various cities, as well as\u0026nbsp;in\u0026nbsp;state and commercial pharmacies, with no significant variation [21].\u0026nbsp;The\u0026nbsp;WHO affirms that the appropriate level of availability for essential medications is at least 80% [22].\u0026nbsp;Monaragla district\u0026nbsp;accounted for\u0026nbsp;77.1%\u0026nbsp;of all districts,\u0026nbsp;which is closer to the WHO recommended level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecord-keeping\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study\u0026nbsp;revealed\u0026nbsp;higher percentages (\u0026gt; 80%)\u0026nbsp;of\u0026nbsp;record-keeping of EMs,\u0026nbsp;possibly\u0026nbsp;because almost all the GHCIs were supported by\u0026nbsp;the\u0026nbsp;computerized Medical Supplies Management Information System (MSMIS) provided by the Medical Supplies Division (MSD) of the Ministry of Health.\u0026nbsp;A study conducted in six healthcare centers in Adama town in Ethiopia assessed the accuracy of record keeping\u0026nbsp;via\u0026nbsp;inventory management assessment tool (IMAT) indicators and reported low accuracy of records [20].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStock-out duration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStock-outs arise from an inability to manage medical supplies, report shortages, and act swiftly and effectively to prevent their recurrence. The stock-out duration of essential medicines is an important measure\u0026nbsp;for\u0026nbsp;ensuring the availability of EMs [23]. The average stock-out\u0026nbsp;durations\u0026nbsp;assessed during the last 12 months in this study\u0026nbsp;were\u0026nbsp;reported as 65, 57, 55, 47, 28, and 24 days for DH-C, DGH, PMCU, DH-A, DH-B, and BH-B,\u0026nbsp;respectively. A study conducted at two government healthcare centers in\u0026nbsp;Northwest\u0026nbsp;Ethiopia reported\u0026nbsp;that\u0026nbsp;the average stock-out\u0026nbsp;durations\u0026nbsp;in the last 6-month period\u0026nbsp;were\u0026nbsp;38.8 days and 11.2 days [4]. Another study conducted in Adama Town, Ethiopia, reported\u0026nbsp;that the average length of stock-out days for 11 EMs from 5 healthcare\u0026nbsp;centers\u0026nbsp;throughout the past 12 months was 40.6 days [20].\u003c/p\u003e\n\u003cp\u003eParacetamol oral liquid 120 mg/5 mL),\u0026nbsp;amoxicillin capsules\u0026nbsp;(250 mg, 500 mg),\u0026nbsp;amoxicillin oral suspension 125 mg/5 mL, 100 mL),\u0026nbsp;beclomethasone MDI\u0026nbsp;(100 mcg, 200 doses),\u0026nbsp;hydrocortisone cream 1%;\u0026nbsp;and\u0026nbsp;ciprofloxacin eye drops 0.3% were stock out at the day of visit and in the last 12 months at all GHCIs. This may be due to the high consumption of these medicines at the GHCIs. Studies conducted in Ethiopia reported that ferrous salt + folic acid (150 mg + 0.5 mg), ORS, and amoxicillin syrup 125 mg/5 mL are the\u0026nbsp;medicines\u0026nbsp;most frequently\u0026nbsp;stocked\u0026nbsp;out [4, 20].\u003c/p\u003e\n\u003cp\u003eA shortage of EMs may increase the burden on healthcare staff, as patients may need to make additional visits and referrals. Patients might choose not to take medications that are out of stock\u0026nbsp;owing\u0026nbsp;to unavailability or financial constraints. These stockouts may result from long-distance transportation from suppliers during the procurement process, unavailability of medications from suppliers, or high consumption in the absence of an efficient supply system [4, 20]. A study conducted in 9831 primary healthcare centers in Indonesia reported\u003c/p\u003e\n\u003cp\u003ea lack of necessity was the primary reason for stockouts accounting for 46% of the stock-outs, whereas 38% of the stock-outs were due to medicines not being supplied to healthcare facilities [24].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePresence of expired medicines\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly iron drops of 100 mg/5 mL in 15 mL were reported to present as expired medicines on the shelves during the survey period, as reported by DH-A. A study conducted in Nepal assessing the availability, stockouts, and expiry of 17 EMs in 28 peripheral healthcare facilities (below the district level) reported an average of 3% for the presence of expired medicines at the levels of health posts and subhealth posts. At least 9 out of 17 medicines (52.9% of total medicines) included in that study were found to have expired in at least one health facility at the time of visit\u0026nbsp;[17]. Iran\u0026nbsp;reported\u0026nbsp;only 1% for the presence of expired medicines among public health care facilities,\u0026nbsp;which was reported only at one public pharmacy out of\u0026nbsp;the\u0026nbsp;6 public pharmacies considered in the study [21]. A study conducted at 4 health facilities\u0026nbsp;in the\u0026nbsp;Awi zone, Amhara regional state, Ethiopia,\u0026nbsp;reported that 8.1% of the medications out of 173 medications were reported as expired medicines [25].\u003c/p\u003e\n\u003cp\u003eThe absence\u0026nbsp;of expired medicines, adherence to the standard storage conditions at the dispensing facilities,\u0026nbsp;proper conditions, and standard handling of medicines in storerooms are used as indicators to assess the quality use of the medicines as defined by the WHO [8].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInventory management practices at GHCIs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe average value for conservation conditions and good handling of medicines at both storerooms and dispensing facilities was reported as 75%. This\u0026nbsp;percentage\u0026nbsp;varied from 100% to 50% for storeroom conditions and 80% to 50% for the dispensing area, whereas\u0026nbsp;DH-B reported the highest scores for both the storeroom area and the dispensing area.\u0026nbsp;A study conducted in 5 cities in Iran reported\u0026nbsp;scores of\u0026nbsp;more than 75% by all 5 public health care centers for\u0026nbsp;the\u0026nbsp;adequacy of conservation conditions and\u0026nbsp;the\u0026nbsp;handling of medicines in the storeroom area and the dispensing area [21]. A study conducted in 62 government health facilities across 21 districts of Nepal reported that only 13% of health facilities followed medicine storage guidelines and reported\u0026nbsp;that\u0026nbsp;temperature and humidity levels\u0026nbsp;exceeded\u0026nbsp;recommended limits [26]. A study conducted in Nepal identified delays in the procurement process as the major barrier to the effective management of essential medicines [27].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study investigated only selected EMs, but examining all the EMs in the GHCIs would be of greater value. This study investigated only the availability, stock-out duration, and storage conditions at six GHCIs in the Monaragala district. Assessing the situation at other healthcare facilities in the district would be more representative. This research included only oral and topical medicines, and parenteral medications were excluded. Moreover, the study did not examine any of the factors that affect the availability of EMs in healthcare institutions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDespite the economic crisis faced by Sri Lanka during 2023, the selected GHCIs in \u0026nbsp;Monaragala district presented fairly high availability of selected EMs, indicating that free state health services were given priority when funds were allocated. However, certain areas, such as storage conditions, should be improved at all GHCIs. Even though this study revealed a minimal occurrence of expired medicines, consistent monitoring of healthcare facilities and enhancing the medicine supply system would ensure the availability of EMs and an uninterrupted supply of medicines to patients.\u003c/p\u003e"},{"header":" Abbreviations","content":"\u003cp\u003eEMs: Essential Medicine; WHO: World Health Organization;\u0026nbsp;EML:\u0026nbsp;Essential Medicine List; GHCIs: Government Healthcare Institutions;\u0026nbsp;LMIS: Logistics Management Information System;\u0026nbsp;OPD:\u0026nbsp;Outpatient Department; ETUs:\u0026nbsp;Emergency Treatment Units; WHO-OP: WHO Operational Package for assessing, monitoring, and evaluating country pharmaceutical situations; CD:\u0026nbsp;Communicable Diseases; NCD:\u0026nbsp;Non-Communicable Diseases;\u0026nbsp;MDI: Metered Dose Inhaler; DPC: Dry Powder Capsules;\u0026nbsp;DGH: District General Hospital; BH-B: Base Hospital-Type B; DH-A: Divisional Hospital-Type A; DH-B: Divisional Hospital-Type B; DH-C: Divisional Hospital-Type C; PMCU: Primary Medical Care Units; FEFO: First-Expiry-First Out; LMICs: Lower-Middle-Income Countries; ORS: Oral Rehydration Salt\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eInformed consent:\u003c/strong\u003e Since patient-related information was not collected in this study, informed consent was not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Review Committee of the Open University of Sri Lanka approved the study (FH/ERC/033).\u0026nbsp;Administrative approval was\u0026nbsp;obtained from the Provincial Director of Health Services, Uva\u0026nbsp;Province;\u0026nbsp;the Regional Director of Health Services, Monaragala\u0026nbsp;District;\u0026nbsp;and the heads of the relevant institutions.\u0026nbsp;All\u0026nbsp;methods were performed following relevant guidelines and regulations. The data were kept confidential and\u0026nbsp;were\u0026nbsp;only used for the intended purpose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe consent to publish the information gathered from the GHCIs was obtained from the Provincial Director of Health Sciences. The data are reported in a way that it will not be possible to identify the individual institutions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe online version contains supplementary material available on the publishing website.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was self-funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRBJB conceived the idea of the study,\u0026nbsp;and all\u0026nbsp;the\u0026nbsp;authors participated in designing the study. AAJY was involved in the data collection. AAJY, RBJB, NDDW, CA, JCMT, and RF were involved in the analysis and interpretation of\u0026nbsp;the\u0026nbsp;data. RBJB, AAJY, and NDDW drafted the manuscript,\u0026nbsp;and AAJY, RBJB,\u0026nbsp;NDDW, CA, JCMT, and RF critically revised it. All\u0026nbsp;the\u0026nbsp;authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to health professionals working in GCHIs in Monaragala district for their cooperation during data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Pharmacy, Faculty of Health Sciences, The Open University of Sri Lanka, Nugegoda, Sri Lanka, \u003csup\u003e2\u003c/sup\u003eDistrict General Hospital, Monaragala, Sri Lanka, \u003csup\u003e3\u003c/sup\u003eThe Pharmaceutical Society of Sri Lanka, Colombo, Sri Lanka, \u003csup\u003e4\u003c/sup\u003eProvincial Director of Health Services, Badulla, Uva Province, Sri Lanka, \u003csup\u003e5\u003c/sup\u003eFaculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization (2023) WHO EML 23rd List (2023).\u003c/li\u003e\n \u003cli\u003ePersaud N, Jiang M, Shaikh R, et al (2019) Comparison of essential medicines lists in 137 countries. Bull World Health Organ 97:394-404C\u003c/li\u003e\n \u003cli\u003eMinistry of Health Sri Lanka (2014) National List of Essential Medicines Sri Lanka 2013-2014 Fifth Revision. 28\u003c/li\u003e\n \u003cli\u003eTefera BB, Tafere C, Yehualaw A, Mebratu E, Chanie Y, Ayele S, Adane S (2022) Availability and stock-out duration of essential medicines in Shegaw Motta general hospital and Motta Health Centre, North West Ethiopia. PLoS One 17:1\u0026ndash;10\u003c/li\u003e\n \u003cli\u003eWagenaar BH, Gimbel S, Hoek R, et al (2014) Stock-outs of essential health products in Mozambique - longitudinal analyses from 2011 to 2013. Trop Med Int Health 19:791\u0026ndash;801\u003c/li\u003e\n \u003cli\u003eMekonnen BA, Worku MC, Tefera BB (2024) Evaluation of logistics management information system and availability of nonprogram tracer drugs in public health facilities in Bahir Dar City, Northwest Ethiopia. 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Indian J Pediatr 81:362\u0026ndash;367\u003c/li\u003e\n \u003cli\u003eDistrict Secretariat- Monaragala (2022) Annual Performance Report- Monaragala District.\u003c/li\u003e\n \u003cli\u003eDepartment of Census and Statistics, Ministry of Finance ES and NP (2022) Sri Lanka Labour Force Survey- Annual Bulletin.\u003c/li\u003e\n \u003cli\u003eGelders S, Ewen M, Noguchi N, Laing R (2006) Price, availability and affordability An international comparison of chronic disease medicines.\u003c/li\u003e\n \u003cli\u003eRathish D, Premarathna I, Jayathilake T, Kandegedara C, Punchihewa K, Ananda L, Bandara T, Jayasumana C, Siribaddana S (2017) Availability of essential medicines in selected public, primary and secondary health care institutions of a rural Sri Lankan district: A spot survey. BMC Health Serv Res 17:1\u0026ndash;9\u003c/li\u003e\n \u003cli\u003eShiva Raj Adhikari, Achyut Raj Pandey, Mamata Ghimire, Arjun Kumar Thapa, Dinesh Kumar Lamsal (2018) Universal Access to Essential Medicines: An Evaluation of Nepal\u0026rsquo;s Free Health Care Scheme. J Nepal Health Res Counc 16:36\u0026ndash;42\u003c/li\u003e\n \u003cli\u003eSaeed A, Saeed H, Saleem Z, Fang Y, Babar ZUD (2019) Evaluation of prices, availability and affordability of essential medicines in Lahore Division, Pakistan: A cross-sectional survey using WHO/HAI methodology. PLoS One. https://doi.org/10.1371/journal.pone.0216122\u003c/li\u003e\n \u003cli\u003eMendis S, Fukino K, Cameron A, Laing R, Filipe A, Khatib O, Leowski J, Ewen M (2007) The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull World Health Organ 85:279\u0026ndash;288\u003c/li\u003e\n \u003cli\u003eKefale AT, Shebo HH (2019) Availability of essential medicines and pharmaceutical inventory management practice at health centers of Adama town, Ethiopia. BMC Health Serv Res 19:1\u0026ndash;7\u003c/li\u003e\n \u003cli\u003eMinaei H, Peikanpour M, Yousefi N, Peymani P, Peiravian F, Shobeiri N, Majd ZK, Shamsaee J (2019) Country pharmaceutical situation on access, quality, and rational use of medicines: An evidence from a middle-income country. Iranian Journal of Pharmaceutical Research 18:2191\u0026ndash;2203\u003c/li\u003e\n \u003cli\u003eWorld Health Organization (2013) Global action plan for the prevention and control of noncommunicable diseases, 2013-2020.\u003c/li\u003e\n \u003cli\u003eHodes R, Price I, Bungane N, Toska E, Cluver L (2017) How front-line healthcare workers respond to stock-outs of essential medicines in the Eastern Cape Province of South Africa. South African Medical Journal 107:738\u0026ndash;740\u003c/li\u003e\n \u003cli\u003eBiljers Fanda R, Probandari A, Yuniar Y, Hendarwan H, Trisnantoro L, Jongeneel N, Kok MO (2024) The availability of essential medicines in primary health centres in Indonesia: achievements and challenges across the archipelago.\u003c/li\u003e\n \u003cli\u003eEbrahim AJ, Teni FS, Yimenu DK (2019) Unused and Expired Medications: Are They a Threat? A Facility-Based Cross-Sectional Study. J Prim Care Community Health. https://doi.org/10.1177/2150132719847857\u003c/li\u003e\n \u003cli\u003eDhakal N, Gyanwali P, Humagain B, Bc R, Jha N, Sah P, Pradhan A, Dhimal M, Jha AK (2023) Assessment of quality of essential medicines in public health care facilities of Nepal: Findings of nationwide study. PLOS Global Public Health. https://doi.org/10.1371/journal.pgph.0001841\u003c/li\u003e\n \u003cli\u003eAdhikari B, Ranabhat K, Khanal P, Poudel M, Marahatta SB, Khanal S, Paudyal V, Shrestha S (2024) Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal. PLOS Global Public Health. https://doi.org/10.1371/journal.pgph.0003128\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Essential medicines, availability, stock-out, storage facilities, record keeping","lastPublishedDoi":"10.21203/rs.3.rs-5051616/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5051616/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The availability of essential medicines (EMs) is an important aspect of quality healthcare services. This study aimed to assess the availability, stock-out periods, record-keeping, presence of expired medicines, and conservation and handling of selected EMs across different levels of Government Healthcare Institutions (GHCIs) in Monaragala, one of the rural districts in Sri Lanka.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A descriptive, cross-sectional study was conducted, with retrospective data collection methods where necessary. Six GHCIs representing four different levels of care were selected in Monaragala District, Sri Lanka. EMs for 23 diseases were selected from the National Essential Medicine List (EML) of Sri Lanka. Data was collected using survey forms adapted from the WHO operational package for assessing, monitoring, and evaluating country pharmaceutical situations (WHO-OP). Ethics review approval was obtained from the Ethics Review Committee, the Open University of Sri Lanka, and institutional permissions were obtained from the relevant authorities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The average availability of selected EMs was fairly high (77.1%) in the Monaragala district, while the “highest” availability (80.49%) was recorded by divisional hospitals type B. The highest average stock-out days (66 days) were reported from the Divisional Hospital- Type C. Only Divisional Hospital- Type A reported having expired medicines on shelves (2.43%). All six GHCIs reported more than 80.49% for record-keeping on medicines. Divisional Hospital Type-A reported having the lowest score for warehouse management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The availability of EMs at the GHCIs of the Monaragala district was fairly high. Record keeping of EMs was high while the average number of stock-out days varied per institution. Conservation and handling practices of the store rooms and dispensing areas of the GHCIs in the Monaragala district should be further improved.\u003c/p\u003e","manuscriptTitle":"Availability and Stock Levels of Essential Medicines in Government Healthcare Institutions of Different Settings in a Rural District in Sri Lanka: a multicentre cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-10 06:54:38","doi":"10.21203/rs.3.rs-5051616/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e23a09cd-c073-47cc-933a-e038308bfddf","owner":[],"postedDate":"October 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-05T06:54:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-10 06:54:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5051616","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5051616","identity":"rs-5051616","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}