Is caffeine available and affordable in low and middle-income countries? A survey in sub-Saharan Africa.

Caffeine is the preferred pharmacologic treatment for apnea of prematurity. Little is known about the availability and affordability of caffeine in the low and middle-income countries of sub-Saharan Africa (SSA). We conducted an online survey in 2020 of newborn physicians in SSA to determine their access to caffeine. Of 90 invited participants, 55 responded (61%). They worked in 13 SSA countries and 48 hospitals. Caffeine was used in 6 countries. In 5 of these countries, the price of caffeine was reported and ranged from US $1.73 in Ghana to US $73.63 in Kenya per 3 mL vial. High drug prices and lack of drug availability for purchase were identified most frequently as primary barriers. Some respondents believed that other methylxanthines are adequate substitutes for caffeine. Only 31 of 53 (58%) respondents knew that caffeine is included in the essential drug list of the World Health Organization (WHO).