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Kamiab Hesari D, Aljadeeah S, Brhlikova P, Hyzam D, Komakech H, Patiño Rueda JS, Ocampo Cañas J, Ching C, Orubu S, Bernal Acevedo O, Basaleem H, Orach CG, Zaman M, Prazeres da Costa C. Access to and utilisation of antimicrobials among forcibly displaced persons in Uganda, Yemen and Colombia: a pilot cross-sectional survey. BMJ Open 2024; 14:e084734. [PMID: 39013652 PMCID: PMC11253744 DOI: 10.1136/bmjopen-2024-084734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/13/2024] [Indexed: 07/18/2024] Open
Abstract
OBJECTIVES Identifying key barriers to accessing quality-assured and affordable antimicrobials among forcibly displaced persons in Uganda, Yemen and Colombia and investigating their (1) utilisation patterns of antibiotics, (2) knowledge about antimicrobial resistance (AMR) and (3) perception of the quality of antimicrobials received. DESIGN Pilot cross-sectional survey. SETTING Data were collected from five health facilities in the Kiryandongo refugee settlement (Bweyale, Uganda), three camps for internally displaced persons (IDPs) in the Dar Sad district (Aden, Yemen) and a district with a high population of Venezuelan migrants (Kennedy district, Bogotá, Colombia). Data collection took place between February and May 2021. The three countries were selected due to their high number of displaced people in their respective continents. PARTICIPANTS South Sudanese refugees in Uganda, IDPs in Yemen and Venezuelan migrants in Colombia. OUTCOME MEASURE The most common barriers to access to quality-assured and affordable antimicrobials. RESULTS A total of 136 participants were enrolled in this study. Obtaining antimicrobials through informal pathways, either without a doctor's prescription or through family and friends, was common in Yemen (27/50, 54.0%) and Colombia (34/50, 68.0%). In Yemen and Uganda, respondents used antibiotics to treat (58/86, 67.4%) and prevent (39/86, 45.3%) a cold. Knowledge of AMR was generally low (24/136, 17.6%). Barriers to access included financial constraints in Colombia and Uganda, prescription requirements in Yemen and Colombia, and non-availability of drugs in Uganda and Yemen. CONCLUSION Our multicentred research identified common barriers to accessing quality antimicrobials among refugees/IDPs/migrants and common use of informal pathways. The results suggest that knowledge gaps about AMR may lead to potential misuse of antimicrobials. Due to the study's small sample size and use of non-probability sampling, the results should be interpreted with caution, and larger-scale assessments on this topic are needed. Future interventions designed for similar humanitarian settings should consider the interlinked barriers identified.
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Affiliation(s)
- David Kamiab Hesari
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
- Centre for Global Health, Technical University of Munich, Munich, Germany
| | - Saleh Aljadeeah
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Petra Brhlikova
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dalia Hyzam
- Women's Research and Training Centre, University of Aden, Aden, Yemen
| | - Henry Komakech
- Department of Community Health and Behavioral Science, Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Carly Ching
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Samuel Orubu
- Institute for Health System Innovation and Policy, Boston University, Boston, Massachusetts, USA
- Faculty of Pharmacy, Niger Delta University, Amassoma, Bayelsa, Nigeria
| | | | - Huda Basaleem
- Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | | | - Muhammad Zaman
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Clarissa Prazeres da Costa
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
- Centre for Global Health, Technical University of Munich, Munich, Germany
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Kassahun H, Van Schepdael A, Ketema G, Adams E. Development and validation of a simple and affordable LC-UV method for identification and assay of selected antimicrobial medicines. J Pharm Biomed Anal 2024; 244:116127. [PMID: 38554556 DOI: 10.1016/j.jpba.2024.116127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
Antimicrobials, particularly antibiotics, are among the most common classes of drugs reported as substandard and falsified (SF) in developing countries. Therefore, it is important to develop simple and affordable analytical methods for the quality control of antimicrobial medicines. In this study, a liquid chromatographic method with ultraviolet detection (LC-UV) was developed and validated for the screening and quantification of 13 antimicrobial medicines and one beta-lactamase inhibitor in pharmaceutical formulations. LC separation was carried out on a Kinetex C18 column (150 mm × 4.6 mm, 2.6 µm) with gradient elution. The mobile phase consisted of mixtures of acetonitrile-water-10 mM phosphate buffer pH 3.5 at ratios of 3:92:5, v/v/v for mobile phase A and 50:45:5, v/v/v for mobile phase B with a flow rate of 0.5 mL/min. The screening method was intended for confirmation of the identity of the actives and validated for specificity and robustness, whereas the quantification method (using only a different detection wavelength) was further validated in terms of linearity, accuracy, sensitivity and precision (repeatability, intermediate precision). For all compounds, the method was found to be linear (r2 > 0.999), precise (%RSD < 1%), accurate (% recovery of 98-102%), sensitive, specific and robust. The developed LC method was successfully applied for the identification and assay of 12 antimicrobial samples from Ethiopia. Among the 12 samples analyzed, one (8.3%) product was confirmed to be falsified.
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Affiliation(s)
- Haile Kassahun
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB, 923, Leuven 3000, Belgium; Wollo University, College of Medicine and Health Sciences, Department of Pharmacy P.O. Box 1145, Dessie, , Ethiopia
| | - Ann Van Schepdael
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB, 923, Leuven 3000, Belgium
| | - Gebremariam Ketema
- Wollo University, College of Medicine and Health Sciences, Department of Pharmacy P.O. Box 1145, Dessie, , Ethiopia
| | - Erwin Adams
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB, 923, Leuven 3000, Belgium.
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Asrade Mekonnen B, Getie Yizengaw M, Chanie Worku M. Prevalence of substandard, falsified, unlicensed and unregistered medicine and its associated factors in Africa: a systematic review. J Pharm Policy Pract 2024; 17:2375267. [PMID: 39015754 PMCID: PMC11251437 DOI: 10.1080/20523211.2024.2375267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024] Open
Abstract
Background Substandard, falsified, unlicensed, and unregistered medicines pose significant risks to public health in developed and developing countries. This systematic review provides an overview of the prevalence of substandard, falsified, unlicensed, and unregistered medicine and its associated factors in Africa. Methods Articles published from April 2014 to March 2024 were searched in Google Scholar, Science Direct, PubMed, MEDLINE, and Embase. The search strategy focused on open-access articles published in peer-reviewed scientific journals and studies exclusively conducted in African countries. The quality of the studies was assessed according to the Medicine Quality Assessment Reporting Guidelines (MEDQUARG). This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results Of the 27 studies, 26 had good methodological quality after a quality assessment. Of the 7508 medicine samples, 1639 failed at least one quality test and were confirmed to be substandard/falsified medicines. The overall estimated prevalence of substandard/falsified medicines in Africa was 22.6% (1718/7592). The average prevalence of unregistered medicines was 34.6% (108/312). Antibiotics, antimalarial, and antihypertensive medicines accounted for 44.6% (712/1596), 15.6% (530/3530), 16.3% (249/1530), and 16.3% (249/1530), respectively. Approximately 60.7% (91/150) were antihelmintic and antiprotozoal medicines. Poor market regulatory permission, Free trade zones, poor registration, high demand, and poor importation standards contribute to the prevalence of these problems. Conclusion/Recommendations Substandard, falsified, and unregistered medicines are highly prevalent in Africa, and attention has not been paid to the problem. Antibiotics, antimalarial, anthelmintic, and antiprotozoal are the most commonly reported substandard, falsified, and unregistered medicines. A consistent supply of high-quality products, enhancement of registration, market regulatory permission, and importation standards are essential to counter the problems in Africa. Preventing these problems is the primary duty of every responsible nation to save lives.
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Affiliation(s)
- Biset Asrade Mekonnen
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Muluabay Getie Yizengaw
- Biochemistry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Minichil Chanie Worku
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Almutairi M, Algabbani A, Alasiri A, Alhomaidan A, Alqahtani AS. Human Medicines Recall Announcements in Saudi Arabia Between 2017 and 2022: An Analysis of Saudi Food and Drug Authority (SFDA) Reports. Ther Innov Regul Sci 2024; 58:689-695. [PMID: 38546962 DOI: 10.1007/s43441-024-00635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/15/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE This study aims to explore the characteristics of drug recall announcements issued over six years by the SFDA in Saudi Arabia. Additionally, to examine the patterns of voluntary drug recall requests by pharmaceutical companies (both innovator and generic) in response to product defects. METHODS A retrospective data analysis was conducted on drug recall announcements issued by the SFDA between 2017 and December 2022. The study included recalls of registered and unregistered drugs posted on the SFDA Drugs Circulars and Withdrawal webpage. Descriptive analysis was performed on relevant variables: recall year, therapeutic class, recall type, pharmaceutical company type, recall reasons and voluntary or involuntary product defect reports. RESULTS During the study period, a total of 371 products were recalled, with the majority being involuntary recalls (82.4%). About two-thirds of the recalls (66.0%) were related to registered products. The most common reasons for recalls were non-compliance with the manufacturer's specifications (33.2%), contamination (23.7%), and violations (20.5%). A total of 109 pharmaceutical companies were associated with the recalled products, with (85.3%) being generic pharmaceutical companies. The majority of innovator pharmaceutical companies (68.8%) requested voluntary drug recalls of defective products. Innovator pharmaceutical companies requested voluntary recalls more often than generic pharmaceutical companies. CONCLUSION The study findings highlight the most frequent causes of drug recalls and the patterns of voluntary recall requests by pharmaceutical companies. Non-compliance with manufacturer's specifications was the most common reason for recalls. Significantly, more innovative pharmaceutical companies request voluntary recalls for product defects compared to generic pharmaceutical companies.
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Affiliation(s)
- Malak Almutairi
- Saudi Food and Drug Authority, 3904 Northern Ring Road, Hittin 1351307148, Riyadh, Saudi Arabia.
| | - Aljoharah Algabbani
- Saudi Food and Drug Authority, 3904 Northern Ring Road, Hittin 1351307148, Riyadh, Saudi Arabia
| | - Ajbaa Alasiri
- Saudi Food and Drug Authority, 3904 Northern Ring Road, Hittin 1351307148, Riyadh, Saudi Arabia
| | - Ali Alhomaidan
- Saudi Food and Drug Authority, 3904 Northern Ring Road, Hittin 1351307148, Riyadh, Saudi Arabia
| | - Amani S Alqahtani
- Saudi Food and Drug Authority, 3904 Northern Ring Road, Hittin 1351307148, Riyadh, Saudi Arabia
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Yonga P, Pulcini C, Skov R, Paño-Pardo JR, Schouten J. The case for the access, watch, and reserve (AWaRe) universal guidelines for antibiotic use. Clin Microbiol Infect 2024; 30:848-849. [PMID: 38583520 DOI: 10.1016/j.cmi.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Paul Yonga
- Tropical/Travel Medicine and Infectious Diseases Clinic, CA Medlynks Medical Centre and Laboratory, Nairobi, Kenya.
| | - Céline Pulcini
- Université de Lorraine, UMR 1319 Inserm INSPIIRE, and Université de Lorraine, CHRU-Nancy, Centre Régional en Antibiothérapie du Grand Est AntibioEst, Nancy, France
| | - Robert Skov
- Epidemiological Infectious Disease Preparedness; Statens Serum Institut, and International Centre for Antimicrobial Resistance Solutions, Copenhagen, Denmark
| | - Jose R Paño-Pardo
- Hospital Clínico Universitario Lozano Blesa, and Universidad de Zaragoza. IIS Aragón. CIBERINFEC, Zaragoza, Spain
| | - Jeroen Schouten
- Department of Intensive Care Medicine, Radboudumc, Nijmegen, the Netherlands
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Kennedy C, Ignatowicz A, Odland ML, Abdul-Latif AM, Belli A, Howard A, Whitaker J, Chu KM, Ferreira K, Owolabi EO, Nyamathe S, Tabiri S, Ofori B, Pognaa Kunfah SM, Yakubu M, Bekele A, Alyande B, Nzasabimana P, Byiringiro JC, Davies J. Commonalities and differences in injured patient experiences of accessing and receiving quality injury care: a qualitative study in three sub-Saharan African countries. BMJ Open 2024; 14:e082098. [PMID: 38955369 PMCID: PMC11218010 DOI: 10.1136/bmjopen-2023-082098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 06/02/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES To understand commonalities and differences in injured patient experiences of accessing and receiving quality injury care across three lower-income and middle-income countries. DESIGN A qualitative interview study. The interviews were audiorecorded, transcribed and thematically analysed. SETTING Urban and rural settings in Ghana, South Africa and Rwanda. PARTICIPANTS 59 patients with musculoskeletal injuries. RESULTS We found five common barriers and six common facilitators to injured patient experiences of accessing and receiving high-quality injury care. The barriers encompassed issues such as service and treatment availability, transportation challenges, apathetic care, individual financial scarcity and inadequate health insurance coverage, alongside low health literacy and information provision. Facilitators included effective information giving and informed consent practices, access to health insurance, improved health literacy, empathetic and responsive care, comprehensive multidisciplinary management and discharge planning, as well as both informal and formal transportation options including ambulance services. These barriers and facilitators were prevalent and shared across at least two countries but demonstrated intercountry and intracountry (between urbanity and rurality) variation in thematic frequency. CONCLUSION There are universal factors influencing patient experiences of accessing and receiving care, independent of the context or healthcare system. It is important to recognise and understand these barriers and facilitators to inform policy decisions and develop transferable interventions aimed at enhancing the quality of injury care in sub-Saharan African nations.
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Affiliation(s)
- Ciaran Kennedy
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, St. Olavs University Hospital, Trondheim, Norway
- Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Abdul-Malik Abdul-Latif
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Volta Regional Health Directorate, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Antonio Belli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Anthony Howard
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute of Health Research (NIHR) Biomedical Centre, University of Oxford, Headington, UK
| | - John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Kathryn M Chu
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Karen Ferreira
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Eyitayo O Owolabi
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Samukelisiwe Nyamathe
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Stephen Tabiri
- Ghana HUB of NIHR Global Surgery, Tamale, Ghana
- Department of Public Health, Tamale Teaching Hospital, Tamale, Ghana
- Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
| | | | | | - Mustapha Yakubu
- Department of Public Health, Tamale Teaching Hospital, Tamale, Ghana
- School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Abebe Bekele
- University of Global Health Equity, Kigali, Rwanda
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Barnabas Alyande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jean-Claude Byiringiro
- University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital, Kigali, Rwanda
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Bautista K, Lee YF(A, Higgins CR, Procter P, Rushwan S, Baidoo A, Issah K, Fofie CO, Gülmezoglu AM, Chinery L, Ozawa S. Modeling the economic burden of postpartum hemorrhage due to substandard uterotonics in Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003181. [PMID: 38900726 PMCID: PMC11189185 DOI: 10.1371/journal.pgph.0003181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/09/2024] [Indexed: 06/22/2024]
Abstract
Uterotonics are essential in preventing postpartum hemorrhage (PPH), the leading direct cause of maternal death worldwide. However, uterotonics are often substandard in low- and middle-income countries, contributing to poor maternal health outcomes. This study examines the health and economic impact of substandard uterotonics in Ghana. A decision-tree model was built to simulate vaginal and cesarean section births across health facilities, uterotonic quality and utilization, PPH risk and diagnosis, and resulting health and economic outcomes. We utilized delivery data from Ghana's maternal health survey, risks of health outcomes from a Cochrane review, and E-MOTIVE trial data for health outcomes related to oxytocin quality. We compared scenarios with and without substandard uterotonics, as well as scenarios altering uterotonic use and care-seeking behaviors. We found that substandard uterotonic use contributes to $18.8 million in economic burden annually, including $6.3 million and $4.8 million in out-of-pocket expenditures in public and private sectors, respectively. Annually, the National Health Insurance Scheme bears $1.6 million in costs due to substandard uterotonic use. Substandard uterotonics contribute to $6 million in long-term productivity losses from maternal mortality annually. Improving the quality of uterotonics could reduce 20,000 (11%) PPH cases, 5,000 (11%) severe PPH cases, and 100 (11%) deaths due to PPH annually in Ghana. Ensuring the quality of uterotonics would result in millions of dollars in cost savings and improve maternal health outcomes for the government and families in Ghana. Cost savings from improving uterotonic quality would provide financial protection and help Ghana advance toward Universal Health Coverage.
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Affiliation(s)
- Kiara Bautista
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, North Carolina, Chapel Hill, United States of America
| | - Yi-Fang (Ashley) Lee
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, North Carolina, Chapel Hill, United States of America
| | - Colleen R. Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, North Carolina, Chapel Hill, United States of America
| | | | | | | | | | | | | | | | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, North Carolina, Chapel Hill, United States of America
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, North Carolina, Chapel Hill, United States of America
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Maffioli EM, Montás MC, Anyakora C. Excessive active pharmaceutical ingredients in substandard and falsified drugs should also raise concerns in low-income countries. J Glob Health 2024; 14:03029. [PMID: 38843042 PMCID: PMC11156249 DOI: 10.7189/jogh.14.03029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Affiliation(s)
- Elisa M Maffioli
- University of Michigan, School of Public Health, Department of Health Management and Policy, Ann Arbor, Michigan, USA
| | - Marie C Montás
- Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, USA
| | - Chimezie Anyakora
- Bloom Public Health, Abuja, Nigeria
- School of Science and Technology, Pan Atlantic University, Lagos, Nigeria
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Mengesha A, Bastiaens H, Ravinetto R, Gibson L, Dingwall R. Substandard and falsified medicines in African pharmaceutical markets: A case study from Ethiopia. Soc Sci Med 2024; 349:116882. [PMID: 38669893 DOI: 10.1016/j.socscimed.2024.116882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Substandard and falsified (SF) medicines are a global health problem. Their high prevalence is a threat to public health in low- and middle-income countries (LMICs). However, there are few street-level investigations of how this market works. This case study examines the supply and demand for SF medicines in Southern Ethiopia. METHODS A cross sectional qualitative design, using semi-structured interviews supplemented by participant observation, was adopted. Study participants were selected using purposive, convenience, and snowball sampling techniques. They included pharmacists, physicians, wholesalers, pharmacy owners, regulatory staff, law enforcement agents and the local community. A total of 43 interviews were conducted. The study used Actor-Network Theory (ANT) as an analytic framework. RESULTS The findings show that efforts to address the problem of SF medicines in Ethiopia struggle because of the lack of a clear framing of the issue and consensus on how it should be understood. The pharmaceutical market in Wolaita Zone, Southern Ethiopia is supplied with a wide variety of SF medicines from diverse sources. This complex supply chain emerges due to barriers to accessing essential medicines that are in demand. Control of SF medicines will require a range of interventions thoughtfully tailored to the local contexts and determinants of both supply and demand. CONCLUSION The evidence of confusion, ambiguity, and uncertainty in defining the problem of SF medicines suggest that more research and policy work is required to refine understanding of the issue, and of the local market conditions that join demand and supply for different medicines in Southern Ethiopia. These are likely to apply more widely in comparable contexts throughout sub-Saharan Africa. The current global policy emphasis on stricter regulation and enforcement alone does not adequately address the social and economic factors that collectively create and shape user demand that is met by SF medicines.
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Affiliation(s)
- Akalework Mengesha
- Department of Sociology, College of Social Science, Wolaitta Sodo University (WSU), Woliatta Sodo, Ethiopia.
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Raffaella Ravinetto
- Public Health Department, Institute of Tropical Medicine, Antwerp, Belgium; School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Linda Gibson
- School of Social Sciences, Institute for Health and Allied Professions, Nottingham Trent University (NTU), UK
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Wagnild JM, Akhter N, Lee D, Jayeola B, Darko DM, Adeyeye MC, Komeh JP, Nahamya D, Kasim A, Hampshire K. The role of constraints and information gaps in driving risky medicine purchasing practices in four African countries. Health Policy Plan 2024; 39:372-386. [PMID: 38300508 PMCID: PMC11005838 DOI: 10.1093/heapol/czae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024] Open
Abstract
Substandard and falsified (SF) medical products pose a major threat to public health and socioeconomic development, particularly in low- and middle-income countries. In response, public education campaigns have been developed to alert consumers about the risks of SF medicines and provide guidance on 'safer' practices, along with other demand- and supply-side measures. However, little is currently known about the potential effectiveness of such campaigns while structural constraints to accessing quality-assured medicines persist. This paper analyses survey data on medicine purchasing practices, information and constraints from four African countries (Ghana, Nigeria, Sierra Leone and Uganda; n > 1000 per country). Using multivariate regression and structural equation modelling, we present what we believe to be the first attempt to tease apart, statistically, the effects of an information gap vs structural constraints in driving potential public exposure to SF medicines. The analysis confirms that less privileged groups (including, variously, those in rural settlements, with low levels of formal education, not in paid employment, often women and households with a disability or long-term sickness) are disproportionately potentially exposed to SF medicines; these same demographic groups also tend to have lower levels of awareness and experience greater levels of constraint. Despite the constraints, our models suggest that public health education may have an important role to play in modifying some (but not all) risky practices. Appropriately targeted public messaging can thus be a useful part of the toolbox in the fight against SF medicines, but it can only work effectively in combination with wider-reaching reforms to address higher-level vulnerabilities in pharmaceutical supply chains in Africa and expand access to quality-assured public-sector health services.
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Affiliation(s)
- Janelle M Wagnild
- Department of Anthropology, Durham University, South Road, Durham DH1 3LE, UK
| | - Nasima Akhter
- Department of Anthropology, Durham University, South Road, Durham DH1 3LE, UK
| | - Diana Lee
- Incidents and Substandard/Falsified Medical Products Team, World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland
| | - Babatunde Jayeola
- Incidents and Substandard/Falsified Medical Products Team, World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland
| | | | - Moji Christianah Adeyeye
- National Agency for Food and Drug Administration and Control, Plot 2032, Olusegun, Obasanjo Way, Zone 7, Wuse, Abuja, Nigeria
| | - James P Komeh
- Pharmacy Board of Sierra Leone, New England Ville, Freetown, Sierra Leone
| | - David Nahamya
- Secretary to the Authority, National Drug Authority, PO Box 23096, Kampala, Uganda
| | - Adetayo Kasim
- Department of Anthropology, Durham University, South Road, Durham DH1 3LE, UK
| | - Kate Hampshire
- Department of Anthropology, Durham University, South Road, Durham DH1 3LE, UK
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Awotunde O, Lu J, Cai J, Roseboom N, Honegger S, Joseph O, Wicks A, Hayes K, Lieberman M. Mitigating the impact of gelatin capsule variability on detection of substandard and falsified pharmaceuticals with near-IR spectroscopy. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2024; 16:1611-1622. [PMID: 38406859 DOI: 10.1039/d4ay00001c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Portable NIR spectrometers are effective in detecting authentic pharmaceutical products in intact capsule formulations, which can be used to screen for substandard or falsified versions of those authentic products. However, the chemometric models are trained on libraries of authentic products, and are generally unreliable for detection of quality problems in products from outside their training set, even for products that are nominally the same active pharmaceutical ingredient and same dosage as products in the training set. As part of our research directed at developing better non-brand-specific strategies for pharmaceutical screening, we investigated the impact of capsule composition on NIR modeling. We found that capsule features like gelatin type, color, or thickness, give rise to a similar amount of variance in the NIR spectra as the type of API stored within the capsules. Our results highlight the efficacy of orthogonal projection to latent structures in mitigating the impacts of different types of capsules on the accuracy of NIR chemometric models for classification and regression analysis of lab-made samples. The models showed good performance for classification of field-collected doxycycline capsules as good or bad quality when an NIR-based % w/w metric was used, identifying five samples that were adulterated with talc. However, the % w/w was systematically underestimated, so when evaluating the capsules based on their absolute API content according to the monograph standard, the classification accuracy decreased from 100% to 70%. The underestimation was attributed to an unforeseen variability in the quantities and types of excipients present in the capsules.
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Affiliation(s)
- Olatunde Awotunde
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA.
| | - Jiaqi Lu
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA.
| | - Jin Cai
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA.
| | - Nicholas Roseboom
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA.
| | - Sarah Honegger
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA.
| | - Ornella Joseph
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA.
| | - Alyssa Wicks
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA.
| | - Kathleen Hayes
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA.
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA.
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12
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Anjulo H, Birhane W, Hymete A, Ashenef A. Quality Assessment of Selected Essential Antimicrobial Drugs from Drug Retail Outlets of Selected Cities in Eastern Ethiopia. Am J Trop Med Hyg 2024; 110:596-608. [PMID: 38350137 PMCID: PMC10919192 DOI: 10.4269/ajtmh.23-0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/12/2023] [Indexed: 02/15/2024] Open
Abstract
The prevalence of substandard and falsified (SF) antimicrobial drugs is increasing around the globe. This poses a great concern for the healthcare system. The consumption of SF antimicrobial drugs has the potential to result in treatment failure, emergence and development of antimicrobial resistance, and ultimately a rise in mortality rate. The objective of this study was to assess the quality of four commonly used antimicrobials marketed in the cities of Dire Dawa and Jijiga and the town of Togo-Wuchale, which have high potential for illegal drug trade activities in Ethiopia because they are located near the border with Somalia. A total of 54 brands/samples of amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, and norfloxacin formulations were collected covertly from 43 facilities using a convenience sampling strategy from March 16 to March 29, 2022. The samples were first screened using Global Pharma Health Fund (GPHF)-Minilab protocols and then analyzed using U.S. Pharmacopoeial and British Pharmacopoeia official methods. The quality evaluation detected no falsified product; however, it showed that 14.3% of the samples failed the GPHF-Minilab screening test semiquantitatively. Overall, 22.2% of the products analyzed did not meet any of pharmacopoeial specifications assessed: 13%, 12.2%, and 11.1% of the products failed in assay, dissolution, and weight variation, respectively. Additionally, 56.3% of amoxicillin samples, 60% of amoxicillin/clavulanate, 20% of ciprofloxacin, and 54.5% of norfloxacin samples were found to be pharmaceutically nonequivalent with their respective comparator products regarding dissolution profiles. The study showed the presence of substandard antimicrobial medicines in the eastern Ethiopian market.
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Affiliation(s)
- Hailu Anjulo
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Food and Drug Authority, Addis Ababa, Ethiopia
| | - Worku Birhane
- Department of Pharmacy, College of Health Science, Debremarkos University, Debremarkos, Ethiopia
| | - Ariaya Hymete
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayenew Ashenef
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Maharjan P, Ponganam MP, Lambert P, Vogel JP, McIntosh M, McDougall A. The quality of medicines for the prevention and management of hypertensive disorders of pregnancy: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002962. [PMID: 38412179 PMCID: PMC10898726 DOI: 10.1371/journal.pgph.0002962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
The quality of medicines for the prevention and management of hypertensive disorders of pregnancy globally is a critical challenge in the reduction of maternal mortality rate. We aimed to conduct a systematic review of available studies on the quality of the eight medicines recommended globally for the prevention and management of hypertensive disorders of pregnancy. We searched five electronic databases- Ovid MEDLINE, EMBASE, CINAHL, ProQuest and Cochrane Library, and also grey literature, without year or language limitations. Any study assessing the quality parameters (Active Pharmaceutical Ingredients, pH, sterility, solubility, impurities) of medicines by using any valid laboratory methods was eligible. Two reviewers independently screened the studies, extracted data and applied Medicine Quality Assessment Reporting Guidelines tool for quality assessment. Results were narratively reported and stratified by the drug types. Of 5669 citations screened, 33 studies from 27 countries were included. Five studies reported on the quality of magnesium sulphate-two (Nigeria and USA) found substandard medicine due to failing API specification and contaminants, respectively. Another study from Nigeria and a multi-country study (10 lower-middle- and low-income countries) found poor-quality due to failing the pH criteria. Seven of eight studies evaluating aspirin found quality issues, including degraded medicines in five studies (Brazil, USA, Yugoslavia and Pakistan). Five studies of calcium supplements found quality issues, particularly heavy metal contamination. Of 15 antihypertensives quality studies, 12 found substandard medicines and one study identified counterfeit medicines. This systematic review identified pervasive issues of poor-quality medicines across all recommended medicines used to prevent or treat hypertensive disorders of pregnancy, raising concerns regarding their safety and effectiveness.
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Affiliation(s)
- Pooja Maharjan
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | | | - Pete Lambert
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Joshua P Vogel
- Burnet Institute, Maternal, Child and Adolescent Health Program, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle McIntosh
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Annie McDougall
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
- Burnet Institute, Maternal, Child and Adolescent Health Program, Melbourne, Australia
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14
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Flatie Alemu A, Tegegne AA, Getaw NS. Evaluation of Seven Different Brands of Metformin Hydrochloride Tablets Available in the Market in Gondar City, Ethiopia. Drug Healthc Patient Saf 2024; 16:19-28. [PMID: 38318121 PMCID: PMC10840544 DOI: 10.2147/dhps.s419522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024] Open
Abstract
Background WHO estimates that 15.8% of substandard or falsified medical products are used to treat non-communicable diseases which account for 80% of the global burden including diabetes. The increased level of use of metformin hydrochloride tablets in clinical practice creates the need to monitor and ascertain the quality of the various brands available in the drug market for quality control assessment and generic substitution. This study aims to assess the pharmaceutical quality of seven brands of metformin tablets circulating in pharmacy outlets in Gondar City, North West Ethiopia. Methods Official Pharmacopoeia tests such as uniformity of weight, disintegration, assay, and dissolution tests were used to assess the physicochemical quality control parameters of metformin hydrochloride tablet brands. The unofficial tests conducted included crushing strength/hardness and friability. Results In all seven tests, the tested brands passed the BP official tests for uniformity of weight, friability, disintegration, and dissolution. Each product had a friability of less than 1% with a maximum of 0.385%. In contrast, none of the brands passed the non-official hardness test. Each product disintegrated in seven to twelve minutes, meeting the USP standards. Drug release rates in 45 min ranged from 78.9 to 92.6%, and drug content results were within the USP guidelines (96.55-102.76%). Conclusion The current study demonstrated that all seven brands of metformin hydrochloride 500 mg tablets adhered to the quality control parameters specified in the pharmacopeia, except for the hardness test across all brands.
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Affiliation(s)
- Adane Flatie Alemu
- Pharmaceutical Analysis, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Addisu Afrassa Tegegne
- Pharmaceutical Quality Assurance and Regulatory Affairs, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nurahmed Seid Getaw
- Pharmaceutical Analysis, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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15
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Tegegne AA, Feissa AB, Godena GH, Tefera Y, Hassen HK, Ozalp Y, Suleman S. Substandard and falsified antimicrobials in selected east African countries: A systematic review. PLoS One 2024; 19:e0295956. [PMID: 38277385 PMCID: PMC10817106 DOI: 10.1371/journal.pone.0295956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/04/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Globally, millions of people have been affected by fraudulent pharmaceutical products, particularly those in developing countries. Although the problem of falsified and substandard drugs is acknowledged, the extent of the issue is ever-changing, has a dynamic nature, and should be quantified and captured in a recent snapshot. OBJECTIVE This systematic review seeks to examine the data that can quantify and provide a current snapshot of the prevalence of SF antimicrobials in selected east Africa countries. METHODS Scientific studies on antimicrobial quality were searched in PubMed, Embase, Scopus, and Google Scholar from 2017 to February 2023. The search strategy focused on scientific articles published in peer-reviewed scientific journals written in English and the studies exclusively done in any of the selected countries of east Africa. The articles were carefully reviewed by two individuals for inclusion independently, first by title followed by abstract and the full-text retrieval. To minimize bias associated with the methodology used for data collection, the quality of the studies was assessed for quality according to the Medicine Quality Assessment Reporting Guidelines (MEDQUARG). The reporting of this systematic review was done following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). RESULTS Fifteen studies that estimated the prevalence of poor-quality antimicrobial medicines in selected four east African countries were included. The overall percentage of samples of antimicrobials that failed at least one quality test was 22.6% (151/669) with each class's prevalence of 17% in antibiotics (73/432), 24% in antimalarial (41/171), and 56% in anthelmintics (37/66). Quality control parameters of API content were the most commonly examined in the included studies, accounting for 14/15 (93%) studies. Fifty (33.1%) of the failing samples failed assay API- content determination, while 26.5% (n = 40) failed the visual inspection and packaging analysis; 19.2% (29) failed dissolution; 14% (n = 21) flawed hardness or friability; 4%(n = 6) failed uniformity, as well as 3.2% (n = 5) failed disintegration test of the quality control parameter. CONCLUSION It was found that this review was general in these selected east African countries and was a catalyst for combating the menace of poor-quality medications that affect millions of lives.
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Affiliation(s)
- Addisu Afrassa Tegegne
- Pharmaceutical Sciences, Pharmaceutical Quality Assurance and Regulatory Affairs, University of Gondar, Gondar, Ethiopia
| | - Anbessa Bekele Feissa
- Pharmaceutical Sciences, School of Pharmacy, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Gemmechu Hasen Godena
- Pharmaceutical Sciences, School of Pharmacy, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Yesuneh Tefera
- Pharmaceutical Sciences, Pharmaceutical Quality Assurance and Regulatory Affairs, University of Gondar, Gondar, Ethiopia
| | - Hassen Kebede Hassen
- Ethiopian Agricultural Authority, Veterinary Drug Quality Control and Inspection Directorate, Addis Ababa, Ethiopia
- Department of Pharmaceutical Technology, Near East University, Turkey
| | - Yildiz Ozalp
- Department of Pharmaceutical Technology, Near East University, Turkey
| | - Sultan Suleman
- Pharmaceutical Sciences, School of Pharmacy, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
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Fakayode SO, Bolton B, Dassow B, Galvez K, Chohan H. Rapid screening and multicomponent quantifications of active components of oral syrup over-the-counter medications by Raman and UV-visible spectroscopy and multivariate regression analysis. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 305:123447. [PMID: 37742594 DOI: 10.1016/j.saa.2023.123447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
Over-the-counter medications (OTCMs) are frequently recommended as a first-line treatment for common ailments, diseases, and illnesses. Oral liquid dosage forms are advantageous for rapid absorption with no dissolution time and are easier for pediatric and geriatric consumers to swallow. The production of these medicines by pharmaceutical industry makes them readily available to the public. Although the US Food and Drug Administration (FDA) provides strict guidelines to drug manufacturers of these products; the risk of counterfeiting is a global issue. This can lead to several adverse effects and health issues. Here, we report a fast screening and quality assurance method using Raman and UV-visible spectroscopy combined with Principal Component Analysis (PCA) and Partial-Least-Square (PLS) regression of commonly used OTCM oral syrups. PLS regressions of UV-visible absorption spectra were used for multicomponent quantifications of the active component (acetaminophen, guaifenesin, dextromethorphan HBr, and phenylephrine HCl) concentrations of OTMCs in flavored (sugar or sugar-free) oral syrups. Raman and UV-visible spectral responses varied based on the type and concentration of the active component analyzed. PCA of the spectral data provided pattern recognition of the oral syrup OTCM. The developed PLS method demonstrated good linearity with an R2 > 0.9784 and high sensitivity with a low detection limit of 0.02 mg/mL for acetaminophen and guaifenesin. Moreover, the simultaneous quantification of concentrations of all active components by the described method yielded good accuracies ranging from 88 to 94%. This study provides an example of the benefits of the combined use of Raman and UV-vis spectral profiling, PCA, and PLS regression for the quality analysis of oral syrups OTCM providing multicomponent quantification of active components with no need for sample extraction. The reported method can be easily adapted and scaled for online detection analysis used in the drug manufacturing industry, both in-situ and field analysis, and for the quality control of syrups OTCM by regulatory agencies and quality control officers.
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Affiliation(s)
- Sayo O Fakayode
- Department of Chemistry, Physics & Astronomy, Georgia College, and State University, Milledgeville, GA 31061, United States.
| | - Brinkley Bolton
- Department of Chemistry, Physics & Astronomy, Georgia College, and State University, Milledgeville, GA 31061, United States
| | - Bailey Dassow
- Department of Chemistry, Physics & Astronomy, Georgia College, and State University, Milledgeville, GA 31061, United States
| | - Kairy Galvez
- Department of Chemistry, Physics & Astronomy, Georgia College, and State University, Milledgeville, GA 31061, United States
| | - Harmeet Chohan
- Department of Chemistry, Purdue State University, Department of Chemistry, 560 Oval Drive, West Lafayette, IN 47907-2084, United States
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Hildebrand A, Merchant M, O'Hare D. Voltammetric methods for electrochemical characterization and quantification of artemether-based antimalarials. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2024; 16:161-169. [PMID: 38088798 PMCID: PMC10765968 DOI: 10.1039/d3ay01837g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
Every year substandard and falsified (SF) artemisinin derivative-based antimalarials are responsible for the loss of 450 000 deaths and billions of GBP. The lack of infrastructure and funds to support pharmaceutical quality control in many low-and-middle-income countries contributes to this problem. This work assesses fitness for purpose of voltammetric methods for identification and quantification of artemether in the presence of excipients. Electrochemical characterization of artemether using cyclic voltammetry shows that the reduction of artemether is chemically irreversible within the potential range of -0.4 V to -1.4 V. A chronocoulometric quantification algorithm for artemether is created and tested with pure artemether, as well as filtered and unfiltered Riamet® tablets. Filtration of Riamet® tablets provides no additional benefit for the quantification of artemether in Riamet®. In addition, artemether's response to pH indicates possible protonation and coupled homogeneous chemistry. Finally, sodium sulfite is an effective means of removing dissolved oxygen and improving artemether signal resolution in air-equilibrated PBS. This concludes that electrochemical analysis is a promising method for artemether identification and quantification.
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Affiliation(s)
- Anna Hildebrand
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK.
| | - Mariam Merchant
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK.
| | - Danny O'Hare
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK.
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18
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Patel TS, Sati H, Lessa FC, Patel PK, Srinivasan A, Hicks LA, Neuhauser MM, Tong D, van der Heijden M, Alves SC, Getahun H, Park BJ. Defining access without excess: expanding appropriate use of antibiotics targeting multidrug-resistant organisms. THE LANCET. MICROBE 2024; 5:e93-e98. [PMID: 37837986 PMCID: PMC10789610 DOI: 10.1016/s2666-5247(23)00256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 10/16/2023]
Abstract
Antimicrobial resistance remains a significant global public health threat. Although development of novel antibiotics can be challenging, several new antibiotics with improved activity against multidrug-resistant Gram-negative organisms have recently been commercialised. Expanding access to these antibiotics is a global public health priority that should be coupled with improving access to quality diagnostics, health care with adequately trained professionals, and functional antimicrobial stewardship programmes. This comprehensive approach is essential to ensure responsible use of these new antibiotics.
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Affiliation(s)
- Twisha S Patel
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Hatim Sati
- WHO AMR Division, WHO, Geneva, Switzerland
| | - Fernanda C Lessa
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Payal K Patel
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Infectious Diseases, Intermountain Health, Salt Lake City, UT, USA
| | - Arjun Srinivasan
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauri A Hicks
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melinda M Neuhauser
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Benjamin J Park
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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19
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Sorato MM, Davari M, Kebriaeezadeh A. Improving access to medicines to reduce marketing and use of substandard and falsified medicines in Africa: Scoping review. THE JOURNAL OF MEDICINE ACCESS 2024; 8:27550834241236598. [PMID: 38476401 PMCID: PMC10929061 DOI: 10.1177/27550834241236598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
Background Both constrained access to essential medicines and combatting marketing of substandard and falsified (SF) medicines are unmet health sector goals in Africa. Objective To answer the question of how improved access can reduce the continuous surge of SF medicines in Africa. Design We conducted a scoping review based on standard protocol. Methods We searched articles published in the English language from PubMed/Medline, Cochrane Library, Embase, Scopus, Web of Science, and Google Scholar by using a systematic search query. Results Seventy-one articles were included in this review. Access to quality essential medicines is still a major problem in developing countries in Africa and will continue as a threat for the next decade of health care. Ensuring access to quality medicines and preventing SF medicines in Africa need a systematic approach to address their underlying causes. Failure to ensure access to medicines is the major reason for the availability of SF medicines. Improving access to quality medicines can reduce SF medicine marketing and use. Manipulating the entire supply chain for efficiency, avoiding trade agreements that could reduce access, using compulsory licensing provisions, and pharmaceutical price control, providing incentives for drug development, and promoting rational use of medicines can improve access. Conclusion Ensuring access to medicines and preventing SF medicine marketing cannot be achieved in the planned period in developing countries in Africa unless a comprehensive strategy is used. Improving access to quality medicines can reduce SF medicine marketing and use, that is, ensuring access through uninterrupted supply, improved efficiency, enhanced local production, preventing SF medicine entry, improved medication use system, and improved affordability. Therefore, it is essential to improve supply chain capability, address challenges of the supply chain, improve leadership and governance, establish country-specific anti-counterfeiting and anti-substandardization committees, and collaborate with all relevant stakeholders.
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Affiliation(s)
- Mende Mensa Sorato
- Department of Pharmacy, College of Medicine, Komar University of Science and Technology, Sulaimaniyah, Iraq
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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20
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Kang J, Chae H, Jeong S, Pervin R, Hossain MA. Evaluation of Biological Equivalence for Generic Tulathromycin Injections in Cattle. Int J Mol Sci 2023; 24:16262. [PMID: 38003452 PMCID: PMC10671567 DOI: 10.3390/ijms242216262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
The recent expiration of patents for the antibiotic tulathromycin has led to a significant increase in the number of generic tulathromycin products (GTPs) available. This study aims to evaluate the bioequivalence of four GTPs, which experienced a rapid increase in market share. The bioequivalence was evaluated by performing pharmacokinetic assessments. The four selected GTPs (Tulaject, Tulagen, Toulashot, and T-raxxin) were compared with the reference product, Draxxin. A dose of 2.5 mg/kg.bw/day was administered via subcutaneous injection, and blood samples were collected 460 times from 20 Holstein cattle. Plasma concentrations of tulathromycin were measured over time using LC-MS/MS analysis. Bioequivalence was evaluated using a statistical program for pharmacokinetic parameters, including the area under the concentration time curve (AUC) and the maximum plasma concentration (Cmax). The bioequivalence was considered proven if the difference between the test and reference products was within 20% for both AUC and Cmax. The results showed that the confidence interval (CI, 90%) for both AUC and Cmax values was within the 80~120% range, demonstrating the bioequivalence of the four GTPs compared to Draxxin. This study provides evidence for the bioequivalence of the selected GTPs, contributing to their validation for use as effective antibiotics.
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Affiliation(s)
- JeongWoo Kang
- Animal Disease Diagnosis Division, Animal and Plant Quarantine Agency (APQA), Ministry of Agriculture, Food and Rural Affairs, 177, Hyeoksin 8-ro, Gimcheon-si 39660, Gyeongsangbuk-do, Republic of Korea; (J.K.); (H.C.)
| | - HyunYoung Chae
- Animal Disease Diagnosis Division, Animal and Plant Quarantine Agency (APQA), Ministry of Agriculture, Food and Rural Affairs, 177, Hyeoksin 8-ro, Gimcheon-si 39660, Gyeongsangbuk-do, Republic of Korea; (J.K.); (H.C.)
| | - SungHoon Jeong
- Veterinary Drugs & Biologics Division, Animal and Plant Quarantine Agency (APQA), Ministry of Agriculture, Food and Rural Affairs, 177, Hyeoksin 8-ro, Gimcheon-si 39660, Gyeongsangbuk-do, Republic of Korea;
| | - Rokeya Pervin
- Department of Microbiology and Immunology, College of Medicine, University of Illinois Chicago, 835 S. Wolcott Ave (MC790), Chicago, IL 60612, USA;
| | - Md Akil Hossain
- Institute for Tuberculosis Research, College of Pharmacy, University of Illinois Chicago, 833 S. Wood St. (MC964), Chicago, IL 60612, USA
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21
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Gharaibeh L, Alameri MA, Al-Kabariti AY, Alsa'd AA, Abed A, Karameh N, Aldeeb ID. Practices, perceptions and trust of the public regarding online drug purchasing: a web-based survey from Jordan. BMJ Open 2023; 13:e077555. [PMID: 37890969 PMCID: PMC10619020 DOI: 10.1136/bmjopen-2023-077555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES Online purchasing, including drugs, increased dramatically in the last decade especially through the COVID-19 pandemic. The aim of this study was to investigate the frequency and attitudes of consumers concerning online drug purchasing and assess their perceptions regarding the benefits and disadvantages. DESIGN A web-based survey conducted through a self-administered questionnaire that was approved by the Institutional Review Board (IRB) committee, ethical approval number: IRB/Al-Ahliyya Amman University/3/13/2021-2022. Cronbach's alpha for the attributes of benefits and disadvantages was 0.608 and 0.744, respectively. Primary outcome measures were extent of trust of the public in online drug purchasing using Likert scale. Multivariate linear regression was used to assess predictors of the trust score. SETTINGS Hashemite Kingdom of Jordan. PARTICIPANTS Inclusion criteria; residents of the Hashemite Kingdom of Jordan 18 years or older. The questionnaire was distributed through snowball effect via different social media. RESULTS A total of 428 participants filled the questionnaire, their average age was 29.7±11.2. Almost all participants, 419 (98.6%) use the internet daily but only 79 (18.6%) participants shop online regularly. Fifty participants (11.8%) purchased drugs online and they had higher benefits score of online purchasing compared with those who did not buy drugs online, 12.5±3.7 and 10.9±3.1, respectively, p=0.002. Participant who purchased drugs online had an increase in trust score of 0.847 compared with those who did not purchase drugs online, p<0.001. In the multivariate model, participants with education level of high school or higher than high school, compared with those with education lower than high school had an increase in trust score of 1.336 (p=0.026) and 1.137 (p=0.039), respectively. CONCLUSION The public recognises the risks in buying drugs online. Awareness campaigns and regulations that control and monitor online drug purchasing should be implemented.
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Affiliation(s)
- Lobna Gharaibeh
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | | | - Aya Y Al-Kabariti
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Alhareth A Alsa'd
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Anas Abed
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Nida Karameh
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Ibrahim D Aldeeb
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
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22
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Ene JC, Ajibo HT. Optimizing the utilization of maternal and reproductive healthcare services among women in low-resourced Nigerian settings. BMC Public Health 2023; 23:2070. [PMID: 37872613 PMCID: PMC10591403 DOI: 10.1186/s12889-023-16929-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Quality care delivery is an essential lifesaving interventions for maternal healthcare and reduction in mortality from preventable reproductive conditions. In African countries like Nigeria, numerous perceptions and militating factors present unique challenges in optimizing the utilization of maternal and reproductive healthcare services. As women continuously evolve away from the utilization of healthcare services, achieving universal health coverage for all emerges as a matter of concern. METHOD A phenomenological and descriptive research design was used. The study participants comprised a total of 38 women selected from primary and tertiary healthcare institutions. They were purposively selected from four healthcare institutions in Nsukka, Enugu State, Nigeria. RESULT Findings revealed that most rural women at the prenatal stage, utilize maternal healthcare services, but at the postnatal stage, they reject reproductive healthcare services owing to certain perceptions. Concerns about sub-optimal utilization of maternal and reproductive healthcare services were found under enabling, predisposing and need factors. Evidence-based interventions included instituting health insurance policies, improving the healthcare sector, personnel, collaboration among stakeholders, and grass-roots community education. Participants showed little knowledge of social workers' engagement in healthcare institutions. CONCLUSION Functional network of care between private and public healthcare system is the key to optimizing maternal and reproductive healthcare utilization. The study recommends stakeholder and community engagement in achieving functional networks of care, strengthening relational linkages between frontline health workers and equip rural women with better knowledge. All these are geared toward achieving optimal utilization of maternal and reproductive healthcare services among women in low-resourced Nigerian settings.
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Affiliation(s)
- Jacinta Chibuzor Ene
- Department of Social Work, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria.
| | - Henry Tochukwu Ajibo
- Department of Social Work, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria
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23
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Macé C, Nikiema JB, Sarr OS, Ciza Hamuli P, Marini RD, Neci RC, Bourdillon Esteve P, Ravinetto R. The response to substandard and falsified medical products in francophone sub-Saharan African countries: weaknesses and opportunities. J Pharm Policy Pract 2023; 16:117. [PMID: 37803394 PMCID: PMC10557312 DOI: 10.1186/s40545-023-00628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023] Open
Abstract
Assuring the quality of medical products manufactured, imported or distributed in francophone sub-Saharan Africa remains a challenge, despite positive signals like the growing engagement in the benchmarking of regulatory authorities and -particularly- in the establishment of the African Medicines Agency. In this short report, we describe the existing activities to prevent, detect and respond to substandard and falsified products (SF) in this region, either through African multilateral organizations and initiatives led by the World Health Organization, or through the contribution of other stakeholders, such as local universities and procurement agencies. We underline that these emerging local stakeholders may play a pivotal role to guide and inform the national regulatory authorities about the prevalence and patterns of SF medical products, complementing the market surveillance and control, and building awareness of the importance of pharmaceutical quality assurance for public health.
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Affiliation(s)
| | | | - Omar Serigne Sarr
- University of Dakar Cheikh Anta Diop, Dakar, Senegal
- Senegalese Drug Regulatory Agency, Dakar, Senegal
| | - Patient Ciza Hamuli
- Faculty of Pharmaceutical Sciences, LACOMEDA, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Roland Djang'eing'a Marini
- CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, University of Liege, Liege, Belgium
| | | | - Pernette Bourdillon Esteve
- Incidents and Substandard/Falsified Medical Products Team, World Health Organization (WHO), Geneva, Switzerland
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, 2000, Antwerp, Belgium.
- School of Public Health, University of the Western Cape, Cape Town, South Africa.
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24
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Cavany S, Nanyonga S, Hauk C, Lim C, Tarning J, Sartorius B, Dolecek C, Caillet C, Newton PN, Cooper BS. The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance. Nat Commun 2023; 14:6153. [PMID: 37788991 PMCID: PMC10547756 DOI: 10.1038/s41467-023-41542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023] Open
Abstract
Approximately 10% of antimicrobials used by humans in low- and middle-income countries are estimated to be substandard or falsified. In addition to their negative impact on morbidity and mortality, they may also be important drivers of antimicrobial resistance. Despite such concerns, our understanding of this relationship remains rudimentary. Substandard and falsified medicines have the potential to either increase or decrease levels of resistance, and here we discuss a range of mechanisms that could drive these changes. Understanding these effects and their relative importance will require an improved understanding of how different drug exposures affect the emergence and spread of resistance and of how the percentage of active pharmaceutical ingredients in substandard and falsified medicines is temporally and spatially distributed.
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Affiliation(s)
- Sean Cavany
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Stella Nanyonga
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Medicine Quality Research Group, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Cathrin Hauk
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Medicine Quality Research Group, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Cherry Lim
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Joel Tarning
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Benn Sartorius
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- School of Public Health, Faculty of Medicine, The University of Queensland, St Lucia, Australia
| | - Christiane Dolecek
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Céline Caillet
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Medicine Quality Research Group, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul N Newton
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Medicine Quality Research Group, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ben S Cooper
- NDM Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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25
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Osman A, Amoako Johnson F, Mariwah S, Amoako-Sakyi D, Asiedu Owusu S, Ekor M, Hamill H, Hampshire K. Antimalarial stocking decisions among medicine retailers in Ghana: implications for quality management and control of malaria. BMJ Glob Health 2023; 6:e013426. [PMID: 37734858 PMCID: PMC10846845 DOI: 10.1136/bmjgh-2023-013426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/12/2023] [Indexed: 09/23/2023] Open
Abstract
Global health efforts such as malarial control require efficient pharmaceutical supply chains to ensure effective delivery of quality-assured medicines to those who need them. However, very little is currently known about decision-making processes within antimalarial supply chains and potential vulnerabilities to substandard and falsified medicines. Addressing this gap, we report on a study that investigated decision-making around the stocking of antimalarial products among private-sector medicine retailers in Ghana. Licensed retail pharmacies and over-the-counter (OTC) medicine retail outlets were sampled across six regions of Ghana using a two-stage stratified sampling procedure, with antimalarial medicines categorised as 'expensive,' 'mid-range,' and 'cheaper,' relative to other products in the shop. Retailers were asked about their motivations for choosing to stock particular products over others. The reasons were grouped into three categories: financial, reputation/experience and professional recommendation. Reputation/experience (76%, 95% CI 72.0% to 80.7%) were the drivers of antimalarial stocking decisions, followed by financial reasons (53.2%, 95% CI 48.1% to 58.3%) and recommendation by certified health professionals (24.7%, 95% CI 20.3% to 29.1%). Financial considerations were particularly influential in stocking decisions of cheaper medicines. Moreover, pharmacies and OTCs without a qualified pharmacist were significantly more likely to indicate financial reasons as a motivation for stocking decisions. No significant differences in stocking decisions were found by geographical location (zone and urban/rural) or outlet (pharmacy/OTC). These findings have implications for the management of antimalarial quality across supply chains in Ghana, with potentially important consequences for malaria control, particularly in lower-income areas where people rely on low-cost medication.
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Affiliation(s)
- Adams Osman
- Department of Geography Education, University of Education, Winneba, Ghana
| | - Fiifi Amoako Johnson
- Department of Population and Health, University of Cape Coast Faculty of Social Sciences, Cape Coast, Ghana
| | - Simon Mariwah
- Department of Geography and Regional Planning, University of Cape Coast Faculty of Social Sciences, Cape Coast, Ghana
| | | | - Samuel Asiedu Owusu
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Martins Ekor
- School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Kate Hampshire
- Department of Anthropology, Durham University, Durham, UK
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Wagnild JM, Lee D, Jayeola B, Lukito PK, Fimbo A, Hampshire K. Can a Smartphone Application Help Address Barriers to Reporting Substandard/Falsified Medical Products? A Pilot Study in Tanzania and Indonesia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300034. [PMID: 37640491 PMCID: PMC10461706 DOI: 10.9745/ghsp-d-23-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/14/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Reporting is an essential component of efforts to combat the distribution and circulation of substandard and falsified (SF) medical products worldwide. However, little is known about why health care professionals (HCPs) do not report suspect products to the national medicine regulatory authority (NMRA) and what measures might address this. This pilot study aimed to assess the utility of a smartphone application for reporting SF medical products in Tanzania and Indonesia. METHODS At baseline, in 2017, HCPs completed a survey describing perceived barriers to reporting and received training in the identification of SF products and received use of the smartphone reporting application (N=309). The application reporting system was piloted for 6 months. Evaluations took place with HCPs and NMRA staff at the midpoint and endline of the pilot study (2018). RESULTS At baseline, HCPs surveyed (n=254) identified the following key barriers to reporting: difficulties identifying SF products, frustrations with existing reporting systems, and fears that reporting may have personal or reputational repercussions. During the pilot period, HCPs submitted a total of 36 reports of 27 products to the NMRAs in their respective countries; of these, 8 products were determined to be SF and 2 were unregistered. In all 10 cases, appropriate regulatory action was taken. Feedback from HCPs and NMRA staff was positive in both countries, suggesting that the application addressed several barriers to reporting as it was convenient and, importantly, opened a line of communication between HCPs and the NMRA. However, the application did not address all barriers to reporting, such as concerns of repercussions. CONCLUSION The findings suggest that this smartphone application may be useful for improving HCPs' reporting of suspected SF products. Developing and piloting similar reporting applications in other countries and contexts is required.
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Affiliation(s)
- Janelle M Wagnild
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Diana Lee
- World Health Organization, Geneva, Switzerland
| | | | - Penny K Lukito
- Indonesia National Agency of Drug and Food Control, Jakarta, Indonesia
| | - Adam Fimbo
- Tanzania Medicines and Medical Devices Authority, Dodoma, Tanzania
| | - Kate Hampshire
- Department of Anthropology, Durham University, Durham, United Kingdom
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Salami RK, Valente de Almeida S, Gheorghe A, Njenga S, Silva W, Hauck K. Health, Economic, and Social Impacts of Substandard and Falsified Medicines in Low- and Middle-Income Countries: A Systematic Review of Methodological Approaches. Am J Trop Med Hyg 2023; 109:228-240. [PMID: 37339762 PMCID: PMC10397424 DOI: 10.4269/ajtmh.22-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/10/2023] [Indexed: 06/22/2023] Open
Abstract
Little is known about the adverse health, economic, and social impacts of substandard and falsified medicines (SFMs). This systematic review aimed to identify the methods used in studies to measure the impact of SFMs in low- and middle-income countries (LMICs), summarize their findings, and identify gaps in the reviewed literature. A search of eight databases for published papers, and a manual search of references in the relevant literature were conducted using synonyms of SFMs and LMICs. Studies in the English language that estimated the health, social, or economic impacts of SFMs in LMICs published before June 17, 2022 were considered eligible. Search results generated 1,078 articles, and 11 studies were included after screening and quality assessment. All included studies focused on countries in sub-Saharan Africa. Six studies used the Substandard and Falsified Antimalarials Research Impact model to estimate the impact of SFMs. This model is an important contribution. However, it is technically challenging and data demanding, which poses challenges to its adoption by national academics and policymakers alike. The included studies estimate that substandard and falsified antimalarial medicines can account from 10% to ∼40% of total annual malaria costs, and SFMs affect rural and poor populations disproportionately. Evidence on the impact of SFMs is limited in general and nonexistent regarding social outcomes. Further research needs to focus on practical methods that can serve local authorities without major investments in terms of technical capacity and data collection.
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Affiliation(s)
- Raimat Korede Salami
- Department of Infectious Disease and Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Sara Valente de Almeida
- Department of Infectious Disease and Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Adrian Gheorghe
- Department of Infectious Disease and Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Sarah Njenga
- Department of Infectious Disease and Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Wnurinham Silva
- Department of Infectious Disease and Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Katharina Hauck
- Department of Infectious Disease and Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
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da Costa JAC, de Lourdes Aguiar-Oliveira M, Brown D, Bermudez JAZ, Netto EJR, de Lima Leitão O, de Almeida AECC, Siqueira MM. Ensuring vaccine safety: Case studies of falsified influenza vaccines detected in Brazil. Vaccine X 2023; 14:100343. [PMID: 37457323 PMCID: PMC10339189 DOI: 10.1016/j.jvacx.2023.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/27/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
Falsifications related to health technologies-including vaccines-are a growing threat to patient safety and health systems on a global scale and can cause serious harm to the population (especially vulnerable groups). In Brazil, the manufacturing and spread of counterfeit medicines are prevented through joint actions between different government agencies. In this study, we analyzed three cases of influenza vaccines suspected of counterfeiting. The samples were seized by officials and received by the National Institute for Quality Control in Health (INCQS), the national quality control reference laboratory of the Ministry of Health of Brazil, in 2010, 2017, and 2020. We report the results of our analytical investigations and emphasize the importance of strengthening the partnerships between various national agencies. The seized samples were visually inspected, and their information was compared with that of genuine vaccines (as recorded in the INCQS database). The specific analytical tests were based on quality control tests for biological products. Our results confirmed that all seized samples were falsified. We emphasize the importance of fostering international and intra-national collaborations between various national agencies (such as drug regulatory authorities, official laboratories, customs departments, police forces, and civil society). As demonstrated here, such collaborative actions are essential for combating the release of falsified medical products, safeguarding public health, and strengthening health systems.
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Affiliation(s)
- Jaline Alves Cabral da Costa
- National National Institute for Quality Control in Health (INCQS), Oswaldo Cruz Foundation, Av. Brazil, 4365, Manguinhos, Rio de Janeiro CEP 21040-360, Brazil
| | - Maria de Lourdes Aguiar-Oliveira
- Laboratory of Respiratory Virus and Measles, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av. Brazil, 4365, Manguinhos, Rio de Janeiro CEP 21040-360, Brazil
| | - David Brown
- Laboratory of Respiratory Virus and Measles, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av. Brazil, 4365, Manguinhos, Rio de Janeiro CEP 21040-360, Brazil
| | - Jorge Antonio Zepeda Bermudez
- Sergio Arouca National School of Public Health (ENSP), Oswaldo Cruz Foundation, Av. Brazil, 4365, Manguinhos, Rio de Janeiro CEP 21040-360, Brazil
| | - Eduardo Jorge Rabelo Netto
- National National Institute for Quality Control in Health (INCQS), Oswaldo Cruz Foundation, Av. Brazil, 4365, Manguinhos, Rio de Janeiro CEP 21040-360, Brazil
| | - Ozéias de Lima Leitão
- National National Institute for Quality Control in Health (INCQS), Oswaldo Cruz Foundation, Av. Brazil, 4365, Manguinhos, Rio de Janeiro CEP 21040-360, Brazil
| | | | - Marilda Mendonça Siqueira
- Laboratory of Respiratory Virus and Measles, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av. Brazil, 4365, Manguinhos, Rio de Janeiro CEP 21040-360, Brazil
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Mambula G, Nanjebe D, Munene A, Guindo O, Salifou A, Mamaty AA, Rattigan S, Ellis S, Khavessian N, van der Pluijm RW, Marquer C, Adehossi IA, Langendorf C. Practices and challenges related to antibiotic use in paediatric treatment in hospitals and health centres in Niger and Uganda: a mixed methods study. Antimicrob Resist Infect Control 2023; 12:67. [PMID: 37434224 PMCID: PMC10337096 DOI: 10.1186/s13756-023-01271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Antibiotic resistance is a significant public health problem and is responsible for high mortality in children and new-borns. Strengthening the rational use of antibiotics and improving the quality and access to existing antibiotics are important factors in the fight against antibiotic resistance. This study aims to provide knowledge on the use of antibiotics in children in resource-limited countries in order to identify problems and possible avenues for improvement of antibiotics use. METHODS We conducted a retrospective study in July 2020 and collected quantitative clinical and therapeutic data on antibiotic prescriptions between January and December 2019 in 4 hospitals or health centres in both Uganda and Niger, respectively from January to December 2019. Semi-structured interviews and focus groups were conducted among healthcare personnel and carers for children under 17 years of age, respectively. RESULTS A total of 1,622 children in Uganda and 660 children in Niger (mean age of 3.9 years (SD 4.43)) who received at least one antibiotic were included in the study. In hospital settings, 98.4 to 100% of children prescribed at least one antibiotic received at least one injectable antibiotic. Most hospitalized children received more than one antibiotic in both Uganda (52.1%) and Niger (71.1%). According to the WHO-AWaRe index, the proportion of prescriptions of antibiotics belonging to the Watch category was 21.8% (432/1982) in Uganda and 32.0% (371/1158) in Niger. No antibiotics from the Reserve category were prescribed. Health care provider's prescribing practices are rarely guided by microbiological analyses. Prescribers are faced with numerous constraints, such as lack of standard national guidelines, unavailability of essential antibiotics at the level of hospital pharmacies, the limited financial means of the families, and pressure to prescribe antibiotics from caregivers as well as from drug company representatives. The quality of some antibiotics provided by the National Medical Stores to the public and private hospitals has been questioned by some health professionals. Self-medication is a widespread practice for the antibiotic treatment of children for economic and access reasons. CONCLUSION The study findings indicate that an intersection of policy, institutional norms and practices including individual caregiver or health provider factors, influence antibiotic prescription, administration and dispensing practices.
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Affiliation(s)
- Grace Mambula
- Epicentre - Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, Paris, 75019, France.
| | - Deborah Nanjebe
- Epicentre Uganda, Kabale Road, MUST Campus, P.0. Box 1956, Mbarara, Uganda
| | - Aurelia Munene
- Epicentre Uganda, Kabale Road, MUST Campus, P.0. Box 1956, Mbarara, Uganda
| | - Ousmane Guindo
- Epicentre Niger, Quartier Plateau, Boulevard Mali Béro, Issa Beri rue 31, Porte N° 93, Niamey, BP : 13330, Niger
| | - Aichatou Salifou
- Epicentre Niger, Quartier Plateau, Boulevard Mali Béro, Issa Beri rue 31, Porte N° 93, Niamey, BP : 13330, Niger
| | - Abdoul-Aziz Mamaty
- Epicentre Niger, Quartier Plateau, Boulevard Mali Béro, Issa Beri rue 31, Porte N° 93, Niamey, BP : 13330, Niger
| | - Susan Rattigan
- Epicentre - Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, Paris, 75019, France
| | - Sally Ellis
- GARDP Foundation, Chemin Camille-Vidart 15, Geneva, 1202, Switzerland
| | | | - Rob W van der Pluijm
- Epicentre - Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, Paris, 75019, France
| | - Caroline Marquer
- Epicentre - Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, Paris, 75019, France
| | | | - Céline Langendorf
- Epicentre - Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, Paris, 75019, France
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Olaru ID, Walther B, Schaumburg F. Zoonotic sources and the spread of antimicrobial resistance from the perspective of low and middle-income countries. Infect Dis Poverty 2023; 12:59. [PMID: 37316938 DOI: 10.1186/s40249-023-01113-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is an increasing challenge in low and middle-income countries as it is widespread in these countries and is linked to an increased mortality. Apart from human and environmental factors, animal-related drivers of antimicrobial resistance in low- and middle-income countries have special features that differ from high-income countries. The aim of this narrative review is to address the zoonotic sources and the spread of antimicrobial resistance from the perspective of low- and middle-income countries. MAIN BODY Contamination with extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is highest in poultry (Africa: 8.9-60%, Asia: 53-93%) and there is a risk to import ESBL-producing E. coli through poultry meat in Africa. In aquacultures, the proportion of ESBL-producers among E. coli can be high (27%) but the overall low quality of published studies limit the general conclusion on the impact of aquacultures on human health. ESBL-producing E. coli colonization of wildlife is 1-9% in bats or 2.5-63% birds. Since most of them are migratory animals, they can disperse antimicrobial resistant bacteria over large distances. So-called 'filth flies' are a relevant vector not only of enteric pathogens but also of antimicrobial resistant bacteria in settings where sanitary systems are poor. In Africa, up to 72.5% of 'filth flies' are colonized with ESBL-producing E. coli, mostly conferred by CTX-M (24.4-100%). While methicillin-resistant Staphylococcus aureus plays a minor role in livestock in Africa, it is frequently found in South America in poultry (27%) or pork (37.5-56.5%) but less common in Asia (poultry: 3%, pork: 1-16%). CONCLUSIONS Interventions to contain the spread of AMR should be tailored to the needs of low- and middle-income countries. These comprise capacity building of diagnostic facilities, surveillance, infection prevention and control in small-scale farming.
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Affiliation(s)
- Ioana D Olaru
- Institute of Medical Microbiology, University of Münster, Münster, Germany.
| | - Birgit Walther
- Advanced Light and Electron Microscopy, Robert Koch-Institute, Berlin, Germany
- Department of Environmental Hygiene, German Environment Agency, Berlin, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University of Münster, Münster, Germany
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Yemeke TT, Umaru FA, Ferrand RA, Ozawa S. Impact of the COVID-19 pandemic on the quality of medical products in Zimbabwe: a qualitative study based on key informant interviews with health system stakeholders. BMJ Open 2023; 13:e068923. [PMID: 37290943 PMCID: PMC10254804 DOI: 10.1136/bmjopen-2022-068923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To explore the impact of the Coronavirus disease 2019 (COVID-19) pandemic on the quality of medical products in Zimbabwe, including market risks for substandard and falsified products and impacts on quality assurance activities. DESIGN Qualitative study based on in-depth key informant interviews. SETTING Health system stakeholders across the medical product supply chain in Zimbabwe. PARTICIPANTS 36 key informants were interviewed between April and June 2021. RESULTS We found that the COVID-19 pandemic disrupted quality assurance and regulatory activities of medical products in Zimbabwe, resulted in observations of poor-quality personal protective equipment (PPE) and other COVID-19-related products and led to increased risks to quality. Risks to quality due to COVID-19-related disruptions included increased layers of agents in the supply chain and an influx of non-traditional suppliers. COVID-19-related movement restrictions reduced access to health facilities and thus may have increased the usage of the informal market where smuggled and unregistered medical products are sold with less oversight by the regulator. Most reports of poor-quality medical products were for PPE, such as masks and infrared thermometers, used for the COVID-19 response. Besides these reports, many participants stated that the quality of essential medicines in the formal sector, not related to COVID-19, had largely been maintained during the pandemic due to the regulator's stringent quality assurance process. Incentives for suppliers to maintain quality to retain large donor-funded contracts, and the need for local wholesalers and distributors to comply with quality-related aspects of distribution agreements with global manufacturers of brand-name medical products, mitigated threats to quality. CONCLUSIONS The COVID-19 pandemic presented opportunities and market risks for circulation of substandard and falsified medical products in Zimbabwe. There is a need for policymakers to invest in measures to safeguard the quality of medical products during emergencies and to build resiliency against future supply chain shocks.
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Affiliation(s)
- Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Farouk A Umaru
- Department of Global Public Health, United States Pharmacopeia, Rockville, Maryland, USA
| | - Rashida A Ferrand
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Maternal Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ocan M, Nakalembe L, Otike C, Omali D, Buzibye A, Nsobya S. Pharmacopeial quality of artemether-lumefantrine anti-malarial agents in Uganda. Malar J 2023; 22:165. [PMID: 37237283 DOI: 10.1186/s12936-023-04600-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Substandard anti-malarial agents pose a significant challenge to effective malaria control and elimination efforts especially in sub-Saharan Africa. The quality of anti-malarials in most low-and-middle income countries (LMICs) is affected by several factors including inadequate regulation and limited resources. In this study, the pharmacopeial quality of artemether-lumefantrine (AL) in low and high malaria transmission settings in Uganda was assessed. METHODS This was a cross-sectional study conducted among randomly selected private drug outlets. The AL anti-malarials available in drug outlets were purchased using overt method. The samples were screened for quality using visual inspection, weight uniformity, content assay and dissolution tests. The assay test was done using liquid chromatography-mass spectrometry (LC-MS). The samples were considered substandard if the active pharmaceutical ingredient (API) content was outside 90-110% range of the label claim. Dissolution test was conducted following United States Pharmacopoeia (USP) method. Data was analysed using descriptive statistics and presented as means with standard deviations, frequencies, and proportions. Correlation between medicine quality and independent variables was determined using Fisher's exact test of independence at 95% level of significance. RESULTS A total of 74 AL anti-malarial samples were purchased from high (49/74; 66.2%) and low (25/74; 33.8%) malaria transmission settings. The most common batch of AL was LONART, 32.4% (24/74), with 33.8% (25/74) being 'Green leaf'. Overall prevalence of substandard quality artemether-lumefantrine was 18.9% (14/74; 95% CI: 11.4-29.7). Substandard quality AL was significantly associated with setting (p = 0.002). A total of 10 samples (13.5%) failed artemether content assay test while, 4 samples (5.4%, 4/74) failed the lumefantrine assay test. One sample from a high malaria transmission setting failed both artemether and lumefantrine assay content test. Of the samples that failed artemether assay test, 90% had low (< 90%) artemether content. All the samples passed visual inspection and dissolution tests. CONCLUSION Artemether-lumefantrine agents, the recommended first-line treatment for uncomplicated malaria with APIs outside the recommended pharmacopeial content assay limit is common especially in high malaria transmission settings. There is need for continuous surveillance and monitoring of the quality of artemisinin-based anti-malarials across the country by the drug regulatory agency.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology and Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Loyce Nakalembe
- Department of Pharmacology, Soroti University, P.O. Box 211, Soroti, Uganda
| | - Caroline Otike
- Data Department, Joint Clinical Research Centre, Lubowa, P. O Box 10005, Kampala, Uganda
| | - Denis Omali
- Pharmacokinetics Laboratory Unit, Infectious Disease Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Allan Buzibye
- Pharmacokinetics Laboratory Unit, Infectious Disease Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Sam Nsobya
- Department of Pathology, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Pathak R, Gaur V, Sankrityayan H, Gogtay J. Tackling Counterfeit Drugs: The Challenges and Possibilities. Pharmaceut Med 2023:10.1007/s40290-023-00468-w. [PMID: 37188891 PMCID: PMC10184969 DOI: 10.1007/s40290-023-00468-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 05/17/2023]
Abstract
Drugs that have been manufactured or packaged fraudulently are referred to as counterfeit/fake/spurious/falsified drugs because they either lack active ingredients or have the incorrect dosages. Counterfeiting of drugs has become a global issue with which the whole world is grappling. The World Health Organization states the frightening figure in which almost 10.5% of the medications worldwide are either subpar or fake. Although developing and low-income countries are the targets of the large-scale drug counterfeiting activities, fake/substandard drugs are also making their way into developed nations including the USA, Canada, and European countries. Counterfeiting of drugs is leading to not only economic loss but is also playing its part in the morbidity and mortality of patients. The recent COVID-19 pandemic fuelled the demand for certain categories of medicines such as antipyretics, remdesivir, corticosteroids, vaccines, etc., thus increasing the demand and manufacture of subpar/fake medicines. This review articulates the current trends and global impact of drug counterfeiting, current and potential measures for its prevention and the role of different stakeholders in tackling the menace of drug counterfeiting.
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Affiliation(s)
- Ranjana Pathak
- Dr Reddy's Laboratory Ltd, Banjara Hills, 8-2-337, Road No. 3, Hyderabad, Telangana, 500034, India.
| | - Vaibhav Gaur
- Global Medical Affairs, Cipla Ltd, Mumbai, India
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Efficacy of Penicillin–Streptomycin Brands against Staphylococcus aureus: Concordance between Veterinary Clinicians’ Perception and the Realities. Antibiotics (Basel) 2023; 12:antibiotics12030570. [PMID: 36978437 PMCID: PMC10044686 DOI: 10.3390/antibiotics12030570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Antibiotics must be safe and effective for use in both human and veterinary medicine. However, information about the efficacy of different brands of antibiotics commonly used in veterinary practices is lacking in Ethiopia. In this study, we determined the efficacy of three brands of penicillin–streptomycin (Pen&strep, Penstrep, and Pro&strep) by performing antimicrobial susceptibility testing against Staphylococcus aureus isolated from cow milk from dairy farms in the towns of Sebata and Bishoftu, Central Ethiopia. We also assessed the knowledge, attitudes, and practices (KAP) of veterinarians regarding the quality and use of brand antibiotics and the antibiotic utilization practices of dairy farm personnel using a structured questionnaire. Of 43 S. aureus isolated and tested, 33 (77%), 10 (23%), and 1 (2%) were susceptible to brands A, B, and C, respectively. According to the respondents, all of them reported that penstrep is the most prescribed antibiotic in dairy farms (100%), followed by oxytetracycline (78%) and sulfa drugs (52%). All veterinarians perceived that antibiotics imported from Western countries have a higher efficacy than those from Eastern countries, and they preferred brand A to the other brands, witnessing its better clinical outcome. The majority (87%) and a little more than half (53%) of the respondents perceived the overuse of antibiotics in veterinary clinics and dairy farms, respectively. Our study revealed the better efficacy of brand A against S. aureus compared to the other brands. Interestingly, the veterinarians’ perception of and preference toward the use of brand antibiotics agreed with the findings of our antibacterial susceptibility testing. The prudent use of brand A is critically important for sustaining effective treatment, avoiding the risk of antimicrobial resistance, and helping to address animal welfare issues.
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Harwacki J, Pisklak DM, Szeleszczuk L. Solid state 13C NMR spectroscopy as a tool for identification of counterfeit Viagra tablets and guide for develop new identification approach of falsified product. Int J Pharm 2023; 636:122837. [PMID: 36921742 DOI: 10.1016/j.ijpharm.2023.122837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Abstract
Counterfeit drugs are a global problem that is directly related to the safety and effectiveness of pharmacotherapy. The black market for counterfeit products is constantly growing and related to the wide availability through online shopping. Therefore, there is a constant need to develop analytical methods that would allow for the unambiguous identification of counterfeit products from the original ones. One of such techniques is solid-state NMR spectroscopy, which allows for direct registration and analysis of spectra of multicomponent solid forms of pharmaceutical formulations. The paper explores the possibility of using this technique in the identification of counterfeit Viagra tablets. In this study, solid-state NMR has been used to detect the non-pharmacopoeial cellulose present in the samples of counterfeit Viagra tablets. Besides, the NMR results allowed to develop a rapid dying technique that can be used to distinguish between the counterfeit and original drug. It has been shown that solid-state NMR spectroscopy allows for numerous analyses such as identification of counterfeit products, assessment of the composition of analyte, estimation of qualitative differences between the original and falsified product, and the development of simple analytical methods based on tablets composition differences.
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Affiliation(s)
- Jakub Harwacki
- Medical University of Warsaw, Faculty of Pharmacy, Department of Organic and Physical Chemistry, Stefana Banacha 1, 02-097 Warsaw, Poland.
| | - Dariusz Maciej Pisklak
- Medical University of Warsaw, Faculty of Pharmacy, Department of Organic and Physical Chemistry, Stefana Banacha 1, 02-097 Warsaw, Poland.
| | - Lukasz Szeleszczuk
- Medical University of Warsaw, Faculty of Pharmacy, Department of Organic and Physical Chemistry, Stefana Banacha 1, 02-097 Warsaw, Poland.
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Oliveira CLCG, Machado VF, de Freitas Tavares H, Ribeiro GLM, Arrais PSD. Recall of substandard medicines in Brazil during the period 2010-2018. BMC Health Serv Res 2023; 23:238. [PMID: 36899376 PMCID: PMC10007835 DOI: 10.1186/s12913-023-09225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Even with all the care taken during the production process, the pharmaceutical industries are still subject to manufacturing medicines with quality deviations, generating commercialized products without the required quality and necessitating their subsequent recall from the market. The objective of this study was to evaluate the reasons that led to the recall of medicines in Brazil in the period evaluated. METHODS This is a descriptive study (using document analysis), on the recall of substandard medicines registered on the website of the National Health Surveillance Agency (ANVISA), from 2010 to 2018. The variables studied were the type of medicine (reference, generic, similar, specific, biological, herbal, simplified notification, new and radiopharmaceutical), type of pharmaceutical dosage form (solid, liquid, semi-solid and parenteral preparation), and reason for recall (Good manufacturing practices, quality and quality/good manufacturing practices). RESULTS A total of n = 3,056 recalls of substandard medicine were recorded. Similar medicines had a higher recall index (30.1%), followed by generics (21.3%), simplified notification (20.7%) and reference (12.2%). Different dosage forms had similar recalls: solids (35.2%), liquids (31.2%) and parenteral preparations (30.0%), with the exception of semi-solids (3.4%). The reasons for the highest occurrences were related to good manufacturing practices (58.4%) and quality (40.4%). CONCLUSION The probable cause for this high number of recalls is the fact that, even with all the quality controls and processes in accordance with good manufacturing practices, errors can occur, both human and in automated processes, thus causing the release of batches that should not have been approved. In summary, it is necessary for manufacturers to implement a robust and well structured quality system in order to avoid such deviations, and it is up to ANVISA to apply greater oversight in the post marketing of these products.
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Affiliation(s)
- Cristiani Lopes Capistrano Gonçalves Oliveira
- Pharmacy Department, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Rua Pastor Samuel Munguba, 1210, Rodolfo Teófilo, Fortaleza, 60430-372, Ceará, Brazil.
| | - Virgínia Freire Machado
- Lato Sensu post-graduation in pharmaceutical industry, Pharmacy Department, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Rua Pastor Samuel Munguba, 1210, Rodoldo Teófilo, Fortaleza, Ceará, Brazil
| | - Heitor de Freitas Tavares
- Pharmacy undergraduate student, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Rua Pastor Samuel Munguba, 1210, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Gabriel Lucas Marques Ribeiro
- Pharmacy undergraduate student, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Rua Pastor Samuel Munguba, 1210, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Paulo Sérgio Dourado Arrais
- Pharmacy Department, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Rua Pastor Samuel Munguba, 1210, Rodolfo Teófilo, Fortaleza, 60430-372, Ceará, Brazil
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Covid-19 Recovery and Growth: Promoting Technology Innovation in Healthcare Sector on Hygiene and Safe Medication Practices in Low-Resourced Nigerian Societies. SCIENTIFIC AFRICAN 2023; 19:e01542. [PMID: 36624773 PMCID: PMC9812470 DOI: 10.1016/j.sciaf.2023.e01542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Introduction Globally, the healthcare sector is primarily designated to provide timely, efficient and effective medical services. In African countries like Nigeria, the inequality in the healthcare sector is worsened by the limited coverage of healthcare delivery. This has evolved to an unprecedented effect on the provision of healthcare services in low-resource societies. In the post COVID-19 era, recovery and growth from the pandemic become more demanding with an emphasis on promoting innovative technology in the healthcare sector on hygiene and safe medication practices. Method Data was sourced from mixed research method. Questionnaires, focus group discussions, and in-depth interviews were used to deduce data from 142 healthcare providers, users, and social workers. Participants were randomly selected from three healthcare institutions in Nsukka, Enugu state. Result Findings revealed that although greater positive perception (66.7%) holds on promoting innovative technology in the healthcare sector; concerns on negative perceptions (33.3%) were; the choice of medication, cultural health behavior and non-adherence to health guidelines. Major factors militating against innovative technology in healthcare sector were corruption in healthcare system, patients' economic level and poor healthcare delivery. Findings depict that age (χ²cal= 84.0, p=0.000<0.05) and income (χ²cal= 53.7, p=0.000<0.05) of patients were found to be significant in the utilization of innovative technology in healthcare. Evidence-based interventions on innovative healthcare systems on hygiene and safe medication practices were; intensive community health education at the grass-root, implementation of health policies, and tutors' improved healthcare knowledge. Participants showed little knowledge of social workers' engagement in health institutions. Conclusion Equity in healthcare is a core concern in Sustainable Development Goals. Achieving equal distribution of health services between urban and rural societies in recovery from covid-19 pandemic and growth of the healthcare sector is pegged on promoting innovative technology in hygiene and safe medication practices. The study recommends that social workers' engagement with health providers and users in low-resourced societies could help propagate awareness and self-care management of health challenges through digital information technology in Nigeria.
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Revisiting the blind spot of substandard and fake drugs as drivers of antimicrobial resistance in LMICs. Ann Med Surg (Lond) 2023; 85:122-123. [PMID: 36845783 PMCID: PMC9949790 DOI: 10.1097/ms9.0000000000000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/22/2022] [Indexed: 02/28/2023] Open
Abstract
One of the most significant risks to public health is ongoing antimicrobial resistance (AMR). Substandard and fraudulent medications, particularly in low- and middle-income countries (LMICs), are thought to have a role in the genesis and spread of AMR. There are numerous reports concerning the availability of subpar pharmaceuticals in developing countries, with no scientific evidence as to what exactly is included in some of the prescriptions supplied there. These counterfeit and inferior pharmaceuticals are a financial burden of up to US$200 billion, causing thousands of patient deaths, endangering both individual and public health,and undermining patient trust in the healthcare system. Poor quality and counterfeit antibiotics are often disregarded as possible causes of AMR in AMR studies. Therefore, we examined the issue of fake drugs in LMICs and its possible links to the emergence and spread of AMR.
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Kiguba R, Olsson S, Waitt C. Pharmacovigilance in low- and middle-income countries: A review with particular focus on Africa. Br J Clin Pharmacol 2023; 89:491-509. [PMID: 34937122 DOI: 10.1111/bcp.15193] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 01/25/2023] Open
Abstract
Low- and middle-income countries (LMIC) face unique challenges with regard to the establishment of robust pharmacovigilance systems capable of generating data to inform healthcare policy and practice. These include the limited integration and reliability of pharmacovigilance systems across LMIC despite recent efforts to harmonize pharmacovigilance rules and regulations in several regional economic communities. There are particular challenges relating to the need to translate reporting tools into numerous local languages and the low numbers of healthcare providers relative to number of patients, with very short consultation times. Additional factors frequent in LMIC include high uptake of herbal and traditional medication, mostly by self-medication; disruptive political conflicts jeopardizing fragile systems; and little or no access to drug utilization data, which makes it difficult to reliably estimate the true risks of medicines use. Pharmacovigilance activities are hindered by the scarcity of well-trained personnel with little or no budgetary support from national governments; high turnover of pharmacovigilance staff whose training involves a substantial amount of resources; and little awareness of pharmacovigilance among healthcare workers, decision makers and consumers. Furthermore, little collaboration between public health programmes and national medicines regulatory authorities coupled with limited investment in pharmacovigilance activities, especially during mass drug administration for neglected tropical diseases and mass vaccinations, produces major challenges in establishing a culture where pharmacovigilance is systematically embedded. Very low spontaneous reporting rates with poor quality reports hinders robust signal detection analyses. This review summarises the specific challenges and areas of progress in pharmacovigilance in LMIC with special focus on the situation in Africa.
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Affiliation(s)
- Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda
| | - Sten Olsson
- Pharmacovigilance Consulting, Uppsala, Sweden
| | - Catriona Waitt
- Department of Pharmacology and Therapeutics, University of Liverpool, UK.,Infectious Diseases Institute, Makerere University College of Health Sciences, Uganda
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Kusynová Z, Bais Y, van den Ham HA, Mantel-Teeuwisse AK, Etame-Loe G, Kaale E, Sarr SO, Guiet-Mati F, Bourdillon-Esteve P. Improved knowledge on substandard and falsified (SF) medical products through a dedicated course for pharmacy students at three universities in sub-Saharan Africa. BMJ Glob Health 2023; 6:bmjgh-2022-009367. [PMID: 36731919 PMCID: PMC10175941 DOI: 10.1136/bmjgh-2022-009367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Too few pharmacists receive formal training on substandard and falsified (SF) medical products. Strengthening knowledge across pharmacists is considered a moral and ethical duty of academia, that is, to build the health systems' capacities to combat this global health threat these poor-quality products represent. This study therefore aimed to evaluate whether a dedicated educational course for undergraduate pharmacy students can improve their knowledge on these products. METHODS A survey was conducted at three sub-Saharan universities. Knowledge was assessed through scores on a 20-point questionnaire with questions related to the course content. Scores were compared before and after the course, and a linear mixed-effects model analysis was used to analyse score differences. Students were furthermore asked for feedback and self-assessment. In addition, teachers were interviewed on the context of the course introduction. These data were analysed descriptively. RESULTS Among 335 out of 355 students who completed the survey (n=41/53 in Cameroon, n=244/252 in Senegal and n=50/50 in Tanzania), knowledge of SF medical products was enhanced, with increase in all countries, overall, by 3.5 (95% CI 3.1 to 3.9) score points. Students improved in all offered modules in each country. Students confirmed their improvement through self-assessment.The course was well received among students and teachers. Barriers included time constraints and access to practical means (equipment availability, room allocation, internet accessibility and affordability). These barriers can be overcome by key enablers such as the support from university leadership and early involvement of the university in the course design. CONCLUSIONS The course improved students' knowledge on SF medical products. These findings encourage further full implementation of this course in existing curricula beyond the pilot and can inform possible future scale-up. This has a potential for reinforcing the capacity of health systems to protect communities from SF medicines, by empowering all pharmacist across the health systems to intervene.
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Affiliation(s)
- Zuzana Kusynová
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.,International Pharmaceutical Federation, The Hague, The Netherlands
| | - Youssra Bais
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.,International Pharmaceutical Federation, The Hague, The Netherlands
| | - Hendrika A van den Ham
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | | | - Eliangiringa Kaale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | | | - Fatima Guiet-Mati
- Access to medicines and health products, World Health Organization, Geneva, Switzerland
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Waffo Tchounga CA, Sacré PY, Ciza Hamuli P, Ngono Mballa R, De Bleye C, Ziemons E, Hubert P, Marini Djang’eing’a R. Prevalence of Poor Quality Ciprofloxacin and Metronidazole Tablets in Three Cities in Cameroon. Am J Trop Med Hyg 2023; 108:403-411. [PMID: 36535257 PMCID: PMC9896317 DOI: 10.4269/ajtmh.22-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022] Open
Abstract
Quality is one of the essential components of medicines and needs to be ensured to preserve the population's health. This can be achieved through post-marketing quality control of medicines and is one of the most important duties of national regulatory authorities. In collaboration with the Cameroonian National Drug Quality Control and Valuation Laboratory, the decision was made to initiate a prevalence study to assess the quality of antiinfective medicines in Cameroon. A total of 150 samples of ciprofloxacin tablets and 142 samples of metronidazole tablets were collected from 76 licensed pharmacies and 75 informal vendors in three cities in Cameroon using a random strategy wherever possible and a mystery shopper approach. Three tests were carried out on each of the samples. Visual inspection allowed to find two falsified samples (0.7%) due to lack of information about the manufacturing company, and five more samples (1.7%) were deemed to be substandard due to flaws in the product. An additional 13 samples (4.5%) failed disintegration testing, and six (2.1%) others failed high-performance liquid chromatography assay testing due to insufficient active pharmaceutical ingredient (API) content. All samples were found to contain some API. A prevalence of 7.9% substandard or falsified (SF) medicines was found. Moreover, the prevalence of outlets selling SF medicines was greater in the informal sector (26.7%) than in the formal sector (2.6%). Although the prevalence of SF medicines found was low, efforts need to be made by national regulatory authorities to monitor the pharmaceutical market more closely.
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Affiliation(s)
- Christelle Ange Waffo Tchounga
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Pierre-Yves Sacré
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Patient Ciza Hamuli
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
- Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Rose Ngono Mballa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratoire National de Contrôle des Médicaments et Expertise, Yaoundé, Cameroon
| | - Charlotte De Bleye
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Eric Ziemons
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Philippe Hubert
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Roland Marini Djang’eing’a
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
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Wata D, Ogwu J, Dunford L, Lawson G, Tanna S. Utilizing quantitative dried blood spot analysis to objectively assess adherence to cardiovascular pharmacotherapy among patients at Kenyatta National Hospital, Nairobi, Kenya. PLoS One 2023; 18:e0280137. [PMID: 36662714 PMCID: PMC9858374 DOI: 10.1371/journal.pone.0280137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
The burden of cardiovascular disease (CVD) is rising in Kenya and non-adherence to cardiovascular pharmacotherapy is a growing global public health issue that leads to treatment failure, an increased risk of cardiac events and poor clinical outcomes. This study assessed adherence to selected cardiovascular therapy medications among CVD patients attending outpatient clinics at Kenyatta National Hospital, Kenya by determining drug concentration(s) in patient dried blood spot (DBS) samples. Patients who had been taking one or more of the five commonly prescribed CVD medications (amlodipine, atenolol, atorvastatin, losartan, and valsartan) for at least six months were enrolled. Each patient completed a short questionnaire about their medication history and then provided a finger-prick blood spot sample from which drug concentrations were determined by liquid chromatography-high resolution mass spectrometry analysis. Two hundred and thirty-nine patients (62.3% female) participated in the study. The median number of medications used by patients was 2 (IQR 75%-25% is 3-1). Less than half (117; 49.0%) of patients were adherent to their prescribed CVD pharmacotherapy. Binary regression analysis revealed a significant correlation between non-adherence and the number of medications in the treatment regimen (Odds Ratio (OR) 1.583; 95%CI: 0.949-2.639; P-value = 0.039) and that gender was not an independent predictor of medication adherence (OR 1.233; 95%CI: 0.730-2.083; P-value = 0.216). Valuable information about adherence to each medication in the patient's treatment regimen was obtained using quantitative DBS analysis showing that adherence to CVD medications was not uniform. DBS sampling, due its minimally invasive nature, convenience and ease of transport is a useful alternative matrix to monitor adherence to pharmacotherapies objectively, when combined with hyphenated mass spectrometry analytical techniques. This information can provide physicians with an evidence-based novel approach towards personalization and optimization of CVD pharmacotherapy and implementing interventions in the Kenyan population, thereby improving clinical outcomes.
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Affiliation(s)
- David Wata
- Department of Pharmacy, Kenyatta National Hospital, Nairobi, Kenya
| | - John Ogwu
- Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
| | - Louise Dunford
- Faculty of Health and Life Sciences, Leicester School of Allied Health, De Montfort University, Leicester, United Kingdom
| | - Graham Lawson
- Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
| | - Sangeeta Tanna
- Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
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Rojas-Cortés R, Gorordo M, Vahos J, Galindo Wehdeking R, Saavedra H, Heredia A, Liévano D, Carino J, Sánchez MJ, Castro JL. [Regulation of the online sale of medical products: experiences and strategies for Latin AmericaRegulamentação da venda de produtos médicos pela internet: experiências e estratégias para a América Latina]. Rev Panam Salud Publica 2023; 47:e81. [PMID: 37197594 PMCID: PMC10184577 DOI: 10.26633/rpsp.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/09/2023] [Indexed: 05/19/2023] Open
Abstract
The objective of this special report is to present the advances in Latin America on regulation of the online sale of medical products and to offer guidance to national regulatory authorities (NRAs) on planning and implementing strategies to regulate and oversee the e-commerce of medical products. The regulatory advances and the programs and initiatives implemented in four Latin American countries to control the online sale of medical products are presented, including complementary reviews of the literature and reviews of e-commerce control programs of agencies of reference. Based on this review, the following strategies are proposed: strengthening the regulatory and policy framework; strengthening the capacity for oversight; collaboration with national and international authorities and other key players; and communication and awareness-raising with the community and health care professionals. Each of these strategies should be accompanied by specific actions that can serve as guidelines for NRAs in the Americas and in countries with similar contexts, to strengthen their regulatory frameworks and patient and consumer protections.
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Affiliation(s)
- Robin Rojas-Cortés
- Departamento de InnovaciónAcceso a Medicamentos y Tecnologías Sanitarias (IMT)Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS)Washington D.C.Estados Unidos de AméricaDepartamento de Innovación, Acceso a Medicamentos y Tecnologías Sanitarias (IMT), Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) Washington D.C., Estados Unidos de América.
- Robin Rojas-Cortés,
| | - Marisa Gorordo
- Red Regional para la PrevenciónDetección y Respuesta a Productos Médicos Subestándar y Falsificados en las Américas, consultor independienteBuenos AiresArgentinaRed Regional para la Prevención, Detección y Respuesta a Productos Médicos Subestándar y Falsificados en las Américas, consultor independiente, Buenos Aires, Argentina.
| | - Juanita Vahos
- Facultad de CienciasDepartamento de FarmaciaUniversidad Nacional de ColombiaBogotáColombiaFacultad de Ciencias, Departamento de Farmacia, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Roy Galindo Wehdeking
- Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA)BogotáColombiaInstituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA), Bogotá, Colombia.
| | - Henry Saavedra
- Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA)BogotáColombiaInstituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA), Bogotá, Colombia.
| | - Alexander Heredia
- Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA)BogotáColombiaInstituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA), Bogotá, Colombia.
| | - Diana Liévano
- Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA)BogotáColombiaInstituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA), Bogotá, Colombia.
| | - Jesica Carino
- Red Regional para la PrevenciónDetección y Respuesta a Productos Médicos Subestándar y Falsificados en las Américas, consultor independienteBuenos AiresArgentinaRed Regional para la Prevención, Detección y Respuesta a Productos Médicos Subestándar y Falsificados en las Américas, consultor independiente, Buenos Aires, Argentina.
| | - María José Sánchez
- Red Regional para la PrevenciónDetección y Respuesta a Productos Médicos Subestándar y Falsificados en las Américas, consultor independienteBuenos AiresArgentinaRed Regional para la Prevención, Detección y Respuesta a Productos Médicos Subestándar y Falsificados en las Américas, consultor independiente, Buenos Aires, Argentina.
| | - José Luis Castro
- Red Regional para la PrevenciónDetección y Respuesta a Productos Médicos Subestándar y Falsificados en las Américas, consultor independienteBuenos AiresArgentinaRed Regional para la Prevención, Detección y Respuesta a Productos Médicos Subestándar y Falsificados en las Américas, consultor independiente, Buenos Aires, Argentina.
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Cáceres-Pérez AR, El Kory MB, Suárez-González J, Soriano M, Echezarreta MM, Santoveña-Estévez A, Fariña JB. A pharmaceutical monitoring system to assess the quality of antituberculosis drug products used in Mauritania. PLoS One 2023; 18:e0282023. [PMID: 36928659 PMCID: PMC10019615 DOI: 10.1371/journal.pone.0282023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023] Open
Abstract
The quality of drug products may be affected from manufacture to dispensing, particularly at high temperature and humidity as in Mauritania. This country is not included in the World Health Organization reports on poor quality products due to the lack of a qualified laboratory and monitoring system. Ensuring the quality of medicine is even more relevant in the case of diseases such as Tuberculosis, due to its high prevalence, complex treatment and continuous bacterial resistance. The aim was to develop a monitoring system to assess the quality of antituberculosis drugs products, by the substandard detection based on European and United States Pharmacopeial recommendations regarding quality control. In addition to studying the influence of accelerated storage conditions (40 ± 2°C/75 ± 5% relative humidity) on their qualities and comparing the dissolution profiles to contrast the quality. 18 antituberculosis drug products were taken from Europe and Mauritania, and quality was studied through visual inspection and according to the compliance of the mass uniformity, uniformity of dosage units, dissolution, disintegration and friability pharmacopeial tests. Furthermore, a dissolution profile comparison was carried out to examine quality. A stability study was conducted to assess the influence of climatic conditions on the content and the dissolved amount of the active pharmaceutical ingredients, which were determined by an ultra-performance liquid chromatography system. As result, 69.3% of 13 Mauritanian formulations had a substandard quality mainly due to non-compliance with the test for friability or content uniformity of these medicines. All European drug products complied with pharmacopeia specifications. In addition, storage conditions affected the dissolution rate of ethambutol and the uniformity of the 4 antituberculosis combination drug products.
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Affiliation(s)
- Amor R Cáceres-Pérez
- Facultad de Farmacia, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Programa de Doctorado Ciencias Médicas y Farmacéuticas, Desarrollo y Calidad de Vida, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Mohamed B El Kory
- Laboratoire National de Contrôle de la Qualité des Médicaments, Nouakchott, Islamic Republic of Mauritania
| | - Javier Suárez-González
- Facultad de Farmacia, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Mabel Soriano
- Facultad de Farmacia, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - M Magdalena Echezarreta
- Facultad de Farmacia, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Ana Santoveña-Estévez
- Facultad de Farmacia, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - José B Fariña
- Facultad de Farmacia, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
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Comparing the return on investment of technologies to detect substandard and falsified amoxicillin: A Kenya case study. PLoS One 2023; 18:e0268661. [PMID: 36652447 PMCID: PMC9847901 DOI: 10.1371/journal.pone.0268661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/04/2022] [Indexed: 01/19/2023] Open
Abstract
The prevalence of substandard and falsified medicines in low- and middle-income countries (LMICs) is a major global public health concern. Multiple screening technologies for post-market surveillance of medicine quality have been developed but there exists no clear guidance on which technology is optimal for LMICs. This study examined the return on investment (ROI) of implementing a select number of screening technologies for post-market surveillance of amoxicillin quality in a case study of Kenya. An agent-based model, Examining Screening Technologies using Economic Evaluations for Medicines (ESTEEM), was developed to estimate the costs, benefits, and ROI of implementing screening technologies for post-market surveillance of substandard and falsified amoxicillin for treatment of pediatric pneumonia in Kenya. The model simulated sampling, testing, and removal of substandard and falsified amoxicillin from the Kenyan market using five screening technologies: (1) Global Pharma Health Fund's GPHF-Minilab, (2) high-performance liquid chromatography (HPLC), (3) near-infrared spectroscopy (NIR), (4) paper analytical devices / antibiotic paper analytical devices (PADs/aPADs), and (5) Raman spectroscopy. The study team analyzed the population impact of utilizing amoxicillin for the treatment of pneumonia in children under age five in Kenya. We found that the GPHF-Minilab, NIR, and PADs/aPADs were similar in their abilities to rapidly screen for and remove substandard and falsified amoxicillin from the Kenyan market resulting in a higher ROI compared to HPLC. NIR and PADs/aPADs yielded the highest ROI at $21 (90% Uncertainty Range (UR) $5-$51) each, followed by GPHF-Minilab ($16, 90%UR $4 - $38), Raman ($9, 90%UR $2 - $21), and HPLC ($3, 90%UR $0 - $7). This study highlights screening technologies that can be used to reduce costs, speed up the removal of poor-quality medicines, and consequently improve health and economic outcomes in LMICs. National medicine regulatory authorities should adopt these fast, reliable, and low-cost screening technologies to better detect substandard and falsified medicines, reserving HPLC for confirmatory tests.
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Geleta K, Tufa TB. In vitro Efficacy Evaluation of Leading Brands of Ciprofloxacin Tablets Found in Bishoftu City Against Salmonella Isolates, Central Ethiopia. Infect Drug Resist 2023; 16:1433-1440. [PMID: 36942022 PMCID: PMC10024487 DOI: 10.2147/idr.s402640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Purpose Salmonella Enteritidis (SE) and Salmonella Typhimurium (STM) are the serovars most frequently associated with human illness. Ciprofloxacin is most widely used to manage cases in adults. The present study aimed to evaluate the in vitro antibacterial activity of leading brands of ciprofloxacin (tablets) marketed in Bishoftu city against SE and STM serovars, and field isolates of Salmonella (non-serotyped) from dairy milk in central Ethiopia. Methods Five most widely prescribed ciprofloxacin brands (A-E) were subjected to in vitro efficacy evaluation against Salmonella isolates by using the disc diffusion method. The zone of inhibition (ZI) of the tested brands was compared with the standard disc and interpreted as susceptible, intermediate, and resistant. Results Out of 27 replicates (SE, STM, and field Salmonella isolates each = 9) tested for efficacy, the result revealed the mean ZI of the brands varies for all tested isolates (p < 0.05). The highest mean was recorded for Brand E (24.7±0.71, 24.3±0.50, and 19.5±2.69) and lowest for Brand A (22.0±0.87, 21.0±0.87, and 10.7±1.4) for field Salmonella isolates, STM and SE, respectively. All SE were resistant to four brands (Brand A-D) whereas 67% and 33% of them were resistant and intermediate to Brand E, respectively. Similarly, 33% of STM were resistant to Brand A while all the STM were intermediate to other brands. Furthermore, all non-serotyped field isolates of Salmonella were intermediate to all five tested ciprofloxacin brands with variable ranges of mean of ZI (p<0.05). Conclusion The study revealed that Brand E was found to have relatively better efficacy against SE than other brands. The current study warrants a need for periodic surveillance of both the quality and efficacy of antibiotics to improve patient well-being and minimize the risk of antimicrobial resistance.
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Affiliation(s)
- Kenboni Geleta
- SPANA Ethiopia Project of the College of Veterinary Medicine and Agriculture, Addis Ababa University, Bishoftu, Ethiopia
| | - Takele Beyene Tufa
- Department of Biomedical Sciences, College of Veterinary Medicine and Agriculture, Addis Ababa University, Bishoftu, Ethiopia
- Correspondence: Takele Beyene Tufa, Tel +251 911 532131, Email
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Hampshire K, Mariwah S, Amoako-Sakyi D, Hamill H. “ It is very difficult in this business if you want to have a good conscience”: pharmaceutical governance and on-the-ground ethical labour in Ghana. Glob Bioeth 2022; 33:103-121. [PMID: 35912379 PMCID: PMC9331207 DOI: 10.1080/11287462.2022.2103899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The governance of pharmaceutical medicines entails complex ethical decisions that should, in theory, be the responsibility of democratically accountable government agencies. However, in many Low- and Middle-Income Countries (LMICs), regulatory and health systems constraints mean that many people still lack access to safe, appropriate and affordable medication, posing significant ethical challenges for those working on the “front line”. Drawing on 18 months of fieldwork in Ghana, we present three detailed case studies of individuals in this position: an urban retail pharmacist, a rural over-the-counter medicine retailer, and a local inspector. Through these case studies, we consider the significant burden of “ethical labour” borne by those operating “on the ground”, who navigate complex moral, legal and business imperatives in real time and with very real consequences for those they serve. The paper ends with a reflection on the tensions between abstract, generalised ethical frameworks based on high-level principles, and a pragmatic, contingent ethics-in-practice that foregrounds immediate individual needs – a tension rooted in the gap between the theory and the reality of pharmaceutical governance that shifts the burden of ethical labour downwards and perpetuates long-term public health risks.
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Chabalenge B, Jere E, Nanyangwe N, Hikaambo C, Mudenda S, Banda M, Kalungia A, Matafwali S. Substandard and falsified medical product recalls in Zambia from 2018 to 2021 and implications on the quality surveillance systems. THE JOURNAL OF MEDICINE ACCESS 2022; 6:27550834221141767. [PMID: 36601496 PMCID: PMC9806395 DOI: 10.1177/27550834221141767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/08/2022] [Indexed: 12/27/2022]
Abstract
Background Substandard and falsified (SF) medical products are removed from circulation through a process called 'product recall' by medicines regulatory agencies. In Zambia, the Zambia Medicines Regulatory Authority (ZAMRA) is responsible for recalling SF medical products from the Zambian market through passive and active surveillance methods. This study aimed to describe the prevalence of recalls of SF medical products and to analyse the frequently recalled therapeutic categories, dosage forms, categories of defects that led to the recalls and their sources with respect to the country of the marketing authorisation holder (MAH) or manufacturer. Methods We conducted a descriptive cross-sectional review of the product recalls issued by ZAMRA between January 2018 and December 2021. A search for all medical product alerts and recalls issued by ZAMRA was carried out by reviewing the internal post-marketing surveillance database kept at ZAMRA headquarters. Data were extracted using a structured Excel database and analysed using Microsoft Excel. Results A total of 119 alerts were received during the review period, of which 83 (69.7%) were product recalls. Oral solid dosage forms were the most recalled dosage form (53%). Furthermore, the number of recalls increased in 2020 (44.6%) and 2021 (22.9%), with the majority (20.5%) of the recalled products being substandard products classified as antiseptics and disinfectants and were attributed to the high demand during the COVID-19 pandemic. Manufacturing laboratory control issues were the reason for product recall in almost half (47.4%) of the cases. Most of the products recalled originated from India (38.6%), followed by Zambia (25.3%). Only one suspected falsified product was recalled between 2018 and 2021. A total of 66 recalls of the 83 products were initiated by ZAMRA, with only 17 voluntarily by foreign MAHs. No product recall was initiated by the local representatives of foreign manufacturers or MAH. Conclusion The majority of the pharmaceutical product recalls in Zambia were substandard products. Manufacturing laboratory control issues lead to most recalls and require investigation of the root causes, preventive action, and strict compliance with the good manufacturing practices guidelines by manufacturers.
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Affiliation(s)
- Billy Chabalenge
- Department of Medicines Control, Zambia
Medicines Regulatory Authority, Lusaka, Zambia,Billy Chabalenge, Department of Medicines
Control, Zambia Medicines Regulatory Authority, P. O Box 31890, Lusaka 10101,
Zambia.
| | - Elimas Jere
- Department of Medicines Control, Zambia
Medicines Regulatory Authority, Lusaka, Zambia
| | - Namuchindo Nanyangwe
- Department of Medicines Control, Zambia
Medicines Regulatory Authority, Lusaka, Zambia
| | - Christabel Hikaambo
- Department of Chemistry, Faculty of
Science, University of Cape Town, Cape Town, South Africa
| | - Steward Mudenda
- Department of Pharmacy, University of
Zambia, Lusaka, Zambia
| | - Michelo Banda
- Department of Pharmacy, University of
Zambia, Lusaka, Zambia
| | - Aubrey Kalungia
- Department of Pharmacy, University of
Zambia, Lusaka, Zambia
| | - Scott Matafwali
- Department of Clinical Research,
Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical
Medicine, London, UK
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Mavragani A, Jarmusch AK, Xu Q, Sun K, Lu A, Aguirre S, Lim J, Bhakta S, Dorrestein PC. Multifactor Quality and Safety Analysis of Antimicrobial Drugs Sold by Online Pharmacies That Do Not Require a Prescription: Multiphase Observational, Content Analysis, and Product Evaluation Study. JMIR Public Health Surveill 2022; 8:e41834. [PMID: 36563038 PMCID: PMC9823576 DOI: 10.2196/41834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a significant global public health threat. However, the impact of sourcing potentially substandard and falsified antibiotics via the internet remains understudied, particularly in the context of access to and quality of common antibiotics. In response, this study conducted a multifactor quality and safety analysis of antibiotics sold and purchased via online pharmacies that did not require a prescription. OBJECTIVE The aim of this paper is to identify and characterize "no prescription" online pharmacies selling 5 common antibiotics and to assess the quality characteristics of samples through controlled test buys. METHODS We first used structured search queries associated with the international nonproprietary names of amoxicillin, azithromycin, amoxicillin and clavulanic acid, cephalexin, and ciprofloxacin to detect and characterize online pharmacies offering the sale of antibiotics without a prescription. Next, we conducted controlled test buys of antibiotics and conducted a visual inspection of packaging and contents for risk evaluation. Antibiotics were then analyzed using untargeted mass spectrometry (MS). MS data were used to determine if the claimed active pharmaceutical ingredient was present, and molecular networking was used to analyze MS data to detect drug analogs as well as possible adulterants and contaminants. RESULTS A total of 109 unique websites were identified that actively advertised direct-to-consumer sale of antibiotics without a prescription. From these websites, we successfully placed 27 orders, received 11 packages, and collected 1373 antibiotic product samples. Visual inspection resulted in all product packaging consisting of pill packs or blister packs and some concerning indicators of potential poor quality, falsification, and improper dispensing. Though all samples had the presence of stated active pharmaceutical ingredient, molecular networking revealed a number of drug analogs of unknown identity, as well as known impurities and contaminants. CONCLUSIONS Our study used a multifactor approach, including web surveillance, test purchasing, and analytical chemistry, to assess risk factors associated with purchasing antibiotics online. Results provide evidence of possible safety risks, including substandard packaging and shipment, falsification of product information and markings, detection of undeclared chemicals, high variability of quality across samples, and payment for orders being defrauded. Beyond immediate patient safety risks, these falsified and substandard products could exacerbate the ongoing public health threat of antimicrobial resistance by circulating substandard product to patients.
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Affiliation(s)
| | - Alan K Jarmusch
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Qing Xu
- S-3 Research, San Diego, CA, United States.,Department of Healthcare Technology and Policy, University of California, San Diego, La Jolla, CA, United States
| | - Kunyang Sun
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Aileen Lu
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Shaden Aguirre
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Jessica Lim
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Simran Bhakta
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Pieter C Dorrestein
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States.,Department of Pharmacology, University of California, San Diego, La Jolla, CA, United States.,Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
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50
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Shedul G, Sanuade OA, Ugwuneji EN, Ojo TM, Vijay A, Ponzing P, Okpe I, Shedul GL, Huffman MD, Ojji D, Hirschhorn LR. Stakeholder perspectives on the demand and supply factors driving substandard and falsified blood pressure lowering medications in Nigeria: a qualitative study. BMJ Open 2022; 12:e063433. [PMID: 36549744 PMCID: PMC9791447 DOI: 10.1136/bmjopen-2022-063433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Although substandard and falsified (SF) blood pressure (BP) lowering medications are a global problem, qualitative research exploring factors driving this in Nigeria has not been reported. This study provides information on factors driving demand for and supply of low-quality BP lowering medications in Nigeria and potential strategies to address these factors. METHODS This was a cross-sectional qualitative study. Between August 2020 and September 2020, we conducted 11 in-depth interviews and 7 focus group discussions with administrators of health facilities, major manufacturers and distributors of BP lowering medications, pharmacists, drug regulators, patients and primary care physicians purposively sampled from the Federal Capital Territory, Nigeria. Data were analysed using directed content analysis, with the aid of Dedoose. RESULTS We found that demand for SF BP lowering medications in Nigeria was driven by high out-of-pocket expenditure and stockouts of quality-assured BP lowering medications. Supply of low-quality BP lowering medications was driven by limited in-country manufacturing capacity, non-adherence to good manufacturing and distribution practices, under-resourced drug regulatory systems, ineffective healthcare facility operations, poor distribution practices, limited number of trained pharmacists and the COVID-19 pandemic which led to stockouts. Central medicine store procurement procedures, active pharmaceutical ingredient quality check and availability of trained pharmacists were existing strategies perceived to lower the risk of supply and demand of SF BP lowering medications. CONCLUSION Our findings suggest that demand for and supply of SF BP lowering medications in Nigeria are driven by multi-level, interrelated factors. Multi-pronged strategies need to target stakeholders and systems involved in drug production, distribution, prescription, consumption, regulation and pricing.
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Affiliation(s)
- Grace Shedul
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Olutobi Adekunle Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
- Robert J Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eugenia N Ugwuneji
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Tunde M Ojo
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Aishwarya Vijay
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patrick Ponzing
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Inuwa Okpe
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Gabriel Lamkur Shedul
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Mark D Huffman
- Robert J Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Cardiovascular Division and Global Health Center, Washington University in St Louis, St Louis, Missouri, USA
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Dike Ojji
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
| | - Lisa R Hirschhorn
- Robert J Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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