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Kingori P, Peeters Grietens K, Abimbola S, Ravinetto R. Uncertainties about the quality of medical products globally: lessons from multidisciplinary research. BMJ Glob Health 2023; 6:e012902. [PMID: 37344004 PMCID: PMC10367018 DOI: 10.1136/bmjgh-2023-012902] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Patricia Kingori
- Wellcome Centre for Ethics and Humanities. Ethox Centre, University of Oxford, Nuffield Department of Population Health, University of Oxford, UK
| | | | - Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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2
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Moore-Clingenpeel M, Greenhawt M, Shaker M. Reporting guidelines for allergy and immunology survey research. Ann Allergy Asthma Immunol 2023; 130:674-680.e1. [PMID: 36804464 DOI: 10.1016/j.anai.2023.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
Although survey reports are common, fewer than 10% of medical journals provide clear guidelines to investigators for survey research. In this special article, we provide guidance on minimum recommendations in the form of a CHecklist for Allergy and Immunology Reporting of Survey research (CHAIRS). Key components to consider include providing background information, such as a clear statement of the research hypothesis and question, and rationale for the study. When considering sample selection, a clear understanding of the relationship between the target population, sampling frame, sample scheme, representativeness, and sample size is needed. Review of the survey tool by content experts and assessment of threats to survey validity should occur early in questionnaire development with consideration of cognitive interviews and pretesting to facilitate accurate measurement. Last, a transparent description of data collection and qualitative and quantitative characteristics of response rate is needed to ensure that appropriate inferences and conclusions can be drawn from the survey research.
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Affiliation(s)
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
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3
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Jenkins D, Diallo C, Payne M. Detecting falsified oral contraceptives by visual assessment and diffuse reflectance spectroscopy (350–2500 nm): the need for supplementing traditional pharmacopeia techniques and the public health implications. Heliyon 2022; 8:e10837. [PMID: 36217469 PMCID: PMC9547234 DOI: 10.1016/j.heliyon.2022.e10837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Substandard and falsified pharmaceuticals can present a major health risk, particularly for low- and middle-income countries. In a Sub-Saharan African market, United States Agency for International Development (USAID) staff found an oral contraceptive product (0.15 mg levonorgestrel/0.03 mg ethinyl estradiol) labeled with a logo (and brand name) visually matching one historically used by USAID but purportedly manufactured by an unauthorized source. Additional assessment was conducted to determine if more evidence of falsification was present to better understand the public health impact. Study design Relative to a control, the suspect sample was assessed visually for tablet features and with United States and International Pharmacopeia methods for levonorgestrel/ethinyl estradiol tablets. Diffuse reflectance spectra (350–2500 nm) were collected to further characterize the sample. Results Although the suspect sample aligned with pharmacopeia tests, visual examination of tablet characteristics and diffuse reflectance spectroscopy (350–2500 nm) assessments supported the tablets were not the same as control samples, confirming the suspect sample was falsified. These results raised concerns for the overall regulatory oversight available for the market with uncertainty regarding the true clinical bioequivalence levels (although adequate dissolution levels were observed). Conclusions Comprehensive characterization of suspect pharmaceuticals from the field can often be required depending on the nature of the sample and can have dramatic implications for understanding the public health risks to the end user within the local market. Simple visual assessment and spectroscopic techniques to screen a sample can help to supplement traditional pharmacopeia approaches. Implications Proper characterization of suspect pharmaceuticals is necessary to best understand their potential public health impact. Situations can occur where traditional pharmacopeial techniques may not adequately characterize a sample. Visual assessments and diffuse reflectance spectroscopy can be supplemented to provide a more holistic analysis.
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4
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Masini T, Macé C, Heide L, Hamill H, Hampshire K, Newton PN, Ravinetto R. Out of the boxes, out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain. Res Social Adm Pharm 2022; 18:3694-3698. [DOI: 10.1016/j.sapharm.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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5
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Rahman MS, Yoshida N, Tsuboi H, Karmoker JR, Kabir N, Schaefermann S, Akimoto Y, Bhuiyan MA, Reza MS, Kimura K. A comprehensive analysis of selected medicines collected from private drug outlets of Dhaka city, Bangladesh in a simple random survey. Sci Rep 2022; 12:234. [PMID: 34997152 PMCID: PMC8741935 DOI: 10.1038/s41598-021-04309-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 12/17/2021] [Indexed: 12/22/2022] Open
Abstract
Comprehensive data are needed to prevent substandard and falsified (SF) medicines as they pose a major risk to human health. To assess the quality of selected medicines, samples were collected from random private drug outlets of Dhaka North and South City Corporation, Bangladesh. Sample analysis included visual observation of the packaging, authenticity of the samples, legitimacy and registration verification of the manufacturer, physicochemical analysis, and price. Chemical analysis of the samples was performed using a portable Raman spectroscopy and high-performance liquid chromatography according to the pharmacopoeia. Several discrepancies were noted in the visual observation of samples. Among the 189 collected samples of esomeprazole (ESM), cefixime (CFIX), and amoxicillin-clavulanic acid (CVA-AMPC), 21.2% were confirmed to be authentic, 91.3% manufacturers were confirmed legitimate, and 2.1% of all samples were unregistered. Chemical analysis of the samples revealed that 9.5% (95% CI 5.7-14.6) of samples were SFs. Falsified samples and quality variation in the same generic branded samples were both detected by Raman spectroscopic analysis. Overall, sample prices were satisfactory relative to the international reference price. This study documents the availability of poor-quality medicines, demonstrating the need for immediate attention by the national medicine regulatory authority.
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Affiliation(s)
- Mohammad Sofiqur Rahman
- Medi-Quality Security Institute (MQS), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, 920-1192, Japan.
| | - Naoko Yoshida
- AI Hospital/Macro Signal Dynamics Research and Development Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
| | - Hirohito Tsuboi
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - James Regun Karmoker
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Department of Pharmacy, University of Asia Pacific, 74/A Green Road, Farmgate, Dhaka, 1205, Bangladesh
| | - Nadia Kabir
- Department of Pharmacy, University of Asia Pacific, 74/A Green Road, Farmgate, Dhaka, 1205, Bangladesh
| | - Simon Schaefermann
- Pharmaceutical Institute, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Yoshio Akimoto
- Medi-Quality Security Institute (MQS), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Mohiuddin Ahmed Bhuiyan
- Department of Pharmacy, University of Asia Pacific, 74/A Green Road, Farmgate, Dhaka, 1205, Bangladesh
| | - Md Selim Reza
- Department of Pharmaceutical Technology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Kazuko Kimura
- Medi-Quality Security Institute (MQS), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
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6
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Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, Huy NT, Marušić A, Paul CL, Kwok J, Karbwang J, de Waure C, Drummond FJ, Kizawa Y, Taal E, Vermeulen J, Lee GHM, Gyedu A, To KG, Verra ML, Jacqz-Aigrain ÉM, Leclercq WKG, Salminen ST, Sherbourne CD, Mintzes B, Lozano S, Tran US, Matsui M, Karamouzian M. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med 2021; 36:3179-3187. [PMID: 33886027 PMCID: PMC8481359 DOI: 10.1007/s11606-021-06737-1] [Citation(s) in RCA: 611] [Impact Index Per Article: 203.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/17/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Akash Sharma
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India.,Online Research Club, Nagasaki, Japan
| | - Nguyen Tran Minh Duc
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Tai Luu Lam Thang
- Online Research Club, Nagasaki, Japan.,Department of Emergency, City's Children Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Hai Nam
- Online Research Club, Nagasaki, Japan.,Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sze Jia Ng
- Online Research Club, Nagasaki, Japan.,Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA
| | - Kirellos Said Abbas
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nguyen Tien Huy
- Institute of Tropical Medicine (NEKKEN) and School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan.
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Janette Kwok
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital Hong Kong, Pok Fu Lam, Hong Kong
| | - Juntra Karbwang
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University School of Medicine, Hyogo, Japan
| | - Erik Taal
- Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Joeri Vermeulen
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
| | - Gillian H M Lee
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kien Gia To
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Martin L Verra
- Department of Physiotherapy, Bern University Hospital, Insel Group, Bern, Switzerland
| | | | - Wouter K G Leclercq
- Department of Surgery, Máxima Medical Center, Veldhoven, Veldhoven, the Netherlands
| | - Simo T Salminen
- Department of Social Psychology, University of Helsinki, Helsinki, Finland
| | | | - Barbara Mintzes
- School of Pharmacy and Charles Perkins Centrey, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sergi Lozano
- School of Economics, University of Barcelona, Barcelona, Spain
| | - Ulrich S Tran
- Department of Cognition, Emotion, and Methods in Psychology, School of Psychology, University of Vienna, Vienna, Austria
| | - Mitsuaki Matsui
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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7
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Rahman MS, Yoshida N, Tsuboi H, Maeda E, Ibarra AVV, Zin T, Akimoto Y, Tanimoto T, Kimura K. Patient safety and public health concerns: poor dissolution rate of pioglitazone tablets obtained from China, Myanmar and internet sites. BMC Pharmacol Toxicol 2021; 22:12. [PMID: 33653417 PMCID: PMC7923830 DOI: 10.1186/s40360-021-00478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Poor quality medicines have serious implications for public health. The aim of this study was to explore the quality of the antidiabetic pioglitazone, using samples collected in China and Myanmar, and samples purchased online. Methods In this cross-sectional study, we examined samples (n = 163) collected from hospitals in Shanghai, China in 2012 (n = 44), products purchased via the internet and imported into Japan in 2013 (n = 59), and samples purchased in shops in Yangon, Myanmar in 2015 (n = 60). Collected samples were subjected to visual inspection, authenticity investigation and quality testing (potency, content uniformity and dissolution test) by high-performance liquid chromatography. Samples were rated as compliant or non-compliant based on the relevant pharmacopoeial acceptance criteria. Results Visual inspection of all samples revealed compliant products. However, responses from manufacturers during authenticity investigation were poor. Among the n = 44 samples from China, one was non-compliant in the potency test. Among the n = 59 samples personally imported into Japan, 38% of generic samples were found to be non-compliant. In Myanmar, 13.3% of samples were non-compliant. Non-compliant samples predominantly failed in the dissolution test. All non-compliant samples were generic. Conclusions Despite the apparent satisfactory outcome on the samples from China, pioglitazone samples collected in Myanmar and purchased online for personal import into Japan included many substandard products, which failed quality assessment predominantly because of poor dissolution. Internet providers did not comply with Japanese regulations in various respects. Supplementary Information The online version contains supplementary material available at 10.1186/s40360-021-00478-x.
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Affiliation(s)
- Mohammad Sofiqur Rahman
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, 920-1192, Kanazawa, Japan.
| | - Naoko Yoshida
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | - Hirohito Tsuboi
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | - Erina Maeda
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | | | - Theingi Zin
- Department of Food and Drug Administration (FDA), Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Yoshio Akimoto
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | - Tsuyoshi Tanimoto
- Pharmaceutical and Medical Device Regulatory Science Society of Japan, 150-0002, Osaka, Japan
| | - Kazuko Kimura
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
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8
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Rahman MS, Yoshida N, Tsuboi H, Sokchamroeun U, Keila T, Sovannarith T, Kiet HB, Dararath E, Akimoto Y, Tanimoto T, Kimura K. A Cross-Sectional Investigation of the Quality of Selected Medicines for Noncommunicable Diseases in Private Community Drug Outlets in Cambodia during 2011-2013. Am J Trop Med Hyg 2020; 101:1018-1026. [PMID: 31516106 PMCID: PMC6838583 DOI: 10.4269/ajtmh.19-0247] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although the issue of substandard and falsified medicines is quite well known, most research has focused on medicines used to treat communicable diseases, and relatively little research has been carried out on the quality of medicines for noncommunicable diseases (NCDs). This study was designed to assess the quality of seven widely used medicines for NCDs in Cambodia during 2011–2013. Medicines were collected from private community drug outlets in Phnom Penh (urban area), by stratified random sampling and in Battambang, Kandal, Kampong Speu, and Takeo (rural areas) by convenience sampling. Samples were subsequently analyzed by visual inspection, authenticity investigation, and pharmacopoeial analysis by high-performance liquid chromatography. Various discrepancies were observed in visual inspection of packages and medicines. Of 372 tablet/capsule samples from 64 manufacturers in 16 countries, the manufacturers confirmed 107 (28.8%) as authentic; the authenticity of other samples could not be verified. Three hundred sixty-four (97.8%) samples were registered in Cambodia. Among all samples, 23.4% (95% CI 19.2–28.0) were noncompliant in one or more of the quality tests: 12.9% (95% CI 9.7–16.7) contained an amount of active pharmaceutical ingredient outside the permitted range, including some showing extreme deviations, 14% (95% CI 10.6–17.9) failed because of content variation, and 10.8% (95% CI 7.8–14.4) failed to meet pharmacopoeial reference ranges in dissolution tests. Pharmaceutical quality appeared to be unrelated to storage conditions. Although no sample was obviously falsified, there is a high prevalence of substandard medicines for NCDs in Cambodia, indicating the need for focused regulatory action, including collaborative initiatives with manufacturers.
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Affiliation(s)
- Mohammad Sofiqur Rahman
- Medi-Quality Security Institute, Kanazawa University, Kanazawa, Japan.,Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Naoko Yoshida
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, Kanazawa, Japan
| | - Hirohito Tsuboi
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, Kanazawa, Japan
| | - Uy Sokchamroeun
- National Health Product Quality Control Center, Ministry of Health, Phnom Penh, Cambodia
| | - Tep Keila
- National Health Product Quality Control Center, Ministry of Health, Phnom Penh, Cambodia
| | - Tey Sovannarith
- National Health Product Quality Control Center, Ministry of Health, Phnom Penh, Cambodia
| | - Heng Bun Kiet
- Department of Drugs and Food, Ministry of Health, Phnom Penh, Cambodia
| | - Eav Dararath
- Department of Drugs and Food, Ministry of Health, Phnom Penh, Cambodia
| | - Yoshio Akimoto
- Medi-Quality Security Institute, Kanazawa University, Kanazawa, Japan
| | - Tsuyoshi Tanimoto
- Pharmaceutical and Medical Device Regulatory Science Society of Japan, Osaka, Japan
| | - Kazuko Kimura
- Medi-Quality Security Institute, Kanazawa University, Kanazawa, Japan
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9
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Wiseman V, Lagarde M, Kovacs R, Wulandari LPL, Powell-Jackson T, King J, Goodman C, Hanson K, Miller R, Xu D, Liverani M, Yeung S, Hompashe D, Khan M, Burger R, Christian CS, Blaauw D. Using unannounced standardised patients to obtain data on quality of care in low-income and middle-income countries: key challenges and opportunities. BMJ Glob Health 2019; 4:e001908. [PMID: 31565422 PMCID: PMC6747897 DOI: 10.1136/bmjgh-2019-001908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Virginia Wiseman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mylene Lagarde
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Roxanne Kovacs
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Timothy Powell-Jackson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jessica King
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Goodman
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kara Hanson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosalind Miller
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Dong Xu
- Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Marco Liverani
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Shunmay Yeung
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Dumisani Hompashe
- Department of Economics, University of Fort Hare, Alice, South Africa
| | - Mishal Khan
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Matieland, South Africa
| | - Carmen S Christian
- Department of Economics, University of the Western Cape, Cape Town, South Africa
| | - Duane Blaauw
- Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa
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10
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Hamilton AER, Young CJ. Surveys still teach vital non-technical lessons in General Surgery. ANZ J Surg 2018; 89:159-164. [PMID: 30485674 DOI: 10.1111/ans.14932] [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: 07/02/2018] [Revised: 09/23/2018] [Accepted: 09/29/2018] [Indexed: 11/27/2022]
Abstract
In general surgery, observational studies are disregarded and often seen as non-noteworthy research. We intend to defend the use of surveys in general surgery and colorectal surgery. This review highlights the historical importance and contemporary utility of surveys internationally and in our region, thus reminding Australasian surgeons and clinicians in numerous disciplines of the usefulness of this research tool. Well-constructed surveys often successfully capture qualitative data otherwise impossible to collect through randomized controlled trial. The results of these surveys may advise national policies and medical registration agencies thus having a direct influence on individuals and their public health. Samples from contemporary survey-based research publications from international and Australasian authors are used to illustrate some of the vital non-technical lessons learned in recent times.
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Affiliation(s)
- Auerilius E R Hamilton
- Colorectal Surgery Unit, Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, New South Wales, Australia
| | - Christopher J Young
- Colorectal Surgery Unit, Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
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11
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Schiavetti B, Wynendaele E, De Spiegeleer B, Mbinze GJ, Kalenda N, Marini R, Melotte V, Hasker E, Meessen B, Ravinetto R, Van der Elst J, Mutolo Ngeleka D. The Quality of Medicines Used in Children and Supplied by Private Pharmaceutical Wholesalers in Kinshasa, Democratic Republic of Congo: A Prospective Survey. Am J Trop Med Hyg 2018; 98:894-903. [PMID: 29313479 PMCID: PMC5930909 DOI: 10.4269/ajtmh.17-0732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Poor-quality medicines are a threat to public health in many low- and middle-income countries, and prospective surveys are needed to inform corrective actions. Therefore, we conducted a cross-sectional survey on a sample of products used for children and available in the private market in Kinshasa, Democratic Republic Congo: amoxicillin (AX) and artemether/lumefantrine (AL), powders for suspension, and paracetamol (PC) tablets 500 mg. Overall, 417 products were covertly purchased from 61 wholesalers. To obtain a representative sample, the products were weighted on their market shares and a subset of 239 samples was randomly extracted to undergo in-depth visual inspection locally, and they were chemically assessed at two accredited laboratories in Belgium. Samples were defined of “poor-quality” if they failed to comply with at least one specification of the International Pharmacopoeia (for AL) or United States Pharmacopoeia 37 (for AX and PC). Results are reported according to the Medicine Quality Assessment Reporting Guideline. The visual inspection detected nonconformities in the aspects of antimalarial powders for suspension, and poor-quality labels across all medicine types. According to chemical analysis, 27.2% samples were of poor quality and 59.5% of AL samples were underdosed in artemether. Poor quality was more frequent for locally manufactured antimalarials (83.3%, P = 0.021; 86.4%, P = 0.022) and PC (4.8%, P = 0.000). The poor quality of the surveyed products may decrease the treatment’s efficacy and favor the development of resistances to antimalarials. It is hoped that these findings may guide the corrective actions of the Democratic Republic of Congo Regulatory Authority, which was the main partner in the research.
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Affiliation(s)
| | - Evelien Wynendaele
- Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Bart De Spiegeleer
- Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Geremie J Mbinze
- Faculty of Pharmaceutical Sciences, Laboratory of Drug Analysis, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nicodème Kalenda
- Faculty of Pharmaceutical Sciences, Laboratory of Drug Analysis, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Roland Marini
- Department of Pharmacy, CIRM, Laboratory of Analytical Chemistry, University of Liege (ULg), Liege, Belgium
| | - Vera Melotte
- Belgian Technical Cooperation (BTC), Bruxelles, Belgium
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Meessen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Josiane Van der Elst
- Belgian Federal Agency for Medicines and Health Products (FAGG-AFMPS), Bruxelles, Belgium
| | - Daniel Mutolo Ngeleka
- Direction de la Pharmacie et du Médicament (DPM), Kinshasa, Democratic Republic of Congo
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12
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Phok S, Phanalasy S, Thein ST, Likhitsup A. Private sector opportunities and threats to achieving malaria elimination in the Greater Mekong Subregion: results from malaria outlet surveys in Cambodia, the Lao PDR, Myanmar, and Thailand. Malar J 2017; 16:180. [PMID: 28464945 PMCID: PMC5414126 DOI: 10.1186/s12936-017-1800-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this paper is to review multi-country evidence of private sector adherence to national regulations, guidelines, and quality-assurance standards for malaria case management and to document current coverage of private sector engagement and support through ACTwatch outlet surveys implemented in 2015 and 2016. Results Over 76,168 outlets were screened, and approximately 6500 interviews were conducted (Cambodia, N = 1303; the Lao People’s Democratic Republic (PDR), N = 724; Myanmar, N = 4395; and Thailand, N = 74). There was diversity in the types of private sector outlets providing malaria treatment across countries, and the extent to which they were authorized to test and treat for malaria differed. Among outlets stocking at least one anti-malarial, public sector availability of the first-line treatment for uncomplicated Plasmodium falciparum or Plasmodium vivax malaria was >75%. In the anti-malarial stocking private sector, first-line treatment availability was variable (Cambodia, 70.9%; the Lao PDR, 40.8%; Myanmar P. falciparum = 42.7%, P. vivax = 19.6%; Thailand P. falciparum = 19.6%, P. vivax = 73.3%), as was availability of second-line treatment (the Lao PDR, 74.9%; Thailand, 39.1%; Myanmar, 19.8%; and Cambodia, 0.7%). Treatment not in the National Treatment Guidelines (NTGs) was most common in Myanmar (35.8%) and Cambodia (34.0%), and was typically stocked by the informal sector. The majority of anti-malarials distributed in Cambodia and Myanmar were first-line P. falciparum or P. vivax treatments (90.3% and 77.1%, respectively), however, 8.8% of the market share in Cambodia was treatment not in the NTGs (namely chloroquine) and 17.6% in Myanmar (namely oral artemisinin monotherapy). In the Lao PDR, approximately 9 in 10 anti-malarials distributed in the private sector were second-line treatments—typically locally manufactured chloroquine. In Cambodia, 90% of anti-malarials were distributed through outlets that had confirmatory testing available. Over half of all anti-malarial distribution was by outlets that did not have confirmatory testing available in the Lao PDR (54%) and Myanmar (59%). Availability of quality-assured rapid diagnostic tests (RDT) amongst the RDT-stocking public sector ranged from 99.3% in the Lao PDR to 80.1% in Cambodia. In Cambodia, the Lao PDR, and Myanmar, less than 50% of the private sector reportedly received engagement (access to subsidized commodities, supervision, training or caseload reporting), which was most common among private health facilities and pharmacies. Conclusions Findings from this multi-country study suggest that Cambodia, the Lao PDR, Myanmar, and Thailand are generally in alignment with national regulations, treatment guidelines, and quality-assurance standards. However, important gaps persist in the private sector which pose a threat to national malaria control and elimination goals. Several options are discussed to help align the private sector anti-malarial market with national elimination strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1800-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sochea Phok
- Population Services Khmer, 29 334 St, Boeung Keng Kang, P. O. Box 258, Phnom Penh, Cambodia
| | - Saysana Phanalasy
- Population Services International Lao PDR, T4 Road Unit 16, Donkai Village, P. O. Box 8723, Vientiane, Lao People's Democratic Republic
| | - Si Thu Thein
- Population Services International Myanmar, 16 West Shwe Gone Dine 4th St, Bahan Township, Yangon, Myanmar
| | - Asawin Likhitsup
- , 108/210 Siphraya River View Condo, Yotha Rd, Sampanthawong, Bangkok, 10100, Thailand
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Khuluza F, Kigera S, Heide L. Low Prevalence of Substandard and Falsified Antimalarial and Antibiotic Medicines in Public and Faith-Based Health Facilities of Southern Malawi. Am J Trop Med Hyg 2017; 96:1124-1135. [PMID: 28219993 PMCID: PMC5417205 DOI: 10.4269/ajtmh.16-1008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/07/2017] [Indexed: 11/23/2022] Open
Abstract
AbstractSubstandard and falsified antimalarial and antibiotic medicines represent a serious problem for public health, especially in low- and middle-income countries. However, information on the prevalence of poor-quality medicines is limited. In the present study, samples of six antimalarial and six antibiotic medicines were collected from 31 health facilities and drug outlets in southern Malawi. Random sampling was used in the selection of health facilities. For sample collection, an overt approach was used in licensed facilities, and a mystery shopper approach in nonlicensed outlets. One hundred and fifty-five samples were analyzed by visual and physical examination and by rapid prescreening tests, that is, disintegration testing and thin-layer chromatography using the GPHF-Minilab. Fifty-six of the samples were analyzed according to pharmacopeial monographs in a World Health Organization-prequalified quality control laboratory. Seven out-of-specification medicines were identified. One sample was classified as falsified, lacking the declared active ingredients, and containing other active ingredients instead. Three samples were classified as substandard with extreme deviations from the pharmacopeial standards, and three further samples as substandard with nonextreme deviations. Of the substandard medicines, three failed in dissolution testing, two in the assay for the content of the active pharmaceutical ingredient, and one failed in both dissolution testing and assay. Six of the seven out-of-specification medicines were from private facilities. Only one out-of-specification medicine was found within the samples from public and faith-based health facilities. Although the observed presence of substandard and falsified medicines in Malawi requires action, their low prevalence in public and faith-based health facilities is encouraging.
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Affiliation(s)
- Felix Khuluza
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Stephen Kigera
- Mission for Essential Drugs and Supplies (MEDS), Nairobi, Kenya
| | - Lutz Heide
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
- Pharmaceutical Institute, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
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