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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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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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Barrett R. A cross-sectional study on substandard and falsified medicines (fake or counterfeit drugs) in UK pharmacies during the COVID-19 pandemic. Expert Opin Drug Saf 2023; 22:1289-1299. [PMID: 36374122 DOI: 10.1080/14740338.2023.2147922] [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: 07/18/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Failure of the Falsified Medicines Directive (FMD) in the UK could mean that substandard and falsified medicines (SFs) enter the supply chain. Does this risk patients' health? Readiness to implement FMD, and prevalence of SFs vs. regulator detection were assessed. RESEARCH DESIGN AND METHODS A total of 12,040 primary care pharmacies across England were invited (April 2021-March 2022). Respondent postcodes were used to extract deprivation scores. Information request was placed with the medicine's agency. Survey findings were used to calculate probability and power of a simulated trial. RESULTS A total of 208 participants responded: Of the seven who identified SFs, all but one reported it; 61% were ready to implement FMD, 74.1% had adequate resources, 54.8% expected improved patient safety, and 17.8% had ever reported SFs. SFs were prevalent in deprived areas. Bayesian simulation shows 438 (p = 0.030) incidences with a 3% probability of SFs prevalence. The agency identified 15,238 SFs units in the supply chain (2019 and 2020). Results are credible, reliable, and generalisable, with corroborated longitudinal persistence. CONCLUSIONS FMD or equivalent processes need to be urgently reinstated. Deprived children may be more affected. Pharmacists are worried about liability. All health consultations should assess safety, and effectiveness of medicines. Findings should inform policy, systems planning, surveillance, and evaluations.
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Affiliation(s)
- Ravina Barrett
- Pharmacy Practice, School of Applied Sciences, Cockcroft Building, University of Brighton, Brighton, UK
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Li X, Guan Z, Liu Q, Yang W, Huang J, Yuan M, Yu J. Treatment of condylomata acuminata caused by low-risk human papillomavirus with chloroquine phosphate gel. Front Med (Lausanne) 2023; 10:1171550. [PMID: 37188086 PMCID: PMC10175579 DOI: 10.3389/fmed.2023.1171550] [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: 02/22/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Objective To observe the stability and therapeutic effect of chloroquine phosphate gel on human condylomata acuminata (CA) caused by low-risk human papillomavirus (HPV). Methods The appearance, viscosity, pH, chloroquine concentration, deethylchloroquine concentration and content uniformity of chloroquine phosphate gel were examined for 24 months, the gel met the quality standards throughout the 24-month observation. A nude mouse model harboring CA xenografts was used to observe the therapeutic effect of this gel on CA in vivo. Results After 14 days of gel administration, compared with the control group, the treatment group had significantly smaller warts and significantly reduced DNA copy numbers of HPV6 and HPV11 in the wart tissues. Immunohistochemistry analysis of p53 protein expression in the wart tissues of the treatment group was significantly increased. Conclusion Chloroquine phosphate gel was stable and effective against CA, possibly through the promotion of p53 protein expression to induce apoptosis, leading to the involution of warts.
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Affiliation(s)
- Xiangling Li
- Key Laboratory of Basic Research of Traditional Chinese Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Zhisheng Guan
- Guangzhou Hybribio Biotechnology Technology Co., Ltd., Guangzhou, Guangdong, China
| | - Qi Liu
- Guangzhou Hybribio Biotechnology Technology Co., Ltd., Guangzhou, Guangdong, China
| | - Wei Yang
- Guangdong Lewwin Pharmaceutical Research Institute Co., Ltd, Guangzhou, Guangdong, China
| | - Jie Huang
- Department of Dermatology, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Manli Yuan
- Guangzhou Hybribio Biotechnology Technology Co., Ltd., Guangzhou, Guangdong, China
| | - Junlong Yu
- School of Basic Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
- *Correspondence: Junlong Yu,
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Girma M, Umeta B, Hasen G, Suleman S. Quality of Antimalarial Drugs in East Africa: A Systematic Review. Infect Drug Resist 2022; 15:6085-6092. [PMID: 36277242 PMCID: PMC9585264 DOI: 10.2147/idr.s373059] [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: 05/01/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Background The use of poor quality drugs will have multiple consequences with an extended hazard of growing drug-resistant strains. Purpose The review aimed to provide the quality status of antimalarial drugs in East Africa. Data Source PubMed, Scopus, Web of Science, and Google Scholar were searched from September 5 to September 12, 2021. Study Selection The review included articles available as original research targeted at evaluating the quality of antimalarial drugs. For inclusion, data on at least one of the following quality control parameters were required: packaging and labeling, hardness, friability, weight variation/uniformity of weight, disintegration, dissolution, and assay/percentage purity. Mendeley citation manager version 1.19.4 was used to avoid duplication and organize references, and titles and abstracts were primarily used for screening. Data Extraction The sample collection site, drug name, and the quality control parameters tested were retrieved from the selected studies. Data synthesis Totally, 300 antimalarial drug samples from Ethiopia, Kenya and Tanzania were included in this review. No antimalarial drug tested failed the identification and disintegration test. However, 15.93% (36/226), 5.00% (15/300), and 1.90% (3/158) of antimalarial samples failed the dissolution, assay and mass uniformity test, respectively. Moreover, amodiaquine and sulfadoxine/pyrimethamine samples failed dissolution and assay tests. In addition, amodiaquine samples failed the mass uniformity test. However, artemether/lumefantrine and quinine passed all quality control parameters tested. Overall, 19.67% (59/300) of antimalarial drug samples did not meet at least one quality control parameter. And the higher faller rate was reported for sulfadoxine/pyrimethamine accounting for 52.86% (37/70). Conclusions An unneglected amount of antimalarial drug failed to meet at least one quality control parameter. Strengthening pharmaceutical management systems, including post-marketing surveillance, and providing the resources required for medication quality assurance, are recommended.
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Affiliation(s)
- Million Girma
- School of Pharmacy, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Belachew Umeta
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia,Correspondence: Belachew Umeta, School of Pharmacy, Institute of Health, Jimma University, Po. Box: 378, Jimma, Oromia, Ethiopia, Email
| | - Gemmechu Hasen
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sultan Suleman
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia,Jimma University Laboratory of Drug Quality (JuLaDQ), Jimma University, Jimma, Ethiopia
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Penna EA, de Souza JCQ, de Oliveira MAL, Chellini PR. Determination of antimalarial drugs in pharmaceutical formulations and human blood by liquid chromatography: a review. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2021; 13:4557-4584. [PMID: 34611673 DOI: 10.1039/d1ay01173a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Malaria is a life-threatening disease being treated by oral medication. This is the best treatment to reduce morbidity and mortality, prevent disease progression to the most severe form, lower the transmission of the disease and hinder the appearance of strains resistant to antimalarials. According to the World Health Organization, the most common antimalarial drugs are chloroquine, primaquine, mefloquine, lumefantrine, artemether, and artesunate in single dosage forms or fixed-dose combination. Within this context, the present review aims to show the evolution of different analytical methods that have been applied to the determination of these antimalarial drugs in pharmaceutical formulations and human blood by liquid chromatography in the last 10 years, along with statistical analyses of the methods.
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Affiliation(s)
- Eduarda Alves Penna
- Faculdade de Farmácia, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, Juiz de Fora, MG, 36036-900, Brazil.
| | - Jéssica Cordeiro Queiroz de Souza
- Grupo de Química Analítica e Quimiometria (GQAQ), Departamento de Química, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, Juiz de Fora, MG, 36036-900, Brazil.
| | - Marcone Augusto Leal de Oliveira
- Grupo de Química Analítica e Quimiometria (GQAQ), Departamento de Química, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, Juiz de Fora, MG, 36036-900, Brazil.
| | - Paula Rocha Chellini
- Faculdade de Farmácia, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, Juiz de Fora, MG, 36036-900, Brazil.
- Grupo de Química Analítica e Quimiometria (GQAQ), Departamento de Química, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, Juiz de Fora, MG, 36036-900, Brazil.
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Irungu BN, Koech LC, Ondicho JM, Keter LK. Quality assessment of selected co-trimoxazole suspension brands marketed in Nairobi County, Kenya. PLoS One 2021; 16:e0257625. [PMID: 34551002 PMCID: PMC8457504 DOI: 10.1371/journal.pone.0257625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Quality of medicines in both developed and developing countries is sometimes compromised due to infiltration of counterfeit, substandard or degraded medicines into the markets. It is a public health concern as poor quality medicines endanger public health where patients are exposed to chemical toxins and/or sub-therapeutic doses. This could lead to reduced treatment efficacy and promote development of drug resistance. Co-trimoxazole, a fixed dose combination of sulfamethoxazole and trimethoprim, is a broad spectrum for bacterial diseases and is also used as a prophylaxis for opportunistic infections in HIV infected individuals. This study evaluated quality of selected co-trimoxazole suspension brands marketed in Nairobi County, Kenya. METHODS A total of 106 samples were collected, categorized into 15 brands and evaluated for active pharmaceutical ingredient content (API) and pH following United States Pharmacopeia. Assay for API was conducted using High Performance Liquid Chromatography. Results were compared with pharmacopeia references. Visual examination of labels and confirmation of retention status of the brands with Pharmacy and Poisons Board retention register was carried out. RESULTS The samples were primarily of local origin (86.7%). On October 23, 2019, retention status of six of the fifteen brands documented were no longer listed in the Pharmacy and Poisons Board retention register. Of the 106 samples tested 70.6% and 86.8% were compliant with United States Pharmacopeia (USP) specifications for pH and API respectively while 84.0% adhered to packaging and labelling requirements. CONCLUSION This study has demonstrated that majority of co-trimoxazole suspensions tested were compliant with USP requirements. Additionally, it has provided evidence of poor quality co-trimoxazole medicines that could compromise treatment of infectious diseases in children. This emphasizes the need for regular quality assurance tests to ensure only quality medicines are in the market.
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Affiliation(s)
- Beatrice Njeri Irungu
- Kenya Medical Research Institute, Centre for Traditional Medicine and Drug Research, Nairobi, Kenya
- * E-mail:
| | - Lilian C. Koech
- Kenya Medical Research Institute, Centre for Traditional Medicine and Drug Research, Nairobi, Kenya
| | - Joyce M. Ondicho
- Kenya Medical Research Institute, Centre for Traditional Medicine and Drug Research, Nairobi, Kenya
| | - Lucia K. Keter
- Kenya Medical Research Institute, Centre for Traditional Medicine and Drug Research, Nairobi, Kenya
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Abebe S, Ketema G, Kassahun H. In vitro Comparative Quality Assessment of Different Brands of Furosemide Tablets Marketed in Northwest Ethiopia. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:5119-5128. [PMID: 33262573 PMCID: PMC7700078 DOI: 10.2147/dddt.s280203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022]
Abstract
Background The use of ineffective and poor quality drugs endangers therapeutic treatment and may lead to treatment failure. For desired therapeutic effect, drugs should contain the appropriate amount of active pharmaceutical ingredient and the required physical characteristics. Aim The aim of this study was to evaluate quality as well as physicochemical bioequivalence of different brands of furosemide tablets marketed in Bahir Dar, Northwest Ethiopia. Methods Five different brands of furosemide tablets were purchased from community pharmacies in Bahir Dar city, Northwest Ethiopia. The quality control parameters of furosemide tablets were determined by identification, weight variation, disintegration, assay and dissolution tests and the results were compared with USP and BP pharmacopoeial standards. Difference (f1) and similarity (f2) factors were calculated to assess in vitro bioequivalence requirements. Results Identification test results revealed that all samples contained the stated active pharmaceutical ingredients. The results of weight variation tests indicated that all samples complied with USP specification limits. The active pharmaceutical ingredients quantitative assay showed that all the brands of furosemide tablets were between the 90% and 105% limit of label claim. Similarly, all samples fulfilled disintegration time (i.e., ≤30 min) and dissolution tolerance limits (i.e., Q ≥80% at 60 min). Hence, none of the samples were found to be counterfeit and/or substandard. Difference factor (f1) values were <15 and similarity factor (f2) values were >50 for all the tested brands of furosemide tablets. Conclusion This study revealed that all the furosemide brands met the quality specification of weight variation, hardness, friability, dissolution, disintegration and assay. The study also indicated similarity in the dissolution profile of the brands of furosemide tablets with the innovator product. Hence, all of these generic brands could be substituted with the innovator product in clinical practice.
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Affiliation(s)
- Simachew Abebe
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.,Chagni Primary Hospital, Chagni, Amhara Region, Ethiopia
| | - Gebremariam Ketema
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Haile Kassahun
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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