1
|
Mahmoudi Meymand F, Takian A, Jaafaripooyan E. Economic barriers to prevent the smuggling of health goods in Iran. BMJ Glob Health 2024; 9:e015090. [PMID: 38843898 PMCID: PMC11163594 DOI: 10.1136/bmjgh-2024-015090] [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: 01/28/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION In recent years, smuggling of health goods has apparently increased in the country. Despite the preventive and regulatory measures taken to combat this problem, the outcomes seem to be undesirable. This study thus aims to identify and elucidate the role of economic barriers in the prevention of smuggling health goods in Iran. METHOD We conducted semistructured interviews with 29 purposefully identified key informants in the detection, prevention and control of health goods smuggling in different organisations, between May 2021-January 2022. An inductive data-driven thematic analysis approach was further adopted to identify patterns of meaning, using MAXQDA 2020 software to facilitate data management. RESULTS We identified four main themes representing the economic barriers to prevent the smuggling of health goods in Iran; Monetary and financial policy, which includes subthemes of financial rules and procedures, market regulation, economic incentives and imbalanced development; Behavioural patterns, consisting of consumer behaviour, the opportunism of smugglers, the behaviour of statesmen and politicians; Economic diplomacy, categorised into international relations and interactions, relations and interactions in the national arena, interaction with non-governmental organisations and Health economic monitoring and evaluation including transparency of statistics and economic information and supervision. CONCLUSION Smuggling health goods has become a concerning challenge in the health sector. It is, therefore, imperative to develop and implement appropriate policies and operations towards security and international cooperation, lobbying and coalition-building. Demonopolisation, creating competitive and dynamic markets, removal of rent-seeking layers at all levels, and the use of commercial diplomacy to reduce the burden of smuggling in the health sector of Iran, and perhaps beyond might be of sizeable use to combat such challenge.
Collapse
Affiliation(s)
- Farzaneh Mahmoudi Meymand
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Head, Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Chief Research Officer, Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management, Policy, and Economics, Tehran University of Medical Sciences School of Public Health, Tehran, Iran
| |
Collapse
|
2
|
Bhushan R, Martens J. Generic pharmaceuticals, regulatory aspects, bioequivalence investigation, and perception. Expert Opin Drug Saf 2024; 23:177-186. [PMID: 38221892 DOI: 10.1080/14740338.2024.2305709] [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: 07/28/2023] [Accepted: 01/11/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION The objective and significance of the topic is to draw attention toward regulatory aspects (and pharmacopoeias) for bioequivalence investigation, and perception for generic pharmaceuticals, especially their stereoselective bioequivalence evaluation for understanding the performance of the racemic generic products available in the market. AREAS COVERED The areas covered include bioequivalence studies (and related USP and FDA requirements) on certain generic APIs for comparison, examples of concern related to inspection of pharmaceuticals for export/import. Literature methodology includes search through USP monographs, MDPI.com, msn.com, WHO Drug Information, certain specific web links, PubMed Central®, PubMed®, NLM's advanced biomedical information services, and several pdf published in relevant journals in the field for related authentic information. EXPERT OPINION The USP, the USFDA, and the units alike internationally should enforce pharmaceutical companies to perform stereoselective investigations on generic APIs to show that their PK/PD parameters are (nearly) equal to the standards set by such units for allowing marketing of that API. This should be provided to professionals in the areas of patient care and every country should enforce such regulations at the time of export and import of generics.
Collapse
Affiliation(s)
- Ravi Bhushan
- Department of Chemistry, Indian Institute of Technology Roorkee, Roorkee, India
| | - Jürgen Martens
- Institut für Chemie, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| |
Collapse
|
3
|
Fitsum Y, Werede A, Mahmud Saleh A, Tesfamariam EH, Magombo F, Misghina F, Yemane H, Bahta I, Abraham L, Bahta M, Debesai M, Tesfagaber M, Ghirmai M, Tesfamariam S, Russom M. Understanding, readiness, and response of healthcare professionals in combating falsified medical products in Eritrea: a population-based survey. Ther Adv Drug Saf 2023; 14:20420986231213713. [PMID: 38107771 PMCID: PMC10725142 DOI: 10.1177/20420986231213713] [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: 03/30/2023] [Accepted: 10/17/2023] [Indexed: 12/19/2023] Open
Abstract
Background The circulation of falsified medical products is a global threat and is expected to be higher in low- and middle-income countries. Objective This study was conducted to assess the understanding, readiness, and response of Eritrea's healthcare professionals (HCPs), and identify potential areas of intervention to combat circulation of falsified medical products. Design This was a nationwide population-based cross-sectional survey, conducted in December 2021. Methods This study enrolled representative samples of HCPs working in public and private health facilities. Two-stage stratified cluster sampling was used to select study participants and data were collected through face-to-face interviews. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test along with their post hoc tests, Jonckheere-Terpstra, and logistic regression analyses were performed as appropriate. Results The study enrolled 707 HCPs, and 96.6% were successfully surveyed. The majority of the participants (62.5%) encountered products with suspected quality defects and 63.8% claimed that they had reported the incident(s) at least once. About 85% reported that complaints should be submitted to the Eritrean Pharmacovigilance Centre and 74.0% indicated that it should be reported at the earliest time possible even if the reporter lacks details. The standard reporting form for suspected product quality issues was correctly recognized by 13.8%. Overall, the median knowledge and attitude scores were found to be 9 out of 17 (interquartile range, IQR: 4.0) and 30 out of 35 (IQR: 4.0), respectively. Not knowing how to report (55.6%) and what to report (34.9%), no/delayed feedback from the regulatory authority (30.0%), and unavailability of reporting forms (29.0%) were the frequently reported barriers to reporting. In addition, profession (p = 0.027), no/delayed feedback (adjusted odds ratio [AOR]: 4.70; 95% CI: 2.17-10.18; p < 0.001), and not knowing how to report (AOR: 0.12; 95% CI: 0.05-0.28; p < 0.001) were found to be determinants of reporting suspected product quality defects. Conclusion The readiness and response of Eritrea's HCPs in detecting and reporting falsified medical products seems promising, although a significant knowledge gap was observed.
Collapse
Affiliation(s)
- Yodit Fitsum
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Azania Werede
- Product Evaluation and Registration Unit, National Medicines and Food Administration, Ministry of Health, P.O.BOX 212 Asmara, Eritrea
| | | | | | | | - Freminatos Misghina
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Hermella Yemane
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Iyassu Bahta
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Liya Abraham
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Merhawi Bahta
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Merhawi Debesai
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Meron Tesfagaber
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Michael Ghirmai
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Sirak Tesfamariam
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Mulugeta Russom
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
- European Programme for Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
| |
Collapse
|
4
|
Thakur N. Sub-standard or Sub-legal? Distribution, Pharma Dossiers, and Fake-talk in India. MEDICINE ANTHROPOLOGY THEORY 2023; 10:1-21. [PMID: 38660628 PMCID: PMC7615867 DOI: 10.17157/mat.10.3.7279] [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] [Indexed: 04/26/2024] Open
Abstract
In this article, I look at Indian pharma 'dossiers'-the bundles of paperwork that testify to pharmaceutical quality and adherence to regulatory standards-and how they illustrate a wider and ongoing shift from a paradigm of drug safety to one of drug security. By examining how dossiers enact and enable claims of 'quality', I argue that it is in a drug's paperwork-rather than its chemical composition-that quality or fake-ness is produced. Based on interviews with Indian traders and officials, and an examination of how their work has changed over time in accordance with the regulatory shift to drug security, I show that in many instances the paperwork has come to be more important than the pill itself. This analysis contests the dominant pharmaco-regulatory notion of fake-ness, which privileges chemical composition above all else. In this way, my analysis of the dossier shows that drug security is itself a powerful form of fake-talk, one that informs the entire market and the conditions of possibility of international commerce today.
Collapse
|
5
|
Tharmalinga Sharma JJ, Ketharam M, Herath KB, Shobia SS. Quality of medicines in Sri Lanka: a retrospective review of safety alerts. BMC Health Serv Res 2023; 23:980. [PMID: 37700302 PMCID: PMC10496228 DOI: 10.1186/s12913-023-09995-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Many medicine quality problems are detected after they arrive at health facilities. Thus, critically defective medicines that may pose health risks to patients need to be withheld or recalled. AIMS To investigate the withheld and recalled medicines in relation to the types of defects, their total numbers, therapeutic categories, pharmaceutical dosage forms, and country of manufacturer during the study period. METHODS A retrospective review was performed on withheld and recalled medicines published on the publicly available National Medicines Regulatory Authority (NMRA) official website in Sri Lanka between June 2018 and August 2021. Details on substandard medicines (SM) were extracted and documented. Each record of SM was individually reviewed to determine the type of defect, subsequent action taken by NMRA, therapeutic category, pharmaceutical dosage form, and country of manufacturer. RESULTS A total of 163 defects were identified in 143 defective medicines, among which the most common types of defects were contamination (n = 59, 36.2%), stability defects (n = 41, 25.2%), packaging and labelling defects (n = 27, 16.6%) and active pharmaceutical ingredient defects (n = 26, 15.9%). Out of 143 total defective medicines identified, anti-infectives accounted for 41.9%, while parenteral preparations (44.0%) were found to be frequently defective. Nearly 70% of the recalled and withheld medicines were of Indian origin, and some manufacturers were identified to be repeatedly involved. CONCLUSIONS This study revealed that contamination was the most frequent cause of defective medicines, while parenteral preparations and anti-infectives were the most susceptible pharmaceutical dosage form and therapeutic category found to be substandard, respectively. In addition, the findings show that some manufacturers were accountable for repetitive withholdings and recalls, which reflects the ignorance of quality control measures and weak regulatory inspections as a violation of Good Manufacturing Practice (GMP).
Collapse
Affiliation(s)
- Jegath Janani Tharmalinga Sharma
- Ministry of Health, Nutrition & Indigenous Medicine, Colombo South Teaching Hospital, Baddegama Wimalawansa Thero Mawatha, Colombo, Sri Lanka.
| | | | | | | |
Collapse
|
6
|
Glazov IE, Krut’ko VK, Safronova TV, Sazhnev NA, Kil’deeva NR, Vlasov RA, Musskaya ON, Kulak AI. Formation of Hydroxyapatite-Based Hybrid Materials in the Presence of Platelet-Poor Plasma Additive. Biomimetics (Basel) 2023; 8:297. [PMID: 37504185 PMCID: PMC10807031 DOI: 10.3390/biomimetics8030297] [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: 06/04/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
Biomaterials based on hydroxyapatite with controllable composition and properties are promising in the field of regenerative bone replacement. One approach to regulate the phase composition of the materials is the introduction of biopolymer-based additives into the synthesis process. The purpose of present study was to investigate the formation of hydroxyapatite-based hybrid materials in the presence of 6-24% platelet-poor plasma (PPP) additive, at a [Ca2+]/[PO43-] ratio of 1.67, pH 11, and varying maturing time from 4 to 9 days. The mineral component of the materials comprised 53% hydroxyapatite/47% amorphous calcium phosphate after 4 days of maturation and 100% hydroxyapatite after 9 days of maturation. Varying the PPP content between 6% and 24% brought about the formation of materials with rather defined contents of amorphous calcium phosphate and biopolymer component and the desired morphology, ranging from typical apatitic conglomerates to hybrid apatite-biopolymer fibers. The co-precipitated hybrid materials based on hydroxyapatite, amorphous calcium phosphate, and PPP additive exhibited increased solubility in SBF solution, which defines their applicability for repairing rhinoplastic defects.
Collapse
Affiliation(s)
- Ilya E. Glazov
- Institute of General and Inorganic Chemistry, National Academy of Sciences of Belarus, Surganova Str., 9/1, 220012 Minsk, Belarus; (V.K.K.); (O.N.M.); (A.I.K.)
| | - Valentina K. Krut’ko
- Institute of General and Inorganic Chemistry, National Academy of Sciences of Belarus, Surganova Str., 9/1, 220012 Minsk, Belarus; (V.K.K.); (O.N.M.); (A.I.K.)
| | - Tatiana V. Safronova
- Department of Chemistry, Lomonosov Moscow State University, Building, 3, Leninskie Gory, 1, 119991 Moscow, Russia;
- Department of Materials Science, Lomonosov Moscow State University, Building, 73, Leninskie Gory, 1, 119991 Moscow, Russia
| | - Nikita A. Sazhnev
- Department of Chemistry and Technology of Polymer Materials and Nanocomposites, Kosygin Russian State University, Malaya Kaluzhskaya, 1, 119071 Moscow, Russia; (N.A.S.); (N.R.K.)
| | - Natalia R. Kil’deeva
- Department of Chemistry and Technology of Polymer Materials and Nanocomposites, Kosygin Russian State University, Malaya Kaluzhskaya, 1, 119071 Moscow, Russia; (N.A.S.); (N.R.K.)
| | - Roman A. Vlasov
- Medical Center “Lode”, Gikalo Str., 1, 220005 Minsk, Belarus;
| | - Olga N. Musskaya
- Institute of General and Inorganic Chemistry, National Academy of Sciences of Belarus, Surganova Str., 9/1, 220012 Minsk, Belarus; (V.K.K.); (O.N.M.); (A.I.K.)
| | - Anatoly I. Kulak
- Institute of General and Inorganic Chemistry, National Academy of Sciences of Belarus, Surganova Str., 9/1, 220012 Minsk, Belarus; (V.K.K.); (O.N.M.); (A.I.K.)
| |
Collapse
|
7
|
Tabernero P, Newton PN. Estimating the prevalence of poor-quality anti-TB medicines: a neglected risk for global TB control and resistance. BMJ Glob Health 2023; 8:e012039. [PMID: 37433693 DOI: 10.1136/bmjgh-2023-012039] [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: 02/15/2023] [Accepted: 05/29/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES Tuberculosis (TB) remains a major global public health problem, especially with the recent emergence of multidrug-resistant TB and extensively drug-resistant TB. There has been little consideration of the extent of substandard and falsified (SF) TB medicines as drivers of resistance. We assessed the evidence on the prevalence of SF anti-TB medicines and discussed their public health impact. MATERIALS/METHODS We searched Web of Science, Medline, Pubmed, Google Scholar, WHO, US Pharmacopeia and Medicines Regulatory Agencies websites for publications on anti-TB medicines quality up to 31 October 2021. Publications reporting on the prevalence of SF anti-TB drugs were evaluated for quantitative analysis. RESULTS Of the 530 screened publications, 162 (30.6%) were relevant to anti-TB medicines quality; of those, 65 (40.1%) described one or more TB quality surveys in a specific location or region with enough information to yield an estimate of the local prevalence of poor-quality TB medicines. 7682 samples were collected in 22 countries and of those, 1170 (15.2%) failed at least one quality test. 14.1% (879/6255) of samples failed in quality surveys, 12.5% (136/1086) in bioequivalence studies and 36.9% (87/236) in accelerated biostability studies. The most frequently assessed were rifampicin monotherapy (45 studies, 19.5%) and isoniazid monotherapy (33, 14.3%), rifampicin-isoniazid-pyrazinamide-ethambutol fixed dose combinations (28, 12.1%) and rifampicin-isoniazid (20, 8.6%). The median (IQR) number of samples collected per study was 12 (1-478). CONCLUSIONS SF, especially substandard, anti-TB medicines are present worldwide. However, TB medicine quality data are few and are therefore not generalisable that 15.2% of global anti-TB medicine supply is SF. The evidence available suggests that the surveillance of the quality of TB medicines needs to be an integral part of treatment programmes. More research is needed on the development and evaluation of rapid, affordable and accurate portable devices to empower pharmacy inspectors to screen for anti-TB medicines.
Collapse
Affiliation(s)
- Patricia Tabernero
- Public Health Unit, Faculty of Medicine, Universidad de Alcalá, Alcalá de Henares, Spain
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
- Medicine Quality Research Group, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory (IDDO)/WorldWide Antimalarial Resistance Network (WWARN), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
- Medicine Quality Research Group, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory (IDDO)/WorldWide Antimalarial Resistance Network (WWARN), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
8
|
Dhakal N, Gyanwali P, Humagain B, Bc R, Jha N, Sah P, Pradhan A, Dhimal M, Jha AK. Assessment of quality of essential medicines in public health care facilities of Nepal: Findings of nationwide study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001841. [PMID: 37228001 DOI: 10.1371/journal.pgph.0001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/23/2023] [Indexed: 05/27/2023]
Abstract
Essential medicines are those medicines that satisfy the primary health care needs of the citizens. Poor quality of essential medicines can have serious impact on public health. Thus, this study is aimed to assess the quality of essential medicines available in public health care facilities of Nepal. A cross sectional descriptive study was carried out in 62 health facilities across 21 districts, representing all seven provinces of Nepal and selected proportionately from all three ecological regions i.e. Terai, Hill and Mountain using lottery method. Health facilities in selected districts were chosen using random number generator. Face to face interview was taken with health facility in charge using structured questionnaire. All storage conditions information was recorded through observation checklists. Temperature and humidity were measured using a digital instrument. Similarly, 20 different generic medicines were collected for quality testing. The obtained data were entered in Epidata version 3.1, cleaned in Microsoft Excel 2007 and analyzed in SPSS version 16.0. Among 62 health facilities, only 13% of health facilities were found to follow the medicine storage guidelines, with temperature and humidity levels exceeding recommended limits. Out of 244 batches of 20 different generics of essential medicines, 37 batches were found to be substandard. These substandard medicines were- Ciprofloxacin hydrochloride eye/ear drop, Iron supplement tablets, Metformin Hydrochloric tablet, Metronidazole Tablets, Paracetamol Oral suspension, Paracetamol tablet and Povidone Iodine solution. The study recommends the urgent need for the Government of Nepal to prioritize ensuring the quality of essential medicines in the country.
Collapse
Affiliation(s)
- Neelam Dhakal
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Pradip Gyanwali
- Department of Pharmacology, Maharajgunj Medical Campus, Kathmandu, Nepal
| | | | - Rajendra Bc
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Nisha Jha
- Department of Clinical Pharmacology and Therapeutics, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Phoolgen Sah
- Department of Pharmacy and Pharmacology, Janamaitri Foundation, Institute Of Health Sciences, Kathmandu, Nepal
| | - Amita Pradhan
- Department of Community Dentistry, People's Dental College and Hospital, Kathmandu, Nepal
| | - Meghnath Dhimal
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Bastani P, Jammeh A, Lamar F, Malenfant JH, Adewuyi P, Cavanaugh AM, Calloway K, Crisp C, Fofana N, Hallett TC, Jallow A, Muoneke U, Nyassi M, Thomas J, Troeschel A, Yard E, Yeh M, Bittaye M. Acute Kidney Injury Among Children Likely Associated with Diethylene Glycol-Contaminated Medications - The Gambia, June-September 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:217-222. [PMID: 36862590 PMCID: PMC9997663 DOI: 10.15585/mmwr.mm7209a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
On July 26, 2022, a pediatric nephrologist alerted The Gambia's Ministry of Health (MoH) to a cluster of cases of acute kidney injury (AKI) among young children at the country's sole teaching hospital, and on August 23, 2022, MoH requested assistance from CDC. CDC epidemiologists arrived in The Gambia, a West African country, on September 16 to assist MoH in characterizing the illness, describing the epidemiology, and identifying potential causal factors and their sources. Investigators reviewed medical records and interviewed caregivers to characterize patients' symptoms and identify exposures. The preliminary investigation suggested that various contaminated syrup-based children's medications contributed to the AKI outbreak. During the investigation, MoH recalled implicated medications from a single international manufacturer. Continued efforts to strengthen pharmaceutical quality control and event-based public health surveillance are needed to help prevent future medication-related outbreaks.
Collapse
|
11
|
Karungamye P. Counterfeit and substandard drugs in Tanzania: A review. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2022. [DOI: 10.1016/j.fsir.2022.100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
12
|
Physicochemical Equivalence and Quality Assessment of Various Brands of Gastro-Resistant Omeprazole Capsules in the Kumasi Metropolis. ScientificWorldJournal 2022; 2022:7924600. [DOI: 10.1155/2022/7924600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
The proliferation of counterfeit and poor-quality drugs is a major public health problem, especially in developing countries such as Ghana where there are inadequate resources to effectively monitor their prevalence. Most of these drugs, which are counterfeited, are drugs, which are in high demand and will reap huge profits for the unscrupulous people who engage in such activities. The introduction of Omeprazole as one of the first-line therapies in the management of peptic and duodenal ulcers in the treatment guidelines of Ghana has resulted in many generics being introduced onto the market. The pharmaceutical quality of fifteen randomly sampled Omeprazole capsule brands in the Kumasi metropolis was assessed using the innovator brand as a comparator to confirm their suitability for patient use and to provide data for drug regulatory agencies in Ghana concerning poor quality omeprazole brands. All the sampled brands complied with the official specifications for identification with good primary and secondary packaging characteristics. Ninety-four (94%) of the sampled brands passed the uniformity of weight test. All the brands (n = 16) representing 100% passed the disintegration tests. Sixty percent (60%) of the sampled brands passed the drug content test. Ten brands (66.7%) met the specification for in vitro dissolution test. From f2 analysis, the dissolution profiles of only five brands (31%) were similar to that of the reference brand which indicated that they could be used interchangeably in clinical practice. Conclusively, ten out of the fifteen sampled brands were of good quality and only five could be used as a substitute for the innovator. Thus, regulatory agencies will need to strengthen their postmarket surveillance to ensure that generic brands of good quality are allowed onto the market.
Collapse
|
13
|
Kohler S, Sitali N, Achar J, Paul N. The contribution of drug import to the cost of tuberculosis treatment: A cost analysis of longer, shorter, and short drug regimens for Karakalpakstan, Uzbekistan. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000567. [PMID: 36962528 PMCID: PMC10021759 DOI: 10.1371/journal.pgph.0000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/11/2022] [Indexed: 11/19/2022]
Abstract
Tuberculosis (TB) programs depend on a continuous supply of large amounts of high-quality TB drugs. When TB programs procure TB drugs from international suppliers, such as the Global Drug Facility, they can incur import costs for international transport, customs clearance, and national transport. We assessed the drug costs and import costs of 18 longer (≥18 months), 10 shorter (9-12 months), and 8 short (≤6 months) drug regimens for drug-sensitive (DS) and multidrug-resistant (MDR)-TB treatment. Costs per regimen were estimated by multiplying recommended drug amounts with 2021 Global Drug Facility prices and drug import costs of a TB program in Karakalpakstan, Uzbekistan. The standard short-course treatment of DS-TB requires taking 730 fixed-dose combination tablets, which weigh 0.79 kg and cause an import cost of $4.19 (9.8% of the regimen's drug cost of $43). A new 4-month DS-TB regimen requires taking 1358 tablets, which weigh 1.1 kg and cause an import cost of $6.07 (2.6% of the regimen's drug cost of $233). MDR-TB regimens that last between 24 weeks and 20 months involve 546-9368 tablets and injections. The drugs for these MDR-TB regimens were estimated to weigh 0.42-96 kg and cause an import cost of $2.26-507 per drug regimen (0.29-11% of a regimen's drug cost of $360-15,028). In a multivariable regression analysis, an additional treatment month increased the import cost of a drug regimen by $5.45 (95% CI: 1.65 to 9.26). Use of an injectable antibiotic in a regimen increased the import cost by $133 (95% CI: 47 to 219). The variable and potentially sizable import costs of TB regimens can affect the financial needs of TB programs. Drug regimens that are shorter and all-oral tend to reduce import costs compared to longer regimens and regimens including an injectable drug.
Collapse
Affiliation(s)
- Stefan Kohler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Jay Achar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nicolas Paul
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
14
|
Astone DP. Scarcity, Property Rights, Irresponsibility: How Intellectual Property Deals with Neglected Tropical Diseases. LAW AND CRITIQUE 2022; 34:145-164. [PMID: 37521680 PMCID: PMC9244109 DOI: 10.1007/s10978-022-09324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 08/01/2023]
Abstract
The article addresses the role of scarcity in negotiating the relationship between intellectual property, particularly from a legal-economic perspective, and property rights, as understood by transaction cost economics, to shed light on the deadlock faced by those suffering from neglected tropical diseases (NTDs). The consistency of the law and economics fundamentals that support the trade on knowledge goods, namely patents on essential medicines, is put under check by Scott Veitch's scholarship on legal irresponsibility. The damages that emerge from the operations of the intellectual property system are registered in the novel concept of negative public domain, and are due mainly to the lack of access to treatments that end up being unaffordable, or to innovation that leads to new drugs that is not sufficiently incentivised though price signals. The accountability for such damages is taken into consideration by arguing that the disavowal of responsibility is made possible by the negative public domain, which is balanced by the construction of a positive response through the language of rights. As such, responsibility per se is preserved, evading one instantiation of Teubner's legal paradoxes, but rendered ineffective by design. In other words, even if the harms endured by those affected by the NTDs can be traced back to the operations of the intellectual property system, there is no one to hold accountable. The main goal pursued through the article is to make such an arrangement explicit, by giving centrality to the notion of scarcity and its interplay between legal and economic theory, alongside the novel concept of negative public domain as a site where the actual consequences of irresponsibility lie, to hopefully inform further critique in subsequent works.
Collapse
|
15
|
Fimbo AM, Maganda BA, Mwamwitwa KW, Mwanga IE, Mbekenga EB, Kisenge S, Mziray SA, Kulwa GS, Mwalwisi YH, Shewiyo DH. Post marketing surveillance of selected veterinary medicines in Tanzania mainland. BMC Vet Res 2022; 18:216. [PMID: 35681204 PMCID: PMC9178830 DOI: 10.1186/s12917-022-03329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Veterinary medicines have been widely used for the prevention and treatment of animal diseases. Globally, the veterinary medicine industry is growing. However, there is a significant increase of concern on the quality of veterinary medicines in various developing countries' legal markets. Poor-quality medicines are associated with treatment failure, development of drug resistance, increased healthcare cost, and death. These reasons warrant a need for monitoring the quality of the medicines circulating in the Tanzania Mainland. METHODS This was a survey study and veterinary medicines samples were collected from 9 out of 26 regions of Tanzania mainland between 2014 and 2017. Veterinary medicines were sampled from wholesale pharmacies, retail pharmacies, veterinary clinics and Veterinary Accredited Drug Dispensing Outlets (ADDO-vet). All sampled medicines were subjected to product information review and full quality control testing at the Tanzania Medicines and Medical Devices Authority-World Health Organization prequalified laboratory. RESULTS A total of 238 samples of veterinary medicines were collected. Out of these, 97.1% (231/238) were subjected to full quality control testing and product information review. All sampled veterinary medicines conformed to visual appearance, clarity, pH, solubility and sterility tests. Also, of the sampled veterinary medicines 97.8% (226/231) and 89.2% (206/231) passed identification and assay tests, respectively. As well as, the majority of the collected samples 92% (219/238) failed to comply with product information requirements. The most observed deficiencies on product information were inadequate information on the package insert 94.1% (224/238), inappropriate storage conditions 55.5% (132/238) and lack of Tanzania registration number 27% (64/238). CONCLUSION Veterinary medicines with poor quality were found circulating in the legal markets of Tanzania. This can potentiate treatment failure and the development of drug resistance in animals and humans. Post marketing surveillance program will continue to be implemented to ensure that only good quality, safe and efficacious medicines are circulating in the Tanzania Mainland market.
Collapse
Affiliation(s)
- Adam M. Fimbo
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Betty A. Maganda
- Department of Pharmaceutics and Pharmacy Practice, Muhimbili University of Health and Allied Sciences, P.O BOX 65013, Dar es salaam, Tanzania
| | - Kissa W. Mwamwitwa
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Itikija E. Mwanga
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Engelbert B. Mbekenga
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Seth Kisenge
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Sophia A. Mziray
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Gerald S. Kulwa
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Yonah H. Mwalwisi
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Danstan H. Shewiyo
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| |
Collapse
|
16
|
Dohou AM, Yémoa AL, Guidan DBA, Ahouandjinou SHS, Amoussa A, Dossou FM, Marini Djang’eing’a R, Dalleur O. Assessment of the Quality of Injectable Antibiotics in Benin. Am J Trop Med Hyg 2022; 107:24-31. [DOI: 10.4269/ajtmh.21-0844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/06/2022] [Indexed: 11/07/2022] Open
Abstract
Substandard and falsified medicines are an enormous threat to global health. Poor quality antibiotic preparations contribute to the development of antimicrobial resistance. In surgery, where the occurrence of healthcare-associated infections is high, healthcare teams need to rely on the quality of antibiotic prophylaxis to prevent infections. We assessed the quality of antibiotics used for surgical infection prophylaxis in Benin. Thirty-three samples were collected from six hospitals located in various departments in Benin. The antibiotics (powders for injection: amoxicillin + clavulanic acid, ampicillin, ceftriaxone; solutions for injection: ciprofloxacin, gentamicin, metronidazole) were assessed using visual inspection, pharmacotechnical tests (including uniformity of mass, pH measure, sterility test, and active pharmaceutical ingredient identification), and assay tests (including a simple analytical method thin layer chromatography) and complex analytical techniques (ultraviolet-visible spectrophotometry, high-performance liquid chromatography—diode-array detection, conductometry). Because the material needed for the methods recommended by the pharmacopeias to assess the dosage of gentamicin was not available, we developed and validated a conductometry method. Results showed that 97% (n = 32) of the samples passed visual inspection; 100% (n = 33) of the samples passed the pharmacotechnical tests, identification of active ingredients, and sterility test; 88% (n = 29) passed the test for percentage of active pharmaceutical ingredients. Overall, 15% of the samples did not pass the quality test (3% on visual inspection and 12% for excess active ingredients). Although most of the samples passed the quality tests, it appears important to perform routine quality control for intravenous medicines.
Collapse
Affiliation(s)
- Angèle Modupè Dohou
- Louvain Drug Research Institute, Clinical Pharmacy, Université Catholique de Louvain (UCLouvain), Belgium
- Laboratoire de Chimie Analytique et Analyse des Médicaments, Université d’Abomey Calavi, Bénin
| | - Achille Loconon Yémoa
- Laboratoire de Chimie Analytique et Analyse des Médicaments, Université d’Abomey Calavi, Bénin
| | | | | | - Ahmed Amoussa
- Laboratoire de Chimie Analytique et Analyse des Médicaments, Université d’Abomey Calavi, Bénin
| | - Francis Moïse Dossou
- Service de Chirurgie Générale, Centre Hospitalo-Universitaire Départemental Ouémé-Plateau, Bénin
| | - Roland Marini Djang’eing’a
- Department of Pharmacy, CIRM, Laboratory of Analytical Pharmaceutical Chemistry, University of Liege, Belgium
| | - Olivia Dalleur
- Louvain Drug Research Institute, Clinical Pharmacy, Université Catholique de Louvain (UCLouvain), Belgium
- Pharmacy Department, Cliniques Universitaires Saint-Luc, UCLouvain, Belgium
| |
Collapse
|
17
|
Tabernero P, Swamidoss I, Mayxay M, Khanthavong M, Phonlavong C, Vilayhong C, Sichanh C, Sengaloundeth S, Green MD, Newton PN. A random survey of the prevalence of falsified and substandard antibiotics in the Lao PDR. J Antimicrob Chemother 2022; 77:1770-1778. [PMID: 35137095 PMCID: PMC7614350 DOI: 10.1093/jac/dkab435] [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: 07/07/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In 2012, a stratified random survey, using mystery shoppers, was conducted to investigate the availability and quality of antibiotics sold to patients in the private sector in five southern provinces of the Lao People's Democratic Republic (Laos). METHODS A total of 147 outlets were sampled in 10 districts. The active pharmaceutical ingredient (API) content measurements for 909 samples, including nine APIs (amoxicillin, ampicillin, ceftriaxone, ciprofloxacin, doxycycline, ofloxacin, sulfamethoxazole, tetracycline and trimethoprim), were determined using HPLC. RESULTS All the analysed samples contained the stated API and we found no evidence for falsification. All except one sample had all the units tested with %API values between 75% and 125% of the content stated on the label. However, we identified the presence of substandard antibiotics: 19.6% (201/1025) of samples had their units outside the 90%-110% content of the label claim and 18.3% (188/1025) of the samples had units outside the International Pharmacopoeia/United States Pharmacopoeia assay (percentage of label claim) specifications. Trimethoprim had a high number of samples [51.6% (64)] with units below the limit range, followed by ceftriaxone [42.9% (3)] and sulfamethoxazole [34.7% (43)]. Doxycycline, ofloxacin and ciprofloxacin had the highest number of samples with high API content: 43.7% (38), 14.7% (10) and 11.8% (2), respectively. Significant differences in %API were found between stated countries of manufacture and stated manufacturers. CONCLUSIONS With the global threat of antimicrobial resistance on patient outcomes, greater understanding of the role of poor-quality antibiotics is needed. Substandard antibiotics will have reduced therapeutic efficacy, impacting public health and control of bacterial infections.
Collapse
Affiliation(s)
- Patricia Tabernero
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Public Health Unit, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain
| | - Isabel Swamidoss
- Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuf?eld Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | | | - Chindaphone Phonlavong
- Bureau of Food and Drug Inspection (BFDI), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Chanthala Vilayhong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Chanvilay Sichanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sivong Sengaloundeth
- Food and Drug Department (FDD), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Michael D. Green
- Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuf?eld Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory, Nuf?eld Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| |
Collapse
|
18
|
Shergill RS, Farlow A, Perez F, Patel BA. 3D-printed electrochemical pestle and mortar for identification of falsified pharmaceutical tablets. Mikrochim Acta 2022; 189:100. [DOI: 10.1007/s00604-022-05202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/25/2022] [Indexed: 12/21/2022]
|
19
|
Shergill RS, Kristova P, Patel BA. Detection of falsified clopidogrel in the presence of excipients using voltammetry. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2021; 13:5335-5342. [PMID: 34730129 DOI: 10.1039/d1ay01602d] [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
There has been a recent surge in the amount of substandard and falsified clopidogrel. Pharmacopeial based assays using high performance liquid chromatography and mass spectroscopy are widely used for the measurement of clopidogrel but are not accessible in low to middle income countries. Therefore, our study explored four different techniques (mid-infrared spectroscopy, thin layer chromatography, ultraviolet visible spectroscopy, and differential pulse voltammetry), which could be used in low to middle income countries. Differential pulse voltammetry showed the best performance for accurate and precise determination of clopidogrel in the presence of excipients. Clopidogrel tablets were fully crushed and sonicated in buffer for 30 seconds prior to differential pulse voltammetry measurements using a 3 mm glassy carbon electrode. Measurements were made without removing the excipients and the limit of detection was 0.08 mg ml-1 and the sensitivity was 15.7 μA mg ml-1. When conducting a blinded study, differential pulse voltammetry was able to identify varying types of substandard and falsified samples. Our findings highlight that voltammetry could be a vital analytical technique for the determination of substandard and falsified medicines in low- and middle-income countries.
Collapse
Affiliation(s)
| | - Petra Kristova
- School of Applied Sciences, University of Brighton, Brighton, East Sussex, UK.
| | - Bhavik Anil Patel
- School of Applied Sciences, University of Brighton, Brighton, East Sussex, UK.
| |
Collapse
|
20
|
Lanyero H, Ocan M, Obua C, Stålsby Lundborg C, Agaba K, Kalyango JN, Eriksen J, Nanzigu S. Validity of caregivers' reports on prior use of antibacterials in children under five years presenting to health facilities in Gulu, northern Uganda. PLoS One 2021; 16:e0257328. [PMID: 34529730 PMCID: PMC8445424 DOI: 10.1371/journal.pone.0257328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Given the frequent initiation of antibacterial treatment at home by caregivers of children under five years in low-income countries, there is a need to find out whether caregivers' reports of prior antibacterial intake by their children before being brought to the healthcare facility are accurate. The aim of this study was to describe and validate caregivers' reported use of antibacterials by their children prior to seeking care at the healthcare facility. METHODS A cross sectional study was conducted among children under five years seeking care at healthcare facilities in Gulu district, northern Uganda. Using a researcher administered questionnaire, data were obtained from caregivers regarding reported prior antibacterial intake in their children. These reports were validated by comparing them to common antibacterial agents detected in blood and urine samples from the children using liquid chromatography with tandem mass spectrometry (LC-MS/MS) methods. RESULTS A total of 355 study participants had a complete set of data on prior antibacterial use collected using both self-report and LC-MS/MS. Of the caregivers, 14.4% (51/355, CI: 10.9-18.5%) reported giving children antibacterials prior to visiting the healthcare facility. However, LC-MS/MS detected antibacterials in blood and urine samples in 63.7% (226/355, CI: 58.4-68.7%) of the children. The most common antibacterials detected from the laboratory analysis were cotrimoxazole (29%, 103/355), ciprofloxacin (13%, 46/355), and metronidazole (9.9%, 35/355). The sensitivity, specificity, positive predictive value (PPV), negative predictive value and agreement of self-reported antibacterial intake prior to healthcare facility visit were 17.3% (12.6-22.8), 90.7% (84.3-95.1), 76.5% (62.5-87.2), 38.5% (33.0-44.2) and 43.9% (k 0.06) respectively. CONCLUSION There is low validity of caregivers' reports on prior intake of antibacterials by these children. There is need for further research to understand the factors associated with under reporting of prior antibacterial use.
Collapse
Affiliation(s)
- Hindum Lanyero
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Ocan
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Joan N. Kalyango
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital, Stockholm, Sweden
| | - Sarah Nanzigu
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| |
Collapse
|
21
|
Quality of timolol eye drops marketed in Kinshasa, Democratic Republic of the Congo. J Fr Ophtalmol 2021; 44:1216-1222. [PMID: 34325924 DOI: 10.1016/j.jfo.2021.02.015] [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: 08/26/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the quality of timolol eye drops sold in Kinshasa, Democratic Republic of Congo (DRC). METHODS Seven samples of timolol maleate 0.5% were purchased over the counter in seven randomly selected public pharmacies in 3 neighborhoods in Kinshasa. They were submitted to a quality assessment that included visual inspection, spectrophotometry, high performance liquid chromatography (HPLC), and bacteriologic assessment. RESULTS The samples came from France (n=2), India (n=2) and DRC (n=3). Overall, 3 (2 from India and 1 from the DRC) of the 7 samples, or 3 out of the 5 from developing countries, showed various abnormalities consistent with substandard drugs. One sample (India) demonstrated an incorrect pH, while 3 (2 from India and one from the DRC) had lower than stated volumes as well as lower than required concentrations of the active pharmaceutical ingredient. In addition, one sample from the DRC was bacteriologically contaminated. CONCLUSION These results suggest that some timolol maleate eye drops from Congolese and Indian manufacturers sold in Kinshasa are of substandard quality. This may reflect deficiencies in the manufacturers and local authorities charged with regulation of the quality control and sale of pharmaceuticals. Passing a visual inspection does not necessarily indicate that a drug is not substandard. Analytical chemistry testing and bacteriologic analysis are required to determine with certainty the quality of the drug.
Collapse
|
22
|
Enright K. Elusive quality: the challenges and ethical dilemmas faced by international non-governmental organisations in sourcing quality assured medical products. BMJ Glob Health 2021; 6:bmjgh-2020-004339. [PMID: 34049937 PMCID: PMC8166619 DOI: 10.1136/bmjgh-2020-004339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 11/24/2022] Open
Abstract
Although medical products that are of sound quality are fundamental to the delivery of healthcare, so too is their availability, affordability, accessibility and acceptability. However, achieving all of these aims consistently and simultaneously may be unfeasible due to a host of barriers—no matter the country. If uncertainty, constraints and conflicting priorities also threaten their delivery, not only does the situation becomes yet more challenging, the morally just course of action becomes yet more opaque. While global health organisations, supply chains and projects are heterogenous, international non-governmental organisations (iNGOs) responding to humanitarian crises or delivering development assistance in low-income and middle-income countries are undoubtedly prone to this issue. In a novel framing of the problem of substandard and falsified medicines, this article explores some ethical dilemmas that, directly or indirectly, could result in the quality of medical products in iNGO health projects to be compromised. Drawing on a broad literature base and years of experience as a senior humanitarian pharmacist, the author reflects on the barriers, culture and system that contributes to the existence and persistence of substandard and falsified medical products in global assistance projects. The paper offers an in-depth examination of pressures that may arise in four key areas (capacity, supply chain, bureaucracy and quality assurance) and postulates on the myriad ways in which this may alter the attitudes, behaviours and decision-making of iNGOs in a manner that disincentivises the prioritisation of medical product quality. This paper does not seek to excoriate the aid sector, but rather to lend a new perspective: that such predicaments are overlooked, real-world ethical dilemmas in urgent need of greater openness, research, debate and guidance, for the benefit of moral decision-making and patient care.
Collapse
Affiliation(s)
- Katherine Enright
- Nuffield Department of Population Health, University of Oxford, London, UK
| |
Collapse
|
23
|
McManus D, Naughton BD. A systematic review of substandard, falsified, unlicensed and unregistered medicine sampling studies: a focus on context, prevalence, and quality. BMJ Glob Health 2021; 5:bmjgh-2020-002393. [PMID: 32859648 PMCID: PMC7454198 DOI: 10.1136/bmjgh-2020-002393] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023] Open
Abstract
Substandard and falsified (SF) medicines are a global issue contributing to antimicrobial resistance and causing economic and humanitarian harm. To direct law enforcement efficiently, halt the spread of SF medicines and antimicrobial resistance, academics, NGOs and government organisations use medicine quality sampling studies to estimate the prevalence of the problem. A systematic review of medicine quality studies was conducted to estimate how the methodological quality of these studies and SF prevalence has changed between 2013 and 2018. We also aimed to critique medicine sampling study methodologies, and the systematic review process which generates prevalence estimates. Based on 33 studies, the overall estimated median (Q1-Q3) prevalence of SF medicines appears to have remained high at 25% (7.7%-34%) compared with 28.5% in 2013. Furthermore, the methodological quality of prevalence studies has improved over the last 25 years. Definitive conclusions regarding the prevalence of SF medicines cannot be drawn due to the variability in sample sizes, consistency of design methods, and a lack of information concerning contextual factors affecting medicine quality studies. We contend that studies which present cumulative average prevalence figures are useful in a broad sense but could be improved to create more reliable estimates. We propose that medicine quality studies record the context of the study environment to allow systematic reviewers to compare like with like. Although, the academic rigour of medicine quality studies is improving, medicine sampling study limitations still exist. These limitations inhibit the accurate estimation of SF medicine prevalence which is needed to support detailed policy changes.
Collapse
Affiliation(s)
- Dominic McManus
- School of Pharmacy (Formerly of), University College London, London, UK
| | - Bernard David Naughton
- Saïd Business School, University of Oxford, Oxford, UK .,Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
24
|
Sounding out falsified medicines from genuine medicines using Broadband Acoustic Resonance Dissolution Spectroscopy (BARDS). Sci Rep 2021; 11:12643. [PMID: 34135361 PMCID: PMC8209214 DOI: 10.1038/s41598-021-90323-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
The trade in falsified medicine has increased significantly and it is estimated that global falsified sales have reached $100 billion in 2020. The EU Falsified Medicines Directive states that falsified medicines do not only reach patients through illegal routes but also via the legal supply chain. Falsified medicines can contain harmful ingredients. They can also contain too little or too much active ingredient or no active ingredient at all. BARDS (Broadband Acoustic Resonance Dissolution Spectroscopy) harnesses an acoustic phenomenon associated with the dissolution of a sample (tablet or powder). The resulting acoustic spectrum is unique and intrinsic to the sample and can be used as an identifier or signature profile. BARDS was evaluated in this study to determine whether a product is falsified or genuine in a rapid manner and at lower cost than many existing technologies. A range of genuine and falsified medicines, including falsified antimalarial tablets from south-east Asia, were tested, and compared to their counterpart genuine products. Significant differences between genuine and falsified doses were found in their acoustic signatures as they disintegrate and dissolve. Principal component analysis was employed to differentiate between the genuine and falsified medicines. This demonstrates that the tablets and capsules included here have intrinsic acoustic signatures which could be used to screen the quality of medicines.
Collapse
|
25
|
Preston C, King C, Hinds M, Burnett F, Extavour RM. Pharmaceutical procurement among public sector procurers in CARICOM. Rev Panam Salud Publica 2021; 45:e57. [PMID: 34025728 PMCID: PMC8132958 DOI: 10.26633/rpsp.2021.57] [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: 08/29/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objective. To examine multiple aspects of the medicines in CARICOM procurement markets, including manufacturer headquarters location, regulatory history, and type (innovator versus generic); the proportion of World Health Organization (WHO) essential medicines; and the most expensive medicines procured. Methods. An analysis of procurement information from selected CARICOM procurers. Four public sector procurement lists were obtained based on public availability or sharing of data from public sector procurers. Analyses were based on parameters available or deduced from these data. Results. The majority of products come from manufacturers headquartered in North America and Europe (63%–67%). The percentage of medicines procured from generic companies is 60%–87%; and 25%–50% of medicines procured are on the WHO Essential Medicines List. Wide price variations exist in the most expensive medicines purchased. Conclusions. The analysis identifies vulnerabilities and opportunities in the procurement situation of CARICOM states, particularly related to quality and rational use of medicines. This analysis represents a baseline that governments and other stakeholders can use in the future.
Collapse
Affiliation(s)
- Charles Preston
- Ex officer of Pan American Health Organization Washington, D.C United States of America Ex officer of Pan American Health Organization, Washington, D.C., United States of America
| | - Claire King
- Baylor Scott and White Medical Center Taylor, Tex United States of America Baylor Scott and White Medical Center, Taylor, Tex., United States of America
| | - Maryam Hinds
- Barbados Drug Service St. Michael Barbados Barbados Drug Service, St. Michael, Barbados
| | - Francis Burnett
- Organisation of Eastern Caribbean States Castries Saint Lucia Organisation of Eastern Caribbean States, Castries, Saint Lucia
| | - Rian Marie Extavour
- Caribbean Public Health Agency Port of Spain Trinidad and Tobago Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Quality and Authenticity of Metformin Tablets Circulating on Japanese Websites. Ther Innov Regul Sci 2021; 55:656-666. [PMID: 33595786 PMCID: PMC8238764 DOI: 10.1007/s43441-021-00262-3] [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: 11/25/2020] [Accepted: 01/26/2021] [Indexed: 11/25/2022]
Abstract
Background Low-quality medicines and falsified medicines represent long-standing problems in developing countries. In Southeast Asia, the circulation of low-quality diabetes drugs (metformin) has been confirmed. It is possible that low-quality metformin has entered Japan via personal import through the Internet. This study evaluated the pharmaceutical quality and authenticity of metformin tablets obtained via the Internet in Japan. Methods In total, 33 samples of 500-mg metformin tablets and 7 samples of extended-release/sustained-release tablets (500, 750, and 1,000 mg) were purchased via personal import in January 2017. Confirmation of a prescription was never requested purchase. The obtained samples were subjected to visual observations and authenticity investigations. Additionally, quantitative analysis, content uniformity and dissolution tests were performed using HPLC–PDA. Results Our authenticity investigations revealed that seven samples were genuine products, whereas the authenticity of the remaining 33 samples was unclear. Referring to United States Pharmacopeia 2014 for validation, four samples failed quality testing, five samples failed content uniformity testing, and two samples failed dissolution testing. Conclusions Our findings illustrate that metformin tablets of poor-quantity and unregistered/unlicensed doses are available online and that it is important to increase consumer awareness about the presence of these medicines on the Internet to prevent the purchase of substandard medicines.
Collapse
|
28
|
Abstract
OBJECTIVE To determine the opinions of supervising physicians about the introduction of clinical associates at South African district hospitals in 2012. METHODS Twenty-four healthcare professionals in Gauteng and North West provinces were selected to participate in cross-sectional qualitative interviews exploring their opinions on the clinical practice of clinical associates, the effect of the new cadre, their achievements, and the concerns of the supervisors. The inductive content analysis process generated several themes. RESULTS Three positive themes related to clinical associate practice were identified: professionalism, skill level, and efficiencies in patient management. Themes of concern included overtime and calls, writing prescriptions, and supervision. CONCLUSIONS Interview results highlighted acceptance and appreciation for the introduction of clinical associates. Baseline opinions enhanced curriculum development and will inform further research on the effect of clinical associates on healthcare delivery in South Africa.
Collapse
|
29
|
Mosoro E, Wilson AN, Homer CSE, Vogel JP. Assessing the quality of antenatal corticosteroids in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0243034. [PMID: 33270682 PMCID: PMC7714108 DOI: 10.1371/journal.pone.0243034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/15/2020] [Indexed: 11/26/2022] Open
Abstract
Background The World Health Organization (WHO) recommends the administration of intramuscular antenatal corticosteroids to women at risk of preterm birth to prevent preterm-associated neonatal mortality and morbidity. Poor quality medicines are a major problem for health services in low- and middle-income countries (LMICs), however the quality of antenatal corticosteroids is not well understood. We aimed to conduct a systematic review of available studies describing the quality of recommended injectable antenatal corticosteroids (dexamethasone or betamethasone) in LMICs. Methods Structured search strategy was applied to six databases (MEDLINE, EMBASE, CINAHL, International Pharmaceutical Abstracts, Global Index Medicus, WHO Medicines Quality Database), without year or language restrictions. Any primary study reporting any medicine quality parameter (Active Pharmacological Ingredient, pH and sterility) for injectable dexamethasone or betamethasone was eligible. Two authors independently screened studies for eligibility, extracted data on included studies and applied Medicine Quality Assessment Reporting Guidelines tool to assess study quality. Results were reported narratively, stratified by country of manufacture, organisation type and level of care. Results In total, 15,547 citations were screened with two eligible studies identified that focussed on dexamethasone quality (no studies of betamethasone were identified). One study included 19 samples from 9 LMICs, and the other included “less than 100 samples” from India. The prevalence of failed dexamethasone samples ranged from 3.14% to 32.2% due to inadequate Active Pharmacological Ingredient. A higher prevalence of failed dexamethasone samples were seen at the point of care and the public sector. Conclusions Poor quality maternal and newborn health medicines can endanger women and newborns. Though available evidence on antenatal corticosteroids quality in LMICs is limited, results suggested poor quality dexamethasone may be prevalent in some countries. More primary studies are required to confirm these findings and guide policymakers on procurement of good-quality maternal and newborn health medicines.
Collapse
Affiliation(s)
- Euodia Mosoro
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Alyce N. Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- * E-mail:
| |
Collapse
|
30
|
Hagen N, Bizimana T, Kayumba PC, Khuluza F, Heide L. Stability of Oxytocin Preparations in Malawi and Rwanda: Stabilizing Effect of Chlorobutanol. Am J Trop Med Hyg 2020; 103:2129-2141. [PMID: 32748770 PMCID: PMC7646793 DOI: 10.4269/ajtmh.20-0255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Oxytocin is used for the prevention and treatment of postpartum hemorrhage, the leading cause of maternal mortality in low- and middle-income countries. Because of the high instability of oxytocin, most products are labeled for storage at 2–8°C. Some other products are on the market which are labeled for non-refrigerated storage, but independent evaluations of their stability hardly exist. In the present study, seven brands (nine batches) of oxytocin were purchased from wholesalers and medical stores in Malawi and Rwanda and investigated by accelerated stability testing according to the ICH/WHO guidelines. Two oxytocin brands approved by a stringent regulatory authority (SRA) or by the WHO Prequalification of Medicines program and purchased in Europe were used as comparison. All investigated brands which were either produced in countries with SRAs, or were WHO-prequalified products, were labeled for storage at 2–8°C, and all of them passed stability testing with very good results. Even exposure to 25°C or 30°C for several months hardly affected their oxytocin content. However, two other investigated brands were labeled for non-refrigerated storage, and both of them had been produced in countries without SRAs. These two preparations showed not higher but lower stability than the brands labeled for storage at 2–8°C, and, for both of them, noncompliance with pharmacopoeial specifications was found after accelerated stability testing. At 40°C, and in forced degradation studies at 80°C, chlorobutanol showed a remarkable stabilizing effect on oxytocin, which may deserve further investigation. The results of the present study support the policy “Buy Quality Oxytocin, Keep It Cool.”
Collapse
Affiliation(s)
- Nhomsai Hagen
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Thomas Bizimana
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Pierre Claver Kayumba
- East African Community Regional Centre of Excellence for Vaccines, Immunizations and Health Supply Chain Management (EAC RCE-VIHSCM), University of Rwanda, Kigali, Rwanda
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lutz Heide
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| |
Collapse
|
31
|
Modified aptamers as reagents to characterize recombinant human erythropoietin products. Sci Rep 2020; 10:18593. [PMID: 33122796 PMCID: PMC7596557 DOI: 10.1038/s41598-020-75713-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/14/2020] [Indexed: 11/08/2022] Open
Abstract
Reliable and reproducible monitoring of the conformational state of therapeutic protein products remains an unmet technological need. This need is amplified by the increasing number of biosimilars entering the drug development pipeline as many branded biologics are reaching the end of their market exclusivity period. Availability of methods to better characterize protein conformation may improve detection of counterfit and unlicensed therapeutic proteins. In this study, we report the use of a set of modified DNA aptamers with enhanced chemical diversity to probe the conformational state of 12 recombinant human erythropoietin (rHuEPO) therapeutic protein products; one FDA-licensed rHuEPO originator biological product, three rHuEPO products that are approved for marketing in the US or EU as biosimilars, and eight rHuEPO products that are not approved for marketing in the US or EU. We show that several of these modified aptamers are able to distinguish rHuEPO reference products or approved biosimilars from non-licensed rHuEPO products on the basis of differences in binding kinetics and equilibrium affinity constants. These reagents exhibit sensitivity to the conformational integrity of various forms of rHuEPO and as such represent powerful, simple-to-use analytical tools to monitor the conformational integrity of therapeutic-proteins during manufacture and to screen for and identify both substandard and counterfeit products.
Collapse
|
32
|
Tabernero P, Swamidoss I, Mayxay M, Khanthavong M, Phonlavong C, Vilayhong C, Yeuchaixiong S, Sichanh C, Sengaloundeth S, Green MD, Newton PN. A random survey of the prevalence of falsified and substandard antibiotics in the Lao PDR. J Antimicrob Chemother 2020; 74:2417-2425. [PMID: 31049576 PMCID: PMC6640311 DOI: 10.1093/jac/dkz164] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patricia Tabernero
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Public Health Unit, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain
| | - Isabel Swamidoss
- U.S. Centers for Disease Control and Prevention (CDC), Division of Parasitic Diseases and Malaria, Atlanta, GA, USA
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Centre for Tropical Medicine & Global Health, Nuffield Research Building, Churchill Hospital, University of Oxford, Oxford, UK.,Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | | | - Chindaphone Phonlavong
- Bureau of Food and Drug Inspection (BFDI), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Chanthala Vilayhong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sengchanh Yeuchaixiong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Chanvilay Sichanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
| | - Sivong Sengaloundeth
- Food and Drug Department (FDD), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Michael D Green
- U.S. Centers for Disease Control and Prevention (CDC), Division of Parasitic Diseases and Malaria, Atlanta, GA, USA
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine & Global Health, Nuffield Research Building, Churchill Hospital, University of Oxford, Oxford, UK.,Infectious Diseases Data Observatory, Nuffield Research Building, Churchill Hospital, University of Oxford, Oxford, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| |
Collapse
|
33
|
Quality of medicines for life-threatening pregnancy complications in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0236060. [PMID: 32649710 PMCID: PMC7351160 DOI: 10.1371/journal.pone.0236060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/26/2020] [Indexed: 02/02/2023] Open
Abstract
Background There are concerns about the quality of medicines available in low- and middle-income countries (LMIC) to manage hemorrhage, pre-eclampsia/eclampsia and sepsis. We aimed to identify, critically appraise, and synthesize the findings of studies on the quality of these three types of medicines available in LMIC. Methods This systematic review searched Medline, EMBASE and LILACS (from inception to 25 May 2020) for studies on the quality of selected medicines available in LMIC that provided at least the amount of active pharmaceutical ingredient. We contacted study authors for additional information. We excluded simulation studies. We used the MEDQUARG tool to assess study quality. The main outcome was the prevalence of failed samples. Findings We identified 9699 unique citations and included 34 studies (3159 samples from 40 countries) in the review. Most studies (65%) had low quality (scores <6/12). Overall, 48.9% of 1890 uterotonic samples (19 studies) failed quality tests; failures rates were 75% for ergometrine and nearly 40% each for oxytocin and misoprostol. The overall prevalence of failed injectable antibiotics (1090 samples, 18 studies) was 13.4%, ranging from 2.9% for injectable metronidazole (34 samples, 3 studies) to 16.0% for cefazolin (449 samples, 2 studies). The prevalence of low quality magnesium sulphate (179 samples, 2 studies) was 3.4%. We did not find any studies on the quality of carbetocin, tranexamic acid, or clindamycin. Conclusions There is a widespread problem with the quality of medicines used to manage life-threatening maternal conditions in LMIC. This can be a contributing factor to high maternal mortality rates in these regions.
Collapse
|
34
|
Belugina RB, Monakhova YB, Rubtsova E, Becht A, Schollmayer C, Holzgrabe U, Legin AV, Kirsanov DO. Distinguishing paracetamol formulations: Comparison of potentiometric "Electronic Tongue" with established analytical techniques. J Pharm Biomed Anal 2020; 188:113457. [PMID: 32663766 DOI: 10.1016/j.jpba.2020.113457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
Fast and inexpensive analytical tools for identification of the origin of pharmaceutical formulations are important to ensure consumers safety. This study explores the potential of potentiometric multisensor systems ("electronic tongues") in this type of application. 72 paracetamol samples purchased in different countries and produced by various companies were studied via infrared spectroscopy (IR), near infrared spectroscopy (NIR), nuclear magnetic resonance spectroscopy (NMR) and multisensor system (ET). A variety of chemometric tools was applied to explore and compare the information yielded by these methods. It was found that ET is capable of distinguishing paracetamol formulations from different producers. The chemical information derived from potentiometric sensor responses has something in common with that derived from NIR and IR; however, it is orthogonal to that from NMR. ET can be a valuable tool in express quality assessment of drugs.
Collapse
Affiliation(s)
| | - Yulia B Monakhova
- Institute of Chemistry, Saratov State University, Saratov, Russia; Spectral Service AG, Cologne, Germany
| | - Ekaterina Rubtsova
- Institute of Chemistry, Saratov State University, Saratov, Russia; Saratov State Medical University Named after V. I. Razumovsky, Saratov, Russia
| | - Alexander Becht
- University of Würzburg, Institute for Pharmacy and Food Chemistry, 97074 Würzburg, Germany
| | - Curd Schollmayer
- University of Würzburg, Institute for Pharmacy and Food Chemistry, 97074 Würzburg, Germany
| | - Ulrike Holzgrabe
- University of Würzburg, Institute for Pharmacy and Food Chemistry, 97074 Würzburg, Germany
| | - Andrey V Legin
- ITMO University, St Petersburg, Russia; Institute of Chemistry, Saint Petersburg State University, St Petersburg, Russia
| | - Dmitry O Kirsanov
- ITMO University, St Petersburg, Russia; Institute of Chemistry, Saint Petersburg State University, St Petersburg, Russia.
| |
Collapse
|
35
|
Giralt AN, Ronse M, Ravinetto R. A survey of nongovernmental organizations on their use of WHO's prequalification programme. Bull World Health Organ 2020; 98:413-419. [PMID: 32514215 PMCID: PMC7265931 DOI: 10.2471/blt.19.233882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To obtain the perspectives of some small- and medium-sized organizations on the World Health Organization (WHO) prequalification programme for medicines and to ascertain organizations’ unmet needs. Methods We conducted an exploratory, qualitative study in 2018 among 17 representatives of 15 small- and medium-sized Belgian and non-Belgian organizations who purchase medicines for humanitarian, development or public programmes in low- and middle-income countries. We used semi-structured interviews to obtain respondents’ views and experiences of using WHO prequalification guidance when procuring medicines. We identified emerging themes and formulated recommendations about the activities of the WHO Prequalification Team. Findings Most respondents suggested expanding prequalification to essential antibiotics, particularly paediatric formulations; and insulin, antihypertensives and cancer treatments. Respondents were concerned about irregular availability of WHO-prequalified medicines in the marketplace and sometimes high prices of prequalified products. Small organizations, in particular, had difficulties negotiating low-volume purchases. Organizations working in primary health care and hospitals seldom referred to the prequalified lists. Conclusion We recommend that the WHO-prequalified products be expanded to include essential antibiotics and medicines for noncommunicable diseases. The WHO Prequalification Team could require prequalified manufacturers to make publicly available the details of their authorized distributors and facilitate a process of harmonization of quality assurance policies across all donors. Prequalification of distributors and procurement agencies could help create more transparent and stringent mechanisms. We urge WHO Member States and funders to sustain support for the WHO Prequalification Team, which remains important for the fulfilment of universal health coverage.
Collapse
Affiliation(s)
| | - Maya Ronse
- Public Health Department, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Raffaella Ravinetto
- Public Health Department, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| |
Collapse
|
36
|
Khurelbat D, Dorj G, Sunderland B, Sanjjav T, Bayarsaikhan E, Damdinjav D, Dorj G, Jigjidsuren A, Lkhagvasuren O, Erdenetsetseg B. A cross-sectional analysis of falsified, counterfeit and substandard medicines in a low-middle income country. BMC Public Health 2020; 20:743. [PMID: 32434489 PMCID: PMC7240934 DOI: 10.1186/s12889-020-08897-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/11/2020] [Indexed: 01/26/2023] Open
Abstract
Background High prevalence of falsified, counterfeit and substandard medicines pose a threat to public health and treatment failure. This study aimed to investigate the quality of selected essential medicines available in Mongolia. Methods A cross-sectional study collected essential medicines from pharmacy outlets in Mongolia, during June and July, 2017. These products were then submitted for pharmacopoeial analysis and registration status. Results A total of 1770 samples from 118 pharmacy entities were purchased from wholesalers in urban and rural areas. Pharmacopoeial analysis found 179 (10.1%) samples or eleven product groups were unacceptable. The prevalence of substandard locally produced medicines (n = 105, 5.9%) was higher than imported equivalents [(n = 74, 4.17%, p = 0.0001)]. Approximately one-third of all unacceptable tests were related to assay (n = 73, 30.8%) and weight variation. Of 1770 samples, 76 (4.3%) were unregistered and the prevalence of unregistered samples was 3.8% in Ulaanbaatar city and 5.8% in rural areas, respectively. Conclusions This study has indicated that falsified and substandard medicines are prevalent in Mongolia. Considerable effort is required by regulatory authorities, private manufacturers, as well as importers to increase the quality of essential medicines in Mongolia.
Collapse
Affiliation(s)
- Daariimaa Khurelbat
- School of Pharmacy, Mongolian National University of Medical Sciences, S. Zorig street, Ulaanbaatar, Sukhbaatar District, 14210, Mongolia
| | - Gereltuya Dorj
- School of Pharmacy, Mongolian National University of Medical Sciences, S. Zorig street, Ulaanbaatar, Sukhbaatar District, 14210, Mongolia.
| | - Bruce Sunderland
- School of Pharmacy, Curtin University of Technology, GPO Box U1987, Perth, 6845, Western Australia
| | - Tsetsegmaa Sanjjav
- School of Pharmacy, Mongolian National University of Medical Sciences, S. Zorig street, Ulaanbaatar, Sukhbaatar District, 14210, Mongolia
| | - Enkhtuul Bayarsaikhan
- School of Pharmacy, Mongolian National University of Medical Sciences, S. Zorig street, Ulaanbaatar, Sukhbaatar District, 14210, Mongolia
| | - Davaadagva Damdinjav
- School of Pharmacy, Mongolian National University of Medical Sciences, S. Zorig street, Ulaanbaatar, Sukhbaatar District, 14210, Mongolia
| | - Gantuya Dorj
- School of Public Health, Mongolian National University of Medical Sciences, S. Zorig street, Ulaanbaatar, Sukhbaatar District, 14210, Mongolia
| | - Altantuya Jigjidsuren
- Asian Development Bank, Mongolia Resident Mission, Ulaanbaatar, Sukhbaatar District, 14210, Mongolia
| | - Oyun Lkhagvasuren
- Asian Development Bank, Mongolia Resident Mission, Ulaanbaatar, Sukhbaatar District, 14210, Mongolia
| | - Baasandorj Erdenetsetseg
- School of Pharmacy, Mongolian National University of Medical Sciences, S. Zorig street, Ulaanbaatar, Sukhbaatar District, 14210, Mongolia
| |
Collapse
|
37
|
Olliaro E, Olliaro P, Ho CWL, Ravinetto R. Legal Uncertainty-The Gray Area around Substandard Medicines: Where Public Health Meets Law. Am J Trop Med Hyg 2020; 102:262-267. [PMID: 31746313 PMCID: PMC7008313 DOI: 10.4269/ajtmh.19-0645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A vicious circle links lack of equitable access to health to the supply of poor-quality medicines, which amount to one-tenth of medicines available in low- and middle-income countries. The WHO introduced a new, public health–focused definition of substandard and falsified (SF) medicines, which offers opportunities for governments to broaden the scope of interventions to combat poor-quality medicines. At the same time, translating it into legal and regulatory measures may be challenging because this definition is not free of ambiguity (in that, there is a gray area between intentionally falsified and unintentional substandard medicines), and some countries may not have appropriate regulatory mechanisms/jurisdictions in place. The focus of the article is to consider what a public health–informed legal and regulatory environment could look like in light of WHO’s SF definition and propose appropriate measures to put it into effect. We present a “legal levers matrix” that may assist legislators and policymakers evaluate the adequacy of measures (i.e., criminal, civil, and administrative mechanisms) to address the problem of poor-quality medicines, particularly in terms of their configuration. In addition, this matrix underscores the importance of fostering dialogue between medical/public health and the legal/regulatory communities and to develop alternative/complementary solutions, including regulatory strengthening and nonpunitive actions. Substandard and falsified medicines arise from the interplay between societies, economies, and behaviors: effective regulation is necessary to disincentivize the production and/or supply of SF medicines, whereas health systems should strive to provide affordable medicines to all levels of society.
Collapse
Affiliation(s)
| | - Piero Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Calvin W L Ho
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | |
Collapse
|
38
|
Tauqeer F, Myhr K, Gopinathan U. Institutional barriers and enablers to implementing and complying with internationally accepted quality standards in the local pharmaceutical industry of Pakistan: a qualitative study. Health Policy Plan 2020; 34:440-449. [PMID: 31302684 PMCID: PMC6736431 DOI: 10.1093/heapol/czz054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2019] [Indexed: 11/21/2022] Open
Abstract
Complying with good manufacturing practices (GMP) and ensuring a quality system is integral to production and supply of quality medicines and achieving universal health coverage. This study focus on the local production of medicines in Pakistan, a lower middle-income country that has observed considerable growth in the number of pharmaceutical companies over the past two decades. Against this background, we investigated: (1) How is quality assurance (QA) and GMP compliance understood and acted upon by local pharmaceutical manufacturers?; (2) What are the institutional barriers and enablers for QA and GMP compliance in the local pharmaceutical sector from the perspective of key stakeholders?; and (3) What are the institutional barriers and enablers for strengthening local regulatory capacity to improve QA in the industry in the long term? We used a qualitative study design involving 22 interviews of the drug regulatory bodies (n = 9), academia (n = 3) and local manufacturers (n = 10), identifying key themes in data by thematic analysis. Document analysis was used to collect additional information and supplement the interview data. We identified that manufacturing facilities operated under different GMP standards and interpretations, pointing towards an absence of harmonization in quality standards across the industry. Views diverged about the status of GMP compliance, with interviewees from academia presenting a more critical view compared with regulators who promoted a more positive story. Among the barriers explaining why companies struggled with quality standards, the lack of a mindset promoting quality and safety among profit-oriented manufacturers was prominent. At the federal level, DRAP’s establishment represented an institutional improvement aiming to promote QA through inspections and guidance. While some positive measures to promote quality have been observed, the need for DRAP to strengthen its technical and regulatory capacity, enhance its engagement in international collaboration and learning, and improve transparency and accountability were highlighted. Overall, since the challenges in Pakistan are shared with other low- and middle-income countries with local production, there is a need to commit to international collaborative mechanisms, such as those lead by WHO, on this issue.
Collapse
Affiliation(s)
- Fatima Tauqeer
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, PO Box 1130 Blindern, Oslo, Norway.,Centre for Global Health, Faculty of Medicine, University of Oslo, PO Box 1130 Blindern, Oslo, Norway
| | - Kirsten Myhr
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, PO Box 1130 Blindern, Oslo, Norway
| | - Unni Gopinathan
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, PO Box 1130 Blindern, Oslo, Norway.,Centre for Global Health, Faculty of Medicine, University of Oslo, PO Box 1130 Blindern, Oslo, Norway.,Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway
| |
Collapse
|
39
|
Wang W, Keller MD, Baughman T, Wilson BK. Evaluating Low-Cost Optical Spectrometers for the Detection of Simulated Substandard and Falsified Medicines. APPLIED SPECTROSCOPY 2020; 74:323-333. [PMID: 31617368 PMCID: PMC7066480 DOI: 10.1177/0003702819877422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/20/2019] [Indexed: 05/31/2023]
Abstract
Distribution of substandard and falsified (SF) medicines is on the rise, and its impact on public health, particularly in low-resource countries, is becoming increasingly significant. Portable, nondestructive screening devices can support regulatory authorities in their defense against the spread of SF medicines. Vibrational spectroscopy is an ideal candidate due to its sampling ease and speed. In this work, five portable, among which four are considered low-cost, spectroscopic devices based on near-infrared (NIR), Raman, and mid-infrared (MIR) were evaluated to quantify active pharmaceutical ingredients (APIs) and formulation accuracy within simulated authentic, falsified, and substandard medicines. Binary sample mixtures containing a typical API in antimalarial, antiretroviral, or anti-tuberculosis medicines were assessed. In both univariate and multivariate analyses, the API quantification performance of the digital light processing (DLP) NIR spectrometer and a handheld Raman device consistently matched or exceeded that of the other NIR spectrometers and a scientific grade MIR spectrometer. In the formulation accuracy tests, data from all devices, other than the silicon photodiode array NIR spectrometer, were able to create regression models with less than 6% error. From this exploratory study, we conclude that certain portable NIR devices hold significant promise as cost-effective screening tools for falsified and potentially substandard medicines, and they warrant further investigation and development.
Collapse
Affiliation(s)
| | | | | | - Benjamin K. Wilson
- Benjamin K. Wilson, Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, WA 98007, USA.
| |
Collapse
|
40
|
Opuni KFM, Nettey H, Larbi MA, Amartey SNA, Nti G, Dzidonu A, Owusu-Danso P, Owusu NA, Nyarko AK. Usefulness of combined screening methods for rapid detection of falsified and/or substandard medicines in the absence of a confirmatory method. Malar J 2019; 18:403. [PMID: 31805937 PMCID: PMC6896689 DOI: 10.1186/s12936-019-3045-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/29/2019] [Indexed: 12/05/2022] Open
Abstract
Background The influx of substandard and falsified medicines is a global public health challenge and its rapid detection is a key solution to the menace. This study used three screening methods and one confirmatory method for the quality assessment of 25 batches of artemether/lumefantrine dosage forms from the Ghanaian market to test that combined screening methods only can rapidly detect substandard and/or falsified medicines in areas where confirmatory methods may not be available. Methods The quality of artemether/lumefantrine tablet products obtained from pharmacies and licensed chemical seller shops within the Accra metropolis in Ghana were analysed using three screening methods (GPHF Minilab, Colorimetry and Counterfeit Drug Indicator) and one confirmatory method (high-performance liquid chromatography). Results The results showed that 18/25 batches of the artemether/lumefantrine samples passed using the combined screening and confirmatory methods and 5/25 batches of the artemether/lumefantrine samples failed using the combined screening and confirmatory methods. However, 1/25 batch of the artemether/lumefantrine samples failed using the combined screening methods but passed using the confirmatory method. Also, 1/25 batch of the artemether/lumefantrine samples passed using the combined screening methods but failed using the confirmatory method. This notwithstanding, the combined screening methods and the confirmatory method provided equivalent quality assessment profiles for 23/25 (92%) batches of the artemether/lumefantrine tablet products. Out of the 6 samples that failed the confirmatory test, 1/6, 2/6, and 3/6 failed on the high (> 110%), low (< 90%), and no active ingredient (0%), respectively. The sensitivity of Minilab, colorimetric, CoDI, and the combined screening methods at 95% confidence level were 0.5 ± 0.57, 0.83 ± 0.33, 0.75 ± 0.49, and 0.83 ± 0.33, respectively. Also, the specificity of Minilab, colorimetric, CoDI, and the combined screening methods at 95% confidence level were 1.00, 0.95 ± 0.10, 1.00, and 0.95 ± 0.10, respectively. Conclusion The combined screening methods may be used for rapid detection of falsified and/or substandard medicines without using a confirmatory method. However, additional research on the best combinations of screening devices/methods to rapidly detect the quality of medicines is recommended.
Collapse
Affiliation(s)
| | - Henry Nettey
- Department of Pharmaceutics and Microbiology, School of Pharmacy, University of Ghana, Accra, Ghana
| | - Marvin Adjei Larbi
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, Accra, Ghana
| | | | - Gifty Nti
- Department of Pharmaceutics and Microbiology, School of Pharmacy, University of Ghana, Accra, Ghana
| | - Abraham Dzidonu
- Apotheke Doc Morris, Avantisalle 152, 6422 RA, Heerlen, The Netherlands
| | | | | | - Alexander Kwadwo Nyarko
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Accra, Ghana
| |
Collapse
|
41
|
Singer AC, Kirchhelle C, Roberts AP. (Inter)nationalising the antibiotic research and development pipeline. THE LANCET. INFECTIOUS DISEASES 2019; 20:e54-e62. [PMID: 31753765 DOI: 10.1016/s1473-3099(19)30552-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/28/2019] [Accepted: 09/11/2019] [Indexed: 01/03/2023]
Abstract
In this Personal View, we critically examine the wider context of international efforts to stimulate commercial antibiotic research and development via public-private initiatives. Despite these efforts, antibiotics remain a global resource without an international support structure that is commensurate to the risks from antibiotic-resistant infections and the long-term nature of required solutions. To protect this resource, we propose a two-pronged antibiotic research and development strategy based on a short-term strengthening of incentives (such as market entry rewards) to maximise the delivery of existing opportunities in the pipeline, and on a concurrent medium-term to long-term establishment of a global, publicly funded antibiotic research and development institute. Designed sustainably to deliver novel and first-in-class antibiotics targeting key human health gaps, the institute and its staff would become a global resource that, unlike the private pharmaceutical sector, would be managed as an open science platform. Our model of internationalised public research and development would maximise scientific synergy and cross-fertilisation, minimise replication of effort, acquire and preserve existing know-how, and ensure equitable and sustainable access to novel and effective antibiotics. Its genuinely global focus would also help counteract tendencies to equate donor with global health priorities. Our proposal is not radical. Historical precedent and developments in other research areas show that sustained international funding of publicly owned research can hasten the delivery of critically needed drugs and lower barriers to access.
Collapse
Affiliation(s)
| | - Claas Kirchhelle
- Oxford Martin School and Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | | |
Collapse
|
42
|
Ravinetto R, Dujardin C. Universal health coverage: drug quality and affordability can go together. BMJ 2019; 367:l6004. [PMID: 31615789 DOI: 10.1136/bmj.l6004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Catherine Dujardin
- Belgian Directorate-General Development Cooperation and Humanitarian Aid, Brussels, Belgium
| |
Collapse
|
43
|
Abu-Khalaf N, Zaid AN, Jaradat N, Alkilany AM, Abulateefeh SR, Al Ramahi R, Ghanem M. Identification of substandard drug products using electronic tongue: cefdinir suspension as a pilot example. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:3249-3258. [PMID: 31571827 PMCID: PMC6754525 DOI: 10.2147/dddt.s214228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/11/2019] [Indexed: 11/23/2022]
Abstract
Background Electronic tongue (ET) is a well-established technology that is used to detect the taste of a food or a medicinal product and to differentiate between different products based on their tastes. In addition, it can be used to monitor environmental parameters and biochemical and biological processes. Purpose This study aims to assess any correlation between the results of pharmacopeial quality control (ie, assay, impurities, and dissolution, etc) and ET analysis for reconstituted cefdinir (CR) suspension over 10 days (ie, shelf-life). Methods The reconstituted CR suspension was tested for several quality attributes such as dissolution behavior, pH, assay, related substances, and microbial contamination. An HPLC analytical method was verified and then used for chemical analysis. The taste of CR reconstituted suspension was followed over 10 days and was then compared with the quality control results. Moreover, Pearson’s correlation test was used to find a correlation between chemical analysis results and ET results. Results Pearson’s test of correlation showed a significant correlation (p-value <0.05) between the conventional chemical analysis results (% of CR, % of preservative, % of released CR, % of total impurities and % of total undefined impurities in the reconstituted suspension) with the change of their taste (ie, % pattern discrimination index). ET was able to correlate the results of stability of CR suspension with the change in the taste of the suspension during the shelf life of the reconstituted suspension. Conclusion The obtained results may suggest the use of ET as a new tool for a rapid assessment of the general quality of a suspension. Moreover, such results would suggest the use of ET to identify fake or substandard products, especially those have been stored under inappropriate storage conditions.
Collapse
Affiliation(s)
- Nawaf Abu-Khalaf
- Department of Agricultural Biotechnology, College of Agricultural Sciences and Technology, Palestine Technical University-Kadoorie (PTUK), Tulkarm, Palestine
| | - Abdel Naser Zaid
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nidal Jaradat
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Alaaldin M Alkilany
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, the University of Jordan, Amman 11942, Jordan
| | - Samer R Abulateefeh
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, the University of Jordan, Amman 11942, Jordan
| | - Rowa Al Ramahi
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mashhour Ghanem
- Department of Regulatory, Pharmacare PLC, Ramallah, Palestine
| |
Collapse
|
44
|
Rasheed H, Hoellein L, Bukhari KS, Holzgrabe U. Regulatory framework in Pakistan: situation analysis of medicine quality and future recommendations. J Pharm Policy Pract 2019; 12:23. [PMID: 31528352 PMCID: PMC6737614 DOI: 10.1186/s40545-019-0184-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality issues in pharmaceuticals are identified as a huge global and public health problem, especially with reference to low- and middle-income countries like Pakistan. The 2011 "Fake Drug Crisis" acted as a driving force to reform the regulatory structures of the country and for establishing the autonomous "Drug Regulatory Authority of Pakistan". Despite the fact that Pakistan possesses a huge pharmaceutical industry, there is a severe dearth of published literature and scientific evidence for the country regarding medicine quality and the prevalence of counterfeit and low-quality products, respectively. AIMS AND OBJECTIVES This narrative review covers relevant features of the regulatory framework for pharmaceuticals in Pakistan, its national pharmaceutical industry, as well as a compilation and analysis of published literature for documentation of the country's situation regarding the overall quality of medicines. METHODS Available data including scientific publications on the quality of pharmaceuticals in peer reviewed journals, research reports, notifications, and alerts issued by the World Health Organization and other agencies were accessed and compiled. Post graduate dissertations were used to represent unpublished research data and drug safety alerts issued from the local Pakistan authority were analysed to assess the type and number of quality failures reported for pharmaceuticals. RESULTS It could be clearly shown that there is negligible scientific data available on the issue of medicine quality in Pakistan. The anticipated number of 40-50% of poor-quality drugs in Pakistan cannot be defended by data available from the literature. Accessible technologies and strategies used in recent years at global level, especially in developing countries, were also reviewed and recommendations are devised for Pakistan to combat the fight against poor-quality medicines. CONCLUSION The case reports, investigations, and general data listed for Pakistan suggest the need of strengthening regulatory systems for premises and GMP inspections, analytical laboratories, as well as an overall capacity building in the field of unravelling and controlling substandard and falsified medicines. It is proposed that well-planned and properly funded studies need to be carried out for collecting critical statistics regarding the prevalence of substandard and falsified medicines in Pakistan.
Collapse
Affiliation(s)
- Huma Rasheed
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Ludwig Hoellein
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
| | - Khalid Saeed Bukhari
- USP Promoting the Quality of Medicines (PQM) Program, U.S. Pharmacopeial Convention, 12601 Twinbrook Parkway, Rockville, MD 20852-1790 USA
| | - Ulrike Holzgrabe
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
| |
Collapse
|
45
|
Ning X, Tan G, Chen X, Wang M, Wang B, Cui L. Development of a lateral flow dipstick for simultaneous and semi-quantitative analysis of dihydroartemisinin and piperaquine in an artemisinin combination therapy. Drug Test Anal 2019; 11:1444-1452. [PMID: 31150570 DOI: 10.1002/dta.2656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/06/2019] [Accepted: 05/26/2019] [Indexed: 11/10/2022]
Abstract
Dihydroartemisinin (DHA) and piperaquine (PPQ) are two drugs used in an artemisinin-based combination therapy (ACT). The circulation of counterfeit antimalarial drugs demands the development of simple, point-of-care (POC) tests for monitoring drug quality. Here we aimed to design an antibody-based lateral flow dipstick assay for simultaneous quality control of DHA and PPQ. To obtain a monoclonal antibody (mAb) for PPQ, one structural unit of the symmetric PPQ molecule was used to derive a carboxylic acid for linkage to a carrier protein as immunogen. Screening of hybridoma cells identified an mAb 4D112B2 that reacted with the PPQ-based immunogen. A highly-sensitive icELISA was designed based on this mAb, which showed 50% inhibition concentration of PPQ at 1.66 ng/mL and a working range of 0.35 - 7.40 ng/mL. The mAb showed 10.2, 15.9 and 30.4% cross reactivity to hydroxychloroquine sulfate, chloroquine and amodiaquine, respectively. No cross reactivity was observed to lumefantrine, mefloquine artemisinin and its derivatives. Using our previous DHA dipstick design, a lateral flow dipstick for simultaneous analysis of PPQ and DHA was developed. The indicator ranges for PPQ and DHA were 2 - 5 μg/mL and 250 - 500 ng/mL, respectively. The dipstick was used to semi-quantitatively analyze PPQ and DHA content in commercial ACT drugs, which produced agreeable results to those determined by high-performance liquid chromatography. This combination dipstick makes it a potential POC device for quality control of the two active ingredients in a commonly used ACT.
Collapse
Affiliation(s)
- Xiangxue Ning
- College of Agriculture and Biotechnology, China Agricultural University, Beijing, China
| | - Guiyu Tan
- College of Agriculture and Biotechnology, China Agricultural University, Beijing, China
| | - Xiaojiao Chen
- College of Agriculture and Biotechnology, China Agricultural University, Beijing, China
| | - Mian Wang
- College of Food and Bioengineering, Xihua University, Chengdu, China
| | - Baomin Wang
- College of Agriculture and Biotechnology, China Agricultural University, Beijing, China
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| |
Collapse
|
46
|
Ciza PH, Sacre PY, Waffo C, Coïc L, Avohou H, Mbinze JK, Ngono R, Marini RD, Hubert P, Ziemons E. Comparing the qualitative performances of handheld NIR and Raman spectrophotometers for the detection of falsified pharmaceutical products. Talanta 2019; 202:469-478. [PMID: 31171209 DOI: 10.1016/j.talanta.2019.04.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/15/2019] [Accepted: 04/19/2019] [Indexed: 12/16/2022]
Abstract
Over the last decade, the growth of the global pharmaceutical market has led to an overall increase of substandard and falsified drugs especially on the African market (or emerging countries). Recently, several methods using handheld/portable vibrational spectroscopy have been developed for rapid and on-field drug analysis. The objective of this work was to evaluate the performances of various NIR and Raman handheld spectrophotometers in specific brand identification of medicines through their primary packaging. Three groups of drug samples (artemether-lumefantrine, paracetamol and ibuprofen) were used in tablet or capsule forms. In order to perform a critical comparison, the analytical performances of the two analytical systems were compared statistically using three methods: hierarchical clustering algorithm (HCA), data-driven soft independent modelling of class analogy (DD-SIMCA) and hit quality index (HQI). The overall results show good detection abilities for NIR systems compared to Raman systems based on Matthews's correlation coefficients, generally close to one. Raman systems are less sensitive to the physical state of the samples than the NIR systems, it also suffers of the auto-fluorescence phenomenon and the signal of highly dosed active pharmaceutical ingredient (e.g. paracetamol or lumefantrine) may mask the signal of low-dosed and weaker Raman active compounds (e.g. artemether). Hence, Raman systems are less effective for specific product identification purposes but are interesting in the context of falsification because they allow a visual interpretation of the spectral signature (presence or absence of API).
Collapse
Affiliation(s)
- P H Ciza
- University of Liege (ULiege), CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, Liege, Belgium; University of Kinshasa, Faculty of Pharmaceutical Sciences, LACOMEDA, Lemba, 212 Kinshasa XI, Democratic Republic of Congo
| | - P-Y Sacre
- University of Liege (ULiege), CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, Liege, Belgium.
| | - C Waffo
- University of Liege (ULiege), CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, Liege, Belgium; University of Yaoundé I, Faculty of Medicine and Biomedical Sciences and National Drug Control and Valuation (LANACOME), Cameroon
| | - L Coïc
- University of Liege (ULiege), CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, Liege, Belgium
| | - H Avohou
- University of Liege (ULiege), CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, Liege, Belgium
| | - J K Mbinze
- University of Kinshasa, Faculty of Pharmaceutical Sciences, LACOMEDA, Lemba, 212 Kinshasa XI, Democratic Republic of Congo
| | - R Ngono
- University of Yaoundé I, Faculty of Medicine and Biomedical Sciences and National Drug Control and Valuation (LANACOME), Cameroon
| | - R D Marini
- University of Liege (ULiege), CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, Liege, Belgium
| | - Ph Hubert
- University of Liege (ULiege), CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, Liege, Belgium
| | - E Ziemons
- University of Liege (ULiege), CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, Liege, Belgium
| |
Collapse
|
47
|
Pisani E, Nistor AL, Hasnida A, Parmaksiz K, Xu J, Kok MO. Identifying market risk for substandard and falsified medicines: an analytic framework based on qualitative research in China, Indonesia, Turkey and Romania. Wellcome Open Res 2019; 4:70. [PMID: 31131333 PMCID: PMC6518437 DOI: 10.12688/wellcomeopenres.15236.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: Substandard and falsified medicines undermine health systems. We sought to unravel the political and economic factors which drive the production of these products, and to explain how they reach patients. Methods: We conducted in-depth case studies in China, Indonesia, Turkey and Romania. We reviewed academic papers and press reports (n = 840), developing semi-structured questionnaires. We interviewed regulators, policy-makers, pharmaceutical manufacturers, physicians, pharmacists, patients and academics (n=88). We coded data using NVivo software, and developed an analytic framework to assess national risks for substandard and falsified medicines. We tested the framework against cases reported to the World Health Organization, from countries at all income levels. Results: We found that increasing political commitment to provision of universal health coverage has led to public procurement policies aimed at lowering prices of medical products. In response, legitimate, profit-driven pharmaceutical companies protect their margins by cutting costs, or withdrawing from less profitable markets, while distributors engage in arbitrage. Meanwhile, health providers sometimes protect profits by 'upselling' patients to medicines not covered by insurers. Cost-cutting can undermine quality assurance, leading to substandard or degraded medicines. Other responses contribute to shortages, irrational demand and high prices. All of these provide market opportunities for producers of falsified products; they also push consumers outside of the regular supply chain, providing falsifiers with easy access to customers. The analytic framework capturing these interactions explained cases in most high and middle-income settings; additional factors operate in the poorest countries. Conclusions: Most efforts to secure medicine quality currently focus on product regulation. However, our research suggests market mechanisms are key drivers for poor quality medicines, including where political commitments to universal health coverage are under-resourced. We have developed a framework to guide country-specific, system-wide analysis. This can flag risks and pinpoint specific actions to protect medicine quality, and thus health.
Collapse
Affiliation(s)
- Elizabeth Pisani
- Policy Institute, King's College London, London, London, WC2B 6LE, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, London, WC1E 7HT, UK.,School of Health Policy & Management Health Care Governance, Erasmus University Rotterdam, Rotterdam, 3062 PA, The Netherlands
| | - Adina-Loredana Nistor
- School of Health Policy & Management Health Care Governance, Erasmus University Rotterdam, Rotterdam, 3062 PA, The Netherlands.,Faculty of Criminal Law and Criminology, University of Groningen, Groningen, The Netherlands
| | - Amalia Hasnida
- School of Health Policy & Management Health Care Governance, Erasmus University Rotterdam, Rotterdam, 3062 PA, The Netherlands.,Migunani Research Institute, Sleman, Yogyakarta, Indonesia
| | - Koray Parmaksiz
- School of Health Policy & Management Health Care Governance, Erasmus University Rotterdam, Rotterdam, 3062 PA, The Netherlands.,Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jingying Xu
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, London, WC1E 7HT, UK
| | - Maarten Oliver Kok
- School of Health Policy & Management Health Care Governance, Erasmus University Rotterdam, Rotterdam, 3062 PA, The Netherlands.,Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
48
|
Tremelling J, All A, Lleras L, Cancel A, Jenkins D, Pina C, Goldstein D, Broxton C, Hamel S. Poor quality male latex condoms found in Dominican Republic: Quality assurance evaluation and public health impact. PLoS One 2019; 14:e0210150. [PMID: 30615647 PMCID: PMC6322757 DOI: 10.1371/journal.pone.0210150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 12/18/2018] [Indexed: 11/19/2022] Open
Abstract
Male condoms are important to prevent transmission of HIV (and other STIs) and unwanted pregnancies. Research was conducted to evaluate the quality of male condoms available in the Dominican Republic market based on preliminary concerns of suspect product. Based on international testing standards (ISO 4074 and ASTM D 3492-08), condoms were sampled across ten prominent brands within the market and evaluated for airburst pressure / volume, freedom from holes, visual defects, package seal integrity, packaging and marking, lubricant quantity, and dimensions. Five of the brands were found to have extensive quality problems, where holes were found in 5.7% to 17.5% of the condoms (depending on the brand). Between 5.1% and 30.5% of these condoms failed to meet the requirements for airburst properties, and violations in regulatory labeling where observed. Three additional brands were compliant for the other tests, but were found to have the same challenges with labeling violations as the previous five brands. Two brands were found to be fully compliant with all aspects of the evaluation. The level of defects observed in these samples would greatly increase the risk of HIV transmission (and other STIs) and unwanted pregnancies. When projected on the annual market of male condoms sold in the Dominican Republic (~26 million), potentially over 1 million condoms could be estimated to adversely impact the health risk of the end-user. These results prompted action by the Dominican Republic regulatory authorities to investigate and remove poor quality product from the market. This research study emphasizes the need for continued vigilance towards increased regulatory and market surveillance efforts to better protect public health interests.
Collapse
Affiliation(s)
- Jeff Tremelling
- Product Quality and Compliance, FHI 360, Durham, NC, United States of America
| | - Allen All
- Product Quality and Compliance, FHI 360, Durham, NC, United States of America
| | - Luis Lleras
- Product Quality and Compliance, FHI 360, Durham, NC, United States of America
| | - Aida Cancel
- Product Quality and Compliance, FHI 360, Durham, NC, United States of America
| | - David Jenkins
- Product Quality and Compliance, FHI 360, Durham, NC, United States of America
- * E-mail:
| | - Carolina Pina
- United States Agency for International Development, Santo Domingo, Dominican Republic
| | - Damani Goldstein
- United States Agency for International Development, Santo Domingo, Dominican Republic
| | - Clancy Broxton
- United States Agency for International Development, Washington, DC, United States of America
| | - Steve Hamel
- Product Quality and Compliance, FHI 360, Durham, NC, United States of America
| |
Collapse
|
49
|
Beran D, Pedersen HB, Robertson J. Noncommunicable diseases, access to essential medicines and universal health coverage. Glob Health Action 2019; 12:1670014. [PMID: 31573421 PMCID: PMC6781244 DOI: 10.1080/16549716.2019.1670014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/01/2019] [Indexed: 01/19/2023] Open
Abstract
Universal Health Coverage is key to reach the overall health-related Sustainable Development Goal, and within this, access to safe, effective, quality, and affordable essential medicines is critical. Currently, medicines for noncommunicable diseases in many countries are not available when needed and if they are present, are unaffordable. Countries face the challenges of rising prevalence of noncommunicable diseases due to increasing risk factors and ageing populations, along with under-diagnosis and under-treatment. Providing noncommunicable disease medicines is only one piece of a complex picture of providing care within Universal Health Coverage that requires strengthening health-care systems, as well as financial resources, priority setting, and monitoring and evaluation systems. Financing for Universal Health Coverage needs to enable adequate resources to be allocated for medicines with a focus on equity as well as priority setting for noncommunicable diseases medicines for reimbursement in benefits packages, efficient procurement and distribution of these medicines, supported by price regulation. These processes need to be evidence-based, transparent and grounded on national values and priorities. Monitoring and evaluation of availability and affordability are key components of sustainable reimbursement systems. With the current Universal Health Coverage agenda, the World Health Organization and countries can no longer ignore the issue of access to medicines for noncommunicable disease and need to develop the appropriate responses in order to guarantee equitable access.
Collapse
Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Hanne Bak Pedersen
- Health Technologies and Pharmaceuticals Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Jane Robertson
- Consultant to World Health Organization Regional Office for Europe, Copenhagen, Denmark, Conjoint Senior Lecturer, Clinical Pharmacology, The University of Newcastle, Callaghan, Australia
| |
Collapse
|
50
|
Ravinetto R, Pinxten W, Rägo L. Quality of medicines in resource-limited settings: need for ethical guidance. Glob Bioeth 2018; 29:81-94. [PMID: 30245610 PMCID: PMC6147095 DOI: 10.1080/11287462.2018.1522991] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/10/2018] [Indexed: 01/17/2023] Open
Abstract
The quality of medicines is generally adequately assured by manufacturers and regulatory authorities for well-resourced settings, while the implementation of existing quality standards is challenged in many low- and middle-income countries. This situation of multiple pharmaceutical standards raises the question whether it could ever be ethically justified to compromise on the quality assurance of medicines depending on what individuals, communities, or societies can afford. In this paper, we contend that ethically, any unjustified exceptions to medicines' quality assurance represents a violation of the principles of beneficence and non-maleficence. Exceptions are only acceptable in exceptional and temporary circumstances, if based on a meaningful quality risk assessment, guided by a rigorous ethical framework built on the principles of independence, technical competence, transparency, and accountability. We also discuss how such exceptional and temporary circumstances should be defined/justified. Finally, we propose that empirical bioethics should acknowledge the existence of these dilemmas in public health, and help to build a normative approach to dealing with them. Ideally, an international group of experts in quality assurance/regulatory affairs and health ethicists should be set up to take up this topic and formulate a Guide to Ethical Principles of Quality Assurance of Medical Products.
Collapse
Affiliation(s)
- Raffaella Ravinetto
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Lembit Rägo
- Council for International Organizations of Medical Sciences (CIOMS), Geneva, Switzerland
| |
Collapse
|