A rapid assessment of the National Regulatory Systems for medical products in the Southern African Development Community

BACKGROUND

Access to quality-assured, safe and efficacious medical products is fundamental for Universal Health Coverage and attaining Sustainable Development Goal 3: Ensure Healthy Lives and Well-being for All. To guarantee this right, there is a need for robust and efficiently performing national regulatory systems for the regulation of medical products. Well-functioning regulatory systems apply globally accepted standards which ensure that the level of control is proportionate to the level of public health risk.

OBJECTIVE OF THE STUDY

The study aimed at analysing the regulatory systems for medical products in the 16 Member States of the Southern African Development Community (SADC). It provides an overview of the national regulatory systems for medical products in the region in 2017 and outlines the institutional frameworks, which enable the implementation of regulatory functions.

METHODOLOGY

A survey was conducted in March-December 2017 in English, French and Portuguese. National Regulatory Authorities for medical products (NMRAs) of the 16 Member States within SADC responded to the questions asked and sent in their answers. The survey was constructed around five themes instrumental for implementation of the Universal Health Coverage actions framework. Three of the themes are discussed in this article.

RESULTS

The outcome of the survey demonstrates that within SADC, NMRAs vary in terms of organisational set-up and modalities of medical product regulation. The majority are within the Ministries of Health, and a few are either semi-autonomous or autonomous. Legal frameworks for medical products are in place for some of the SADC NMRAs, although they vary in the scope of products subject to regulation. Traditional medicines, biologicals and medical devices are regulated, however not uniformly across the region.

CONCLUSION

Despite major progress over the years, the survey demonstrates variable levels of governance and regulatory framework among NMRAs in SADC. The survey supports the need for shifting from the broad strengthening of the regulatory systems which exist and are underpinned by the mandates, to more product-type focused approaches. This shift will ensure that medical products are quality-assured, safe and effective for a performant Health Systems attainment of the Universal Health Coverage and Sustainable Development Goals.

The African medicines regulatory harmonization initiative: rationale and benefits

Medicines regulation remains an important but neglected component of promotion and protection of public health because it helps to ensure that patients have access to quality, safe, and efficacious medicines. Investing in the African Medicines Regulatory Harmonization (AMRH) initiative provides an opportunity for strengthening regulatory capacity, cost-effective use of the limited financial and human resources, attainment of the three health-related Millennium Development Goals (MDGs), and promotion of trade and socioeconomic development for African countries and regions.

Co-occurrence of fumonisins with aflatoxins in home-stored maize for human consumption in rural villages of Tanzania

This study determined maize-user practices that influence the presence of fumonisin and aflatoxin contamination of maize in food consumed in the rural areas of Tanzania. Samples of the 2005 maize harvest in Tanzania were collected from 120 households and examined for fumonisins and aflatoxins. Information on whether the maize was sorted to remove defective (visibly damaged or mouldy) maize before storage and whether the damaged and mouldy maize or the non-dehulled maize was used as food was also collected. In addition, the percentage of defective kernels in the samples was determined. Ninety per cent of the households sorted out defective maize, 45% consumed the defective maize and 30% consumed non-dehulled maize. In 52% of the samples fumonisins were determined at levels up to 11,048 microg kg(-1) (median = 363 microg kg(-1)) and in 15% exceeded 1000 microg kg(-1); the maximum tolerable limit (MTL) for fumonisins in maize for human consumption in other countries. Aflatoxins were detected in 18% of the samples at levels up to 158 microg kg(-1) (median = 24 microg kg(-1)). Twelve per cent of the samples exceeded the Tanzanian limit for total aflatoxins (10 microg kg(-1)). Aflatoxins co-occurred with fumonisins in 10% of the samples. The percentage defective kernels (mean = 22%) correlated positively (r = 0.39) with the fumonisin levels. Tanzanians are at a risk of exposure to fumonisins and aflatoxins in maize. There is a need for further research on fumonisin and aflatoxin exposure in Tanzania to develop appropriate control strategies.

Human exposure to fumonisins from home grown maize in Tanzania

Fumonisins contaminate maize worldwide resulting in unacceptable fumonisin exposures in people relying on maize as staple food. This study determined fumonisins B1 (FB1) and B2 (FB2) in maize from 120 rural households: 30 from each of four main maize producing regions of Tabora, Ruvuma, Iringa and Kilimanjaro in Tanzania in order to estimate total fumonisin (FB1 + FB2) exposures to adult individuals in the households. The average daily per capita maize consumption of 771 g, recommended by the Tanzania Food and Nutrition Centre (TFNC) for an adult relying on it as a main meal, and also average daily per capita maize consumptions of 129, 308 and 356 g documented for Tanzania, were used in the exposure estimation. The fumonisins were determined by HPLC using fluorescence detection. Total fumonisins exposure (µg/kg body weight (bw)/day) was determined by multiplying average daily per capita maize consumption (kg) by fumonisin level in maize (µg/kg) from a given household and then dividing by an average bw of an adult of 60 kg. Of the 120 samples, 52% were contaminated with fumonisins at levels of up to 11,048 µg/kg (median; 363 µg/kg). Based on the recommended maize consumption of 771 g/person/day, fumonisin exposures to adult individuals in 38% of the households would exceed the provisional maximum tolerable daily intake (PMTDI) of 2 µg/kg bw, recommended by the Joint FAO/WHO Expert Committee on Food Additives. At the least documented maize consumption of 129 g/person/day, fumonisin exposures in 16% of the households were still above the PMTDI. Reduction of the maize consumption level to 40 g/person/day is an impractical, and reduction of the maximum contamination level to 155 µg/kg is a possibly practical, option for effective minimisation of fumonisin exposures in these communities. A relatively larger study is needed in order to generate comprehensive data for the formulation of appropriate strategies to minimise fumonisin exposures in Tanzania.