Sale of substandard and falsified medicines - including those used to treat deadly diseases like malaria - are prevalent in the developing world, say scientists who found that 13 per cent of the sampled medicines in low and middle-income countries were below par.
When looking specifically at African countries, almost 19 per cent of the essential medicines that satisfy the priority health care needs of the population was found to fall in this category, according to a study by researchers from the University of North Carolina (UNC) at Chapel Hill in the US.
Falsified medicines are medical products that deliberately and fraudulently misrepresent their identity, composition or source.
Substandard medicines are real medical products that fail to meet quality standards or specifications for a variety of reasons, including poor manufacturing, shipping or storage conditions, or because the drug is sold beyond its expiration date.
Researchers analysed 96 previous studies of falsified and substandard medicines and each of the studies tested more than 50 medications.
The team found that antimalarials and antibiotics were the medicines most commonly sold in substandard or falsified conditions.
In low- and middle-income countries, 19 per cent of antimalarials and 12 per cent of antibiotics are substandard or falsified.
"The prevalence of substandard and falsified medicines is a substantial public health problem because these medicines can be ineffective or harmful and can prolong illnesses, cause poisoning or lead to dangerous drug interactions," said Sachiko Ozawa, an associate professor at UNC.
"Our study shows that a concerted global effort is needed to improve supply chain management for medicines and to identify solutions to this understudied issue," said Ozawa, who led the research published in the journal JAMA Network Open.
The researchers searched five databases for studies related to substandard and falsified medicines. They reviewed 256 studies and included 96 studies in their analysis.
"We need more global collaboration to implement laws on drug quality, increase quality control capacity, and improve surveillance and data sharing," said James Herrington, a professor at the UNC.
"This can strengthen the global supply chain against poor quality medicines, improve health outcomes by reducing antimicrobial and anti-parasitic resistance and, ultimately, help governments, businesses and patients save money," said Herrington.
The team's analysis found limited information on the economic impact of poor quality medicines, with the estimates of market size ranging widely from USD 10-200 billion.
Substandard and falsified medicines can burden health systems by diverting resources to ineffective or harmful therapies and cause additional treatment costs and reduced worker productivity due to treatable illnesses, but these effects have not been measured.
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