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    Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain

    199195_116535_Page-Sharp_PLOSOne_2014.pdf (223.5Kb)
    Access Status
    Open access
    Authors
    Hetzel, M.
    Page-Sharp, Madhu
    Bala, N.
    Pulford, J.
    Betuela, I.
    Davis, T.
    Lavu, E.
    Date
    2014
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Hetzel, M. and Page-Sharp, M. and Bala, N. and Pulford, J. and Betuela, I. and Davis, T. and Lavu, E. 2014. Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain. PLoS ONE. 9 (5): pp. e96810-1 – e96810-10.
    Source Title
    PLoS ONE
    DOI
    10.1371/journal.pone.0096810
    ISSN
    19326203
    Remarks

    This article is published under the Open Access publishing model and distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/ Please refer to the licence to obtain terms for any further reuse or distribution of this work.

    URI
    http://hdl.handle.net/20.500.11937/7445
    Collection
    • Curtin Research Publications
    Abstract

    Background: Poor-quality life-saving medicines are a major public health threat, particularly in settings with a weak regulatory environment. Insufficient amounts of active pharmaceutical ingredients (API) endanger patient safety and may contribute to the development of drug resistance. In the case of malaria, concerns relate to implications for the efficacy of artemisinin-based combination therapies (ACT). In Papua New Guinea (PNG), Plasmodium falciparum and P. vivax are both endemic and health facilities are the main source of treatment. ACT has been introduced as first-line treatment but other drugs, such as primaquine for the treatment of P. vivax hypnozoites, are widely available. This study investigated the quality of antimalarial drugs and selected antibiotics at all levels of the health facility supply chain in PNG.Methods and Findings: Medicines were obtained from randomly sampled health facilities and selected warehouses and hospitals across PNG and analysed for API content using validated high performance liquid chromatography (HPLC). Of 360 tablet/capsule samples from 60 providers, 9.7% (95% CI 6.9, 13.3) contained less, and 0.6% more, API than pharmacopoeial reference ranges, including 29/37 (78.4%) primaquine, 3/70 (4.3%) amodiaquine, and one sample each of quinine, artemether, sulphadoxine-pyrimethamine and amoxicillin. According to the package label, 86.5% of poor-quality samples originated from India. Poor-quality medicines were found in 48.3% of providers at all levels of the supply chain. Drug quality was unrelated to storage conditions.Conclusions: This study documents the presence of poor-quality medicines, particularly primaquine, throughout PNG. Primaquine is the only available transmission-blocking antimalarial, likely to become important to prevent the spread of artemisinin-resistant P. falciparum and eliminating P. vivax hypnozoites. The availability of poor-quality medicines reflects the lack of adequate quality control and regulatory mechanisms. Measures to stop the availability of poor-quality medicines should include limiting procurement to WHO prequalified products and implementing routine quality testing.

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