Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain
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...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Journal Article |
| Published: |
Public Library of Science
2014
|
| Online Access: | http://hdl.handle.net/20.500.11937/7445 |
| _version_ | 1848745370294681600 |
|---|---|
| author | Hetzel, M. Page-Sharp, Madhu Bala, N. Pulford, J. Betuela, I. Davis, T. Lavu, E. |
| author_facet | Hetzel, M. Page-Sharp, Madhu Bala, N. Pulford, J. Betuela, I. Davis, T. Lavu, E. |
| author_sort | Hetzel, M. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T06:16:17Z |
| format | Journal Article |
| id | curtin-20.500.11937-7445 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T06:16:17Z |
| publishDate | 2014 |
| publisher | Public Library of Science |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-74452017-09-13T14:37:01Z Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain Hetzel, M. Page-Sharp, Madhu Bala, N. Pulford, J. Betuela, I. Davis, T. Lavu, E. 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. 2014 Journal Article http://hdl.handle.net/20.500.11937/7445 10.1371/journal.pone.0096810 Public Library of Science fulltext |
| spellingShingle | Hetzel, M. Page-Sharp, Madhu Bala, N. Pulford, J. Betuela, I. Davis, T. Lavu, E. Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain |
| title | Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain |
| title_full | Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain |
| title_fullStr | Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain |
| title_full_unstemmed | Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain |
| title_short | Quality of antimalarial drugs and antibiotics in Papua New Guinea: A survey of the health facility supply chain |
| title_sort | quality of antimalarial drugs and antibiotics in papua new guinea: a survey of the health facility supply chain |
| url | http://hdl.handle.net/20.500.11937/7445 |