Evidence map›Paper›PMID 24828338›Full record

ArticlePloS one2014

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

Manuel W Hetzel, Madhu Page-Sharp, Nancy Bala, Justin Pulford, Inoni Betuela, Timothy M E Davis, Evelyn K Lavu

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 2 pooled it
2.9field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 37 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Review
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 3 countries.

Manuel W HetzelPapua New Guinea Institute of Medical Research, Goroka, EHP, Papua New Guinea; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Madhu Page-SharpCurtin University, School of Pharmacy, Perth, WA, Australia.
Nancy BalaCentral Public Health Laboratory, Boroko, NCD, Papua New Guinea.
Justin PulfordPapua New Guinea Institute of Medical Research, Goroka, EHP, Papua New Guinea; The University of Queensland, School of Population Health, Herston, QLD, Australia.
Inoni BetuelaPapua New Guinea Institute of Medical Research, Madang, MDG, Papua New Guinea.
Timothy M E DavisUniversity of Western Australia, School of Medicine and Pharmacology, Fremantle, WA, Australia.
Evelyn K LavuCentral Public Health Laboratory, Boroko, NCD, Papua New Guinea.
Papua New Guinea Institute of Medical Research · PGCurtin University · AUUniversity of Western Australia · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPoor-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

findingsMedicines 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.

conclusionsThis 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.

Indexed as

AmodiaquineAmoxicillinAntimalarialsArtemetherArtemisininsBiosimilar PharmaceuticalsChloroquineDrug ResistanceHealth FacilitiesHumansMalaria, FalciparumMalaria, VivaxPapua New GuineaPrimaquineQuality ControlQuinineAmodiaquineAmoxicillinAntimalarialsArtemetherartemisininArtemisininsBiosimilar PharmaceuticalsChloroquinePrimaquineQuinine

Identifiers

PMID24828338
PMCPMC4020934
OpenAlexW2017824350

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.