Evidence map›Paper›PMID 36427901›Full record

ArticleBMJ global health2022

A study of the quality of cardiovascular and diabetes medicines in Malang District, Indonesia, using exposure-based sampling.

Aksari Dewi, Anushka Patel, Anna Palagyi, Devarsetty Praveen, Bachtiar Rifai Pratita Ihsan, Ayuk Lawuningtyas Hariadini, Diana Lyrawati, Sujarwoto Sujarwoto, Asri Maharani, Gindo Tampubolon and 2 more

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Article in BMJ global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
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

6 citing papers in PubMed.

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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

12 authors.

Aksari DewiThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia aksari.iraska@gmail.com.ORCID 0000-0002-2232-5215
Anushka PatelThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Anna PalagyiThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Devarsetty PraveenThe George Institute for Global Health, University of New South Wales, Hyderabad, India.
Bachtiar Rifai Pratita IhsanDepartment of Pharmacy, Brawijaya University, Malang, Indonesia.
Ayuk Lawuningtyas HariadiniDepartment of Pharmacy, Brawijaya University, Malang, Indonesia.
Diana LyrawatiDepartment of Pharmacy, Brawijaya University, Malang, Indonesia.
Sujarwoto SujarwotoDepartment of Public Administration, Brawijaya University, Malang, Indonesia.ORCID 0000-0003-4197-4592
Asri MaharaniBiology, Medicines and Health, University of Manchester, Manchester, UK.
Gindo TampubolonGlobal Development Institute and Manchester Institute for Collaborative Research on Ageing, University of Manchester, Manchester, UK.
Stephen JanThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Elizabeth PisaniThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.ORCID 0000-0002-3674-631X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe WHO has warned that substandard and falsified medicines threaten health, especially in low and middle-income countries (LMICs). However, the magnitude of that threat for many medicines in different regions is not well described, and high-quality studies remain rare. Recent reviews of studies of cardiovascular and diabetes medicine quality recorded that 15.4% of cardiovascular and 6.8% of diabetes samples failed at least one quality test. Review authors warn that study quality was mixed. Because they did not record medicine volume, no study reflected the risk posed to patients. METHODS AND

findingsWe investigated the quality of five medicines for cardiovascular disease and diabetes in Malang district, East Java, Indonesia. Our sample frame, based on dispensing volumes by outlet and price category, included sampling from public and private providers and pharmacies and reflected the potential risk posed to patients. The content of active ingredient was determined by high-performance liquid chromatography and compared with the labelled content. Dissolution testing was also performed.We collected a total of 204 samples: amlodipine (88); captopril (22); furosemide (21); glibenclamide (21) and simvastatin (52), comprising 83 different brands/products. All were manufactured in Indonesia, and all samples met specifications for both assay and dissolution. None was suspected of being falsified.

conclusionsWhile we cannot conclude that the prevalence of poor-quality medicines in Malang district is zero, our sampling method, which reflects likely exposure to specific brands and outlets, suggests that the risk to patients is very low; certainly nothing like the rates found in recent reviews of surveys in LMICs. Our study demonstrates the feasibility of sampling medicines based on likely exposure to specific products and underlines the dangers of extrapolating results across countries.

Indexed as

Counterfeit DrugsDiabetes MellitusPharmaciesHumansIndonesiaCounterfeit DrugsCardiovascular diseaseCommunity-based surveyDiabetesHealth systemsPublic Health

Identifiers

PMID36427901
PMCPMC9703323

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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.