title: Substandard anti-malarial drugs in Burkina Faso.
abstract: BACKGROUND
  There is concern about an increasing infiltration of markets by substandard and fake medications against life-threatening diseases in developing countries. This is particularly worrying with regard to the increasing resistance development of Plasmodium falciparum against affordable anti-malarial medications, which has led to a change to more expensive drugs in most endemic countries.
  
  
  METHODS
  A representative sample of modern anti-malarial medications from licensed (public and private pharmacies, community health workers) and illicit (market and street vendors, shops) sources has been collected in the Nouna Health District in north-western Burkina Faso in 2006. All drugs were tested for their quality with the standard procedures of the German Pharma Health Fund-Minilab. Detected low standard drugs were re-tested with European Pharmacopoeia 2.9.1 standards for disintegration and ultraviolet-visible spectroscopy at the laboratory of the Heidelberg University for confirmation.
  
  
  RESULTS
  Overall, 86 anti-malarial drug samples were collected, of which 77 samples have been included in the final analysis. The sample consisted of 39/77 (50%) chloroquine, 10/77 (13%) pyrimethamine-sulphadoxine, 9/77 (12%) quinine, 6/77 (8%) amodiaquine, 9/77 (12%) artesunate, and 4/77 (5%) artemether-lumefantrine. 32/77 (42%) drug samples were found to be of poor quality, of which 28 samples failed the visual inspection, nine samples had substandard concentrations of the active ingredient, four samples showed poor disintegration, and one sample contained non of the stated active ingredient. The licensed and the illicit market contributed 5/47 (10.6%) and 27/30 (90.0%) samples of substandard drugs respectively.
  
  
  CONCLUSIONS
  These findings provide further evidence for the wide-spread existence of substandard anti-malarial medications in Africa and call for strengthening of the regulatory and quality control capacity of affected countries, particularly in view of the now wider available and substantially more costly artemisinin-based combination therapies.
authors.affiliation: Department of Tropical Hygiene and Public Health, Ruprecht-Karls-University Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. maike.tipke@web.de
authors.forename: Maike
authors.initials: M
authors.lastname: Tipke
authors.forename: Salou
authors.initials: S
authors.lastname: Diallo
authors.forename: Boubacar
authors.initials: B
authors.lastname: Coulibaly
authors.forename: Dominic
authors.initials: D
authors.lastname: Störzinger
authors.forename: Torsten
authors.initials: T
authors.lastname: Hoppe-Tichy
authors.forename: Ali
authors.initials: A
authors.lastname: Sie
authors.forename: Olaf
authors.initials: O
authors.lastname: Müller
mesh_terms: D000818:Animals; D000962:Antimalarials / Q000494:pharmacology* / Q000592:standards; D002050:Burkina Faso; D006302:Health Services Research; D006801:Humans; D021261:Parasitic Sensitivity Tests; D010963:Plasmodium falciparum / Q000187:drug effects*; D011786:Quality Control
chemical_list: D000962:Antimalarials