title: Quality of anti-malarial drugs provided by public and private healthcare providers in south-east Nigeria.
abstract: BACKGROUND
  There is little existing knowledge about actual quality of drugs provided by different providers in Nigeria and in many sub-Saharan African countries. Such information is important for improving malaria treatment that will help in the development and implementation of actions designed to improve the quality of treatment. The objective of the study was to determine the quality of drugs used for the treatment of malaria in a broad spectrum of public and private healthcare providers.
  
  
  METHODS
  The study was undertaken in six towns (three urban and three rural) in Anambra state, south-east Nigeria. Anti-malarials (225 samples), which included artesunate, dihydroartemisinin, sulphadoxine-pyrimethamine (SP), quinine, and chloroquine, were either purchased or collected from randomly selected providers. The quality of these drugs was assessed by laboratory analysis of the dissolution profile using published pharmacopoeial monograms and measuring the amount of active ingredient using high performance liquid chromatography (HPLC).
  
  
  RESULTS
  It was found that 60 (37%) of the anti-malarials tested did not meet the United States Pharmacopoeia (USP) specifications for the amount of active ingredients, with the suspect drugs either lacking the active ingredients or containing suboptimal quantities of the active ingredients. Quinine (46%) and SP formulations (39%) were among drugs that did not satisfy the tolerance limits published in USP monograms. A total of 78% of the suspect drugs were from private facilities, mostly low-level providers, such as patent medicine dealers (vendors).
  
  
  CONCLUSIONS
  This study found that there was a high prevalence of poor quality drugs. The findings provide areas for public intervention to improve the quality of malaria treatment services. There should be enforced checks and regulation of drug supply management as well as stiffer penalties for people stocking substandard and counterfeit drugs.
authors.affiliation: Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria. onwujekwe@yahoo.co.uk
authors.forename: Obinna
authors.initials: O
authors.lastname: Onwujekwe
authors.forename: Harparkash
authors.initials: H
authors.lastname: Kaur
authors.forename: Nkem
authors.initials: N
authors.lastname: Dike
authors.forename: Elvis
authors.initials: E
authors.lastname: Shu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Uzochukwu
authors.forename: Kara
authors.initials: K
authors.lastname: Hanson
authors.forename: Viola
authors.initials: V
authors.lastname: Okoye
authors.forename: Paul
authors.initials: P
authors.lastname: Okonkwo
mesh_terms: D000818:Animals; D000962:Antimalarials / Q000032:analysis* / Q000592:standards* / Q000627:therapeutic use; D002851:Chromatography, High Pressure Liquid; D006282:Health Personnel; D006801:Humans; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology; D009549:Nigeria; D010594:Pharmacies; D010602:Pharmacopoeias as Topic; D010961:Plasmodium / Q000187:drug effects; D011786:Quality Control
chemical_list: D000962:Antimalarials