title: Perceptions and practices of pharmaceutical wholesalers surrounding counterfeit medicines in a developing country: a baseline survey.
abstract: BACKGROUND
  Recent investigations by the Ministry of Health of Cambodia suggest that counterfeit medicines have been introduced into the pharmaceutical market in tampered packaging. To further explore this possibility, an interview survey was conducted at the wholesaler level to investigate the medicinal supply chain in Cambodia.
  
  
  METHODS
  Managing executives of 62 (83.8%) registered wholesalers of modern medicines in Cambodia were interviewed in 2009 on their knowledge of, perception on, and practices related to counterfeiting issues through a semi-structured questionnaire.
  
  
  RESULTS
  According to our findings, 12.9% of the wholesalers had encountered counterfeit medicine. However, they demonstrated a variety of perceptions regarding this issue. A majority (59.7%) defined counterfeit medicines as medicines without registration, while other definitions included medicines that were fraudulently manufactured, medicines without a batch/lot number, those containing harmful ingredients or a reduced amount of active ingredients, and expired medicines. Additionally, 8.1% responded that they did not know what counterfeit medicines were.During procurement, 66.1% of the wholesalers consider whether the product is registered in Cambodia, while 64.5% consider the credibility and quality of the products and 61.3% consider the reputation of the manufacturers. When receiving a consignment, 80.6% of wholesalers check the intactness of medicines, 72.6% check the specification and amount of medicines, 71% check Cambodian registration, 56.5% check that the packaging is intact, 54.8% check batch and lot numbers, 48.4% check the dates of manufacture and expiration, and 9.7% check analytical certificates.Out of 62 wholesalers, 14.5% had received medicines that arrived without packages or were separated from their packaging and had to be repacked before distribution. Significant statistical association was found between wholesalers who received medicines separately from their packs/containers and who consider their belief on reliability of pharmaceutical products of certain manufacturing country during procurement (Chi-square: 12.951, P = 0.002). When wholesalers divide medicines from larger packs into smaller ones, 54.8% use packaging purchased from local markets.
  
  
  CONCLUSIONS
  A number of wholesalers think counterfeit medicines are medicines without registration, and/or do not have any uniform ideas on the issue and what to do, when they find or suspect counterfeits. Furthermore, their strict adherence to anti-counterfeiting measures is urgently needed.
authors.affiliation: Drug Management and Policy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa City, 920-1192, Japan. mohiuddin_khn@yahoo.com
authors.forename: Mohiuddin H
authors.initials: MH
authors.lastname: Khan
authors.forename: Manabu
authors.initials: M
authors.lastname: Akazawa
authors.forename: Eav
authors.initials: E
authors.lastname: Dararath
authors.forename: Heng B
authors.initials: HB
authors.lastname: Kiet
authors.forename: Tey
authors.initials: T
authors.lastname: Sovannarith
authors.forename: Nam
authors.initials: N
authors.lastname: Nivanna
authors.forename: Naoko
authors.initials: N
authors.lastname: Yoshida
authors.forename: Kazuko
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000328:Adult; D002160:Cambodia; D058110:Counterfeit Drugs; D003906:Developing Countries; D004345:Drug Industry; D005260:Female; D005607:Fraud; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D011795:Surveys and Questionnaires
chemical_list: D058110:Counterfeit Drugs
references.citation: Res Social Adm Pharm. 2009 Sep;5(3):286-97
references.pmid: 19733829
references.citation: Southeast Asian J Trop Med Public Health. 2004 Sep;35(3):741-7
references.pmid: 15689098
references.citation: Nature. 2005 Mar 10;434(7030):132-6
references.pmid: 15758966
references.citation: World Health Organ Tech Rep Ser. 2010;(957):1-276, back cover
references.pmid: 20560300
references.citation: Trans R Soc Trop Med Hyg. 2006 Nov;100(11):1019-24
references.pmid: 16765399
references.citation: Pharm Res. 2011 Mar;28(3):484-9
references.pmid: 20886264
references.citation: Trop Med Int Health. 2010 May;15(5):639-44
references.pmid: 20214756
references.citation: Clin Pharmacol Ther. 2007 Mar;81(3):445-9
references.pmid: 17251983
references.citation: N Engl J Med. 2004 Apr 1;350(14):1384-6
references.pmid: 15070787