In Nigeria and other sub-Saharan African countries, the alarming statistic is that 1 in 6 cancer medications is found to be defective, a study has reported.
Researchers at the University of Notre Dame published in The Lancet Global Health said that from large hospitals to small pharmacies, at least 10% of medicines in sub-Saharan Africa are substandard or falsified.
Patients who receive insufficient dosages of these ingredients could see their tumours keep growing, and possibly even spread.
The researchers had collected dosage information, sometimes covertly, from a dozen hospitals and 25 pharmacies across Ethiopia, Kenya, Malawi and Cameroon.
They tested 251 cancer drugs across several brands from both public hospitals and private markets. Around 17% — roughly one in six — were found to have incorrect active ingredient levels, cutting across every country and in private as well as public settings.
In the study, barely a quarter of the substandard products were identified through visual inspection. Laboratory testing identified the rest.
Some drugs had far too little of the ‘active ingredient’, the part that treats cancer. Others had too much, which could be harmful.
The safe range for these ingredients is between 90 per cent and 110 per cent of what’s written on the label. But researchers found medicines with as little as 28 per cent and as high as 120 per cent.
According to them, the system in place in these countries to check medicine quality fails to address most of these issues. Visual inspection only caught one out of 10 bad medicines.
The study also highlighted bigger issues like weak drug regulations, poor manufacturing standards, and unsafe storage and shipping conditions, making it easier for substandard drugs to slip into hospitals and pharmacies.
Professor of chemistry and biochemistry at Notre Dame and lead author of the study, Marya Lieberman, said that it is important that cancer medications contain the right amount of the active ingredients so the patient gets the correct dose.
Lieberman declared: “If the patient’s dose is too small, the cancer can survive and spread to other locations. If the patient’s dose is too high, they can be harmed by toxic side effects from the medicine.
“If you can’t test it, you can’t regulate it. The cancer medications are difficult to handle and analyse because they’re very toxic, and so many labs don’t want to do that. And that’s a core problem for the sub-Saharan countries where we worked.
“Even though several of those countries have quite good labs, they don’t have the facilities that are needed for the safe handling of the chemo drugs.”
Fixing the problem, Lieberman said, will require improving regulation and providing screening technologies and training where they’re needed.
Similar numbers of substandard antibiotics, antimalarial, and tuberculosis drugs have been reported in the past, but this is the first time that such a study has found high levels of falsified or defective anticancer drugs in circulation.
In a reaction, the World Health Organisation said it was working with the four affected countries to address the problem.
In a statement, WHO added, “We are concerned with the findings the article has highlighted. We expect to assess full information to evaluate the situation, which often takes time and capacity. But we’re committed to addressing these issues, working with the relevant countries and partners.”
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