Poor quality cardiovascular medications remain a problem in Africa

More than 16 percent of cardiovascular medicines used in sub-Saharan Africa are of poor quality, according to an analysis of seven common drugs from 10 countries on the continent.

Lead researcher Marie Antignac, PharmD, PhD, of Saint-Antoine Hospital and East Paris University Hospitals in Paris, and colleagues published their results online Oct. 19 in JAMA Cardiology.

They collected 3,648 samples between November 2012 and August 2014 for the following medications: acenocoumarol (an anticoagulant); simvastatin (a statin); furosemide (an antihypertensive drug); hydrochlorothiazide (a diuretic); captopril (an ACE inhibitor); atenolol (a beta-blocker) and amlodipine (a calcium channel blocker). They obtained the samples from pharmacies and street markets in Benin, Burkina Faso, the Republic of the Congo, Côte D’Ivoire, Guinea, Mauritania, Niger, the Democratic Republic of the Congo, Senegal and Togo.

The researchers developed a reversed-phase liquid chromatography with a tandem mass spectrometry method to quantify the active ingredient of the medications. They then obtained the ratio of measured to expected dose of the active ingredient.

They considered the drug to be of low quality if the ratio was 85 percent to less than 95 percent or greater than 105 percent to 115 percent. They considered the drug to be of very low quality if the ratio was less than 85 percent or greater than 115 percent. They defined poor quality as low or very low quality.

Of the 1,530 medicines that the researchers tested at random, 16.3 percent were deemed to be of poor quality. The prevalence of poor quality drugs were as follows: acenocoumarol (0 percent), hydrochlorothiazide (1.9 percent), furosemide (12.5 percent), atenolol (15.1 percent), simvastatin (17.8 percent), captopril (25.5 percent) and amlodipine (28.5 percent).

The proportions of poor quality drugs among the countries were 0.8 percent in Senegal, 4 percent in Guinea, 9.0 percent in Togo, 10.0 percent in Burkina Faso, 15.3 percent in Mauritania, 17.6 percent in Côte D’Ivoire, 20.6 percent in Benin, 22.0 percent in the Republic of the Congo, 24.0 percent in Niger and 26.7 percent in the Democratic Republic of the Congo.

The results and variation in quality did not surprise the researchers. They noted that an operation in 23 African countries in 2013 led to the interception of more than 500 million illicit or falsified drugs. Most of the medications were from Benin, Tanzania and the Democratic Republic of the Congo, according to the researchers.

“A combination of political apathy and corruption may make the task of improving the quality of drugs especially challenging in the developing world,” the researchers wrote. “Increasing public awareness and heightening international scrutiny are necessary to bring about changes. Improving the quality of cardiovascular drugs would be a major achievement for the prevention and control of non- communicable diseases in sub-Saharan Africa.”