It is easy to take medicine for granted.
When we fall sick, we go to a health facility, buy a tablet from a pharmacy or receive an injection, expecting that the medicine will work.
Why am I writing about medicine? It’s because a new study suggests that, for too many people across Africa, that assumption may not always hold.
Researchers have found that nearly one in five essential medicines tested across Africa failed to meet quality standards.
The study, published in PLOS Global Public Health, examined 123 studies covering more than 36,000 medicine samples from 34 African countries. Overall, 17.9% of the medicines tested were classified as substandard or falsified.
That is almost one in every five. Let’s pause for a moment. What does “substandard” or “falsified” actually mean?
A falsified medicine is deliberately misrepresented. It may contain the wrong ingredient, no active ingredient at all, or be made to look like a genuine product.
A substandard medicine is different. It may be a genuine product, but it fails to meet the required quality standards. It could contain too little or too much of the active ingredient or fail other pharmaceutical tests.
And this was the bigger problem in the study. Substandard medicines accounted for most of the poor-quality products, with a pooled prevalence of 12.8%, compared with 1.2% for falsified medicines.
But what caught my attention most was what the researchers found about medicines used to protect mothers and children.
Take uterotonics—medicines used to prevent or treat heavy bleeding after childbirth. The pooled prevalence of substandard or falsified uterotonics was 43.9%.
That is a worrying number because severe bleeding after childbirth can become a medical emergency, and medicines such as oxytocin and misoprostol can be lifesaving.
The concerns do not stop there.
Antimalarial medicines had a pooled prevalence of 19.4% for substandard or falsified products. In a continent where malaria remains a major threat, the quality of these medicines matters enormously.
If an antimalarial does not contain the right amount of active ingredient, treatment may fail. Poor-quality treatment can also contribute to concerns about drug resistance.
The problem is not the same everywhere.
Western Africa recorded a pooled prevalence of 21.3%, followed by Central Africa at 20.0%. Eastern Africa recorded 8.6%, while Southern Africa had the lowest estimate at 1.3%.
But the researchers warn us not to read the lower numbers as proof that medicines are safer in those regions.
Why? Because many African countries have little or no medicine-quality surveillance data. Some studies also focus on formal health facilities and may not capture what is happening in informal markets.
There is another complication. Testing methods differ. Some studies use rapid screening tools, while others rely on more sophisticated laboratory tests. Some quality problems, such as poor packaging, contamination or storage damage, may also escape chemical testing.
So the 17.9% figure should not be interpreted as saying that 17.9% of all medicines sold in Africa are poor quality. It is the pooled estimate among the medicines that were tested in the studies included in the review.
Still, the message is difficult to ignore.
The researchers are calling for stronger post-market surveillance, better laboratory capacity and more systematic testing of medicines, including those sold through private and informal markets.
They also want African countries to share information more effectively, particularly because medicines can cross borders easily.
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