A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistance
<p>Abstract</p> <p>Background</p> <p>Counterfeit oral artesunate has been a major public health problem in mainland SE Asia, impeding malaria control. A countrywide stratified random survey was performed to determine the availability and quality of oral artesunate in ph...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2009-07-01
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| Series: | Malaria Journal |
| Online Access: | http://www.malariajournal.com/content/8/1/172 |
| _version_ | 1819043875007758336 |
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| author | Vongsack Latsamy Khounsaknalath Lamphet Hostetler Dana Mildenhall Dallas C Nyadong Leonard Hampton Christina Y Insixiengmay Vongsavanh Phommavong Khamlieng Manolin Ot Fernández Facundo M Green Michael D Sengaloundeth Sivong Phompida Samlane Vanisaveth Viengxay Syhakhang Lamphone Newton Paul N |
| author_facet | Vongsack Latsamy Khounsaknalath Lamphet Hostetler Dana Mildenhall Dallas C Nyadong Leonard Hampton Christina Y Insixiengmay Vongsavanh Phommavong Khamlieng Manolin Ot Fernández Facundo M Green Michael D Sengaloundeth Sivong Phompida Samlane Vanisaveth Viengxay Syhakhang Lamphone Newton Paul N |
| author_sort | Vongsack Latsamy |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Counterfeit oral artesunate has been a major public health problem in mainland SE Asia, impeding malaria control. A countrywide stratified random survey was performed to determine the availability and quality of oral artesunate in pharmacies and outlets (shops selling medicines) in the Lao PDR (Laos).</p> <p>Methods</p> <p>In 2003, 'mystery' shoppers were asked to buy artesunate tablets from 180 outlets in 12 of the 18 Lao provinces. Outlets were selected using stratified random sampling by investigators not involved in sampling. Samples were analysed for packaging characteristics, by the Fast Red Dye test, high-performance liquid chromatography (HPLC), mass spectrometry (MS), X-ray diffractometry and pollen analysis.</p> <p>Results</p> <p>Of 180 outlets sampled, 25 (13.9%) sold oral artesunate. Outlets selling artesunate were more commonly found in the more malarious southern Laos. Of the 25 outlets, 22 (88%; 95%CI 68–97%) sold counterfeit artesunate, as defined by packaging and chemistry. No artesunate was detected in the counterfeits by any of the chemical analysis techniques and analysis of the packaging demonstrated seven different counterfeit types. There was complete agreement between the Fast Red dye test, HPLC and MS analysis. A wide variety of wrong active ingredients were found by MS. Of great concern, 4/27 (14.8%) fakes contained detectable amounts of artemisinin (0.26–115.7 mg/tablet).</p> <p>Conclusion</p> <p>This random survey confirms results from previous convenience surveys that counterfeit artesunate is a severe public health problem. The presence of artemisinin in counterfeits may encourage malaria resistance to artemisinin derivatives. With increasing accessibility of artemisinin-derivative combination therapy (ACT) in Laos, the removal of artesunate monotherapy from pharmacies may be an effective intervention.</p> |
| first_indexed | 2024-12-21T10:03:43Z |
| format | Article |
| id | doaj.art-a4ce5d6c63844fa580f011bdfd1e0eb0 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-21T10:03:43Z |
| publishDate | 2009-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-a4ce5d6c63844fa580f011bdfd1e0eb02022-12-21T19:07:52ZengBMCMalaria Journal1475-28752009-07-018117210.1186/1475-2875-8-172A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistanceVongsack LatsamyKhounsaknalath LamphetHostetler DanaMildenhall Dallas CNyadong LeonardHampton Christina YInsixiengmay VongsavanhPhommavong KhamliengManolin OtFernández Facundo MGreen Michael DSengaloundeth SivongPhompida SamlaneVanisaveth ViengxaySyhakhang LamphoneNewton Paul N<p>Abstract</p> <p>Background</p> <p>Counterfeit oral artesunate has been a major public health problem in mainland SE Asia, impeding malaria control. A countrywide stratified random survey was performed to determine the availability and quality of oral artesunate in pharmacies and outlets (shops selling medicines) in the Lao PDR (Laos).</p> <p>Methods</p> <p>In 2003, 'mystery' shoppers were asked to buy artesunate tablets from 180 outlets in 12 of the 18 Lao provinces. Outlets were selected using stratified random sampling by investigators not involved in sampling. Samples were analysed for packaging characteristics, by the Fast Red Dye test, high-performance liquid chromatography (HPLC), mass spectrometry (MS), X-ray diffractometry and pollen analysis.</p> <p>Results</p> <p>Of 180 outlets sampled, 25 (13.9%) sold oral artesunate. Outlets selling artesunate were more commonly found in the more malarious southern Laos. Of the 25 outlets, 22 (88%; 95%CI 68–97%) sold counterfeit artesunate, as defined by packaging and chemistry. No artesunate was detected in the counterfeits by any of the chemical analysis techniques and analysis of the packaging demonstrated seven different counterfeit types. There was complete agreement between the Fast Red dye test, HPLC and MS analysis. A wide variety of wrong active ingredients were found by MS. Of great concern, 4/27 (14.8%) fakes contained detectable amounts of artemisinin (0.26–115.7 mg/tablet).</p> <p>Conclusion</p> <p>This random survey confirms results from previous convenience surveys that counterfeit artesunate is a severe public health problem. The presence of artemisinin in counterfeits may encourage malaria resistance to artemisinin derivatives. With increasing accessibility of artemisinin-derivative combination therapy (ACT) in Laos, the removal of artesunate monotherapy from pharmacies may be an effective intervention.</p>http://www.malariajournal.com/content/8/1/172 |
| spellingShingle | Vongsack Latsamy Khounsaknalath Lamphet Hostetler Dana Mildenhall Dallas C Nyadong Leonard Hampton Christina Y Insixiengmay Vongsavanh Phommavong Khamlieng Manolin Ot Fernández Facundo M Green Michael D Sengaloundeth Sivong Phompida Samlane Vanisaveth Viengxay Syhakhang Lamphone Newton Paul N A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistance Malaria Journal |
| title | A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistance |
| title_full | A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistance |
| title_fullStr | A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistance |
| title_full_unstemmed | A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistance |
| title_short | A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistance |
| title_sort | stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the lao pdr implications for therapeutic failure and drug resistance |
| url | http://www.malariajournal.com/content/8/1/172 |
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