Table 2. Quality of Artemisinin-Containing Antimalarials (ACAs) purchased per outlet using convenience, mystery clients and overt sampling approaches in Enugu, Nigeria; n = 3024.
| Outlets (n) | Acceptable quality for both AD & PD | Substandard AD only | Substandard PD only | Substandard AD & PD | Degraded | Falsified | Total |
|---|---|---|---|---|---|---|---|
| Convenience (n = 200; total brands = 49; brands per outlet = 2.1) | |||||||
| Pharmacies (4) | 62 (88.6%) | 1 (1.4%) | 3 (4.3%) | 0 | 2 (2.9%) | 2 (2.9%) | 70 |
| PMVs (16) | 97 (81.5%) | 6 (5.0%) | 9 (7.6%) | 1 (0.8%) | 2 (1.7%) | 4 (3.4%) | 119 |
| Public health facilities (2) | 4 (80.0%) | 1 (20.0%) | 0 | 0 | 0 | 0 | 5 |
| Market stalls (1) | 6 (100.0%) | 0 | 0 | 0 | 0 | 0 | 6 |
| All outlets (23) | 169 (84.5%) a , b | 8 (4.0%) | 12 (6.0%) c , d | 1 (0.5%) | 4 (2.0%) | 6 (3.0%) e , f | 200 |
| Mystery clients (n = 1919; total brands = 102; brands per outlet = 0.4) | |||||||
| Pharmacies (92) | 803 (90.0%) | 23 (2.6%) | 25 (2.8%) | 20 (2.2%) | 16 (1.8%) | 5 (0.6%) | 892 |
| PMVs (174) | 94 (91.9%) | 29 (3.0%) | 7 (0.7%) | 15 (1.5%) | 9 (0.9%) | 19 (2.0%) | 973 |
| Public health facilities (13) | 51 (94.4%) | 3 (5.6%) | Acceptable 0 | 0 | 0 | 0 | 54 |
| All outlets (279) | 1748 (91.1%) a | 55 (2.9%) | 32 (1.7%) c | 35 (1.8%) | 25 (1.3%) | 24 (1.2%) e | 1919 |
| Overt (n = 905; total brands = 79; brands per outlet = 0.7) | |||||||
| Pharmacies (54) | 488 (89.4%) | 27 (4.9%) | 16 (2.9%) | 7 (1.3%) | 8 (1.5%) | 0 | 546 |
| PMVs (65) | 340 (94.7%) | 7 (1.9%) | 5 (1.4%) | 1 (0.3%) | 1 (0.3%) | 5 (1.4%) | 359 |
| Public health facilities (0) | - | - | - | - | - | - | - |
| All outlets (119) | 828 (91.5%) b | 34 (3.8%) | 21 (2.3%) d | 8 (0.9%) | 9 (1.0%) | 5 (0.6%) | 905 |
ACAs = artemisinin containing antimalarial; AD = artemisinin derivative (always the ACAs); PD = partner drug (always the non-ACAs); PMVs = patent medicine vendors. Substandard = genuine medicines produced by legitimate manufacturers that do not satisfy the pharma set quality specifications. Degraded = result from exposure of good quality medicines to excessive heat and humidity. Falsified = deliberately and fraudulently mislabelled with respect to identity and/or source. Include both branded and generic products and may include wrong ingredients or no active ingredients or counterfeited packaging. Significant difference between sampling approaches for each quality category are indicated as follows: between convenience and mystery clients =
a (p = 0.002),
c (p<0.001),
e (p = 0.046); between convenience and overt =
b, f (p = 0.002),
d (p = 0.006). Other comparisons were not significantly different (p>0.05).