Conclusions
The data available for assessing the frequency of poor quality anti-malarials and their public health impact are of poor quality but suggest that there are severe problems at least in some important foci with high malaria burden. Poor-quality antimalarials that contain sub-therapeutic amounts of active ingredient increase the risk of drug resistance and may put at risk current therapeutic control strategies. There is an immediate need for standardizing sampling and assay methods and achieve consensus in defining different types of poor quality medicines.
In a social and economic landscape where 30% of the world's MRAs do not have functional capacity and most developing countries do not have national laboratories, inspectors are not able to objectively screen for suspect medicines. In order to properly assess the quality of medicines, it needs to be ensured that such techniques are accessible in lower income countries and, as has happened in wealthy countries, empowering routine inspection must be a much higher public health priority.
Ethics Statement
An ethics statement was not required for this work.