One in five chemotherapy drugs in Africa fails quality tests – Study

Nigerian postgraduate student Ekezie Okorigwe of the University of Notre Dame in the United States co-authored a recent study that found that nearly one in five chemotherapy medications tested in portions of sub-Saharan Africa was either severely underdosed or overdosed.

Between April 2023 and February 2024, 251 samples of seven regularly used cancer medications were gathered from hospitals, pharmacies, and unofficial sources in Ethiopia, Kenya, Malawi, and Cameroon for the extensive investigation, which was published in The Lancet Global Health. According to the results, 19% did not match international quality standards; some of them had as little as 28% of the active component listed, while others had more than 120%.

Okorigwe, who collaborated on the project with a global group of experts, stated that his personal belief in trust is what drives him to address the issue.

"When people purchase medication, they should have confidence that it will fulfil its intended purpose," he stated. "Even if treatment is later corrected, bad quality drugs can cause harm to the body that is not always reversible."

He clarified that poor quality cancer medications cause needless suffering for patients in addition to wasting the money and time needed to produce them. He stated, "It hurts for people to spend money on treatment in the hopes of getting better, only to have the drug make things worse."

To address the problem, Okorigwe and his colleagues are developing an affordable, portable testing device known as the chemoPAD — a paper-based card that can quickly screen chemotherapy drugs for quality.

Speaking about the device, Okorigwe’s advisor, project leader, and analytical chemist Professor Marya Lieberman described it as similar to the batik cloth-printing technique, but for medicines.

“The card has wax-printed lines forming channels. We smear a small amount of the drug between two arrows, dip the card in water, and the water carries the chemicals through the channels to meet the drug. If the medicine is of poor quality, it produces specific colours,” she explained.

ChemoPAD can identify the "worst of the worst" medications with less than half of their necessary active ingredient for a fraction of the cost of expensive laboratory testing, but it cannot completely replace it. While the chemoPAD can test a single pill, full lab analysis can cost up to $1,200 per sample and require roughly 100 tablets.

Ten medications on the World Health Organization's priority watch list can already be analysed by the technology, which was first created for antibiotics and TB medications. The researchers intend to broaden its focus with more financing in order to include more antimalarial and antibiotic medications, which are also prone to quality problems in low- and middle-income nations.

Lieberman emphasised that complicated supply chains, pressure to purchase less expensive medications, and lax regulation are frequently the causes of low-quality medications in Africa. She cautioned that "poor quality cancer medications can mean the difference between life and death."

In the past 30 years, the number of cancer cases in sub-Saharan Africa has doubled, and doctors caution that subpar medications may make the region's already low survival rates worse.

According to Okorigwe, integrating quality surveillance into routine medical procedures is the answer.

He asserted that "clinicians are not trained to perform complex lab tests in the field." "This research focusses on the need for easy-to-use, portable, and efficient tools to protect patients."