The role of antimalarial quality in the emergence and transmission of resistance

Brock, Aleisha R.; Ross, Joshua V.; Parikh, Sunil; Esterman, Adrian

doi:10.1016/j.mehy.2017.12.018

Cited by 10 publications

(9 citation statements)

References 47 publications

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“…Recent studies have reported that 20–40 percent of anti-malarials and antibiotics sold in official outlets in Ghana fail quality standards (<= 80% of active ingredient: Kaur et al, 2016; Fadeyi et al, 2015; Tivura et al, 2016). Globally, poor-quality anti-malarial and antibiotic medicines are thought to be responsible for more than 100,000 under-five deaths annually, concentrated in Sub-Saharan Africa (Renschler et al, 2015; WHO, 2017b), in addition to risks of accelerated antimicrobial resistance that arise through persistent under-dosing (Dondorp et al, 2009; Newton et al, 2016; Brock et al, 2018; Sharma et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context

Hamill

Hampshire

Mariwah

et al. 2019

Social Science & Medicine

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Where regulation is weak, medicine transactions can be characterised by uncertainty over the drug quality and efficacy, with buyers shouldering the greater burden of risk in exchanges that are typically asymmetric. Drawing on in-depth interviews (N = 220) and observations of medicine transactions, plus interviews with regulators (N = 20), we explore how people in Ghana negotiate this uncertainty and come to trust a medicine enough to purchase or ingest it. We identify two mechanisms – attempts to mitigate uncertainty through seeking observable signs of quality and attempts to reduce informational asymmetry – that underpin cognitive assessments of a medicine's trustworthiness. However, these ‘cognitive’ forms of trust assessment have limited traction where uncertainty is high and trustworthiness remains unknowable, so a third mechanism comes into play: one based on affective relationships within which transactions are socially embedded. Even these, however, cannot eliminate uncertainty, because of the dispersed and under-regulated nature of wider supply chains. In conclusion, we reflect on the need for careful research on actors' practices and decision-making across supply chains to inform more effective policy and regulation.

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Section: Introductionmentioning

confidence: 99%

Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context

Hamill

Hampshire

Mariwah

et al. 2019

Social Science & Medicine

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“…[23, 25–37]. Simple models, based on the Ross and MacDonald model [38, 39], have considered specific components of the epidemiology of resistance and, therefore, are not sophisticated enough to answer questions on how factors have jointly impacted establishment and spread of drug resistance [26, 30–33, 36, 37]. Most models have investigated specific transmission scenarios and questions, such as how within-host competition between parasites influences development of drug resistance [25, 28, 35], and did not systematically assess the impact of assumptions used on their results.…”

Section: Introductionmentioning

confidence: 99%

“…Mathematical models of infectious disease have not previously been used to systematically assess the joint influence of multiple factors on the establishment and spread of drug resistance, e.g. [23,[25][26][27][28][29][30][31][32][33][34][35][36][37]. Simple models, based on the Ross and MacDonald model [38,39], have considered specific components of the epidemiology of resistance and, therefore, are not sophisticated enough to answer questions on how factors have jointly impacted establishment and spread of drug resistance [26, 30-33, 36, 37].…”

Section: Introductionmentioning

confidence: 99%

The influence of biological, epidemiological, and treatment factors on the establishment and spread of drug-resistant Plasmodium falciparum

Masserey

Lee

Golumbeanu

et al. 2022

Preprint

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The effectiveness of artemisinin-based combination therapies (ACTs) to treat Plasmodium falciparum malaria is threatened by resistance. The complex interplay between sources of selective pressure - treatment properties, biological factors, transmission intensity, and access to treatment - obscures understanding how, when, and why resistance establishes and spreads across different locations. We developed a disease modelling approach with emulator-based global sensitivity analysis to systematically quantify which of these factors drive establishment and spread of drug resistance. Drug resistance was more likely to evolve in low transmission settings due to the lower levels of (i) immunity and (ii) within-host competition between genotypes. Spread of parasites resistant to artemisinin partner drugs depended on the period of low drug concentration (known as the selection window). Spread of partial artemisinin resistance was slowed with prolonged parasite exposure to artemisinin derivatives and accelerated when the parasite was also resistant to the partner drug. Thus, to slow the spread of partial artemisinin resistance, molecular surveillance should be supported to detect resistance to partner drugs and to change ACTs accordingly. Furthermore, implementing more sustainable artemisinin-based therapies will require extending parasite exposure to artemisinin derivatives, and mitigating the selection windows of partner drugs, which could be achieved by including an additional long-acting drug.

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“…Poor-quality antibiotics and antimalarials are believed to result in more than 200 000 child deaths per year 1 3–5 and contribute significantly to antimicrobial resistance. 6 7 …”

Section: Introductionmentioning

confidence: 99%

Monitoring, reporting and regulating medicine quality: tensions between theory and practice in Tanzania

et al. 2021

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In 2012, the WHO launched its Global Surveillance and Monitoring System (GSMS) for substandard and falsified medicines, with the aim of improving the quality of reporting and using the data to inform post-market surveillance and build regulatory capacity. However, from a regulatory governance perspective, its effectiveness depends on the willingness and ability of actors ‘on the ground’ to identify, report and investigate possible infringements and to enforce penalties. This paper presents findings from 27 interviews with representatives of agencies charged with regulating pharmaceutical markets and 4 interviews with pharmaceutical industry representatives in Tanzania. Their experiences provide important insights into how the theorised mechanism between reporting and a reduction in undesirable behaviours can play out in a low-income context, revealing hidden assumptions about regulator behaviour and motivations. A combination of chronic under-resourcing, information gaps and enforcement challenges conspires to limit the efforts of local regulators to achieve the GSMS goals, shedding new light on the relationship between apparent ‘misconduct’ and structural constraints.

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The role of antimalarial quality in the emergence and transmission of resistance

Cited by 10 publications

References 47 publications

Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context

Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context

The influence of biological, epidemiological, and treatment factors on the establishment and spread of drug-resistant Plasmodium falciparum

Monitoring, reporting and regulating medicine quality: tensions between theory and practice in Tanzania

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