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Table 1 Summary of case reports of poor anti-malarial medicine quality in Africa.

From: Poor quality vital anti-malarials in Africa - an urgent neglected public health priority

Medicine
Country
Classification Stated Manufacturer Chemistry/Pollen Packaging/Notes
'Artesunate' 50 mg tablets
Cameroon
Counterfeit 'Mekophar Chemical Pharmaceutical Joint-Stock Company'
Marketed by: 'Neros Pharmaceuticals Ltd., Lagos Nigeria'
Contains chloroquine. No artesunate detected. Pollen grains of bulrush (Typha angustifolia). Pollen and chemistry suggests two different types Collected because of suspicion of their low cost (1500 FCFA ~$3/pack of 12 tablets). Packet and leaflet colours and holograms differed and the counterfeit packets were heavier.
'Artesunate' 100 mg tablets
DR Congo
Poor quality 'Marinate'. No manufacturers details on the packaging. Only 'GUJ/DRUGS/1407' 79 and 88% artesunate/tablet, but analysed 19 months after expiry Probably labeled as made in Gujerat, India. Genuine packaging not available
'Artesunate' 100 mg tablets
DR Congo
Counterfeit Astrinate on one face of leaflet and Arinate on reverse
Stated to be 'Manufactured for AT17 RUE POISSONNIERS 75018 PARIS'
88.5, 70.9 mg artesunate/tablet No agent/company in Rue Poissonniers. 'Arinate' is the trade name of artesunate monotherapy from Dafra Pharma, Belgium.
'Artesunate' 50 mg tablets
Ghana
Poor quality 'LEVER Artesunate'
Stated to be manufactured by
'ADAMS PHARAMCEUTICAL (ANHUI) CO., LTD. ANHUI, CHINA
Division of Sunflower Int'l Group'
artesunate 39.0, 43.0, 47.0, 47.0 mg/tablet Unable to obtain sample of genuine packaging
'Dihydroartemisinin' 60 mg tablets
Kenya
Counterfeit 'Jiaxing Nanhu Pharmaceutical Co. Ltd. Jiaxing City, under license of Beijing Holley-Cotec Pharmaceuticals (PR China)' with stated trade name 'Cotecxin' No dihydroartemisinin detected. Chenopodiaceae pollen consistent with a source in SE China or in adjacent areas of SE and south Asia but not with Africa The counterfeit tablet diameter and blister foil are larger and markedly lighter orange, respectively
'Halofantrine'
250 mg tablets
Sierra Leone, Nigeria, Cameroon, DRC, Tanzania, Liberia, China
Counterfeit 'SmithKline Beecham Laboratoires Pharmacetiques' One contained correct % halofantrine-fraudulent extension of expiry date. Artemisinin, acetaminophen, dipyrone, pyrimethamine wrong APIs. Fagopyrum (buckwheat) and Sesamum (sesame) pollen in counterfeits. Consistent (but does not prove) with seasonally arid source in southern China. Betula (birch) pollen grain and a Stenochlaena fern spore in other counterfeits suggesting E/SE Asia, inconsistent with India/Africa 12 counterfeit Halfan tablets were classified as Types A, B, C, D, & E. Type A contained artemisinin while B, C, D & E contained acetaminophen or no API detected
Halofantrine
Syrup 30 ml bottle
DR Congo
Counterfeit 'SmithKline Beecham Laboratoire Pharmaceutiques Esplanade Charles de Gaulle 92731 NANTERRE Cedex,' No API detected Came with a spoon, leaflet and packet, suggesting considerable investment in deception.
'Dihydroartemisinin-piperaquine'
40/320 mg tablets
China
Counterfeit 'Zheijiang Holley Nanhu Pharmaceutical Group Ltd Under license of HolleyPharm' with stated trade name 'Duo-Cotecxin' Sildenafil (Viagra; median (range) 10.4 (6.1-18.4) mg/tablet) detected in the matrix of the counterfeit tablets. Cibotium fern, widespread in SE and south Asia in both counterfeits and comparator genuine samples, suggesting that both manufactured in same region Packaging with language errors with English and French (Franglais)
'Artemether-lumefantrine'
20/120 mg tablets
Ghana
Counterfeit 'Beijing Novartis Pharma Ltd, Beijing, China' No artemether or lumefantrine detected. Contain pyrimethamine (6.2-25 mg/tablet) and unidentified yellow pigment in counterfeits. Pollen in counterfeit samples consistent with manufacture in E/SE Asia but not in Africa or India 8 tablets/blister for counterfeits rather than 6 for genuine. Errors in German language spelling
'Artemether-lumefantrine'
20/120 mg tablets
Cameroon
Counterfeit 'Beijing Novartis Pharma Ltd, Beijing, China' No artemether or lumefantrine detected. Contained pyrimethamine and sulphadiazine 6 tablets/blister for counterfeits
Artesunate & amodiaquine co-blistered. 100/300 mg tablet
Ghana
Poor quality 'Pharmanova Limited, Accra, Ghana. Manufactured by: Atlantic Pharmaceuticals Limited Accra, Ghana' Artesunate 92.0, 103 mg/tablet and amodiaquine 237, 240 mg/tablet Unable to obtain sample of genuine packaging
  1. See Additional File 2 for details.