Counterfeit and substandard drugs in Sub-Saharan Africa may pose a major hurdle to H3Africa’s initiative to study genetics of kidney disease progression

Abstract

The Human Heredity and Health in Africa Kidney Disease Research Network aims to investigate the genetics of renal disease progression.1Osafo C. Raji Y.R. Olanrewaju T. et al.Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network.Kidney Int. 2016; 90: 2-5Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Diabetes mellitus and hypertension have emerged as the commonest cause of end-stage renal disease in Sub-Saharan Africa.2Barsoum R.S. Chronic kidney disease in the developing world.N Engl J Med. 2006; 354: 997-999Crossref PubMed Scopus (359) Google Scholar Additionally, obstructive uropathy (observed in malaria), HIV infection, and toxic nephropathies also contribute considerably. Therefore, apposite management of the above conditions is essential before mapping the phenotype of renal-disease progression to the genotype. However, Sub-Saharan Africa is the major site for the sale and distribution of counterfeit drugs (Figure 1a ), where counterfeit drugs represent 50% of the pharmaceutical market in several African countries.3Karunamoorthi K. The counterfeit anti-malarial is a crime against humanity: a systematic review of the scientific evidence.Malar J. 2014; 13: 209Crossref PubMed Scopus (47) Google Scholar, 4Banerjee Y. Mission Indradhanush and the counterfeit drug trade in India.Lancet Infect Dis. 2015; 15: 1379-1380Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Several studies (Figure 1b) in Sub-Saharan Africa show that drugs that are used for the management of the above conditions causing nephropathy are spurious or of substandard quality. We therefore believe that the Human Heredity and Health in Africa Kidney Disease Research Network should take appropriate measures to account for the possible adverse effects of counterfeit drugs upon the clinical outcomes of Africans with kidney disease.Figure 1Global distribution of counterfeit medicine from manufacture to selling (a). The impetus of the figure was obtained from Dégardin et al.5Dégardin K. Roggo Y. Margot P. Understanding and fighting the medicine counterfeit market.J Pharm Biomed Anal. 2014; 87: 167-175Crossref PubMed Scopus (130) Google Scholar The intensity of counterfeit drug trade in the respective countries is color coded. Note that the intensity of the sale of counterfeit drugs is the highest in the African countries compared with other (refer to the text for details). Published reports of some counterfeit drug–related incidents in Africa (b). Note: in all the incidents the drug used to treat the condition detrimentally affects renal health. Hence, use of the counterfeit drug will not negate the effect of the condition on renal health in addition to plausibly causing nephrotoxicity. SSA, Sub-Saharan Africa.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) Kidney Disease Research NetworkKidney InternationalVol. 90Issue 1PreviewIn a typical day in Korle-Bu Teaching Hospital, Ghana (and in most teaching and referral hospitals in Sub-Saharan Africa), physicians are often confronted with challenging cases not based on medical diagnosis but on the ability to offer appropriate medical care. Here, we describe a case that typifies the ethical dilemma facing nephrologists in low resource countries. Ama (name changed for privacy), age 15 years, developed edema a few months before presentation. At admission, she had significant pulmonary congestion and was diagnosed with end-stage renal disease (ESRD) documented by an ultrasound demonstrating small kidneys bilaterally. Full-Text PDF Open ArchiveThe Authors ReplyKidney InternationalVol. 91Issue 1PreviewWe are grateful for Dr. Banerjee’s comment (“Counterfeit and Substandard Drugs in Sub-Saharan Africa May Pose a Major Hurdle to H3Africa’s Initiative to Study Genetics of Kidney Disease Progression”1) on our study.2 The use of counterfeit drugs may be an issue in Africa. However, we are not giving the patients any medication in our study nor are we measuring the clinical outcomes of the drugs that the patients are taking. The point that Banerjee makes is interesting but out of scope for what the Human Heredity and Health in Africa (H3Africa Kidney Disease Research Network) is trying to achieve. Full-Text PDF Open Archive