Exposure of consumers to substandard antibiotics from selected authorized and unauthorized medicine sales outlets in Ghana.

OBJECTIVE: To assess the quality of antibiotics sampled from authorized sales outlets (ATs) (i.e, hospitals/health centres, pharmacies, and licensed chemical shops) and unauthorized sale outlets (UATs) (mainly street vendors) in Ghana and to explore the health seeking behaviour of medicine consumers. METHODS: The contents of 14 active pharmaceutical ingredients (APIs) in 348 sampled products were determined using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Data on health seeking practices were collected through entry and exit interviews, and field observations from ATs and UATs. RESULTS: It was observed that 66.38% of all sampled antibiotic products were substandard; they either contained less ( 110%) than the label claimed. Medicines from UATs recorded substantially less API than those from ATs (F(2,419) = 43.01, p < 0.0001). For example, 90.54% of street vendor samples contained <90% of the API. 75.93% of consumers often sought self-treatment with drugs without a prescription from UATs, as they perceived UATs as easily accessible, trustworthy and knowledgeable, and their medicines as inexpensive. These consumers also thought of the formal health care providers as alternative sources. CONCLUSIONS: Consumers who purchase from UATs are at high risk of receiving substandard medicines. The quality of medicines in the national healthcare system, in the supply chain and in the distribution system needs to be monitored regularly to reduce the incidence of substandard medicines and their impact on antimicrobial resistance. The fight against substandard medicines needs to incorporate a full understanding of socioeconomic factors that drive consumer decisions regarding their health and choice of healthcare providers.