Exposure of consumers to substandard antibiotics from selected authorised and unauthorised medicine sales outlets in Ghana

Samuel Oppong Bekoe, Mary-Anne Ahiabu, Emmanuel Orman, Britt Pinkowski Tersbøl, Reimmel Kwame Adosraku, Martin Hansen, Niels Frimodt-Moller, Bjarne Styrishave

16 Citations (Scopus)


Objective: To assess the quality of antibiotics sampled from authorised sales outlets (ATs) (i.e. hospitals/health centres, pharmacies and licensed chemical shops) and unauthorised sales 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 (<90%) or more API (>110%) than the label claim. Medicines from UATs recorded substantially less API contents than those from ATs (F (2,419) = 43.01, P < 0.0001). For example, 90.54% of street vendor samples contained < 90% of the APIs. 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 rather thought of the formal healthcare 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.

Original languageEnglish
JournalTropical medicine & international health : TM & IH
Issue number8
Pages (from-to)962-975
Number of pages14
Publication statusPublished - Aug 2020


  • antibiotic medicines
  • antimicrobial resistance
  • drug quality assessment
  • liquid chromatography
  • medicine sales outlets
  • poor-quality medicines
  • tandem mass spectrometry method


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