University of Oulu

Salami, R. K., Valente de Almeida, S., Gheorghe, A., Njenga, S., Silva, W., & Hauck, K. (2023). Health, Economic, and Social Impacts of Substandard and Falsified Medicines in Low- and Middle-Income Countries: A Systematic Review of Methodological Approaches. The American Journal of Tropical Medicine and Hygiene, 109(2), 228-240,

Health, economic, and social impacts of substandard and falsified medicines in low- and middle-income countries : a systematic review of methodological approaches

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Author: Salami, Raimat Korede1; de Almeida, Sara Valente1; Gheorghe, Adrian1;
Organizations: 1Department of Infectious Disease and Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
2Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: American Society of Tropical Medicine and Hygiene, 2023
Publish Date: 2023-10-31


Little is known about the adverse health, economic, and social impacts of substandard and falsified medicines (SFMs). This systematic review aimed to identify the methods used in studies to measure the impact of SFMs in low- and middle-income countries (LMICs), summarize their findings, and identify gaps in the reviewed literature. A search of eight databases for published papers, and a manual search of references in the relevant literature were conducted using synonyms of SFMs and LMICs. Studies in the English language that estimated the health, social, or economic impacts of SFMs in LMICs published before June 17, 2022 were considered eligible. Search results generated 1,078 articles, and 11 studies were included after screening and quality assessment. All included studies focused on countries in sub-Saharan Africa. Six studies used the Substandard and Falsified Antimalarials Research Impact model to estimate the impact of SFMs. This model is an important contribution. However, it is technically challenging and data demanding, which poses challenges to its adoption by national academics and policymakers alike. The included studies estimate that substandard and falsified antimalarial medicines can account from 10% to ∼40% of total annual malaria costs, and SFMs affect rural and poor populations disproportionately. Evidence on the impact of SFMs is limited in general and nonexistent regarding social outcomes. Further research needs to focus on practical methods that can serve local authorities without major investments in terms of technical capacity and data collection.

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Series: American journal of tropical medicine and hygiene
ISSN: 0002-9637
ISSN-E: 1476-1645
ISSN-L: 0002-9637
Volume: 109
Issue: 2
Pages: 228 - 240
DOI: 10.4269/ajtmh.22-0525
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3141 Health care science
3142 Public health care science, environmental and occupational health
Funding: This project was funded by National Institute for Health Research (Grant no. 131145).
Copyright information: © 2023 The author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.