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An estimated 10% of medicines and medical products in low- and middle-income countries are either falsified or substandard, killing hundreds of thousands of patients and wasting billions of dollars each year, according to new research published by WHO.

Driven by demand, falsified or substandard medical products including antibiotics, cancer treatments and diabetes medication make their way onto the market in countries around the globe, meaning that many patients are taking medicine that cannot treat or prevent disease, WHO said.

The agency said it has received 1,500 reports of these products through a global surveillance program established in 2013, split almost evenly between generic and patented products.

Two British universities used WHO data to estimate that up to 169,000 children die each year from pneumonia and as many as 158,000 more die from malaria due to falsified or substandard antibiotics or antimalarials. These medications not only lead to treatment failures, but also contribute to antimicrobial resistance.

In a telebriefing, WHO experts said fixing the problem will take more political will in the form of human and financial resources to translate policies and strategies that have been agreed upon at the global level to sustainable actions on the ground.

“Substandard and falsified medicines particularly affect the most vulnerable communities,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc,said in a statement. “This is unacceptable. Countries have agreed on measures at the global level — it is time to translate them into tangible action.”

WHO published data on reports filed through the Global Surveillance and Monitoring System for substandard and falsified products from July 2013 through June 2017. Most of the reports — 42% — came from sub-Saharan Africa, with another 42% originating in either the Americas or Europe. More than 36% of the reports involved either antibiotics or antimalarials, the two most commonly reported drugs.

WHO said the data likely represent only a small fraction of the overall problem. For example, it said, only 8% of the reports came from the Western Pacific, 6% from the Eastern Mediterranean and just 2% from the Southeast Asia region.

Michael Deats, WHO expert on medicine safety and diligence, said access and affordability are two factors that allow fake medical products to make their way to patients. He noted a 2015 outbreak of meningitis C in Niger that resulted in a vaccine shortage, leading to supplies of fake drugs when the country turned to wholesalers in neighboring countries to fill the gap.

“If there’s insufficient product on the market, within days the vacuum is filled with falsified versions,” Deats said during the briefing. “Sometimes it’s about access and sometimes it’s about affordability, but not always. Sometimes it’s about governance.”

Malaria medication made up nearly 20% of all products reported through the WHO surveillance program, and antibiotics accounted for almost 17%. Anesthetics and painkillers, lifestyle products including cosmetics, erectile dysfunction drugs and bodybuilding or diet products, and cancer medications were also commonly mentioned.

Deats said the problem of falsified and substandard medical products is widespread in Africa but can be found in most places. “The equivalent of a street market in Africa is an unregulated website in a high-income country,” he said. “This affects all parts of the world.”

The financial toll is also significant. A WHO study based on more than 100 published research papers estimated a 10.5% failure rate in all medical products used in low- and middle-income countries at a cost of around $30 billion.

“These are approximations because we do not have reliable data,” Suzanne Hill, BMed, PhD, director of the WHO Department of Essential Medicines and Health Products, said during the telebriefing. “One of the points we want to make in this report is that we need better data from countries on how much they spend on pharmaceuticals.” – by Gerard Gallagher

https://www.healio.com/infectious-disease/antimicrobials/news/online/%7b82afac1e-c5a9-4a75-99be-42c18eb26170%7d/who-10-of-medicine-in-developing-countries-fake-or-substandard?page=2

Milk is a common drink of our daily diet. But not every-time the milk we take is pure; it may have urea, formalin, vanaspati, starch and water as impurity. Packed milk from reputed brands as well as milk purchased from milk-vendors can be adulterated so its important to check for them before consuming.

Test for adulteration in milk can be done at home using following ways,

1. Reduction Test

Boil milk on slow heat for 2-3 hours till it solidifies and become hard (khoya). Rock solid, rough residue means the milk is adulterated while oily residue means its of good quality.

2. Checking for Synthetic Milk

Synthetic milk is made by mixing chemicals and things like soap in natural milk. Synthetic milk can be easily identified by bad taste. It feels soapy when rubbed and turns yellowish when heated.

3. Water in milk

Water in milk may not be bad for your health but definitely for your pocket. To check, put a drop of milk on your fist or any slanted surface and let it flow down. If the milk leaves a trail behind, it’s not pure else its good.

4. Vanaspati/Dalda in milk

Vanaspati is not good for health if consumed in big quantity. To check if milk is adulterated with vanaspati, add 2 tbps of hydrochloric acid and 1 tbsp of sugar to 1 tbsp of milk. If the mixture turns red, its impure.

5. Starch in milk

If your vendor has added starch to milk, you can detect it by adding 2 tablespoons to salt (iodine) to 5 ml of milk. Mixture will turn blue if milk is adulterated else it remains intact.

6. Formalin in milk

Formalin is used for preservation purposes. Since its transparent in color and can preserve milk for long time, packaged manufacturers use it for adulteration purposes. To test for formalin existence in milk, take 10 ml of milk in test tube and put 2-3 drops of sulphuric acid into it. If a blue ring appears at the top, milk is adulterated else not.

7. Test for urea in milk

One of the most common form of adulteration in milk is mixing of urea since it doesn’t changes the taste and is little difficult to detect. To check for urea in milk, mix half tablespoon of milk and soyabean (or arhar) powder together and shake well. After 5 minutes, dip litmus paper for 30 seconds and if there is a color change from red to blue it means the milk has urea in it.

https://www.quora.com/How-do-I-identify-adulterated-milk-and-milk-products-at-a-home-level-without-using-chemicals?ch=3&share=483769ad&srid=oyRV

In the year 2008 there were several reports that high levels of melamine have been detected in food and feed from around the world which triggered large-scale melamine testing of food products. On investigation the adulteration of the food and feed melamine was traced back to China.

It was later established that certain unscrupulous individuals had carried out large-scale adulteration of food with melamine powder to falsely increase the protein content. When protein content was tested in the melamine contaminated foods the values were significantly higher value. This is due to the nitrogen content of melamine molecules. It was reported that more than 1 lakh children had become sick after consuming powdered milk and baby food which had been adulterated with melamine.

Based on these reports the Food Safety and Standards Authority of India had issued an advisory in 2008 highlighting the incidence of melamine adulteration. The harmful effect of melamine along with toxicological references as well as a list of methods for melamine testing of food products was publicized.

FSSAI also had directed the State food authorities to carry out extensive melamine contamination testing of food materials and to enforce withdrawal of Chinese dairy products from the market if they contain more than 2.5 ppm of melamine.

On 5 January 2016 the Gazette notification was published on amending the Food Safety and Standards (Contaminants, Toxins and Residues) Regulation 2011. These amendments have come into force on the date of their publication. Through this amendment limits have been prescribed for melamine in products like powdered infant formula, liquid infant formula as well as other foods. The limits are given in the table below –

https://testing-lab.com/melamine-test/