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. 2020 Jul 10;15(7):e0236060.
doi: 10.1371/journal.pone.0236060. eCollection 2020.

Quality of medicines for life-threatening pregnancy complications in low- and middle-income countries: A systematic review

Maria Regina Torloni  1 , Mercedes Bonet  2 , Ana Pilar Betrán  2 , Carolina C Ribeiro-do-Valle  3 , Mariana Widmer  2
Affiliations

Quality of medicines for life-threatening pregnancy complications in low- and middle-income countries: A systematic review

Maria Regina Torloni et al. PLoS One. .

Abstract

Background: There are concerns about the quality of medicines available in low- and middle-income countries (LMIC) to manage hemorrhage, pre-eclampsia/eclampsia and sepsis. We aimed to identify, critically appraise, and synthesize the findings of studies on the quality of these three types of medicines available in LMIC.

Methods: This systematic review searched Medline, EMBASE and LILACS (from inception to 25 May 2020) for studies on the quality of selected medicines available in LMIC that provided at least the amount of active pharmaceutical ingredient. We contacted study authors for additional information. We excluded simulation studies. We used the MEDQUARG tool to assess study quality. The main outcome was the prevalence of failed samples.

Findings: We identified 9699 unique citations and included 34 studies (3159 samples from 40 countries) in the review. Most studies (65%) had low quality (scores <6/12). Overall, 48.9% of 1890 uterotonic samples (19 studies) failed quality tests; failures rates were 75% for ergometrine and nearly 40% each for oxytocin and misoprostol. The overall prevalence of failed injectable antibiotics (1090 samples, 18 studies) was 13.4%, ranging from 2.9% for injectable metronidazole (34 samples, 3 studies) to 16.0% for cefazolin (449 samples, 2 studies). The prevalence of low quality magnesium sulphate (179 samples, 2 studies) was 3.4%. We did not find any studies on the quality of carbetocin, tranexamic acid, or clindamycin.

Conclusions: There is a widespread problem with the quality of medicines used to manage life-threatening maternal conditions in LMIC. This can be a contributing factor to high maternal mortality rates in these regions.

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Conflict of interest statement

The authors have declared that no competing interests exist

Figures

Fig 1
Fig 1. Flow chart of the process of study identification and selection.
ATB: antibiotics, LMIC: Low- and middle-income countries.
Fig 2
Fig 2. Prevalence of failed medicines used to manage treat life-threatening maternal conditions in LMIC.
* Prevalence of failed samples for each medicine (number of failed samples/ total number of samples assessed). ** Number in parentheses indicates the number of studies for each medicine.
See this image and copyright information in PMC

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