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Nigerians can determine the authenticity of malaria medication at the click of a button. But are they using the system? Dunoi Afam wanted to find out as part of his University of Liverpool online Master of Public Health.

Malaria is a serious public health concern around the world. In common with other countries in sub-Saharan Africa, Nigeria not only has to deal with treatment and prevention of the disease, but also with combatting the distribution of counterfeit malaria medication.

In 2012, a third of anti-malaria drugs in the region were fake, according to research published in the Lancet. Counterfeit medicines often contain anti-malarial drugs, but in a diluted form that is ineffective in treating the illness, and could lead to drug resistance, the study’s authors claim. The medicines are sold over-the-counter by sellers who often have no training as pharmacists, leaving the public exposed to the risk of suffering from a life-threatening disease that is treatable – with the right medication.

Mobile phones as a public health tool

Technology has come to the rescue. In Nigeria, packs of pills come with a panel that can be scratched to reveal a unique code. People buying malaria drugs are able to check their authenticity by sending the code via text message (SMS), free-of-charge, to a dedicated number that will let them know if the medicine they are buying is genuine, or not.

Dunoi Afam, a graduate of the University of Liverpool’s online Master of Public Health programme, chose to focus on this initiative in his dissertation. He was curious to find out how successful the mobile authentication service was. He wanted to determine whether people were aware of the service, and whether they were using it.

“The fact that you are aware doesn’t mean that you use it,” he explains, “so I also looked at that.”

A pharmacist by training, Afam is Chief Regulatory Officer for Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC), which put him in an ideal position to pass on his findings to the people operating the authentication service.

Research results

Afam found there was very good awareness of the mobile authentication service among the group he interviewed. The usage of the service was also good, though he found there was a gap between awareness and utilisation, with some people who were aware of the service but not using it.

His dissertation research also revealed that some people were not able to trust the authentication service because of a minor detail in its implementation.

“I checked what their impression was of the service: Are they satisfied with it? Do they think it is helping them? Is it giving them confidence to buy the malaria medication? A lot of them said yes. A few of them had their doubts.”

Afam discovered that some consumers were concerned about the location of the authentication code which manufacturers put on the outer packaging, not on the blister pack containing the pills. This meant that it would be possible for counterfeit pills to be inserted into an authentic box and not be detected by the mobile authentication service. Afam informed his colleagues, and immediate action was taken to change the practice to make the authentication service more reassuring and more secure. Those who benefit are the vulnerable people whose lives Afam wants to improve.

He was able to interview over 500 people. Now the director in charge of research at NAFDAC is planning to expand the survey to gather more data.

“That’s something that gives me a lot of joy,” says Afam. “In a big meeting of top people in the organisation the director mentioned this in front of everyone. I was very excited about that.”

Read more about technologies being developed in Africa to tackle counterfeiting not only in pharmaceuticals but in other products, in this Bloomberg article.

For a different view about the prevalence of fake medicines, see this video summarising a study by the ACT Consortium which is coordinated through the London School of Hygiene and Tropical Medicine and funded by the Bill and Melinda Gates Foundation.

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