Medication errors in primary care in the developing world

Global spending on pharmaceuticals is roughly a $1 trillion, dominated by the US, Japan and major EU economies. Yet emerging markets and the developing world still account for around a third of expenditure. That’s a lot of medicines and it’s growing. With this substantial use of medications comes a significant risk of harm, compounded by the increasingly complex medical needs of an ageing population. A considerable body of evidence points to medication errors as an important problem.

Importantly, however, most of the studies are hospital based and originate from Western nations. There are few relevant data on medication errors in developing and transitional countries, especially outside the hospital environment. A handful of studies have examined the issue in primary care in Latin America, the Middle East and Asia, although there is a notable lack of evidence from Africa. A 2013 WHO study reviewed medication use more generally in such countries, finding poor (<40%) adherence to standard treatment guidelines, worse in the private-for-profit sector.

There is a pressing need for more studies from these regions, given they experience different challenges to Western nations where the majority of large, high-quality studies have been based. Differences exist in terms of clinical problems, drug classes and health service organisation. For example, primary health care is significantly underdeveloped in Africa, there may be inadequate training in pharmacy, and access to health care in developing countries may be poor and depend on private and informal health care providers. Patient issues are also relevant, with differing health care beliefs, and lower levels of education and literacy. Availability of counterfeit medicines is a further concern. A specific area of importance is injections; the prevalence of injection use is considerably higher in low income countries, introducing issues around storage, reconstitution, weight-dependent dosing, route of administration, and infection control.

All these issues mean that the risks of medications posed in developing and transitional countries, as well as the solutions required, may differ considerably from those in Western nations, and the definition and classification of medication errors, together with corresponding safety indicators, may need to be refined accordingly in these settings.

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