The region is also suffering from

The region is also suffering from administrative negligence, extreme poverty, lack of basic health facilities, and weak infrastructure, which have increased its vulnerability to the climatic misery. Travel time to the nearest health facility is 2–4 h, at a cost of PKR 1000–4000 (US$10–40) in a region with an average monthly income of PKR 4391 ($44). Women\'s health is neglected, as it is in many remote villages of Pakistan. The problems are rooted in cultural beliefs and lack of reproductive heath facilities. Only 14% of births are attended by skilled birth attendants, and among women who conceived in the past 3 years, fewer than half made one antenatal visit. The district ranks last in Sindh province in terms of access to improved drinking water and sanitation. Fewer than half of the children are fully immunised and only 60% children younger than 1 year are immunised against measles. The infant mortality rate is 87 per 1000 livebirths and maternal mortality rate 297 per 100 000 livebirths. The health sector in the region is facing a dearth of doctors, paramedics, medicines, and equipment. There are 150 doctors, eight lady health visitors, 32 midwives, and almost no paramedics. There are only three hospitals and 32 basic health units for a galanin of almost a million.
Poor-quality medicines and medical products, both substandard and falsified, cause avoidable morbidity, mortality, drug resistance, and loss of faith in health systems, especially in low-income and middle-income countries. We report the analysis of two falsified medicines from Angola and discuss what lessons such a discovery could hold. The tablets were seized at Luanda docks in June, 2012, after failing Minilab testing. The seized shipment was enormous (1·4 million packets), and hidden in loudspeakers in a container from China. One sample was labelled as an adult course of the vital antimalarial drug artemether-lumefantrine, and as being manufactured by “Novartis Pharmaceutical Corporation”; Transplantation antigen also bore an Affordable Medicines Facility—malaria logo (). Another sample was labelled as the broad-spectrum anthelmintic mebendazole, and as being manufactured by “Janssen-Cilag SpA”. We analysed the tablets with an array of analytical platforms, including high-performance liquid chromatography, ambient ionisation mass spectrometry, Raman spectroscopy, Xray powder diffraction (XRD) analysis, , and botanical assays. Packaging was analysed with the portable counterfeit detection device CD-3 (see for detailed methods). No artemether, lumefantrine, or other active pharmaceutical ingredients were detected in the “artemether-lumefantrine” tablets by any of the chemical assay techniques. Brushite and three different yellow dyes (pigment yellow 3, pigment yellow 81, and pigment yellow 151) were detected. No mebendazole was detected in the “mebendazole” tablets, but the active ingredient levamisole (270 mg/tablet) was. XRD analysis revealed the presence of calcite (CaCO), with IRMS data suggesting that it was either hydrothermal or medical in origin. The CD-3 ultraviolet-visible and infrared images of the falsified and genuine packaging readily showed substantial differences between them. Language errors on the “mebendazole” packages were common, suggesting that the forger may have had some knowledge of English but little of French and Spanish. Falsified artemether-lumefantrine has also been described across central and west Africa. Such products will inevitably cause increased morbidity, mortality, and transmission, and could falsely indicate that artemisinin resistance had arrived. Additionally, modelling strongly suggests that underdosing is an important contributor to resistance. Therefore, if patients consume co-circulating falsified and substandard medicines sequentially, so that heavy parasite burdens encounter low drug concentrations, the risks of engendering resistance are high.