USP in Developing Countries

Antimicrobial drug resistance (AMR) has emerged as a major public health issue in recent years. Initially, the problem of AMR was solved by the discovery of new classes of drugs and by modifying existing drugs; unfortunately, the development of new antimicrobial drugs cannot keep pace with the ability of microorganisms to develop resistance.

A young girl in a remote village in Stung Treng province, Cambodia, practices handwashing, following hygiene advice provided by a Pharmaciens Sans Frontières (PSF) health education team.

The increase in the incidence of AMR contributes to comparable increases in morbidity, mortality, and cost of health care; prolonged periods during which individuals are infectious; and greater opportunities for spread of infection to other individuals. Infectious diseases, such as tuberculosis (TB), sexually–transmitted infection, acute respiratory infection, malaria, dysentery, and HIV/AIDS are becoming increasingly difficult and expensive to treat. And while the problem of AMR is troublesome both in developed and developing countries, the burden is greatest in developing countries where resources are limited, the availability and use of antimicrobials are poorly controlled, and infection rates are high.

The many factors contributing to AMR are more evident in resource–constrained countries with deficient health systems and weak pharmaceutical drug management capacity, including scarce health professional expertise on AMR and rational antimicrobial use. Although proven tools and approaches exist to improve the management and use of antimicrobials, there are few AMR advocacy and containment programs in place at the country level. Awareness about the dangers posed by AMR is generally non–existent and relevant packages of pharmaceutical management and AMR interventions are not being implemented. Further, the public health is increasingly threatened by counterfeit and substandard pharmaceutical products which can also accelerate the development of resistance.

USP DQI promotes the implementation of appropriate preventive strategies to help reduce the problem of AMR in health care settings and in the community. USP DQI leads a Working Group of the International Federation of Pharmacists (FIP) to examine the causes and the magnitude of the problem from a regional and global perspective, to help define the roles of pharmacists and professional health organizations in setting strategies to reduce them, to define measures to curb the problem of AMR, and to identify information resources on the appropriate use of antimicrobials. USP DQI collaborates with the International Council of Nurses to produce an Antimicrobial Drug Resistance Fact Sheet For Nurses (available in English

(173KB), French

(180KB) and Spanish

(209KB)) that provides essential information to community nurses about the dangers of AMR and what they—often the first contact for patients seeking treatment—can do to promote rational antimicrobial use and encourage the use of preventive measures. In addition, USP DQI actively participates in international conferences and collaborations to understand the science of AMR and advance strategies for implementation of practical prevention of its further proliferation.

Avian Influenza

A nurse reads a USAID brochure on Avian Flu safety at an Azerbaijan Hospital.

Since its emergence in Southeast Asia in mid–2003, avian influenza (AI) has spread across Asia, into some countries in Europe and Eurasia, and to Africa. Due to the rapid spread of the virus, there is increasing concern that it could potentially develop into a global human pandemic. The United States Agency for International Development (USAID) and its partners find the greatest concern in South East Asia, where recurring outbreaks of the H5N1 strain of the virus in animals have occurred in more than 17 countries, resulted in the largest portion of confirmed AI cases and deaths. A drug product used to effectively treat AI, oseltamivir phosphate (Tamiflu® capsule), is currently in production; however, many country governments have begun to stockpile the product, anticipating a shortage in the event of pandemic, and anecdotal reports of counterfeited medicine sold by unreliable sources have raised concerns among experts and consumers alike. USP DQI is assisting the international effort in preparing to treat AI by addressing the issues of drug quality as well as preventing outbreaks by raising awareness of the disease through its drug information centers.

A drug product used to effectively treat AI, oseltamivir phosphate (Tamiflu® capsule), is currently in production; however, many country governments have begun to stockpile the product, anticipating a shortage in the event of pandemic, and anecdotal reports of counterfeited medicine sold by unreliable sources have raised concerns among experts and consumers alike. USP DQI is assisting the international effort in preparing to treat AI by addressing the issues of drug quality as well as preventing outbreaks by raising awareness of the disease through its drug information centers.

With support from the USAID Regional Development Mission in Asia, USP DQI is providing technical assistance to selected countries in the region to build the capacity of medicine regulatory agencies and national infectious disease programs. USP DQI is developing analytical testing methods for oseltaminir phosphate, allowing regional sentinel sites to detect substandard and counterfeit preparations and developing guidelines on the procurement, distribution, storage, and analysis of oseltamivir phosphate products to ensure its quality throughout the entire distribution chain. Establishing or improving existing pre–marketing authorization and post–marketing surveillance activities could reduce the prevalence of poor quality medicines for infectious diseases circulating in Asia's regional markets.

Maternal and Child Health

Child survival interventions in Peru focus on child nutrition, the control of diarrheal disease, and immunizations.

Childhood Diarrhea: Approximately 1.5 million children under the age of five die every year from acute diarrhea, primarily in developing countries, despite using oral rehydration salts (ORS) and oral rehydration therapy (ORT). Diarrhea can lead to micronutrient deficiency such as zinc loss. Zinc plays an important role in growth and development; it also boosts the immune system needed to fight diseases. Clinical studies have shown that zinc with ORS not only treats acute diarrhea, but reduces the severity of diarrheal episodes and helps prevent future occurrence in children.

Postpartum Hemorrhage (PPH): PPH accounts for about 25% of maternal deaths worldwide and for up to 60% in some developing countries. Incidence of PPH is exacerbated in the developing world because appropriate drugs are often unavailable and predisposing factors, such as high multiparity and severe anemia, are commonly found. PPH can be prevented with active management of the third stage of labor through administration of oxytocics, early cord clamping and cutting, and delivery of the placenta by controlled cord traction of the umbilical cord.

Antimicrobial Resistance

Avian Influenza

Maternal and Child Health