Counterfeit drugs and public health: a global examination of the impact, challenges, and solutions in low- and middle-income countries

Abstract

Counterfeit drugs remain a significant public health concern in Nigeria, undermining treatment outcomes and consumer trust. This study investigates the prevalence, patterns, and detection practices of counterfeit drug sales in Uyo Metropolis, Nigeria. A cross-sectional survey design was adopted, targeting 200 drug outlets across pharmacies, drugstores, and informal sellers. One respondent—pharmacist or sales personnel was selected per outlet via convenience sampling. Data collection involved structured questionnaires (assessing knowledge, practices, and experiences) and analysis of six-month sales records to identify trends in counterfeit drug sales. Observational visits were also conducted in 50 outlets to assess physical security measures and inventory practices. Quantitative data were analyzed using SPSS (Version 20) with descriptive statistics and chi-square tests, while qualitative data were analyzed thematically. Approximately 75% of pharmacists-sales person reported encountering counterfeit drugs within the past year, with antimalarials, antibiotics, and pain relievers being the most affected. Only 45% could confidently identify counterfeit drugs unaided, while 30% had received formal training. About 60% relied on visual inspection for detection. Consumers were moderately aware of counterfeit drugs (68%), but only 40% knew how to verify them. Sales data revealed that 12% of drugs sold were flagged as counterfeit. Consumer behavior indicated that 45% prioritized price over brand, and 60% were willing to pay a premium for verified medications. Observational assessments revealed limited use of advanced detection tools. The widespread presence of counterfeit drugs and limited detection capacity underscore the need for strengthened regulation, pharmacist training, and consumer education to enhance pharmaceutical safety in Uyo.