Substandard, falsified, unlicensed, and unregistered medicines pose significant risks to public health in developed and developing countries. This systematic review provides an overview of the prevalence of substandard, falsified, unlicensed, and unregistered medicine and its associated factors in Africa. Articles published from April 2014 to March 2024 were searched in Google Scholar, Science Direct, PubMed, MEDLINE, and Embase. The search strategy focused on open-access articles published in peer-reviewed scientific journals and studies exclusively conducted in African countries. The quality of the studies was assessed according to the Medicine Quality Assessment Reporting Guidelines (MEDQUARG). This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Of the 27 studies, 26 had good methodological quality after a quality assessment. Of the 7508 medicine samples, 1639 failed at least one quality test and were confirmed to be substandard/falsified medicines. The overall estimated prevalence of substandard/falsified medicines in Africa was 22.6% (1718/7592). The average prevalence of unregistered medicines was 34.6% (108/312). Antibiotics, antimalarial, and antihypertensive medicines accounted for 44.6% (712/1596), 15.6% (530/3530), 16.3% (249/1530), and 16.3% (249/1530), respectively. Approximately 60.7% (91/150) were antihelmintic and antiprotozoal medicines. Poor market regulatory permission, Free trade zones, poor registration, high demand, and poor importation standards contribute to the prevalence of these problems. Substandard, falsified, and unregistered medicines are highly prevalent in Africa, and attention has not been paid to the problem. Antibiotics, antimalarial, anthelmintic, and antiprotozoal are the most commonly reported substandard, falsified, and unregistered medicines. A consistent supply of high-quality products, enhancement of registration, market regulatory permission, and importation standards are essential to counter the problems in Africa. Preventing these problems is the primary duty of every responsible nation to save lives.

Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antimicrobial stewardship (AMS). There is a need to review current evidence on antibiotic use, access, and AMR, in primary care across key countries.Areas covered: This narrative review analyses publications from 2018 to 2024 regarding access, availability and use of appropriate antibiotics. There were very few studies focussing on a lack of access to antibiotics in primary care. However, there was considerable evidence of high rates of inappropriate antibiotic use, including Watch antibiotics, typically for minor infections, across studied countries exacerbated by patient demand. The high costs of antibiotics in a number of LMICs impacts on their use resulting in short courses and sharing of antibiotics. This can contribute to AMR alongside the use of substandard and falsified antibiotics. Overall, limited implementation of national action plans, insufficient resources, and knowledge gaps, affects sustainable development goals to provide routine access to safe, effective and appropriate antibiotics. There is a clear need to focus health policy on the optimal use of essential AWaRe antibiotics in primary care settings to reduce AMR in LMICs.

Introduction: Having good knowledge and a favorable attitude toward human papillomavirus (HPV) and HPV vaccinations is the cornerstone for increasing the use of HPV vaccinations and preventing cervical cancer. The objective of this study was to evaluate the level of knowledge, attitudes, and practices regarding HPV and HPV vaccinations, as well as to identify associated factors among female undergraduate health science students at both the University of Gondar (UoG) and Bahir Dar University (BDU), Amhara, Ethiopia. Methods: Institutional-based multicenter descriptive cross-sectional study was conducted from June 1, 2023, to July 30, 2023. A multistage sampling technique was used to select 633 female undergraduate health science students, and data were collected using a structured, self-administered questionnaire. The data were coded, entered in Epi-data, and exported to SPSS for analysis. Variables with a P-value < 0.25 in the bivariate analysis were inserted in a multivariate logistic regression model, and those with a P-value of < 0.05 in the multivariate binary logistic regression were considered statistically significant factors for knowledge, attitude, and practice regarding HPV and vaccine against it. Results: The study included 600 participants with a mean age of 20.8 ± 0.75 years. Using Bloom’s cutoff points for the KAP study, among the participants, 436 (72.7%) had good knowledge about HPV, whereas 315 (52.5%) had good knowledge about HPV vaccinations. More than half of the participants, 359 (59.8%) heard about HPV vaccinations in Ethiopia. More than half of the participants, 342 (57%) had favorable attitudes toward HPV vaccinations. Only 261 (43.5%) participants believed the HPV vaccine was safe and effective. All participants had never been tested for HPV, and 471 (78.5%) refused to have their samples for regular HPV testing. The factors like ages between 21 and 23 years (AOR, 2.12, 95% CI: 1.22–3.09) and favorable attitudes toward HPV vaccinations (AOR: 1.88; 95%, CI: 1.15–3.41) were associated with the participant’s knowledge about HPV vaccinations. Having good knowledge about the virus (AOR: 1.92; 95%, CI: 1.11–5.88) and its vaccine (AOR:1.60; 95%CI: 1.07–2.47) were factors associated with the attitude of the participants about HPV vaccinations. Additionally, HPV vaccination practice was significantly associated with the attitude of the participants toward HPV vaccinations (AOR: 1.85; 95%CI: 1.15–3.45), knowledge about HPV (AOR: 1.18; 95%CI: 0.55–5.50), and HPV vaccinations (AOR: 1.85; 95%CI: 1.08–2.44). Conclusion: This study revealed that half of the students had good knowledge and a favorable attitude toward HPV vaccinations, but there was poor HPV vaccination practice. There is still a need for continued health education, training, and counseling services for students to strengthen HPV vaccination practices, improve students’ attitudes and knowledge about the benefits of vaccination, and improve counseling abilities against HPV-induced cancer.

Introduction. Fresh vegetables are of a great value and the most common foods in the human diet around the world. They contain minerals, vitamins, antioxidants, antimetabolites, protein, carbohydrates, and water. However, they are a major source of heavy metals, which contain both essential and toxic heavy metals over a wide range of concentrations. The study sites serve as a regional commercial center, where vegetables such as cabbages, onions, carrots, potatoes, beetroots, lettuce, and tomatoes were irrigated year round and sold to consumers. The aim of the study was to determine the level of cadmium, chromium, copper, and lead and to estimate the health risks associated with their daily intake of vegetables marketed in Bahir Dar town, Northwest Ethiopia. Methods. The concentrations of copper (Cu), chromium (Cr), cadmium (Cd), and lead (Pb) were determined, and their health risks were estimated using estimated daily intake (EDI), target hazard quotient (THQ), hazard index (HI), and target cancer risk (TCR) for selected heavy metals by using flame atomic absorption spectrometry. A total of 5kg composite samples for each type of vegetable were collected by simple random sampling from an open market in Bahir Dar town, Northwest Ethiopia, and subsamples (1.25kg) were digested via the wet digestion method. Results. The average concentrations of Cr and Cu in all selected vegetables were lower than the maximum limit of expected values. However, the concentration (mg.kg⁻¹) of Pb in carrots, potatoes, and beetroots exceeded the safe limit of 0.3mg·kg⁻¹ set by the FAO/WHO and the concentration of Cd (mg·kg⁻¹) in carrots, which is higher than the FAO/WHO limit, 0.2mg·kg⁻¹, in dry weight. The health index (HI) values (mg·kg⁻¹ day⁻¹) of all vegetables except carrots were lower than one. The TCR values for Pb, Cd, and Cr in all vegetables exceeded the US-EPA recommended threshold risk limit, but the TCR value of carrot was above the moderate risk limit (>1×10⁻³) set by the US-EPA. Conclusion. This study indicated that the concentration level of lead and cadmium in potatoes, onions, carrots, and beetroots marketed in Bahir Dar town is not safe for use by the local community. The consumption of carrots in the study area may cause both noncancerous and cancerous health risks. Therefore, regular monitoring of these toxic metals in vegetables should be carried out to prevent heavy metal toxicity associated with the consumption of those vegetables marketed in Bahir Dar town, Ethiopia.

Background. Environmental contamination by heavy metals has become a worldwide problem in recent years because of industrial and agricultural development which causes cereal crop contamination via their wastes. The presence of toxic heavy metals in cereal crops accumulate in the body for a prolonged period of time which poses acute and chronic health risks. The aim of the study was to assess the level of heavy metals in selected cereals sold at Debre Markos local market, in Ethiopia. Methods. The samples were prepared for analysis by using the dry ashing method, and their cadmium, lead, chromium, and copper contents were analyzed by using microwave-induced plasma-atomic emission spectroscopy (MP-AES) and were expressed in mgkg⁻¹ dry weight. The accuracy of the method was analyzed by the spike recovery test. Results. The percentage recovery for Cr, Cu, Pb, and Cd in each sample ranged from 85.6 to 112.8. The levels of heavy metals (mean±SD) were as follows: chromium, 2.20±0.072, 2.22±0.061, 1.57±0.48, and 1.84±0.26; copper, 2.94±0.19, 2.31±0.06, 1.28±0.13, 1.52±0.035, and 2.31±0.06; lead, 0.49±0.031, 0.34±0.121, 0.52±0.029, and 0.37±0.15; and cadmium, 2.01±1.73, 1.84±1.60, 1.95±1.69, and 1.93±1.67 for barley, teff, wheat, and maize, respectively. This study revealed that the levels of Cr and Cu are generally below the permissible limit. However, the levels of Pb and Cd in all cereal samples were found to be above the permissible limit set by FAO/WHO, 0.2 and 0.1mgkg⁻¹, respectively. Conclusion. The findings of the study suggest that most of the analyzed crops contained unsafe levels of lead and cadmium that exceeded the WHO permissible limits. Therefore, regular monitoring of these toxic metals in cereal crops should be carried out to prevent heavy metal toxicity associated with the consumption of some cereal crops marketed in the Debre Markos local market, Ethiopia.

Background: Anthrax is a zoonotic disease caused by the Bacillus anthracis bacteria, which is one of the top five important livestock diseases and the second top priority zoonotic disease, next to rabies, in Ethiopia, which remains a major problem for animals and public health in Ethiopia. This study was conducted to verify the existence of the outbreak, determine risk factors, and implement measures to control the anthrax outbreak in Farta woreda, South Gondar zone, Northwest Ethiopia in 2019. Methods: A community-based case-control study was conducted from March 25 to April 1, 2019. A structured questionnaire was used to collect data and for review of documents and discussion with livestock and health office staff. The collected data were analyzed by SPSS and presented in tables and graphs. Results: A total of 20 human anthrax cases with an attack rate of 2.5 per 1000 population were reported from the affected kebele. The age of the cases ranged from 1 month to 65 years (median age = 37.5 years). Of the total cases, 66.7% were male and 77.8% were 15 and older. The probability of developing anthrax among people who had unvaccinated animals was higher than in those who didn’t have unvaccinated animals with an AOR = 8.113 (95% CI 1.685–39.056) and the probability of getting anthrax in relation to people’s awareness of anthrax was AOR = 0.114 (95% CI 0.025–0.524). Conclusion: An anthrax outbreak occurred in Wawa Mengera Kebele of Farta woreda. The presence of unvaccinated animals in a household was found to be a risk factor for anthrax cases. Timely animal vaccination and strengthening health education on the vaccination of animals, mode of transmission, and disposal of dead animals are essential for preventing anthrax cases.