Published in PLOS One on 2025-12-26, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: David Musoke, Grace Biyinzika Lubega, Claire Brandish, Kate Russell-Hobbs, Natasha Hamilton, Jody Winter, Carol Esther Nabbanja, Filimin Niyongabo, Michael Obeng Brown, Elma Rejoice Banyen, Herbert Bush Aguma, Linda Gibson
Source: PLOS One • DOI 10.1371/journal.pone.0339569
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Few studies have taken a broad perspective on substandard and falsified medicines (SFMs) in community settings in Uganda. We therefore qualitatively assessed the perceptions and practices on SFMs for humans and animals in Wakiso District, Uganda.
This qualitative study employed 12 focus group discussions among community health workers and farmers, as well as 11 key informant interviews among health professionals, local leaders, veterinary and human drug shop operators, and Ministry of Health and Ministry of Agriculture, Animal Industry and Fisheries officials. Data was analysed thematically using NVivo (2020).
Findings are presented under four themes: definition of SFMs; identification of SFMs; drivers of SFMs; and challenges in reporting SFMs. Although participants felt that the term SFMs was too broad to define, many explained it in relation to consequences (such as side effects, disabilities, and death), and the different methods that may be employed to identify SFMs. SFMs were said to be identified through changes in appearance such as colour, texture and packaging. However, the most reported way of identifying SFMs was based on negative effects on humans and animals after use. Customer drivers of SFMs included inadequate knowledge, lack of finances, and lack of access to licensed drug shops/ pharmacies. Supplier drivers of SFMs included limited regulation and enforcement, and the business orientation of drug shops/ pharmacies. Lack of knowledge of how to report suspected cases of SFMs, lack of proof of purchase of SFMs, fear of reporting, and lack of trust in government procedures were the challenges identified to reporting SFMs.
Several drivers of SFMs in the community were established related to individuals, sources of medicine, and regulatory frameworks. Increased awareness on SFMs, improved traceability of purchases and reporting, and better enforcement of regulations are needed to reduce the use and risks associated with SFMs to protect public health.
Introduction
Substandard medicines are authorised medical products that fail to meet the quality standards or specifications set out by regulatory bodies [1,2]. They may contain insufficient quantities of active ingredients or incorrect formulations, typically due to deficiencies in the manufacturing, distribution and/or storage processes [1,2]. For example, the quality of a medicine can deteriorate over time if it is stored incorrectly, leading to inadequate dosing. Falsified medicines deliberately misrepresent their identity, composition, and/or source. These products may intentionally contain no active ingredients, wrong ingredients, or incorrect quantities of the ingredients [1,2]. Between 2017 and 2021, the global incidence of Substandard and Falsified medicines (SFMs) increased by 36.3% [3]. SFMs have been identified as potential drivers of antimicrobial resistance (AMR) [4–9], undermining antimicrobial stewardship (AMS) efforts. As such, action plans, including the Uganda AMR National Action Plan, have a strong emphasis on strengthening detection mechanisms to identify and address SFMs [10,11].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 David Musoke, Grace Biyinzika Lubega, Claire Brandish, Kate Russell-Hobbs, Natasha Hamilton, Jody Winter, Carol Esther Nabbanja, Filimin Niyongabo, Michael Obeng Brown, Elma Rejoice Banyen, Herbert Bush Aguma, Linda Gibson. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Perceptions and experiences of Hospital-Acquired Diarrhea among children aged 0–59 months with Severe Acute Malnutrition at Mwanamugimu Nutrition Unit, Mulago, Uganda: A qualitative study
- Evidence brief: Leadership and management competencies and practices among health managers in Wakiso District, Uganda
- Evidence brief: Early community reactions and acceptance of the Sliding-Scale Community Based Health Insurance Scheme in Ethiopia: Qualitative Findings from the treatment arm
