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School of Pharmacy, Centro Escolar University-Manila, 9 Mendiola St., San Miguel, Manila 1008, Metro Manila, Philippines.
Copyright © 2022 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0.
Extent of Filipinos’ Awareness in Identifying Counterfeit Medicines: A Quantitative
Cross-Sectional Study
Jennie Vave D. Isuga 1, *, Cathlyanna May D. Dela Cruz 1, Jacob T. Urriza 1, Luigi G. Abas 1, Eireen Mean D. Dela
Cruz 1, Del Celestine B. Jardinero 1, Maria Elisha A. Flores 1, Shaira Mae D. Sevilla 1, Mary D. Catapang 1, Cecilia
D. Santiago 1, 2 and Mylene S. Andal 1
1 School of Pharmacy, Centro Escolar University-Manila, 9 Mendiola St., San Miguel, Manila 1008, Metro Manila, Philippines.
2 The Graduate School, Centro Escolar University-Manila, 9 Mendiola St., San Miguel, Manila 1008, Metro Manila,
Philippines.
GSC Advanced Research and Reviews, 2022, 12(03), 094 –108
Publication history: Received on 06 August 2022; revised on 07 September 2022; accepted on 09 September 2022
Article DOI: https://doi.org/10.30574/gscarr.2022.12.3.0237
Abstract
Counterfeit drugs have been purposefully and falsely mislabeled in terms of their identity and/or source of both
branded and generic products. The use of these drugs can lead to reduced safety and efficacy that may result in adverse
events. This study aimed to assess the extent of Filipinos’ awareness in identifying counterfeit medicines, and its
association with the sociodemographic characteristics of the respondents. A quantitative cross-sectional survey was
conducted on 267 Filipino consumers residing in the Philippines with the use of convenience sampling, where a pre-
validated online questionnaire was utilized to gather data about the respondents’ sociodemographic characteristics,
sources of information, knowledge of counterfeit medicines, and ability to identify counterfeit medicines. The study
utilized frequencies, percentages, mean, standard deviation, Chi-square, and t-test for independence. Among the six
demographic characteristics, only the respondents’ marital status (p-value = 0.000) had a significant association with
the sources of information regarding counterfeit medicines while both age (p-value = 0.010) and marital status (p-value
= 0.000) were found to be associated with their knowledge of counterfeit medicines. The results of the Chi-square test
showed that a high level of knowledge was significantly associated only with a moderate level of ability to identify
counterfeit medicines (p-value=0.000) since 73.03% of the sample had a high level of knowledge while 61.80% had a
moderate level of ability to identify counterfeit medicines. Therefore, the need for public education and raising
awareness is essential, which necessitates the involvement of healthcare professionals.
Keywords: Counterfeit medicines; Awareness; Identification; Cross-sectional
1. Introduction
Counterfeit drugs are defined as drugs that have been purposefully and falsely mislabeled in terms of their identity
and/or source of both branded and generic products. In addition to that, counterfeit medicines may also be products
that have specified ingredients but are deficient in terms of their quantities, such as inadequacy or absence of active
pharmaceutical ingredients, as well as those products that have erroneous ingredients. Moreover, counterfeit medicines
have fraudulent parts, and containers, or branded without the approved trademark, brand names, or other recognition
label or imprint that indicates registration or property to the Bureau of Patent, Trademark, and Technology Transfer
(BPTTT) in the title of another human or non-human legal entity. Furthermore, unregistered foreign-made products
that are not acknowledged or merited by associated health information, and drugs that contain counterfeit active
substances or below 80% of the active material it claims to acquire are also considered counterfeit medicines. In which
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all of these may result in reduced safety, efficacy, quality, strength, and/or purity of the drugs leading to adverse events
[1, 2]. These products do not undergo various processes and validation upon marketing resulting in reduced safety,
efficacy, quality, strength, and/or purity of the drugs leading to adverse events such as unexpected side effects, allergic
reactions, worsened pre-existing conditions, or even death [3].
This major public hazard is observed in many underdeveloped countries such as Asia, Latin America, and Africa where
the number of counterfeit pharmaceuticals on the market is more than 30%. Meanwhile, less than 10% of all
pharmaceuticals available in other developing markets are counterfeit [4]. Despite the rampancy of counterfeit
pharmaceuticals, studies have shown that these countries often focus on efforts that measures and quantify the
incidences of counterfeit medicines and neglect to address the variables that contribute to their prevalence. For
instance, the demand from the consumers contributes to the continuous supply of counterfeit drugs but there has been
surprisingly little research aimed at investigating the counterfeit drug problem in these countries, particularly from the
standpoint of consumers. In fact, the Philippines is still named as the leading source of counterfeit drugs by the United
States Trade Representative (USTR) despite the presence of RA 8203 or the Special Law on Counterfeit Drugs. This is
due to the fact that this law is more focused on the supply side, but the problem applies to both supply and demand.
Therefore, there is a dire need in assessing the situation from the Filipino consumers’ point of view.
Lack of awareness and identification limits consumer involvement or readiness to report counterfeit products, as a
consequence, scattered and insufficient reporting of occurrences is obtained, making it difficult to quantify the effect on
patient's health and the implications of counterfeit drugs [5, 6].With that, this study aims to determine the extent of
Filipinos' awareness in identifying counterfeit medicines to help raise public knowledge against counterfeit drugs, and
public awareness about the growing counterfeit drug trade as well as the dangers they pose to public health.
2. Material and methods
This quantitative cross-sectional study was conducted in the Philippines between February 2022 and March 2022 and
was approved by the Centro Escolar University Institutional Ethics Review Board prior to the data collection. A sample
size of 267 respondents was determined using Cochran’s formula, wherein a non-probability convenience sampling was
utilized. The respondents were Filipino consumers 18 years old and above with English and/or Filipino literacy who
tend to use and purchase their medicines in either drug stores or online platforms. People below 18 years old who lack
access to the Internet were not included in the study. The questionnaire was validated (Cronbach’s α = 0.928) by three
BS Pharmacy lecturers from CEU-Manila, and one faculty from the Psychology Department of CEU-Makati.
The research instrument used in this study was in the form of an online survey questionnaire through Google Forms,
which was inspired by previously conducted similar studies. It was composed of forty-nine items, which were divided
into four sections namely respondent’s socio-demographic profile, sources of information, knowledge of counterfeit
medicines (CFMs), and ability to identify CFMs. All the questions on knowledge of CFMs and ability to identify CFMs
were prepared on a four-point Likert scale, ranging from strongly disagree to strongly agree, corresponding to 1 point
to 4 points, respectively. A scale based on a study by Alfadl et al. [7]. was modified and used to assess the extent of
respondents’ knowledge regarding CFMs and their ability to identify CFMs. The total scores for the 14 questions on the
knowledge of CFMs were classified as low-level (14-27), moderate level (28-44), and high-level (45-56). On the other
hand, the total scores for the 24 questions on the ability to identify CFMs were also categorized as low-level (24-47),
moderate level (48-76), and high-level (77-96).
Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 21. Frequencies and percentages
were used to determine the socio-demographic profile of the respondents. Means and standard deviations were utilized
in determining the respondents’ main source of information regarding CFMs, knowledge of CFMs, and ability to identify
CFMs. Chi-square was performed to determine the association between independent variables and the extent of
Filipinos’ awareness in identifying CFMs. Lastly, t-test for independence was utilized to determine if there was a
difference between the respondents’ ability to identify counterfeit over-the-counter medicines and counterfeit
prescription medicines.
3. Results and discussion
In this study, the majority of the respondents were 18-25 years old (47.57%) belonging to Gen Z. Most of the
respondents were female (76.03%), single (71.16%), college graduates (50.56%), and had a healthcare-related
occupation (41.95%). Also, most of the respondents have a monthly income of P24,001 to P47,000 (36.70%),
categorized as a lower-middle-income class (Table 1).
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Table 1 Respondents’ Sociodemographic Characteristics
Sociodemographic
Characteristic
Parameter
Frequency (n)
Percentage (%)
Age
18 – 25
127
47.57
26 – 41
101
37.83
42 – 57
37
13.85
58 – 67
2
0.75
68 – 76
0
0.00
Sex
Male
64
23.97
Female
203
76.03
Marital Status
Single
190
71.16
Married
73
27.34
Separated or Divorced
1
0.37
Widowed
3
1.12
Educational Attainment
Elementary Undergraduate
0
0.00
Elementary Graduate
1
0.37
High School Undergraduate
2
0.75
High School Graduate
21
7.87
Vocational
9
3.37
College Undergraduate
83
31.09
College Graduate
135
50.56
Post-Baccalaureate
16
5.99
Occupation
Healthcare Related
112
41.95
Non-healthcare Related
66
24.72
Unemployed
89
33.33
Household's Average
Monthly Income
Below P12,000
36
13.48
P12,001 to P24,000
67
25.09
P24,001 to P47,000
98
36.70
P47,001 to P82,000
49
18.35
P82,001 to P140,000
7
2.62
P140,001 to P234,000
6
2.25
P234,000 and above
4
1.50
The majority of the respondents mentioned healthcare facilities as a source of information (mean = 3.195), which was
then followed by various social media platforms (mean = 3.127) (Figure 1). This finding opposed the results of a study
by Wagiella et al. [8], which suggested that social media platforms are the main source of information about CFMs,
followed by pharmacies.
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Figure 1 Respondents’ Sources of Information Regarding CFMs
The respondents defined CFMs as products with insufficient amounts of correct ingredients, wrong ingredients, without
active ingredients, and with sufficient quantity of active ingredients, which might all result in the reduction of the drug’s
safety, efficacy, quality, and strength, or purity (mean = 3.386); and as a drug that is deliberately and intentionally
mislabeled with respect to identity and/or source or with fake packaging (mean = 3.386) (Table 2). The second
definition coincides with that of the World Health Organization, which defines it as deliberately and fraudulently
produced and/or mislabeled with respect to identity and/or source to make it appear to be a genuine product [9]. On
the other hand, the respondents recognized checking if the security seal is intact or has been tampered with as the main
method of checking the authenticity of medicines (mean = 3.618) (Table 3). This result corresponds with the finding of
a survey in Hong Kong, which revealed that the top method for verifying the authenticity of medicines was also checking
the intactness of the security seal [10]. Meanwhile, treatment failure was the most identified health consequence of
CFMs (mean = 3.573) (Table 4). This finding is higher than that of the study conducted in India wherein more than half
of the respondents had the knowledge that counterfeit drugs are associated with treatment failure [11].
Table 2 Respondents’ Knowledge of CFMs Based on their Definition on RA 8203
Sr.
no.
Definition of CFMs
Mean
Verbal
Interpretation
I am aware that CFMs refer to:
1.
Medicinal products with insufficient amount of correct ingredients, wrong
ingredients, without active ingredients, with sufficient quantity of active
ingredient; which might all result in the reduction of the drug’s safety, efficacy,
quality, strength or purity.
3.386
Strongly Agree
2.
A drug which is deliberately and intentionally mislabelled with respect to identity
and/or source or with fake packaging.
3.386
Strongly Agree
3.
Products that can be both branded and generic.
2.996
Agree
4.
A drug product refilled in containers by unauthorized persons if the legitimate
labels or marks are used.
3.273
Strongly Agree
5.
An unregistered imported drug product that is not confirmed and justified by
accompanying medical records.
3.292
Strongly Agree
Overall Mean
3.267
Strongly
Agree
*Verbal Interpretation: Strongly disagree = 1.00-1.74; Disagree = 1.75-2.49; Agree = 2.50-3.24; Strongly Agree = 3.25-4.00
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Table 3 Respondents’ Knowledge of CFMs Based on the Methods of Checking the Authenticity of Medicines
Sr.
no
Method of Checking the Authenticity of Medicines
Mean
Verbal
Interpretation
I am aware that methods of checking the authenticity of medicines include:
1
Checking if the security seal is intact or has been tampered with.
3.618
Strongly Agree
2
Looking out for unusual fonts, font sizes, print color, and spelling errors.
3.446
Strongly Agree
3
Asking a doctor about the authenticity of the medicine.
3.386
Strongly Agree
4
Asking a pharmacist about the authenticity of the medicine.
3.543
Strongly Agree
Overall Mean
3.498
Strongly
Agree
*Verbal Interpretation: Strongly disagree = 1.00-1.74; Disagree = 1.75-2.49; Agree = 2.50-3.24; Strongly Agree = 3.25-4.00
Table 4 Respondents’ Knowledge of CFMs Based on their Health Consequences
Sr.
no.
Health Consequence of CFMs
Mean
Verbal
Interpretation
I am aware that counterfeit medicine/s is/are associated with:
1
Treatment failure.
3.573
Strongly Agree
2
Increased number of unexpected side effects.
3.569
Strongly Agree
3
Unexpected allergic reactions.
3.566
Strongly Agree
4
Overdosing, which in some cases may lead to poisoning.
3.509
Strongly Agree
5
Increase in the cost of treatment.
3.431
Strongly Agree
Overall Mean
3.530
Strongly
Agree
*Verbal Interpretation: Strongly disagree = 1.00-1.74; Disagree = 1.75-2.49; Agree = 2.50-3.24; Strongly Agree = 3.25-4.00
In terms of the ability to identify CFMs, the most identified physical attribute was the pattern on the packaging and
placement of the printed details (mean = 3.378) (Table 5). This finding did not coincide with the studies conducted by
El-Dahiyat et al. [12], wherein the most identified label of information was found to be the manufacturing and expiration
date. On the other hand, Phenylephrine HCl + Chlorpheniramine Maleate + Paracetamol was the most identified
counterfeit over-the-counter (OTC) medicine (mean = 3.191) (Table 6), while Sildenafil citrate (mean = 3.195) was
established as the most identified counterfeit prescription medicine (Table 7). The sophisticated skills of counterfeit
manufacturers led to the production of drugs where the packaging looks almost exactly the same as the authentic
medicines, coming to the point where the only method to distinguish them is through chemical tests and analytical
techniques [10]. It justifies the result that regardless of the category of the medicine, counterfeiting skills are applied to
maximize fraudulent activities. Meanwhile, the result in the t-test of independence showed that there was no significant
difference between the respondents’ ability to identify counterfeit OTC medicines and counterfeit prescription
medicines (p-value = 0.697) (Table 8).
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Table 5 Respondents’ Ability to Identify CFMs Based on Label, Packaging, and Appearance
Sr.
no
Ability to Identify CFMs Based on Label, Packaging, and Appearance
Mean
Verbal
Interpreta
tion
I am aware that the presented image is a/an:
1
Counterfeit medicine
based on its generic
name.
2.813
Agree
2
Counterfeit medicine
based on its batch
number/lot number.
3.060
Agree
3
Counterfeit medicine
based on its pack size.
2.753
Agree
4
Counterfeit medicine
based on its dosage
strength & dosage form.
2.914
Agree
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5
Counterfeit medicine
based on its
manufacturing &
expiration date.
2.850
Agree
6
Authentic medicine
based on its brand
name.
3.337
Strongly
Agree
7
Authentic medicine
based on the pattern on
the packaging and the
placement of the
printed details.
3.378
Strongly
Agree
8
Authentic medicine
based on its net volume.
3.011
Agree
9
Authentic medicine
based on the tablet
markings.
2.929
Agree
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10
Authentic medicine
based on the tablet’s
color.
3.165
Agree
Overall Mean
3.021
Agree
*Verbal Interpretation: Strongly disagree = 1.00-1.74; Disagree = 1.75-2.49; Agree = 2.50-3.24; Strongly Agree = 3.25-4.00
Table 6 Respondents’ Ability to Identify Counterfeit OTC Medicines
Sr. no
Ability to Identify Counterfeit OTC Medicines
Mean
Verbal
Interpreta
tion
I am aware that:
1
Figure A is an
authentic medicine
compared to
Figure B.
2.891
Agree
2
Figure B is an
authentic medicine
compared to
Figure A.
3.180
Agree
3
Figure B is an
authentic medicine
compared to
Figure A.
3.191
Agree
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4
Figure A is an
authentic medicine
compared to
Figure B.
2.528
Agree
5
Figure A is an
authentic medicine
compared to
Figure B.
2.798
Agree
6
Figure B is an
authentic medicine
compared to
Figure A.
2.865
Agree
7
Figure A is an
authentic medicine
compared to
Figure B.
2.805
Agree
Overall Mean
2.894
Agree
*Verbal Interpretation: Strongly disagree = 1.00-1.74; Disagree = 1.75-2.49; Agree = 2.50-3.24; Strongly Agree = 3.25-4.00
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Table 7 Respondents’ Ability to Identify Counterfeit Prescription Medicines
Sr. no
Ability to Identify Counterfeit Prescription Medicines
Mean
Verbal
Interpreta
tion
I am aware that the presented image is a/an:
1.
Figure A is an
authentic medicine
compared to Figure B.
3.064
Agree
2.
Figure A is an
authentic medicine
compared to Figure B.
2.708
Agree
3.
Figure A is an
authentic medicine
compared to Figure B.
2.955
Agree
4.
Figure B is an
authentic medicine
compared to Figure A.
2.603
Agree
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5.
Figure A is an
authentic medicine
compared to Figure B.
2.801
Agree
6.
Figure A is an
authentic medicine
compared to Figure B.
3.105
Agree
7.
Figure B is an
authentic medicine
compared to Figure A.
3.195
Agree
Overall Mean
2.919
Agree
*Verbal Interpretation: Strongly disagree = 1.00-1.74; Disagree = 1.75-2.49; Agree = 2.50-3.24; Strongly Agree = 3.25-4.00
Table 8 Difference Between the Respondents’ Ability to Identify Counterfeit OTC Medicines and Counterfeit
Prescription Medicines
Differentiated Variables
p-value
Interpretation
Counterfeit OTC Medicines and Counterfeit
Prescription Medicines
0.697
No Significant Difference
*Significant at .05 level (p<.05)
Among the six sociodemographic characteristics of the respondents, only the marital status was found to be significantly
associated with sources of information regarding CFMs (p-value = 0.000), which opposed the findings of Włodarczak et
al. [13] that linked higher education to increased access to information (Table 9).
Both the respondents’ age (p-value = 0.010) and marital status (p-value = 0.000) had a significant association with the
knowledge of CFMs (Table 10). These findings did coincide with the results of a study by Mhando et al. [14], which
suggested that the respondents with healthcare- related occupations had a higher level of knowledge of CFMs compared
to those who had non-healthcare-related occupations. All the respondents’ sociodemographic characteristics were not
significantly associated with the ability to identify CFMs. These findings coincide with the result of a study by Mhando
et al. [14], wherein age, sex, education level, and marital status were not determinants for the identification of
counterfeit drugs. Moreover, this finding corresponded with the results in a study conducted by Por et al. [15] where
both educational attainment and monthly income did not have a significant relationship with the respondents’ ability
to identify whether medicines are authentic (Table 11).
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Table 9 Association Between the Respondents’ Sociodemographic Characteristics and Sources of Information
Regarding Counterfeit Medicines
Sociodemographic Characteristic
Sources of Information
Regarding CFMs
Verbal Interpretation
p-value
Age
0.423
No Significant Association
Sex
0.490
No Significant Association
Marital Status
0.000
Significant Association
Educational Attainment
0.143
No Significant Association
Occupation
0.274
No Significant Association
Household’s Average Monthly Income
0.298
No Significant Association
*Significant at .05 level (p<.05)
Table 10 Association Between the Respondents’ Sociodemographic Characteristics and Knowledge in Counterfeit
Medicines
Sociodemographic Characteristic
Knowledge of CFMs
Verbal Interpretation
p-value
Age
0.010
Significant Association
Sex
0.124
No Significant Association
Marital Status
0.000
Significant Association
Educational Attainment
0.339
No Significant Association
Occupation
0.060
No Significant Association
Household’s Average Monthly Income
0.785
No Significant Association
*Significant at .05 level (p<.05)
Table 11 Association Between the Respondents’ Sociodemographic Characteristics and Ability to Identify Counterfeit
Medicines
Sociodemographic Characteristic
Ability to Identify CFMs
Verbal Interpretation
p-value
Age
0.946
No Significant Association
Sex
0.190
No Significant Association
Marital Status
0.822
No Significant Association
Educational Attainment
0.624
No Significant Association
Occupation
0.122
No Significant Association
Household’s Average Monthly Income
0.611
No Significant Association
*Significant at .05 level (p<.05)
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The results indicated that 73.03% of the sample had a high level of knowledge (Table 12) while 61.80% had a moderate
level of ability in identifying CFMs (Table 13). Based on the Chi-square test, a significant association was found between
the respondents’ knowledge of CFMs and their ability to identify CFMs (p-value=0.000), showing that a high level of
knowledge of CFMs was associated with only a moderate level of ability to identify CFMs (Table 14).
Table 12 Respondents’ Level of Knowledge of Counterfeit Medicines
Respondents’ Level of Knowledge of CFMs
Level of Knowledge
Frequency
Percentage (%)
Low
11
4.12
Moderate
61
22.85
High
195
73.03
*Legend: Low-level = 14-27, Moderate level =28-44, and High-level = 45-56
Table 13 Respondents’ Level of Ability in Identifying Counterfeit Medicines
Respondents’ Level of Ability in Identifying CFMs
Level of Ability
Frequency
Percentage (%)
Low
13
4.87
Moderate
165
61.80
High
89
33.33
*Legend: Low-level = 24-47, Moderate level =48-76, and High-level = 77-96
Table 14 Association Between the Respondents’ Knowledge of CFMs and their Ability to Identify CFMs
Variables
p-value
Verbal Interpretation
Respondents’ Knowledge Regarding CFMs and Ability
to Identify CFMs
0.000
Significant Association
*Significant at .05 level (p<.05)
4. Conclusion
Among the sociodemographic characteristics of the respondents, only marital status was associated with the sources of
information regarding counterfeit medicines, while both age and marital status were significantly associated with the
knowledge of counterfeit medicines. On the other hand, all of the demographic characteristics of the respondents were
not significantly associated with their ability to identify CFMs. It was also found that there was no significant difference
between the respondents’ ability to identify counterfeit over-the-counter medicines and counterfeit prescription
medicines. Moreover, a high level of knowledge of the respondents regarding counterfeit medicines was significantly
associated only with a moderate level of ability to identify counterfeit medicines. Overall, the majority of the
respondents showed a moderate extent of awareness in identifying counterfeit medicines, which is concerning. Hence,
there is still a need to raise awareness and educate the public to decrease their vulnerability to counterfeit medicines,
which necessitates the involvement of healthcare professionals.
Compliance with ethical standards
Acknowledgments
The authors sincerely thank the respondents who volunteered to take part in the study, the CEU-IERB for the approval
of the study protocol, Mr. Nhoriel I. Toledo for his valuable help in the formulation of the questionnaire and in the
analysis of data, and also their research advisers and instructors of CEU School of Pharmacy for their significant
contribution to this study. The authors would also like to thank Department of Science and Technology – Science
Education Institute (DOST-SEI) for providing thesis allowance, which helped the authors with the expenses.
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Disclosure of conflict of interest
The authors declare no conflict of interest.
Statement of ethical approval
The authors hereby confirm that the study protocol and informed consent underwent review, and were approved by
the Centro Escolar University - Institutional Ethics Review Board (CEU-IERB) last March 20, 2022.
Statement of informed consent
Informed consent was obtained from all individual participants included in the study.
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