Nine in 10 Nairobi pharmacies selling substandard, illegal medicines: Study finds
The researchers identified 22 parallel-imported medicines. Nearly three-quarters were drugs for heart conditions, diabetes, urinary problems, and mental health.
What you need to know:
- Researchers visited 2,348 outlets between September 1, 2023 and October 31, 2024.
- Six wards: Kilimani, Parklands, Kangemi, Korogosho, Njiru, and Roysambu were selected for detailed analysis based on socioeconomic profiles and distance from the Central Business District.
Nearly every pharmacy in Nairobi is stocking imported medicines that violate Kenyan law, according to new research published in a French pharmaceutical journal, raising serious questions about patient safety and the effectiveness of drug regulation.
The study, conducted by consultants Valérie Faillat and Epaphrodite Twahirwa of Mount Kenya University, found that 90 per cent of retail pharmaceutical outlets across all 85 Nairobi wards were selling at least one unauthorised parallel-imported medicine.
Researchers visited 2,348 outlets between September 1, 2023 and October 31, 2024. Six wards: Kilimani, Parklands, Kangemi, Korogosho, Njiru, and Roysambu were selected for detailed analysis based on socioeconomic profiles and distance from the Central Business District.
The researchers identified 22 parallel-imported medicines. Nearly three-quarters were drugs for heart conditions, diabetes, urinary problems, and mental health. Half were on Kenya's official essential medicines list. Almost all were already available as cheaper generics in pharmacies, with patients in some cases having more than 10 generic options. Most imports came from Turkey, with smaller numbers from Italy, South Africa, Hungary, and Pakistan.
Parallel importation; bringing medicines into Kenya from overseas markets without the patent holder's consent, is legal in principle. The Pharmacy and Poisons Board (PPB) introduced rules in 2019 to govern the practice following international trade agreements intended to lower medicine costs. But the study found the reality bears little resemblance to that intention.
Of 22 medicines examined, 90 per cent had packaging entirely in foreign languages, predominantly Turkish, making it impossible for patients or pharmacists to verify dosage instructions, side effects, or storage requirements.
All 22 failed at least one major regulatory requirement.
More alarming, 45 per cent were labelled with storage instructions designed for cooler European climates, not Kenya's hot and humid conditions. Medicines stored outside their required temperature range risk losing potency or becoming toxic. One sample of the diabetes drug Diamicron displayed contradictory storage instructions on the same packaging, raising suspicion of falsification.
"Regulatory non-compliance was widespread," the study reads. "Ninety per cent of PI products failed to meet labelling and package insert requirements, primarily due to foreign-language packaging that precluded verification of critical safety information. Forty-five per cent displayed storage instructions inconsistent with Kenya's ICH climatic Zone IV requirements, indicating supply chains not adapted to tropical conditions."
The study further notes that 90 per cent lacked the amount of active pharmaceutical ingredient per dosage unit, batch number, manufacturing and expiry dates, and the name and address of the marketing authorisation holder.
Ninety per cent of blister packs did not comply with essential information requirements. Only two elements were consistently compliant: Braille and unique product identifiers.
The researchers also found that almost all imported medicines were long off-patent and already available as affordable generics, meaning there was no public health justification for importing them. Unauthorised imports were found in nine out of every 10 pharmacies visited. On price, the picture was mixed: while some parallel imports were cheaper, nearly half offered no savings at all.
The study challenged the economic argument for parallel importation. In nearly half of all price comparisons, the imported products offered no price advantage over authorised channels. For Norvasc, a common blood pressure drug, there was no meaningful price difference in 92 per cent of cases.
The problem was worse in wealthier neighbourhoods. In Kilimani, the painkiller Cataflam and hormonal drug Duphaston were found in every pharmacy visited. Several other non-compliant imports, including heart drugs Atacand and Diamicron, appeared in half of all outlets. Parklands told a similar story, with Diamicron and anxiety medication Atarax found in six out of 10 pharmacies, and several heart and cholesterol medicines in four out of 10.
In lower-income areas, the picture was somewhat better. In Kangemi and Korogocho, most imported medicines were absent, but Duphaston was still found in every pharmacy. In Njiru and Roysambu, Duphaston and Cataflam were present in all outlets. The pattern suggests that wealthier areas, where patients are more likely to request brand-name medicines, had higher levels of non-compliant imports, while generics dominate in poorer areas, reducing the market for them.
The findings point to deep structural weaknesses in Kenya's pharmaceutical oversight. The country has only 0.2 pharmacists per 10,000 people, far below the global average of 4.8. While only 1,189 pharmacies are formally registered in Nairobi, researchers visited 2,348 outlets, meaning more than half operate without a PPB licence.
Dr Kiplangat Ngetich, an industrial pharmacist at Kenyatta University Teaching and Referral Hospital, says the findings are alarming but not surprising to those on the frontlines. The label is the first and often only communication between manufacturer and patient, he explains. If one cannot read it, they cannot confirm dosage, frequency, what to avoid, or what side effects to watch for.
A pharmacist encountering a foreign-language label may recognise the brand name or active ingredient in Latin characters and make assumptions based on experience. But assumptions, he warns, are not good enough.
"A medicine for heart disease or epilepsy requires precise dosing," he says. "Getting it wrong, even slightly, can mean a patient's condition goes uncontrolled, or they suffer a serious adverse reaction."
He warns that using medicines not suited for the climate can significantly affect drug quality. "Heat and humidity accelerate chemical reactions inside a medicine. The active ingredient breaks down, meaning the patient takes a weaker dose than they think. For someone managing diabetes or high blood pressure, that could mean their condition goes uncontrolled without them realising it."
"But degradation does not only mean a medicine becomes weaker," he adds. "In some cases, it becomes actively harmful. The breakdown products can be toxic. A medicine tested for a cool European climate has not been validated for Nairobi's conditions. You are using the product outside the conditions it was designed for."
What makes this particularly treacherous is that the damage is almost invisible. The tablet looks the same: no smell, no unusual colour. The patient takes it faithfully, believing they are being treated, while their condition may quietly worsen.
"Occasional physical signs like discolouration, powdery tablets, or unusual sediment can serve as red flags," Dr Ngetich says. "But for most solid medicines, a degraded tablet is indistinguishable from a good one to the naked eye."
"For patients with chronic conditions, the stakes are high," he adds. "A diabetic whose medication has lost potency may believe they are managing their condition while blood sugar climbs unchecked. Over months, uncontrolled blood sugar damages blood vessels, kidneys, and nerves. By the time the problem is discovered, the harm may already be done. The same applies to a hypertensive patient —uncontrolled blood pressure silently increases the risk of stroke and heart attack."
There is also the question of hidden ingredients. Kenyan regulations require medicines to list inactive ingredients such ascolourants, preservatives and binding agents because some patients have known sensitivities. On a foreign-language label, this list is inaccessible. A pharmacist cannot warn a patient with a known allergy if they cannot read the excipient list. The patient could suffer a reaction ranging from a mild rash to a life-threatening emergency, and neither would necessarily connect it to the medicine.
"If you suspect the medicine you have been given is not genuine or properly labelled, raise concern immediately," Dr Ngetich advises. "If you have suffered unusual symptoms, see a doctor and mention the medicine. Your complaint could protect many other patients taking the same product."
The PPB had not responded to questions at the time of publication. The Nation reached out to CEO, Dr Ahmed Mohammed, about steps the board is taking to crack down on illegally labelled drugs, address risks from climate-mismatched medicines, close gaps in port-of-entry inspections, and review guidelines on which medicines qualify for parallel importation. He had not responded by press time.
