Assay and impurity profiling of the pharmaceuticals are the key routine quality control methods employed worldwide for which High Performance Liquid Chromatography (HPLC) is the most widely used technique. The ability to carry out these routine laboratory procedures in low- and middle- income countries (LMICs) need the methods to be based upon simple instruments manageable with moderate levels of personnel skill and costs involved. Simple, convenient, and cost effective reverse phase HPLC methods were developed using phosphate buffer and methanol as mobile phase with C18 column as stationary phase for the impurity profiling and assay of beta lactam antibiotics. Isocratic elution and UV detection was employed in these methods. Impurity profiling method was developed for coamoxiclav tablets and ceftriaxone bulk drug. The method for ceftriaxone included a supplementary method to quantify one of its known impurity (Impurity D of ceftriaxone). This method involved use of acetonitrile where as the two main methods were achieved on the targeted method design, described above. With the exception of impurity A of ceftriaxone, the methods developed can successfully quantify impurities to the concentration as low as ≤0.05%, which is in accordance with the current guidelines for the impurity profiling of antibiotics issued by European Medicines Agency. As ensuring cost reduction was one of the key objectives of carrying out the method development exercise, in situ methods for the preparation of impurities were also identified and some new methods were introduced. The stability of beta lactam antibiotics and the choice of solvent were given due attention during the process of method development revealing information on the presence of new impurities. Deacetyl cefotaxime and 2-mercaptobenzathiazole were identified in this process as new impurities of ceftriaxone currently not listed under known impurities by United States Pharmacopoeia and European Pharmacopoeia. However, deacetyl cefotaxime is a known impurity of cefotaxime whereas the latter molecule is a degradation product of one of the synthesis impurities of ceftriaxone. This substance is reported to be carcinogenic and is resolved using the supplementary method developed for ceftriaxone, hence making its detection and quantification possible. A known inactive impurity of ceftriaxone (Impurity A, E-isomer of ceftriaxone) was` also shown to be produced by exposure to day light, thus warranting the light protection of the ceftriaxone solution, an information that is of critical importance in the clinical settings. A series of experimentation was carried out on the finished products of beta lactam antibiotics sampled from Pakistan and few other countries, to identify key quality issues in the samples. Though the limited sample size and convenient sampling did not provide results that could yield a decisive figure for the country status for prevalence of substandard and falsified medical products, but the experiments have clearly indicated that the problems in drug quality do exist and beta lactam antibiotics form a class of high-risk medicine with respect to surveillance for poor-quality medicines. Isolation of unknown impurities was also carried out along with the introduction of new and modified methods for preparation of impurities of beta-lactam antibiotics. In addition, detailed literature survey was carried out for understanding the complex problem of the poor-quality medicine, impact of poor quality antimicrobials on health care system and the magnitude of the problem at the global level. The country status of Pakistan regarding quality of medicines was recorded based upon the available documentary evidence. The current technologies and strategic options available for low- and middle-income countries in aiding fight for combating poor quality medicines was also laid down to design recommendations for Pakistan. A comprehensive review of the information technology tools used for identification and control of substandard and falsified medicines was also conducted. / Für die Bestimmung der Reinheit und des Gehaltes von Arzneistoffen wird weltweit maßgeblich die Hochleistungs-Flüssigchromatographie (HPLC) eingesetzt. Damit die entsprechenden Methoden auch in Entwicklungs- und Schwellenländern angewendet werden können, müssen sie zur Verwendung mit sehr einfachen Messgeräten geeignet sein und von auch weniger gut ausgebildetem Personal durchgeführt werden können. Zudem sollten die Kosten möglichst niedrig sein. Für die Reinheitsanalytik sowie die Bestimmung des Gehaltes von Betalaktam-Antibiotika wurden einfache, praktische und kostengünstige chromatographische Methoden unter Verwendung von Umkehrphasen entwickelt, die als mobile Phase Gemische aus Phosphatpuffern und Methanol sowie als stationäre Phase C18-Säulen verwenden. Die Methoden sind isokratisch, die Detektion erfolgt mittels UV/Vis-Spektrometer. Für Coamoxiclav-Tabletten sowie den Arzneistoff Ceftiaxon wurden Methoden zur Reinheitsprüfung entwickelt. Für die Reinheitsprüfung von Ceftriaxon wurde eine zweite Methode benötigt, um eine der bekannten Verunreinigungen (Ceftriaxon-Verunreinigung D) zu quantifizieren. Hierbei musste Acetonitril als Bestandteil der mobilen Phase gewählt werden, wohingegen die beiden Hauptmethoden dem beschriebenen Methodendesign folgten. Außer im Falle der Ceftriaxon-Verunreinigung A können mit den Methoden Verunreinigungen bis zu einem Konzentrationslevel ≤ 0,05 % bestimmt werden, was den Vorgaben aktueller Richtlinien für die Reinheitsanalytik der Europäischen Arzneimittelbehörde entspricht. Da es ein Kernziel während der Methodenentwicklung war, die Kosten für die Analytik möglichst gering zu halten, wurden in situ-Methoden für die Gewinnung von Verunreinigungen entwickelt und einige neue eingeführt. Während des Entwicklungsprozesses wurde besonders auf die Stabilität der Antibiotika und auf die Wahl des Lösungsmittels geachtet, wobei Erkenntnisse über die Anwesenheit neuer Verunreinigungen erlangt werden konnten. Desacetylcefotaxime und 2-Mercaptobenzathiazol wurden als neue Verwandte Substanzen von Ceftriaxon identifiziert und sind derzeit nicht als bekannte Verunreinigen in der United States Pharmacopoeia sowie dem Europäischen Arzneibuch aufgeführt. Desacetylcefotaxime ist eine bekannte Verunreinigung von Cefotaxime, wohingegen das zweite Molekül ein Abbauprodukt einer der Verunreinigungen ist, die während der Synthese von Ceftriaxon entstehen können. Es ist bekannt, dass diese Substanz karzinogen ist, und sie kann mit der erweiterten zweiten Methode für Ceftriaxon erfasst und quantifiziert werden. Unter Lichteinfluss bildete sich zudem eine weitere bekannte, inaktive Verunreinigung von Ceftriaxon (Verunreinigung A, E-Isomeres von Ceftriaxon), weshalb Ceftriaxon-haltige Lösungen vor Licht geschützt aufbewahrt werden sollten. Dieses Wissen ist besonders für den klinischen Bereich relevant. An einer Reihe von Betalaktam-haltigen Fertigarzneimitteln aus Pakistan und einigen anderen Ländern wurden mehrere Qualitätsuntersuchungen angestellt. Obwohl der geringe Probenumfang und die Methoden der Probensammlung kein eindeutiges Bild darüber zeichnen konnte, ob in einem bestimmten Land Arzneimittelfälschungen besonders häufig auftreten, konnte durch die Versuche dennoch festgestellt werden, dass es Probleme bei der Arzneimittelqualität gibt und dass Betalaktam-Antibiotika eine Hochrisikogruppe darstellen, die besonders gut hinsichtlich des Vorkommens minderwertiger Arzneimittel untersucht werden muss. Zudem wurden unbekannte Verunreinigungen aus den Proben isoliert und neue sowie modifizierte Methoden entwickelt, um Verunreinigungen der untersuchten Substanzen zu gewinnen. Zudem wurde eine ausführliche Literaturrecherche durchgeführt, um das komplexe Problem minderwertiger Arzneimittel, den Einfluss minderwertiger Antibiotika auf das Gesundheitssystem sowie das globale Ausmaß des Problems zu verstehen. Für Pakistan wurde der status quo der Arzneimittelqualität aufgrund vorhandener Dokumentation ermittelt. Außerdem wurde dargelegt, inwiefern die heutigen modernen Technologien und Strategien, die für Entwicklungs- und Schwellenländern zur Verfügung stehen, zur Bekämpfung von qualitativ minderwertigen Arzneimitteln in Pakistan beitragen können. Hierzu wurde eine Übersicht aktueller, moderner digitaler Techniken angefertigt, die für die Aufdeckung und Bekämpfung von minderwertigen und gefälschten Arzneimitteln verwendet werden können.

After over 25 years of decline, the global poverty rate has started to increase driven by the COVID-19 pandemic, taking millions back into poverty, most of them live in Sub-Saharan Africa. Low-income consumers are underserved and do not have the means to pay for or access to goods or services which are required for a minimum standard of living. These consumers struggle to find essential goods, the products do not always meet their needs or are too expensive for them to afford and the products' benefits are not easily understood. Yet the spending power and demand from consumers at the bottom of the economic pyramid in emerging markets and developing countries are motivating for global consumer goods companies. Not only does the opportunity presents financial benefit but is a social obligation to democratise new product innovations across markets. The 4As Framework (Affordability, Acceptability, Availability and Awareness) encompass factors which help manufacturers to better reach and serve low-income consumers. This framework is applied in this research to understand products meet their needs of low-income consumer across these four factors; and how designers employ human centred design to design products for low-income consumers against these factors. Human Centred Design has been employed to develop solutions to complex problems with great empathy to users and stakeholders for many years but has been gaining popularity with business and social ventures since the early 2000s. By interviewing consumers and designers, this study delved into understanding (1) the motivations and challenges of designing products for low income consumers, (2) how human centred design was being employed in the design of consumer goods for this group against the 4As framework and (3) how products currently meet the needs of low-income consumers, against the 4As framework. It was found that designers were consistently motivated by designing products for this consumer group which they believed served them. However, the constant evolution of needs, and needing to design for an affordable price were challenges. It was also found that some human centred design practices were prominent but there was more consistency needed in application, particularly when dealing with acceptability, affordability and awareness.

The current study utilized data from a federally-funded healthy marriage grant to examine pre, post, and three-to-six month follow-up changes in relationship satisfaction (as measured by the Dyadic Adjustment Scale total scores) and individual distress (as measured by the Outcomes Questionnaire 45.2). Additionally, the study evaluated income and dosage as predictors of relationship satisfaction and individual distress change at post-assessment and three-to-six month follow-up. Participants included 220 married individuals with children who completed PREP 7.0 (Prevention Relationship Enhancement Program). A repeated measures, split plot, MANOVA indicated statistically significant improvements in relationship satisfaction and individual distress for participants at post-assessment and three-to-six month follow-up. No significant differences existed in relationship satisfaction and individual distress changes between men and women. Hierarchical multiple regression indicated combined monthly income and dosage (as measured by number of lessons attended) did not predict changes in relationship satisfaction and individual distress at post-assessment and three-to-six month follow-up. However, partner scores accounted for the largest percent of variance in relationship satisfaction change. Discussion of results, implications for research and practice, and study limitations are provided.

Violence and Stigmatization against children with disabilities are critical public health issues. Children with disabilities are a vulnerable population as they are exposed to various forms of discrimination and violence globally. The forms of abuse include, but are not limited to, physical, emotional, and sexual abuse. The experiences of Children with disabilities are massively undocumented and there is also a lack of existing literature addressing the issue. The abuse and violence against children with disabilities are also underreported specifically in cultures where this abuse is socially accepted. There are gaps in the literature regarding the condition of children with disabilities and the attitude towards disability, especially in lower-income communities. Given the invisibility of children with disabilities in most developing countries, especially Africa, it is reasonable to speculate that both killing and abuse of this population is more widespread than reported. The purpose of this study is to explore the various forms of stigmatization and violence against children with disabilities. The secondary purpose is to examine the effects, a child with disabilities might have on caregivers, especially parents. A literature review examining the prevalence and risk of violence against children with disabilities was conducted utilizing various online databases. Peer-reviewed research articles published in the English Language from 2010-2021 that focused on stigmatization and violence against children with disabilities were included for synthesis. Results suggest that children with disabilities are at a higher risk for stigmatization and violence than their non-disabled counterparts.

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