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HEALTH-UGANDA: Self Medication Blamed for Increased Drug Resistance

Joshua Kyalimpa

KAMPALA, Jul 15 2011 (IPS) - In pharmacies in the heart of Kampala men and women line up to buy drugs that you usually need a prescription for, like Coartem, a drug used to treat malaria.

Edna Nakyanzi had malaria symptoms, so she bought the antimalarial drug, Fansidar, without a prescription. According to Dr. Emmanuel Semugabi of Hope Clinic, Fansidar should only be prescribed to patients after the first line treatment of Coartem fails.

But Nakyanzi said that she prefers this drug because she has to take fewer doses of it. “I only take three tablets of Fansidar and go to bed and the next day I am fine. But with Coartem you have to swallow many tablets and I hate that,” said Nakyanzi.

But Nakyanzi’s story is a common one. In Uganda patients can easily buy drugs you normally need a prescription for over the counter as government has been lax in stopping the illegal practice. Under the Pharmacy and Drugs Act of 1970 sale of prescription drugs over the counter is prohibited. Those doing so could loose their pharmacy license and also face a jail term. While National Drug Authority inspectors are mandated to regulate this, they have never been effective.

And increasingly people are resorting to self-medication to treat themselves for malaria and other ailments, either to save the money they will have to spend on costly doctors fees, or because some areas lack health officers.

Thelma, another advocate of self-medication, told IPS she regrets spending the equivalent of 10 dollars in consultation fees when she was ill recently because doctors could not adequately diagnose what was wrong with her.

“They told me that I was suffering from fatigue because of over work and advised me to rest and gave me some painkillers. Imagine, I spent close to two hours there after a day at work,” Thelma said. The Uganda Medical Association warns that this commonplace unregulated self-medication is responsible for growing drug resistance in the country.

“Some drugs, like antibiotics, are (bought over) the counter and abused, which causes serious problems. Really those loopholes should be checked,” said Dr. Margaret Mungherera president of the Uganda Medical Association and a member of the Medical Council.

In many cases patients use strong combinations of drugs for minor illnesses, sometimes drugs are taken in inappropriate doses and sometimes the incorrect drugs are used.

Dr. Peter Langi of the malaria control unit at the Mulago National Referral hospital said self-medication is one of the reasons why the fight against malaria has not succeeded.

“When people self-medicate, they fail to take the adequate doses they need to cure malaria, which causes some to develop resistance against the drugs and hence (results in) their eventual death,” said Langi.

A report by the ministry of health says that in some districts resistance to malaria treatment is more than 60 percent. However, the national average of resistance to malaria treatment stands at 11.7 percent.

Aggrey Mubaale said he often suffers from bouts of malaria but swallows several doses of antimalarial tablets without going to a doctor.

“When I was still studying I would carry some antimalarial tablets just in case and still do, even after I left school. It (taking antimalarial tablets) has become a part of me,” said Mubaale.

Mungherera said her association has now teamed up with the Pharmaceutical Society of Uganda, the National Drug Authority and the Association of Nurses and Midwives to address the growing problem. They intend to inspect pharmacies to find those that are dispensing prescription drugs over the counter. Those found to be doing so will have their licenses withdrawn or could face arrest.

“Most of the people dispensing medicine (in) most pharmacies are not trained and will not insist on getting a prescription. In fact, some cannot even read or understand the documents,” said Mungherera.

But this does not mean that all pharmacies in Uganda sell prescription medication over the counter. John Mukama, a dispenser at a pharmacy in Kampala, insists they do not sell prescription drugs to people without a doctor’s prescription.