Drug resistance, complications worry medics as rate of self-medication rises
Whenever Anastacia Karia, a Nairobi resident and librarian falls sick, going to the hospital usually is the last thing in her mind. Her first instinctive reaction is a visit to the nearby dispensing pharmacy for a chat with the pharmacist who assists her determine what drugs to take whenever she presents with various symptoms of illnesses. The only time she has to bear the inconvenience of visiting a hospital is when she gets extremely sick and unable to function normally.
She says that going to the hospital has become so expensive, especially with the current high cost of living and with so many chemists in the estate, it saves her time and stress spent on doctor visits.
“You waste a lot of time queuing at the hospital to see the doctor, get lab tests done, see the doctor after lab results are ready for a prescription, and queue again at the pharmacy to get drugs. This is often almost a whole day’s event, and also I want to decrease absenteeism from work due to a minor illnesses,” Anastacia says.
However, as much as this helps, it at times come with its fair share of challenges too. She recounts how at one time after developing a stomach ache and trying several over the counter medications that did not work. As the situation worsened, she resorted to consulting a doctor and tests found that she had Helicobacter pylori (H. pylori) infection, a bacteria that can damage the stomach’s protective lining, and which could not be treated with mere painkillers of flagyl.
“I was told any other delays in seeking proper testing and treatment would have led to a number of digestive problems, including stomach or duodenal ulcers and, much less commonly, stomach cancer,” she shares.
Danger to children
Despite the incident, Anastacia says she hasn’t stopped self-medication yet because of the costs involved. She also admits that at times she is afraid to go to hospital because of this persistent, irrational fear of contracting a serious, even life-threatening disease, so she’d rather get treated over-the-counter.
Asked whether she knows the dangers of self-medication, Anastacia says she doesn’t know much about it, but cares more about feeling better. “As long as I am feeling good and can do my daily activities, then there is nothing to be worried about,” she says.
According to the World Health Organisation (WHO), self-medication involves the use of medicinal products by the consumer to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of medication prescribed by a physician for chronic or recurrent diseases or symptoms.
Dr Mutsune Willis, the Medical Director at Quiver Medical Centre in Lavington, Nairobi observes that self-medication is risky, especially when unprescribed medicine is administered on young children.
“For instance, medicines, even as basic as painkillers is adminstered depeding on the age and weight of the child, one dosage doesnt fit all, particularly when it comes to children, even if they are just one year apart. A six year old will not get the same prescription as a seven year old,” Dr Mutsune shares.
Expectant mothers who self-medicate are also putting their unborn babies at risk. Dr Mutsune says that some drugs should not be taken by expectant mothers because they can also cause malformations in their babies.
“Taking medications without having gone to a professional who prescribes them, the symptoms of a disease can be modified and the diagnosis delayed. This can cause the patient to become aggravated.Identifying the problem early would have made treatment easier,” he says.
Dr Mutsune further says that some medications cannot be used concurrently, but while self-medicating, patients end up using drugs, which are medically unaccepted to be used concurrently thus leading to overdosing, decreasing their potency, or even increase it and generate side effects such as bleeding, drowsiness or headache.
Antimicrobial resistance
It is the increased use of uprescribed medication that led the Pharmacy and Poisons Board to warn Kenyans recently against engaging in self-medication and embracing a culture of purchasing medicines as prescribed by licensed healthcare profession. The board said self medication lead patients to the dangerous road of antimicrobial resistance, which is a threat to public health globally.
It sounded alarm over the huge number of Kenyans who are unaware of the dangers of taking unprescribed medicine owing to lack of awareness and ignorance.
Dr Lucas Nyabero, the CEO Pharmaceuticals Society of Kenya says that medicines are always available thus Kenyans choose to self-medicate instead of going to see a doctor. He also points out tough economic times as one of the reasons people choose to self-medicate. However, he reiterated on importance of getting the guidance of a doctor before taking any medication.
“People self-medicate not because drugs are expensive, but because they are available. You can easily walk to a pharmacy and buy medication, which makes people lazy. The reason you have to go and see a doctor is because they have been train to diagnose and can figure out what one is ailing from a professional point,” he says.
Google prescription
He also says the use of the internet has become the major source of health-related information, leading to a growing trend toward unsupervised self-medication using the internet.
Dr Nyabero, however, warns that going online to find symptoms, causes and treament for an ailment is a dangerous affair. He says Google is a computer algorithm based on the number of people that have used the application the most. In this case, the largest users of Google, are in developed countries, therefore, a Google search will most certainly give result based on diseases that are common in those parts of the world. “Google doesn’t ask questions. In most cases, you will assume that what you are reading is what you are suffering from, which means you could be treating something totally different,” he warns.
Dr Nyabero says antimicrobial resistance is the biggest hurdle in healthcare as it takes a lot of time to develop antibiotics. He warns that a continual use of antibiotics without prescription poses a great threat since bacteria will develop resistance to available antibiotics. Additionally, resistant bacteria can be transmitted to other people. “We have a big problem with anti-biotics, because soon or later, we might not have antibiotics to treat illnesses that we could treat for a long time. Completing the dose prescribed is also very important as it ensures all bacteria is killed. Failure to do so, the remaining bacteria will develop resistance,” he articulates.
“Omeprazole, antibiotics, pain-killers and anxiety drugs are the most abused drugs,” he adds.
With continual use of drugs without the recommendation from a physician, patients are likely to develop other serious health conditions, including suppression of serious illnesses, such as cancer and dependency on medicines.
Dependency and organ damage
That way, a person will not be able to lead normal life without taking such drugs. Organ damage is also likely to occur when one uses medicine without knowledge of their side efects, Dr Nyabero explains. “Drugs don’t have brains, they will do what they do how they do it. So, using unprescribed medicine might cause dependency where a person will not function unless they use that medicine and the body will require it all times. Unprecribed drugs could also suppresses diseases, hence its progression and by the time you know it, it’s too late,” he explains.
Allergic reactions are other complications that can appear. These conditions start moderately, but serious and even fatal cases can be registered.
Self-medication in Kenya and Africa at large has gotten to a level of crises and threats, as people use and take any drugs in without regard to how toxic the substance may be. The circumstances that erupt from self-medication have become a burden in Africa due to factors, such as low effectiveness of healthcare sectors, ignorance, and poverty, unlicensed and unqualified medical professionals who prescribe drugs for people without a medical diagnosis and drug abuse.
The Kenya Bureau of Statistics (KEBS)states that the prevalence of self medication in Kenya is 58.2 per cent, in Nyanza it is 68.5 per cent and in Kisumu it is 64.8 per cent. Legal provisions exist in Kenya to govern dispensing practices of pharmaceutical personnel and professional codes of conduct exist governing their professional behaviour.
There is irrational dispensing of antibiotics at retail pharmacies and formal health care facilities with patient self medication and consumer demand for specific antibiotics and up to a third of the population uses retail pharmacies as their first point of care, with a large majority of clients demanding specific drugs.
Over 94 per cent of pharmacies interviewed in Nairobi indicated a willingness to negotiate antibiotic treatment protocols to meet the financial needs of clients.
