Kenyans, like their livestock, are getting more difficult and costly to treat as a result of increased misuse of medicines. The situation has been worsened by incompetent and, in some cases, greedy heath care personnel.
Misuse of livestock medicines is so rampant that your favourite weekend nyama choma excursion may be more than just chomping on some heart-ruining fat; you could be gobbling chemicals whose effect on your body will be reflected in your next hospital bill.
In the animal kingdom, the worst affected are the popular Maasai plains as new evidence shows high residue levels of antibiotics in meat originating from Kajiado and Narok, from where most of the butcheries in Nairobi get their supplies.
“This is not just a medical earthquake, it is a tsunami,” says Dr Samuel Kariuki of the Kenya Medical Research Institute. “We are killing our medicines and, in the process, killing ourselves and our children.”
Dr Kariuki’s warning is supported by an 84-page situational analysis of antibiotic use and resistance in Kenya that shows that germs that have been easy to kill are fighting back — and winning — against administered antibiotics.
From the Maasai plains to the country’s hospitals, the bugs are waging a war that seems almost won and it is only a matter of time before the situation explodes out of control if nothing is done.
If you are admitted to Kenyatta National Hospital’s intensive care unit for more than two days, for instance, you are likely to acquire a new infection, mainly because of overcrowding and poor infection control.
What is happening at Kenyatta is only a tip of the iceberg. Typhoid, a common disease in Kenya that sometimes explodes into epidemics, is becoming almost impossible to treat.
Medical researchers say that only about 20 out of 100 patients are responding to five commonly used medicines in Thika and Embu districts, for instance.
Diseases such as gonorrhoea were easy to treat two decades ago — in fact, many referred to them as “a small bout of cold” — but these have now turned into medical nightmares. Then treated with a cheap dose of penicillin or tetracycline, gonorrhoea is now proving a veritable headache in the medical field and its treatment has become expensive.
Penicillin, once a wonder drug, has lost its magic even in the treatment of pneumonia, a major killer of children in Kenya. More than half of children with severe pneumonia are no longer responding to penicillin and a similar number of adult cases are not sensitive to the second- and third-line medications.
While a penicillin combination treatment for children would cost about Sh400 at Kilifi District Hospital, the alternative treatment goes for up to Sh5,000. The loss of penicillin’s viability in the medical field would be a major blow in Kenya, considering that it is the most prescribed antibiotic in the country because of its affordability and capacity to treat numerous bacterial infections.
So, what brought about this?
“Over-use, misuse, self-medication, wrong prescriptions, and over-the-counter sales of antibiotics have done us in,” says Dr Kariuki in his study, which involved researchers from Kemri, the Livestock Ministry, Kenyatta National Hospital, and the universities of Nairobi, Aga Khan, and Maseno.
Others were from the Ecumenical Pharmaceutical Network, the Pharmacy and Poisons Board, and the US Centres for Disease Control and Prevention.
The team blamed ignorant and greedy doctors and poor regulatory systems for the crisis. Those at most risk are patients with good medical insurance. They often get prescriptions for too many and unnecessary drugs and expensive second-line medicines.
“In some Nairobi hospitals, staff and consultant doctors within the same facility are held to different prescribing standards, depending on the amount of revenue they generate for the hospital,” says the study.
It was also found that the more expensive the drug was, the more likely the dispenser was to recommend it.
“Retail prices in the private sector are more than three times the international reference price for the lowest priced generic, and nearly 17 times the international reference price for the most expensive innovator brands,” says the study of the fleecing of patients in local private hospitals.
In district hospitals, the team says nearly 71 per cent of the antibiotics prescribed for pneumonia should have been for severe cases and only 16 per cent should rightly have been put on such a regimen.
Half of the children in western Kenya diagnosed with pneumonia or measles were found to have been wrongly put on chloroquine, a malaria medicine, while many cases of malaria had been wrongly put on penicillin.
“Almost all recommended antibiotics for dysentery were incorrect.”
The rate of misinformation among health workers was alarming, raising questions about the quality of medical training in Kenya. Over 70 per cent of medical workers, for example, said antibiotics effectively kill viruses that cause diarrhoea.
Poor Kenyans in Nairobi were found to be unable to afford the full prescription, prematurely ending treatment when symptoms subside.
Sharing of medication among family members and friends and hoarding drugs for future use were also identified as contributory factors to growing drug resistance.
A spot check carried out by this newspaper in Nairobi found that some pharmacies split doctors’ prescriptions and dispense only what the patient can afford in the hope that they will come back later for the remainder. However, no records are kept for such transactions, making patient follow up difficult even for chronic diseases.
“Retail pharmacies, frequently operating without a licence, appear to be more accessible to patients. They are located within the community, do not charge consultant fees, have shorter waiting times, and are willing to negotiate treatment protocols to meet the financial needs of clients,” says the study.
More than a third or Nairobi residents use retail pharmacies as their first site for outpatient care, according to Dr Kariuki.
Some pharmacies were found to hold commercial contracts with physicians or are physician-owned. Therefore, the clinicians derive direct financial benefits from drug prescriptions and sales.
The researchers also cast doubt on the quality of antibiotics being dispensed in Kenya, saying there are indications that 30 per cent of the products in the market would not meet the necessary potency tests.
The report indicates poor storage facilities at hospitals and antibiotics stock-outs lasting for up to three months. For the nyama choma crowd, there is an even bigger risk of ingesting meat with high levels of antibiotic residues.
Also detected are significant levels of antibiotic residues in milk, mainly because of indiscriminate use of anti-mastitis drugs by small-scale farmers who supply much of the unpasteurised milk in Nairobi.
“Penicillin is the most common residue in milk, with levels often exceeding the allowable limits two-fold, while tetracycline is the most commonly used antibiotic in rearing chicken.”
Significant drug resistant bacterial strains were also identified in pigs, with the researchers expected to make far reaching recommendations on the rational use of antibiotics in the next few months.