Why self-medication is a big threat in rural areas

Six-year-old Base Namukobe had malaria-like symptoms. So her parents, Zacharia and Anna Kutosi reached for a small tin hidden in one of the corners of the house, got hedex and chloroquine tablets and gave it to the little girl before going out to buy more antimalarial drugs.

Without any prescription from a trained health care worker, they administered more medication to the child with the hope that it would cure the illness.

Namukobe, a usually cheerful girl, according to her parents, however, did not live to share her usual smile with them.

After becoming critically ill, even after taking the medication, she was admitted to Bududa hospital, where she died several days later.
Namukobe’s story is a common occurrence in rural areas, where many people have died of drug under or overdose as a result of self-medication.

In Uganda, it is easy for a person who feels unwell to walk into a pharmacy or drug shop and buy any medication they want without a doctor’s prescription.

Doctor’s prescription
While many drugs can be bought over-the counter without much trouble, there are some that will strictly require a doctor’s prescription, but which many people are accessing easily.

Such practices have led to poor treatment adherence and in some cases even death, especially among children and pregnant mothers.
In 2010, the National Drug Authority (NDA) estimated that eight in every 10 people self-medicate or buy drugs over the counter.

NDA attributes this to the increased number of pharmacies and drug shops in rural areas, expensive treatment from clinics and long distances that people have to make to access health facilities.

“This has led to many health problems such as the increase in drug resistance, poor compliance, over or under dosing, drug poisoning and toxicity reactions,” says Dr Mohammed Mulongo, the District Health Officer for Bulambuli.

He says although fansidar should only be prescribed to patients after the first line treatment of coartem has failed, it is common to find many people in rural areas lining up at drug shops to purchase the drug without a doctor’s prescription.

“When you do not know how much medicine to take, it means a person may fail to respond to medication, and this can lead to drug resistance,” says Dr Mulongo.

Drug overdose
In Namukobe’s case, Dr Mulongo says it is likely she died of drug overdose as she had taken different medicines to treat the same illness within a short period of time.

Dr Peter Nabende, the District Health Officer for Sironko says self-medication is one of the reasons the fight against malaria has not been successful.

“When people self-medicate, they fail to take adequate doses they need to cure malaria. This leads to drug resistance,” says Dr Peter Nabende.

Dr Nabende says even though the new clinical guidelines limit the sale of prescription-only drugs to qualified medical personnel, the practice is still common in rural areas because of poor policing and law enforcement.

Dr Dominic Waburoko, of St Martin’s clinic and chairperson of Mbale Regional Referral Hospital’s management committee says there are cases of patients with malaria preferring to take fansidar without prescription instead of coartem because the former is taken in fewer doses.

Dr Waburoko says the lack of access to medical professionals is partly to blame for this growing problem.

“Increasingly, people are resorting to self-medication to save money that they could have otherwise spent on consulting with a doctor, especially in areas where public facilities do not have qualified doctors,” he adds.

According to Dr Margaret Mungherera, the president of the Uganda Medical Association, and a member of the Medical Council, the council intends to start inspecting pharmacies and drug shops that dispense prescription-only drugs without the buyer first presenting a medical note from the doctor.

Effects
Dr Waburoko says one of the negative side effects of self-prescription is that over time, the cost of treatment will go up as the available cheaper drugs will no longer be effective in managing a particular disease to which the drug has become resistant.

“This means more sophisticated medicines, which are also expensive and may not be affordable to everyone will be used,” he says.

Another danger of self-medication, doctors note, is patients may end up treating an ailment, suspecting it to be a minor complication yet in the end it could turn out to be a chronic or life-threatening condition.

Dr Mungerera says there is need to educate the public about the dangers of self- medication and buying prescription-only drugs from over-the counter.