TB Spike In Horn Of Africa Linked To Non-Prescription Drugs

 The Somali healthcare system has been one of the institutions severely affected by collapse of the state.

Before 1991, the Health Ministry coordinators ran hospitals and clinics in regions around the country. 

Those hospitals, despite being under-resourced and understaffed, delivered basic health services and ran health awareness campaigns on vaccination against “six deadly diseases”.

Mogadishu had several public hospitals such as Digfeer and Martini in addition to privately owned clinics at which government-employed doctors practiced in the afternoon to supplement their incomes. 

Tuberculosis patients in regions preferred to travel to Mogadishu where the Somalia-Finland Tuberculosis Project was based. The decision to base key health projects in the capital city was a feature of health inequalities in Somalia.

A different healthcare challenge emerged after 1990 though:  predominantly private healthcare systems characterized by poor quality control and unregulated pharmacies.

A sample of antibiotics Puntland Post reporters managed to buy at several pharmacies in Garowe

The sale of antibiotics without prescription throughout Somalia demonstrates the enormity of the problem.

Pharmacies in Puntland sell medicines imported from different countries.

In Somalia, there is no authority tasked with ensuring that pharmacies employ qualified pharmacists bound by a professional code of ethics.

Many pharmacies in Puntland sell antibiotics to customers with or without a prescription from a doctor.

Puntland Post reporters have managed to buy different types of antibiotics from several pharmacies in Garowe.

No pharmacist asked our reporters to produce a prescription from a doctor or tried to ask why the antibiotics were needed in the first place. Many pharmacies sell antibiotics the way they sell over-the-counter medicines such as paracetamol, aspirin, and ibuprofen.

A paper published in 2009, in the American Journal of Respiratory and Critical Care Medicine delineated how “common antibiotic may be undercutting its utility as a first-line defense against drug-resistant tuberculosis (TB)”.

A silent epidemic

In Puntland, Medicins Sans Frontiers supports a tuberculosis hospital where drug-resistant tuberculosis patients undergo a treatment regimen.

In a 2013, paper published in Emerging Infectious Diseases researchers discussed the spread of drug-resistant tuberculosis in Somalia. 

750 out of 9,760 pulmonary TB cases notified in Somalia in 2011 were multidrug-resistant tuberculosis “and therefore required treatment with second-line drugs…”

The documented levels of MDR TB [in Somalia] are among the highest reported in Africa and the Middle East…” the researchers concluded. “Puntland Ministry of Health is aware of the availability of antibiotics sold without prescription. The research conducted in 2011 on which the paper is based shows comparatively marked prevalence of multidrug-resistant tuberculosis in Somalia, but no preventive measures have so far been taken” says a senior Puntland Health Ministry official who spoke to Puntland Post on condition of anonymity.

Without the Puntland State Government taking decisive steps to crack down on the sale of antibiotics without a prescription from a practicing doctor, there is a risk that patients with drug-resistant tuberculosis could overwhelm the rudimentary healthcare system of Puntland State at a time the second wave of COVID-19 is costing lives in Somalia.

It is not solely a matter for Puntland State. It is matter for all Federal Member States and the Federal Government of Somalia to agree a health strategy to tackle the silent epidemic of  drug-resistant tuberculosis added the Puntland Health Ministry official.

This article first appeared in the © Puntland Post, 2021, and is republished with permission.

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