Drug resistance: Malawi’s death trap

Malawi is in danger of losing more lives as cases of drug resistance due to abuse of antibiotics are increasing, Nation on Sunday has learnt.

Experts say it is becoming increasingly difficult to treat some communicable diseases due to antibiotic resistance, a development experts say require urgent attention.

According to the experts, antibiotic resistance in the country is largely fuelled by abuse of antibiotics by patients who access the protected drug without prescription despite clear guidelines which demand that they should only be sold or ordered with a prescription.

Though the Ministry of Health acknowledges that the problem is huge and whose resulting deaths have not yet been quantified in the absence of data, some central hospitals are already registering weekly cases of drug resistance.

Said Watipaso Kasambara, national coordinator for Antimicrobial Resistance in the Ministry of Health: “The problem is huge.  We are affected as a country, but we have not systematically started collecting data on deaths due to AMR [antimicrobial resistance].”

Queen Elizabeth Central Hospital laboratory manager Joseph Bango said in October, they recorded five cases of resistance, which is a significant figure in medical terms.

“In just one month [October], we recorded five cases of resistance at Queen Elizabeth Central Hospital. The number may look small, but it is serious because the hospital incurs a lot of costs attending to cases of resistance as doctors have to start guessing on medication which would work. In some cases, we have lost patients like this,” she said.

According to Bango, patients’ easy access to antibiotics in the country is largely contributing to resistance.

“Hospitals have no guidelines on how to administer these drugs.  It is usually guesswork in the absence of a proper diagnosis. At the same time, people can access them without prescription because those selling the drugs are more interested in money than [in the health of the patients],” he said.

Faheema Choonara, a microbiologist working at Kamuzu Central Hospital (KCH), said such cases are recorded frequently; sometimes twice, thrice a week, meaning the problem of drug resistance is equally more prevalent in the Central Region.

“It must be understood that we come across these cases because someone has been referred to the central hospital otherwise district hospitals have no capacity to detect resistance, making it difficult to ascertain the actual figure of resistance which could be more than what we have captured,” she said.

Choonara also agrees that weaker regulatory frameworks have made it possible for people to access antibiotics anyhow, which leads to over-use and abuse of the drugs.

“Antibiotics access should be restricted to prescriptions only. People should not just buy it over the counter. Patients need to be made aware and educated or raise awareness on antibiotic use and risk of using unnecessary antibiotics,” she said.

In the Northern Region, the situation is even more precarious as Mzuzu Central Hospital records an average of three to four cases every day, according to the hospital’s laboratory manager Master Chisale.

He blames some health workers’ tendency of providing ‘presumptive diagnosis’ as a cause for overuse and underuse of antibiotics.

“Most health facilities do not have laboratories to carry out tests; hence they provide presumptive diagnosis which leads to abuse of antibiotics eventually causing resistance. I must emphasise that we are having long hospitalisation of patients in our hospitals who cannot respond to any line of antibiotics and this is the economic cost of resistance,” said Chisale.

But Professor Adamson Muula of College of Medicine (CoM) argues that the country needs to invest in proper diagnosis of diseases instead of asking for more drugs.

“Well, is it not the media and civil society organisations that are asking government for more and more medicines or drugs? I find the never-ending song of asking for more medicines without asking for improvements in diagnosis misplaced. It is time we started asking for proper diagnosis.  The laboratories and X-ray departments are key; so is the availability of well-trained health workers,” he said.

Nation on Sunday snap check in Lilongwe revealed how easy it is for someone to access antibiotics without prescription as its crew was able to purchase different types of antibiotics from six pharmacies and clinics.

But AMR national coordinator attributed the present scenario to “weak legislation within Pharmacy and Medicines, and Poisons Board, lack of antibiotic policy, lack of coordinated activities among the health, pharmacy board and the police for enforcement.”

There was no immediate comment from the Pharmacy, Medicines and Poisons Board, who are supposed to regulate administration of drugs.

But Kasambara painted a grim picture of the current scenario.

“We are in a very critical situation. Imagine, the number of people with HIV– most of them depend on antibiotics to treat opportunistic infections and when they are resistant to drugs, what happens? We are likely to have more deaths from HIV,” she said.

The World Health Organisation (WHO) has identified antibiotic resistance as a serious issue of concern, calling for more actions from member States to avert unnecessary deaths.

“The prospect of the world entering a ‘post-antibiotic era’, where common infections can no longer be cured, is therefore a real possibility,” warns the WHO report of 2016.

WHO estimates that worldwide 700 000 people die annually due to drug resistance a number which is likely to increase to 10 million people annually by 2050.