Medics prescribe measures to tame rising drug abuse

Dr Patrick Oyaro of Kemri and British Prime Minister David Cameron are equally concerned. Antimicrobial resistance means antibiotics available now will not treat even the mildest of sicknesses.

This means diseases that were once curable such as pneumonia, diarrhoea, tuberculosis will come back with fury and even the strongest drugs will not work.

Again, the prophylactic antibiotics prescribed for mothers delivering through the Caesarean Section (CS) will not protect their wounds from infections.

The topic about antibiotics losing their power grabbed the world’s attention in December 2014 when the findings about AMR study that was commissioned by Cameron were made public.

Every year, the Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations report revealed, there will not only be 10 million more deaths all over the world but the global economy will be 64 trillion Euros poorer.

Drug resistance is an old public health concern, but it was only after Cameron’s commission that associated economic losses came to the fore on how these affect labour force, human capital, and economic output.

Audit firms KPMG and RAND Europe used the figures in Cameron’s report against populations and economic indicators and found that Africa would “suffer greatly.”

KPMG’s economic analyst Dennis Tatarkov explained to the Business Daily how Africa’s vulnerability is tied to the drug report.

“The report considers a number of issues, such as current infection and resistance rates in calculating the potential impact of AMR.

“About Africa, the most important factor comes from the prevalence of malaria. Our estimates of the current number of malaria infections are over 90 million for Africa, which is a much higher rate than found elsewhere. In addition to this, the high incidence of HIV also contributes to the higher mortality rate in Africa. Combined with the development of resistance, this leads to high losses both in lives and economic output. This gives the 20 per cent loss in GDP relative to the baseline in the most severe scenario for Africa by 2050.”

This GDP loss is equivalent to $2,895 billion. Insurance companies and employers have a reason to worry about the economic dent that the resistance in TB might cause due to longer stay in hospital and resorting to more expensive drugs with many side effects.

Dr Oyaro says soon medics may not be able to save lives and Mr Cameron is looking at the economic dent his country will face because 16 per cent of the monetary losses quoted above will be footed by the United Kingdom.

From the 291 cases of drug resistant TB, Dr Oyaro can extrapolate possible very undesirable outcomes.

He wrote in an email: “Up to 20 contacts will be infected by one infectious TB case.”

Dr Oyaro goes on: “Do you ever take time to open windows in the vehicle for proper ventilation? Who bothers when a teacher coughs continuously and teaches children every day in school? Or who are you exposed to at the queue in a banking hall?”

There were 68 cases of new infections in Nairobi alone.

From his statement, it means if all of these 68 people were going about their duties, say queuing in banking halls, using a bus to work or a teacher in a school, they would leave 1,360 people infected.

This translates to a huge treatment cost, taking into account that treating one patient alone needs a whopping Sh2 million.

It is scarier that the resistance is noted even in a special group of antibiotics called carbapenems, third and last line of treatment comprising of very strong drugs.

Sam Kariuki, the director of Centre for Microbiology Research at Kemri, said that Kenyans’ abuse of antibiotics by taking drugs without prescription, even when it is not necessary or not completing the dosage, is a major problem.

He said: “When you expose pathogens to subtle doses of antibiotics, or keep exposing them to drugs unnecessarily even when there is no cause, they are intelligent enough to study patterns of the drugs and change their forms in a way that the drugs will not subdue them in the future.”

Seven diseases

The World Health Organisation (WHO) has raised the alarm on abuse of drugs.

No one, Prof Kariuki said, may be talking about this now, but in the near future the deaths will cause a public health crisis that will get everyone’s attention.

In 2013, WHO in their first report of the problem listed seven diseases that are gradually morphing into ‘modern plagues’.

All of the diseases that WHO reported have been noted in Kenyan surveys as major causes of problems in drug resistance: sepsis (blood stream infections), diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

In 2013 alone, the Economic Survey of 2014 shows malaria was the number one killer disease, claiming 23, 899 lives and pneumonia 22, 918. Kenya has had a history of drug resistance, but, Prof Kariuki says, the subject received little attention.

In a document prepared by Kemri in the Global Antibiotic Resistance Partnership (GARP), in 1998, 50 per cent of the strains of Typhus Fever were resistant to the recommended antibiotics — Ampicillin, Chloramphenicol, Tetracycline, Streptomycin and Cotrimoxazole — and that figure rose to 82 in certain parts of Thika, Embu and Nairobi by 2002.

In 2012, some regions had been noted to report resistance of up to 88 per cent in even the third line last resort treatment of diarrhoeal diseases. But there is no hope going by the figures observed in other gastrointestinal infections.

Only more prudent use of the antibiotics and preventing diseases would help, medics have warned.

Prof Kariuki said: “It has been proven since time immemorial that preventive approach in medicine is better than curing, so Kenyans should be taught about hygiene and any other practice that will keep diseases at bay.”

“Kenyans need to learn to finish the doses and avoid taking antibiotics for every common cold or flu.” As for the pulmonary illnesses, Dr Oyaro advises regular checkups and construction of uses in a manner that ensure free circulation of air.