Are you unwell? You are at risk of getting bad medicines

Some government-owned health facilities in Nairobi have been giving patients substandard medicines, a new study has revealed.

The research conducted by World Bank found that patients in the city are routinely given drugs, including antibiotics and painkillers, that do not meet the required standards.

But it is not only public hospitals that stock bad medicines. The survey, which was conducted in 2015, also found poor quality medicines in private clinics and pharmacies

Investigators expressed surprise to find substandard medicine in public health outlets in the report, which was published last Friday.

Medicines include the popular painkiller ibuprofen, the antibiotic amoxicillin, the asthma drug prednisone and the allergy treatment cetirizine. Others are clavulanic acid combinations,  salbutamol and zinc tablets.

The researchers had collected 300 prescriptions from 42 health facilities and retail pharmacies across Nairobi County.

Seventeen per cent of these samples failed quality tests at Kenya National Quality Control Laboratory. Approximately 67 and 86 per cent of sampled medicines came directly from publicand private health facilities, respectively.

Low quality medicines were found in both poor and rich neighbourhoods with samples collected from Dagoretti, Kamkunji, Kasarani, Langata, Starehe and Westlands.

The survey is part of Kenya Patient Safety Impact Evaluation Project, a joint initiative of Ministry of Health and the World Bank Group. The study findings were published in the journal Drugs -Real World Outcomes.

Nine researchers from different sections of World Bank — Nairobi and Washington — had investigated medicines for four common diseases in the city; child diarrhoea, asthma, tuberculosis and chest pains or angina.

Wrong diagnosis

Apart from the substandard drugs, the researchers also found that some patients had been diagnosed wrongly and given incorrect prescriptions.

“In our analysis, for instance, we found that five of the patients presenting symptoms of angina were inappropriately treated and still went on to receive medicines that did not meet required specifications.”

Similarly, three patients with asthma symptoms got the wrong diagnosis, had the wrong treatment prescribed, and received medicines that failed the quality tests.

The study differs significantly with periodic drug quality reports by the Pharmacy and Poisons Board which largely indicate that all is well in the sector.

“The Pharmacy and Poisons Board’s pharmacovigilance mechanisms are yet to achieve a meaningful impact,” said the World Bank researchers led by Frank Wafula who is also a senior lecturer at Strathmore University.

The study warned that the problem could be bigger and more widespread in the country.

In 2014, a study by Kenya Medical Research Institute, also involving Dr Wafula, linked persistence of poor quality drugs in the local market to collusion between inspectors from the board and pharmacy managers.

The study reveled how the two were running a corruption pre and post-paid mobile money network to allow the sale of substandard medicines.

To avoid such loopholes or where health facilities or pharmacies would give investigators only samples known to be of good quality while hiding suspect products, the World Bank employed an innovative approach.

Wafula and his team used what researchers call “mystery patients” where select members of the public are coached on how to present themselves to a health facility as patients.

They are asked to give specific disease symptoms and go through the whole process from consultation to collecting prescription drugs from the facility or buying them from the nearest pharmacy.

Later, the mystery patients presented the medicines to the researchers who sent them for laboratory analysis.

— www.rocketscience.co.ke