Monday, January 29, 2018

This is the right time to fight antibiotic resistance


By Dr Wilson Lugano lugano_

        A couple of years ago I attended to a 36-year-old patient who, for ethical reasons, I will simply name her SK.

This was at a medical centre somewhere in Temeke, Dar es Salaam where I worked. The patient reported to me with complaints of lower abdominal pain and painful urination.

I remember recommending that she takes a urine test. Later, findings revealed a huge amount of bacteria in her urine. That’s when I knew she was suffering from urinary tract infection (UTI).

But before I went ahead to prescribe antibiotics for her, she intervened and said in Kiswahili, “usinipe Sipro wala pawasefu, kwani hizo nimetumia mara nyingi bila kupona, kila hospitali nikienda wananiapa hizo hizo.”

She was actually saying, “Don’t give me the antibiotics ciprofloxacillin nor powercef/ceftriaxone. I have had enough of that in almost every hospital I have visited. By the way they have not helped me.”

She went on saying, “Nimechoka, sijui ni UTI gani hii haiponi,” meaning, “Am fed-up, what kind of UTI this? It doesn’t get cured!”

Well, on my part, it was wise not to interrupt her. In fact, she had genuine concerns. According to various studies, the bacteria causing UTI have become resistant to the antibiotics she was mentioning.

Known in Tanzania as “usugu wa dawa” the threat of antibiotic resistance means that some of the most common illnesses such as UTI cannot be treated easily.

My decision at that time was that the patient should undergo a culture and sensitivity test. I had to explain it to her plainly and in a friendly way.

However, such a test couldn’t be done at that centre where I was working. I suggested that she gets it at one of the biggest private health facilities in Dar es Salaam.

What’s troubling is that she came back to me the next day saying that the test was very expensive and that she couldn’t afford it.

The story of my patient is clear testimony of what most people are going through today—dealing with common bacterial diseases that are too difficult to treat.

Why I write this today

A fortnight ago I made a seminar presentation on the same matter, under the auspices of Professor Matee, a renowned microbiologist at Muhimbili University of Health and Allied Sciences (Muhas).

During the session we looked into the genetic and non-genetic causes of this. We dwelt much on how the local community contributes to the rise of antibiotics resistance.

We identified issues such as overuse and misuse of antibiotics, the administration of wrong drugs and dosage, the use of long course antibiotics as well as the use of antibiotics for infections that can heal even when left untreated. We also highlighted cases where people tend to use many antibiotics at a time.

We went as far as exploring patient self-prescription behaviour of over-the-counter drugs, as well as misuse of antibiotics in animals for treatment and rapid growth promotion.

But resistance is not in bacteria alone. I fact, we are generally talking about Antimicrobial Resistance (AMR) or the resistance of microorganisms/germs or the so-called “Vimelea vya magonjwa,” such as viruses, bacteria, parasites among others.

My focus on bacteria

In this article, I am focusing on bacteria because they seem to be the most prevalent.

Of late the Tanzania’s government in collaboration with other stakeholders, has embarked on an action plan to fight against AMR.

In principle, strategies include prevention, diagnosis and managing infections as well as wise use of antibiotics.

In the story of the patient I narrated earlier, for example, you learnt that there was no culture and sensitivity test in the health facility. This, however, is a common phenomenon in many health facilities at all levels across the country.

But not that easy

When the test is available, one can only get it at private labs at high cost. The poor can’t afford this. As a result of this, doctors end up prescribing antibiotics. This is like groping in the dark.

Sometimes the appropriate medicines such as meropenam which may be found to be responsive and effective are sold at an exorbitant price.

There is no better time to deal with this menace than now but the fight will require for multi-sectoral approach.