Kenya facing drug failure crisis against top killer diseases

By Gatonye Gathura

Kenya is quickly running out of options to treat pneumonia, malaria and HIV, the top killer diseases in the country.

Recent evidence shows high rates of drug failure in treating all these disease, including chemicals used in malaria mosquito control.

Further evidence also shows, de-wormers being administered to millions of schoolchildren are no longer working while most antibiotics have because almost useless.

Last week the Swiss Tropical and Public Health Institute reported the top two drugs, albendazole and mebendazole used to deworm seven million school children in Kenya are no longer effective.

In June the Kenya Medical Research Institute, (Kemri) said the number one malaria treatment based on the compound artemisinin, had lost its edge and called for other options.

This followed a regional study covering Kenya, Tanzania and Rwanda which showed higher than expected treatment failure in patients treated with top line malaria drugs called ACTs.

This week, the scientific journal, The Lancet warned that malaria resistance to the ACTs in parts of Asia is up to 60 per cent which when exported to Africa could be catastrophic.

Last year the Chinese Academy of Sciences and the Sino-Africa Joint Research Center- Nairobi, reported unhealthy levels of soil contamination with DDT from donor malaria control projects in western Kenya.

It has also been reported that malaria mosquitoes have developed high resistance to the chemical DDT used in indoor spraying and pyrethroid insecticides used in treating bed nets.

A team led by Dr Elizabeth Mumbi Kigondu of Kemri is analyzing the levels of pyrethrins in soils and drinking water around pyrethrum farms in Kiambogo and Naivasha in Nakuru County and Endarasha in Nyeri County.

“We hope to be able to tell whether the levels of pyrethrins present in those samples are safe for the environment, more so for farmers and the people living around pyrethrum farms,” said Dr Kigondu at an in-house conference.

The 2017 Economic Survey shows pneumonia, malaria, cancer and HIV as top killer diseases in the country accounting for 32.9 per cent of all reported deaths in 2016.

But this could get worse as suggested by the US Army Medical Research Directorate-Kenya and the Kenya Medical Research Institute, who in June reported high levels of drug resistance pneumonia strains circulating in Kenya.

Samples collected from eight Kenyan clinics, including district hospitals of Kisumu, Kisii, Migori, and Homa Bay showed pneumonia strains that were resistant to all the common available medicines.

As if this is not enough, at a global HIV conference in Paris, France in August the charity group MSF (Doctors without Borders) raised alarm over high levels HIV treatment failure among patients in its facilities in Kenyans and other parts of Africa.

In April a Ministry of Health study reported the emergence of totally untreatable HIV patients in Kenya.

“Our findings indicate that nearly one in four patients in Kenya failing second-line treatment has completely exhausted the available antiretrovirals,” said their report in the journal Aids.

In response to this escalating HIV drug failure, the Ministry of Health and donors have thrown more drugs to the problem.

This has included the targeting of 500,000 healthy Kenyans with the daily HIV prevention pill Truvada.

Already researchers at Moi Teaching and Referral Hospital and Moi University School of Medicine have presented evidence showing the drug to cause serious kidney problems to users.

The drug which is also used to treat HIV positive patients has also been reported to have developed significance levels of resistance in local users.

The over medicalization of Kenya’s healthcare, experts say can be traced to  huge donor projects in HIV, malaria, tuberculosis and deworming.

This they say are supported by the pharmaceutical industry and their success is measured on the number of doses distributed.

A policy change in 2014 by the US President’s Emergency Plan for Aids Relief (PEPFAR) has since dramatically put treatment over prevention.

In the policy the Americans classified HIV activities as core, near-core and non-core, with funding reducing as you move from the centre.

The core includes products such as medicines, condoms and testing kits while near-core are healthcare workers and the most outer layer, non-core, includes awareness creation, advocacy and capacity building.

“We are very worried about the persisting high rates of new HIV infections, despite our big spend in treatment and medicines,” said Dr Nduku Kilonzo, head of the National Aids Control Council.

Dr Kilonzo was addressing a recent conference in Nairobi organized by The Lancet Commission on the future of healthcare in Africa.

“We have shifted our emphasis to prevention over treatment by a ratio of 40 /60,” she said.

However she was of the opinion that donors can put their money where they want since nothing much could be done about it.

Dr Samuel Kariuki, a senior scientist at Kemri, and heading a regional initiative on antibiotic resistance says the drug crisis can be partially addressed through adopting preventive healthcare.

A cardinal rule to maintain the integrity of medicines and treatments, Dr Kariuki says is preventing disease before an outbreak,

“To prevent most diseases including diarrhea and pneumonia, we don’t need rocket science but one of the oldest inventions – a bar of soap,” said Dr Myriam Sidibe of Unilever, Nairobi, and co-founder of the Global Handwashing Day.

Washing hands reduces diarrhea by half and respiratory disease by a third.

Uganda for example, has reverted to some traditional malaria control strategies such as clearing stagnant water and encouraging abstention and fidelity to control HIV among the youth.

Kenya has on the other hand thrown away initiatives such as ‘Nime Chill’ for a packet of condoms and daily HIV prevention pills for school children.

Reports also show the deliberate over-prescription of drugs for profit maximization is also widespread both in the private and public health sectors.

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