Selling Antibiotics Without Prescription Linked to Spike in Drug-resistant TB Cases in Puntland

[Deeq A.]

Garowe (PP News Desk) — The Somali healthcare system has been one of the institutions severely affected by collapse of the state. Before 1991, the Health Ministry coordinators ran hospitals and clinics in regions.  Those hospitals, under-resourced and understaffed, delivered basic health services and ran health awareness campaigns on vaccination against “six deadly diseases”. Mogadishu had several public hospitals such as Digfeer and Martini in addition to privately owned clinics at which government-employed doctors practised in the afternoon to supplement their incomes.  

Tuberculosis patients in regions preferred to travel to Mogadishu where Somalia-Finland Tuberculosis Project was based. The decision to base key health projects in the capital city was a feature of health inequalities in Somalia. A different healthcare challenge emerged after 1990:  predominantly private healthcare systems characterised by poor quality control and unregulated pharmacies.

A sample of antibiotics Puntland Post reporters managed to buy at several pharmacies in Garowe

The sale of antibiotics without prescription throughout Somalia demonstrates the enormity of the problem. Pharmacies in Puntland sell medicines imported from different countries. In Somalia, there is no authority tasked with ensuring that pharmacies employ qualified pharmacists bound by a professional code of ethics.

Many pharmacies in Puntland sell antibiotics to customers with or without a prescription from a doctor. Puntland Post reporters have managed to buy different types of antibiotics from several pharmacies in Garowe. No pharmacist asked our reporters to produce a prescription from a doctor or tried to know why antibiotics were needed in the first place. Many pharmacies sell antibiotics the way they sell over-the counter medicines such as paracetamol, aspirin and ibuprofen.

A paper published in 2009 in American Journal of Respiratory and Critical Care Medicine delineated how “common antibiotic may be undercutting its utility as a first-line defence against drug-resistant tuberculosis (TB)”. 

A silent epidemic

In Puntland Medicins Sans Frontiers supports a tuberculosis hospital where drug-resistant tuberculosis patients undergo a treatment regimen. In a 2013 paper published in Emerging Infectious Diseases researchers discussed the spread of drug-resistant tuberculosis in Somalia. 750 out of “9,760 pulmonary TB cases notified in Somalia in 2011” were multidrug-resistant tuberculosis “and therefore required treatment with second-line drugs…”

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“The documented levels of MDR TB [in Somalia] are among the highest reported in Africa and the Middle East…” the researchers concluded. “Puntland Ministry of Health is aware of the availability of antibiotics sold without prescription. The research conducted in 2011 on which the paper is based shows comparatively marked prevalence of multidrug-resistant tuberculosis in Somalia, but no preventive measures have so far been taken” says a senior Puntland Health Ministry officer who spoke to Puntland Post on condition of anonymity.

Without Puntland State Government taking decisive steps to crack down on the sale of antibiotics without prescription from a practising doctor, there is a risk that patients with drug-resistant tuberculosis could overwhelm the rudimentary healthcare system of Puntland State at a time a second wave of Covid-19 is costing lives in Somalia. “It is not solely a matter for Puntland State. It is matter for all Federal Member States and the Federal Government of Somalia to agree a health strategy to tackle the silent epidemic of  drug-resistant tuberculosis” added the Puntland Health Ministry official. 

© Puntland Post, 2021

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