SELF-MEDICATION AND YOUR HEALTH: Malaria: Tales of poverty, ignorance, deaths.......

Malaria has remained a major cause of deaths in Nigeria, worsened by the increasing instances of self-medication, complicated by ignorance and poverty, writes SEGUN ADEOYE

Entering the apartment of Judith Duba, a civil servant residing at Kpor, in the Gokana Local Government Area of Rivers State, one could sense a thick atmosphere of grief.

Duba sits alone at a corner of her room, cold and lost in thoughts. She wears a sad expression, as she gazes through the window looking at no one in particular. Every morning, she wakes up to the sad reality that her husband of two years, Justice Duba, is no more.

“My husband lost weight drastically while he was taking medications for malaria; and instead of getting better, he got worse,” she says, a tear drop rolling down her cheek.

Duba’s husband, who hails from Nwebiama in the same local government area, having felt some ache, headache, pain and high body temperature, went to a local drug store, bought some drugs and placed himself on what he believed was malaria treatment.

“His health condition did not get better and so we eventually took him to the Bori General Hospital at the local government headquarters, where he was diagnosed with acute malaria, with traces of typhoid, and given adequate treatment,” she says.

Surprisingly, though he responded to initial hospital treatment, his health began to deteriorate.

Further medical test was carried out and it was discovered that he had developed a kidney problem, thus needing daily dialysis to stay alive.

“He was unable to breathe due to his failing health and was placed on oxygen, but we had no money to carry out the dialysis,” she says.

Justice died on April 18, 2014, leaving behind a grieving widow and a 60-year-old father, Vika Duba, who says, “It is a taboo that I live to bury my son instead of my son to bury me at my old age.”

At the Nyobe Bangha community is yet another family reeling in the pain of a dead family member – their breadwinner. Abel Lenu, 50, a farmer married to Comfort, with five children, has also gone to the world beyond.

As in the case of Justice, Lenu, having experienced some discomfort, concluded he must be having malaria. He placed himself on medication that included drugs like Chloroquine and Cenox, but his condition worsened. Kadisi, one of his sons, says it was later discovered that the drugs he used were actually expired drugs, which he had unknowingly bought from a drug seller known simply as Kelechi. Such drug sellers are a common sight across Nigeria, even selling unregistered drugs in buses and marketplaces.

“My father wasn’t taken to the hospital until he died, and post mortem examination later showed that he suffered kidney failure as a result of the drugs he used and his liver was also affected,” Kadisi says.

Barika Dumle, 59, a mother of six children, is lucky to be alive to tell her own story by herself. It’s a stroke of luck that she will forever cherish.

“Anytime I have pains, fever or headache, I just know it’s malaria and I treat myself and get results. So again, this time around, when I started feeling like that, I treated myself as I used to, taking drugs that I believe were to treat malaria, but I almost died,” she says.

A visibly grateful woman, who expressed gratitude to God for being alive, Barika says, “I developed blisters and rashes which worsened with severe pain all over my left arm and breast. So, I rushed to a nearby hospital, where after diagnosis, I was told I didn’t even have malaria, but was reacting to a drug in a mixture I had taken.”

The medical doctor eventually gave her the appropriate medication, but Barika says that though hale and hearty, she still feels pain in her left arm.

Godwin Kinanee, 68, a native of Luegbo Beeri, at the Khana Local Government Area of Rivers State, has his son to thank after several drugs he had taken to treat himself for malaria, nearly killed him. “I almost lost my life. I had been treating myself for three weeks, but the illness persisted. As a result, I decided to try another drug that my friend introduced to me, but it was even worse, so much so that I could not get up from my bed,” he says.

His son, apparently concerned about his ailing and dying father, immediately raised the alarm, calling on neighbours for help. A neighbour who is a nurse had to immediately apply first aid to revive him, before he was subsequently rushed to the hospital where tests later showed that he had taken an overdose of the drugs.

In Igbara-Oke, a community in Ondo State, Felicia Ayegbo, a trader and mother of two children, who used to take solace in patronising sellers of herbal concoction, narrates an experience, which she says almost took her life.

“The herbal sellers used to give me concoction any time I was ill, but this time around, even after taking it, I didn’t feel better. And when I went to the hospital I was tested for malaria, which the concoction could not treat,” she says.

The tales of instances of self-medication goes on and on. A study used as a case-study of self-medication in Nigeria, published in the Journal of Medicine, entitled Malaria self-medication among students of a Nigerian Tertiary Institution, indicated that out of 240 students monitored, 160 representing 67 per cent, engage in self-medication.

The cases of Justice Duba and Abel Lenu are just two of millions of cases of deaths recorded as a result of engaging in self-medication, says, Dr. Faithlyne Ogaga, a specialist at the Irrua Teaching Hospital in Edo State.

She warns, “When you buy drugs based on self-medication, you could react to it because our body chemistry differs. Some people react to drugs like Fansidar, developing skin rashes, though it’s a very good anti-malaria drug. So if one is not examined by a medical personnel and the person goes and buys any drug, the person can be sure to have a very unpalatable experience, sometimes even organ failure.”

It’s a trend, which the Ondo State Malaria Control Officer and a medical practitioner, Dr. Waheed Folayan, attributes to poverty.

“Malaria is a poverty disease, and it’s endemic, and if not well treated, can lead to complications and then death; it’s not an ordinary illness and so should be treated at a health facility; malaria is not caused by witchcraft, or excessive work in the sun,” he says. He adds that children under the age of five, pregnant women, people with sickle cell anaemia and HIV-infected individuals are more at the risk of having malaria.

Desire Ehimere, a medical practitioner, shares the view of Folayan. “Many people tend to self-medicate because of ignorance and also poverty, and it’s rather unfortunate that many people just assume that they are having malaria because they have headache or high body temperature, without confirming through medical test,” she says.

Ehimere shares the story of a nursing mother who was administering malaria drugs to her nine-month-old baby who had high body temperature, but rather than subside, the temperature became unbearable, with rashes all over the baby’s body. “It was a tortuous period for the baby, because at the end of the day, the baby was diagnosed of having measles and not malaria,” Ehimere says.

Ehimere adds that there is a relationship between body weight and the quantity and type of malaria drug to be administered. She says a friend of hers almost had her liver damaged after she was given an overdose of malaria drugs. “The weight of patients differ, therefore before I give a drug to a patient, I try to know the age, the weight and any medical records. These are important because the weight must be able to withstand the strength of the drug given, in order to avoid any complications,” Ehimere says.

In a country where, according to the United Nations Human Development Index, 70.8 per cent of the population live on less than one dollar a day, and 92.4 per cent on less than two dollars a day, going to a medical laboratory for medical tests is seen as a burden. To conduct a basic malaria test in medical laboratory in Nigeria costs about N600 (about $3).

For some, the lack of money to go for medical tests as well as the non-availability of health facilities and centres, has always prodded them to embark on one form of self-medication or the other. Bekeme Amuluku, a resident of Agadagba, a riverine community in Ondo State, while admitting to having engaged in self-medication, says, “lack of access to medical professionals is a major factor for engaging in self-medication, because you consider the money you’re going to use for the test, and sometimes, even the cost to get to the health centre.” Bekeme adds that sometimes at the health centres, the health workers are not always available.

The situation is even worse in remote areas in the country, where access to health facilities is a major burden. In many cases, it could take about one hour drive from the community to the nearest health centre to access medical care. Indeed, the implication is that many resort to patronising unregistered drug sellers who, sadly, are always readily available to provide drugs that they claim treat malaria, and in many instances, drugs that can cure any form of illness.

Promise Jumbo, a patent medical dealer at Kabangha, a community in Rivers State, says, “Many of our people resort to self-medication as a result of poverty, because they don’t have money to conduct basic tests, before procuring drugs.”

The prevalence of unregistered drug sellers, as well as fake drugs in the country, made the Federal Government to set up the National Agency for Food and Drug Administration and Control in 1993. The agency, which is under the Federal Ministry of Health, is tasked with regulating and controlling the importation, exportation, manufacture, advertisement, distribution, sales and use of drugs, medical devices and packaged food and water.

The late Prof. Dora Akunyili, who died on June 7, 2014, made her name combating fake drugs in the country during her tenure as the Director General of NAFDAC. On assuming duty in April 2001, she observed, “So many of my countrymen and women are fighting killer diseases like malaria with little more than sugar syrup and chalk tablets, cynically packaged to look like the real thing.”

The abuse of various malaria drugs has also brought up recurring cases of resistance to the drugs. Scientists have also indicated that one of the problems in treating malaria is as a result of the malaria parasite building resistance to known drugs. It has resulted in existing drugs failing, and necessitating the need for re-engineering drug compositions to battle new strains.

Cases of such drug resistance made the World Health Organisation in 2010, to release new guidelines for treating malaria, which includes emphasis on testing before treating, and addition of the new treatment called artemisinin-based combination therapy. Known simply as ACT drugs, it has become the accepted form of treating malaria.

Doctors, however, express worry that self-medication may, even with the emergence of ACT drugs, increase the number of deaths from malaria, as ACT drugs, if not properly used, could also become ineffective.

The chief medical director, Ubiaja General Hospital, Edo State, Dr. Dom Asuelimhen, is of the view that engaging in self-medication, is as dangerous as embarking on a suicide mission.

“Those who engage in self-medication while treating malaria are usually not well treated, so they end up producing resistant traits and when you now use the correct drug dosage, it can no longer kill the plasmodium that causes the virus, so it becomes difficult to treat than what you would normally treat with the conventional method,” he says. He adds that poor sanitary condition contributes to the prevalence of malaria.

In a country where accurate data is relatively difficult to come by, various statistics on malaria in Nigeria point in one direction – it is a critical situation. Indeed, according to the Nigerian Ministry of Health, malaria accounts for 60 per cent of outpatient visits to health facilities, 30 per cent of childhood deaths, 25 per cent of deaths in children under one year, and 11 per cent of maternal deaths. According to the Malaria Action Programme for States in Nigeria, the Federal Ministry of Health estimates that malaria causes a financial loss to the tune of N132bn per year (about $838m). The total budget of the country for 2014 was put at N4.962tr. The implication is that in terms of financial loss, malaria would, this year, account for about three per cent of the budget.

The NetsForLife, a partnership for malaria prevention in Africa, says it is estimated that a child dies every minute of malaria, while on a yearly basis, malaria costs an estimated $12bn in lost productivity in Africa. The sad reality is that despite the various efforts to wipe out malaria in the country, a factor like self-medication has continued to contribute to malaria-related deaths.

A chemist at Ubiaja, Edo State, Mr. Francis Sakpana, re-echoes the views of Asuelimhen. “Self-medication is like committing suicide; you must know what is wrong, and you should, in fact, know the percentage of malaria in your blood before taking any drug,” he says.

Programme Manager of the Malaria Elimination Programme in Abuja, Nigeria’s Federal Capital Territory, Dr. Humphrey Aniebo, boasts that malaria prevalence has dropped by 43 per cent in the country. While attributing the achievement to the successes of the programme, he says 30 model caregivers are being trained to further help in eradicating malaria from the FCT.

“When people have fever, they will test them for malaria, using Rapid Diagnostic Test kit,” he says.

While the Ministry of Health had in recent times, embarked on malaria prevention campaigns, including the distribution of treated mosquito nets, there are still misconceptions in the minds of many.

A resident of Edo, Michael Omijie, says, “For me, it’s not comfortable to sleep under the mosquito net.” His thoughts are shared by Suzanne Ogunleye, who says, “I stopped using it when I started having rashes all over my body.” Indeed, it was discovered that in most communities visited, rather than sleep in mosquito nets, some residents have chosen to use the nets for their windows. Comfort Kabari, a mother of four, though received one of the free treated mosquito nets provided by the government, chose to use it to protect the plants in a vegetable garden, in order to shield them from rodents. “It’s very effective against pests,” she says.

In many instances, the treated nets, rather than end up in homes, end up in shopping stores, where they are sold for as much as N1,500 (about $9).

Adeoye wrote this story with additional reports from the following citizen journalists – Esther Ndeesor Isaac, Nornubari Kote, Bere Letam Noble, Bunmi Owolabi, Innocent Okoh, and Miriam Efom.

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