New Vision (Kampala)

Uganda: Self-Medication Could Cause Cancer

Paracetamol is a popular painkiller among Ugandans. But the reports of overdose among patients show a darker side of the tablets. Is it time to restrict the drug? writes Carol Natukunda

They are easy to swallow. They give ready relief from headaches, fever and menstrual cramps, among others. Cheap and accessible, Paracetamol (Panadol, Kamadol, Cetamol and Maradol) has turned us into a generation of self-medicators. You can get tablets for as little as sh500.

While statistics on how many tablets Ugandans use annually are scanty, an average 85% of Ugandans buy essential medicines, including Paracetamol, from private pharmacies and drug shops, according to the 2009 health ministry study titled 'Essential medicines and health supplies tracking study."

And in the study, most people stated that they found Paracetamol affordable, with some thinking it was alright to buy less than full dosage or a little more for future use. The implication here is that affordability does not consider the issue of right dosage.

The risks

According to the report, using medicines in this way is inappropriate and leads to problems in future such as antibiotic resistance. Developed countries are now grappling with this dilemma. For instance, admissions to Victorian hospitals in Australia for Paracetamol poisoning quadrupled between 1987 and 2001, rising from 341 to 1,490 a year. About five times more adults are hospitalised for Paracetamol poisoning than heroin overdoses, according to figures compiled by Monash University's Accident Research Centre.

Uganda's health experts are particularly concerned about wrong self-prescription. Prof. Celestine Obua, a pharmacologist at the Makerere University College of Health Sciences, says while Paracetamol is one of the safest and most effective painkillers on the market, it has the possibility of causing cancer if used in excess. More so, he says, it could cause liver damage.

"We normally take drugs in form of a molecule which the liver tries to break down or modify. During the process, a toxic substance (metabolite) is formed as a by-product, which may lead to poisoning of the liver. Such toxic effects may affect DNA formation. This may lead to cellular changes, thus cancer," he says.

Obua, however, attributes this level of poisoning to careless use or consumption of substandard drugs. He adds that components used in making some of the fake drugs may contain toxic substances.

Health experts are also concerned about accidental overdoses in young children, who either are given too much Paracetamol or who manage to access child-resistant containers. In 2003, The New Vision broke a story in which three children died and one was admitted to Kayunga Hospital in critical condition after their mother gave them an overdose of Panadol tablets.

Dr. Sabrina Kitaka, the head of paediatrics at Mulago Hospital, says children get poisoned with all sorts of medicines, including Paracetamol. Some children are poisoned after accessing the Cetamol bottles, simply because their caretakers are careless.

"It is critical for parents to close their drug cupboard, and strictly keep all drugs away from children. Paracetamol poisoning can occur if the recommended dose exceeds the kilogram per body weight. And this can present liver failure," Kitaka observes.

Another doctor at Nsambya Hospital who prefers anonymity remarks: "Every time a child's temperature is up, a parent rushes to the Cetamol syrup. You think you are doing the right thing, yet you might be giving too much if you do not follow advice from an expert."

Even a good dose of paracetamol given over a period of time could result in drug resistance, according to experts.

Need to regulate outlets

Despite these concerns, the Government is yet to curb the availability of over-the-counter drugs. Anyone can walk into any drug shop and buy any amount of medicine without a hassle. Uganda has a total of 11 licensed local pharmaceutical manufacturers, 477 registered pharmacies and over 4,370 chemist shops, according to the 2010 Uganda pharmaceutical profile by the United Nations Industrial Development Organisation.

The difficulty of reducing access to paracetamol tablets is one task that critics feel should be looked into. Beatrice Nandawula, the director of Makerere Youth and Adolescent Counselling Centre says: "I strongly support reduced access to any painkiller. The fact that you can buy any amount of medicines without anyone restricting you is totally irresponsible."

Pharmacists shortage

Yet, the bigger problem is the shortage of pharmacists. Uganda's population is 34 million. Only 476 pharmacists are estimated to be licensed and registered. This implies one pharmacist for every 100,000 Ugandans, compared to the recommended ratio of 1:2,000 by the World Health Organisation. This leaves room for illegal and unqualified personnel to take advantage of the gap.

Recently, the secretary of the Pharmaceutical Society of Uganda, Yusuf Sembatya disclosed that several students who failed core subjects (biology and chemistry) at A' level were pursuing pharmacy in Ukraine, Russia, Cuba, India, among other countries.

Sembatya also disclosed that some students pursuing medical degrees abroad choose to do pharmacy as a major or minor degree course and attempt to start practicing the profession. This is contrary to the regulations governing the profession.

"Most people now believe that pharmacy is very lucrative and they will try all sorts of avenues to become pharmacists," he said. "But we want to ensure only the best people practice pharmacy because what we do affects the lives of everybody," he added.

Ali Senteza, an independent medical consultant is dismayed that anyone - even a P7 leaver - can be an attendant in a drug shop. Senteza is also dismayed at the way some organisations promote painkillers on TV, "like they are marketing chewing gum!"

Way forward

Frederick Sekyana, the spokesperson of the National Drug Authority (NDA) says NDA is strengthening the inspectorate division to address the challenges. In the meantime, he cautions the public to seek services from qualified pharmacists.

Effective this month, NDA has banned the dispensing of bare tablets normally sold in tins. "Pharmacies and drug shops will be required to stock and dispense tablets and capsules to patients in blister and strip form only," Sekyana says.

Blister packs, in most cases, are labelled with clear instructions and are not exposed to damage and germs like the unsealed tablets.

Sekyana also says people need to be aware that taking more than the recommended dose of any medicine without medical advice can be harmful. As much as possible, keep the medicines out of reach of ildren.

According to Sembatya, parents also need to offer career guidance to their children. "Even if one studies pharmacy abroad without the core subjects, you cannot be allowed to practice since they do not meet the requirements specified in the Pharmacy and Drugs Act, 1970," he says.

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