The chaotic drug distribution system in the country has been largely blamed for promoting counterfeiting, drug abuse, among others. Implementing the New Drug Distribution Guideline will restore order. APPOLONI A ADEYEMI reports
I n 2011, Toluwani Cooker was in Austin, Texas as part of five American states’ visit under the International Visitor Programme (IVP), which was fully funded by the United States Educational and Scientific Programme. After leaving the Texas Government House on that fateful day, she and other members of the visiting team were taken to a local restaurant for lunch. As she sat down and placed order for the meal, she whispered to the guide that she had been under intense headache in the last two hours.
“I have a severe headache,” she also told a colleague that was siting near her. “I need any medication that can tackle the pain,” she added. The guide quickly informed the head of the restaurant who promised to get an analgesic for Toluwani.
More than 15 minutes afterwards, the sad news reached Toluwani: “Without a doctor’s prescription, the pharmacist nearby couldn’t be persuaded to dispense the needed drug.” This happened in faraway America. But in Nigeria, it is a different story.
Enter any patent-medicine store and even some pharmacies in this country and ask for non-prescription drugs, without a doctor’s prescription, a consumer of health seeking to purchase the drug will get the medication. The death of Cynthia Osokogu, the Nasarawa State University postgraduate student, who was killed by her facebook lover, was an example of how drugs getting into wrong hands could be deadly.
What is instructive in her death is that, Rohyphnol the medication used to drug Osokogu before killing her, was bought from a pharmacy in Festac, Lagos without a doctor’s prescription. Orji Osita, the pharmacist that sold the medication was prosecuted but finally discharged for want of evidence. Although, Rohypnol is not a prescription drug, yet it was sold without a doctor’s prescription. This is a common feature in Nigeria where drugs are merely handled as articles of trade, prompting all manner of people to be in the business of medicines. In Nigeria, people that are not supposed to be handling drugs are handling them and this is as a result of the existence of illegal drug premises popularly known as open drug markets.
Today, the four major open drug markets in the country that are of concern to stakeholders are the Idumota Drug market, Lagos, Onitsha Overhead Bridge , Anambra State, Ariaria Drug Market in Aba , Abia State and the Sabon Gari Drug Market in Kano State. One of the major challenges in the use of medicines in the country has been traced to the current chaotic open drug distribution system in the country.
The unsatisfactory drug distribution system has led to poor medicine handling, difficulty in product tracking for statistical purpose and for recall, circulation of substandard products, difficulty in audit trail and destruction of professional practice. C onsequently, the Minister of health, Prof. Isaac Adewole recently announced plans of the Federal Government to close these drug markets so as to pave way for a new order that would ensure sanity by January 2019.
This is not the first time the government would announce plan to close existing open drug markets. Under the administration of the former President, Goodluck Jonathan, June 2017 deadline was initially fixed to close down all such markets, but that date has passed without the Federal Government taking the necessary step to dislodge the operators of the markets.
Highlighting the dangers inherent in the current open drug markets, President of the Pharmaceutical Society of Nigeria (PSN), Dr. Ahmed Yakasai said in multiple drug premises like Aba, Onitsha, Kano and Lagos, drugs are kept in poorly ventilated structures housing between 10,000 to 20,000 smaller drug holdings and kept in extreme temperature, which often leads to accelerated degeneration of drugs.
“If you produce a medicine that is designed to expire after three years and you perpetually expose that medicine to a temperature of above 25 degrees centigrade, the expiry which is about three years will automatically drop to about six months within days,” he said. Yakasai lamented that in these illegal drug premises, operators dispense and sell all manner of drugs including narcotics and other controlled drugs and substances. He said, “This is possible because the practice is unregulated; hence anybody walks into those places including our west African neighbours, to buy huge chunks of drugs.
“These encourage extremes of drug misuse and drug abuse because drugs get into wrong hands. “That is where drug hawkers get their drugs; that is where unregistered drug premises scattered in the nook and cranny of Nigeria source their medicines as well.” President of the PSN said what these promote is unhindered access to medicines in Nigeria which comes with tragic consequences including high rate of morbidity and mortality.”
However, National Chairman of the Association of Community Pharmacists of Nigeria (ACPN), Dr. Albert Kelong Alkali said “We find ourselves in this situation because of the chaotic drug distribution system that we have in this country. I know that the National Drug Distribution Guideline was launched at one time, but the implementation date has been shifted severally and that is because of lack of political will by the Federal Government. “Government is not taking this matter seriously. I think that the key culprit in this situation is the Federal Government.”
Beyond the affirmation of the minister of health, the Registrar of the Pharmacy Council of Nigeria (PCN), Elijah Mohammed similarly asserted that the open drug markets will be relocated to the Coordinated Wholesale Centres (CWC) by January 1, 2019.
“The PCN has inspected and approved the various locations of the CWC for each of the open drug markets in Idumota (Lagos State), Onitsha (Anambra State), Ariara (Abia State) and Sabon-gari(Kano State). Explaining how the new order would emerge, Mohammed said the Manufacturers and importers of medicines will only supply their products to the Mega Wholesale Centres (MWCs) otherwise known as Mega Drug Distribution Centres, Public Wholesale Centres (PWCs) otherwise known as State
Drug Distribution Centres, Coordinated Wholesale Centers (CWCs) or Stand-alone Wholesale Centers, which are the conventional wholesalers. These middle level wholesalers will be responsible to supply the retailers which include community pharmacies, public and private health institutions and Patent and Proprietary Medicine Vendors (PPMVs) from which point the public access drugs. “The PPMVs have approved list of medicines which can be sold by them and these are the items they are allowed to stock,” added Mohammed.
According to him, the new system would bring sanity to drug distribution system in the country and promote product tracking and recall when the need arises. Consequently, he noted that the quality and efficacy of the drugs in the new distribution system can be guaranteed and better health assured for the citizenry.
“The operations of the current open drug markets are not under the regulation of any of the regulatory agencies. What this means is that neither officials of the PCN nor that of the National Agency for Food and Drug Administration and Control (NAFDAC) are present in these drug markets.”
However, the Registrar of the PCN said the CWCs will in the first instance be subjected to the rigours of inspection, recommendations and approval and each shall be registered and superintended by registered pharmacists.
He added, “This will instill high ethical accountability.” He stated that the facilities are purpose built. “There will also be distribution managers who shall be pharmacists to coordinate the operations of the subsidiary units. “There are already drawn out operational guidelines and Standard Operating Procedures (SOP). Each CWC will have offices for PCN, NAFDAC and Police Post.
“All CWCs will operate within the framework of the National Drug Distribution Guidelines approved by the Federal Ministry of Health.” Furthermore, Mohammed said the new system will improve international businesses whereby those individuals and companies from African countries who in time past patronised the Nigerian pharmaceutical markets in Kano, Onitsha and Lagos but left for some obvious reasons would come back.
Scientists link western diet with kidney stones
Scientists said western diet, widely acclaimed to be unhealthy, could be linked to high prevalence of kidney stones. A study by the Mayo Clinic found kidney stones increased more than 300 per cent in women and 100 per cent in men within 30 years.
Although, the increase in kidney stones can in part be explained by improvements in medical imaging technology, medical experts linked it to the same dietary factors driving increases in colon cancer, heart disease, diabetes and obesity.
Kidney stones (renal lithiasis, nephrolithiasis) are hard deposits made of minerals and salts that form inside your kidneys.
Kidney stones have many causes and can affect any part of the urinary tract — from kidneys to the bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallise and stick together.
Passing kidney stones are hard masses that form in the kidneys and take a painful route through the urinary tract when exiting the body. Passing out kidney stones can be quite painful, but the stones usually cause no permanent damage if they’re recognised in a timely fashion.
Depending on the situation, one may need nothing more than to take pain medication and drink lots of water to pass a kidney stone. In other instances — for example, if stones become lodged in the urinary tract, are associated with a urinary infection or cause complications — surgery may be needed.
The Mayo study examined first-time presenters of kidney stones from residents in Olmsted County, Minnesota in the United States (US), from 1984 to 2012, focusing specifically on differences between gender and age group. Previous studies of kidney stones were less accurate because they relied on diagnostic codes or survey questions to identify patients with stones.
‘30% of Nigerians suffer tooth decay’
Dr. Olurotimi Olojede is the former President of the Nigerian Dental Association (NDA) and the Secretary General of the African Regional Organisagion of World Dental Federation. In this interview with APPOLONIA ADEYEMI, he discusses factors fueling tooth decay, mouth odour, teeth extraction and measures to improve oral health generally
What are the common tooth problems in Nigeria?
Basically, in Nigeria, we have two major tooth problems. One has to do with the hard tooth structure and the second is the soft tissue. The hard tooth structure has to do with any disease that will affect the enamel. We call it cavity conformation or dental caries and we have the disease of the soft tissues or supporting structures of the teeth. It may be the gum, which is the periodontal disease and other parts of the tooth.
Race and environmental factors tend to affect the prevalence or occurrence of these dental problems at a particular point in time in different environments.
There is also oral cancer. Some may be benign while some are malignant.
Are they very common?
They are common; the only challenge we have is that patients don’t come to the hospital because some of the oral cancers are not painful at the onset and the swelling is gradual.
Some people carry the swelling for between eight to ten years and sometimes fifteen years until when they start to have deformation or cosmetic embarrassment. That’s when they seek medical advice and by that time it’s almost late. In fact, a very serious damage must have been done and surgery to correct that is very expensive.
What is the burden of dental caries in terms of available data?
If we are to look at available data, we will be talking about 25 per cent to 30 per cent of our population that comes down with dental caries.
Dental caries or cavities, which are also known as tooth decay, is a breakdown of teeth due to acids made by bacteria.
The cavities may be a number of different colours from yellow to black. Symptoms may include pain and difficulty with eating.
It’s a cross-sectional thing; it cuts across male, female, children and adults. If children takes things that will lead to it, it will happen. If adults, too take some of those things that will lead to it, adults too will develop it.
Specifically, what are the causes?
The four major things interplay in the development of dental caries; if one is missing out of those four major things, dental caries will not occur.
Number one is that it is not the quantity, but the frequency of the intake of refined sugar that is behind it.
Secondly, a susceptible tooth could also develop caries; that is to say that some teeth are made to have caries because of some things happening in them.
Then, the immunity of the patients is also very important and finally, bacteria in the saliva is another major problem leading to caries. All of us have bacteria in our saliva. So, when there are those enabling environment in the patient’s mouth, the patient will develop caries. We all have different species of bacteria in our mouth. Those four factors are very germane to the development of caries.
How can people prevent developing caries?
That’s why I said, it is not the quantity of refined sugars consumed that causes it, but the frequency. Even if you are taking it in small quantity, but also taking it frequently, the refined sugar will increase your risk of developing tooth decay. If you engage in taking refined sugar from morning till night, under one month, you will develop carries. Whereas, I might just sit down before my wife’s refrigerator before my lunch and take all the cakes there. You will realize that I will not have dental caries while someone taking tom-tom on regular basis throughout the day will have dental caries.
So, it’s the frequency of the intake of sugary diet that fuels tooth decay. For example, if before you leave your house in the morning, you drank tea or coffee with sugar and milk; When you get to work, you had another coffee or at meeting, they served you meat pie and soft drinks.
Thereafter in the afternoon you say, “Oh!, I’m really hungry. Can I have soft drinks,” which also contains refined sugar. Similarly, before you go to bed, you say, “Oh! You must give me my coffee” with milk and sugar. Before you know it, you have challenged your mouth regularly, eight to twelve hours with sugary substances.
Therefore, if you do that consistently for one month, you will have to get a good deal with your dentist.
One paramount method of prevention is, whether there is complaint or not, you must make sure you see your dentist every six months or twice a year.
You must also brush your teeth twice a day, first thing in the morning and last thing before you go to bed at night.
Similarly, you must make sure that you avoid what is called ‘in-between’ meals. You have taken breakfast, then you see somebody taking chin-chin, you take a little; someone is eating When you’ve taken your breakfast, you should relax. When you want to take snacks, take snacks and rinse your mouth and end it there.
Much more than that, you ought to involve in principles of hygiene; it’s very important and that is why I said that you shouldn’t wait until you a have a complaint before you visit your dentist.
In addition, you should use what is called medium toothbrush. In the market, there are trademarks, showing types of toothbrush; we have soft, medium and hard brushes.
Look on the packet, you will see medium for adults and then, you ask your dentist to teach you how to brush your teeth. It’s very important; we call it oral hygiene instruction.
If you do all that, you can keep your teeth for a lifetime, except you have trauma.
Adelusi-Adeluyi: Use digital platforms to improve patient outcomes
An appeal has gone out to healthcare professionals in the country to leverage communication and networking in order to improve the net worth of health service given to the patients.
To underscore this approach, they were urged to become early adopters in the use of digital health platforms that will positively improve patient outcomes.
This was the unequivocal submission of leading health practitioners at the launch in Nigeria of the IQVIA HCPSpace a digital healthcare platform by leading global provider of information, innovative technology solutions and human data science, IQVIA, formerly known as Quintiles IMS.
IQVIA HCPSpace is a web and mobile based platform designed to bring together all specialties and sub specialties of doctors, pharmacists, nurses, medical laboratory scientists, and all other healthcare professionals, where they can connect with peers, follow key opinion leaders (KOLs), discuss medical cases, establish public/private groups, view videos for increased knowledge, earn Continuing Professional Development, CPD points from content provided by approved bodies and KOLs, find jobs and career opportunities across multiple regions in Africa and the Middle East.
Chairman of the occasion and President, Nigerian Academy of Pharmacy, Prince Julius Adelusi-Adeluyi noted that IQVIA’s HCPSpace is a bridge-building tool that will encourage collaboration among healthcare providers whilst driving efficiency, performance and capacity utilisation as well as innovation in the nation’s health space as a whole.
“I would like to commend IQVIA for trying to crack a problem that has remained with Nigeria for quite a while given the numbers of government committees that had been set up in the past to solve the challenge of interprofessional collaboration and promote harmony in the health space. This tool will be a blessing to the nation as it will radically alter Nigeria’s health landscape for good and help to reduce unnecessary competition among professionals,” Adelusi-Adeluyi stated.
Chairman of the IQVIA HCPSpace Advisory Board, Dr. Femi Olugbile, pointed to the growing domestication of technology for personal and professional use across the world as well as creating a sense of team in community via multi-specialty task performance and problem solving tools.
“All over the world, there is an increasing awareness that communication and collaboration are essential ingredients for the creation of a thriving, high-achieving healthy work force.
Providing the reason for the platform’s existence, Country Manager, West Africa, IQVIA in General, Pharm. Remi Adeseun recalled that a communiqué was issued at the end of the Inter-Professional Collaboration Symposium organised by the Nigeria Academy of Pharmacy in collaboration with the Pharmaceutical Society of Nigeria, PSN. The event which held on May 11 2017 at the University of Lagos, encapsulated an 8-point resolution, and underscored the need to deepen the concept of universal communication and collaboration among healthcare professionals via tools that are yielding documented benefits and gains in the healthcare sector across the world.
“We are very confident that the
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