Malawi joined other countries on Wednesday in commemorating World Tuberculosis Day — this to draw attention to a disease that claimed two million lives last year, according to the World Health Organisation. However, the efforts of Malawian officials to curb tuberculosis (TB) are being dogged by the theft of TB drugs from state hospitals.
Felix Salaniponi, programme manager for the country’s National TB Control Programme, says the stolen drugs are often used to treat ailments other than TB: ”These include non-specific coughs, bloody diarrhoea, sexually transmitted infections and some HIV/Aids-related conditions.”
This indiscriminate use of the medicines, he adds, is leading to the development of a multi-drug-resistant strain of TB (MDR TB) for which 10 cases have already been registered. As the name implies, MDR TB is virtually untreatable, and can lead to death.
While police public-relations officer Willie Mwaluka says the pilfering is decreasing, health officials remain alarmed at the damage that could be caused before the drug theft is completely eliminated.
”The main frustration here is that a new condition of untreatable TB is being created, on top of the current burden of TB. This is creating a man-made disaster,” says Salaniponi. (The emergence of MDR TB has also been linked to the failure of TB patients to complete the courses of medication prescribed for them — often because they start to feel better after having taken the first few doses of drugs.)
MDR TB threatens to exacerbate the effects of the Aids pandemic in Malawi, which has made the population especially vulnerable to TB.
According to the National TB Control Programme, about 77% of all new TB infections in the country are as a result of HIV/Aids. The National Aids Commission estimates that 14,4% of Malawian adults have contracted HIV.
Salaniponi says the theft of TB drugs was first noted in 1990, and that it has continued despite tight security measures introduced by his office, the government’s Central Medical Stores, the Medical Council of Malawi and the Pharmacy and Poisons Board.
Minister of Health Yussuf Mwawa says his department has also taken steps to ensure that ”these drugs do not develop legs”. These include the positioning of security guards at drug storage areas and the launch of a public awareness campaign to inform people about the dangers of abusing TB drugs.
Nonetheless, ”Every three months, we hear that there are up to two incidences of suspected anti-TB-drug thefts,” notes Salaniponi.
He blames most of the pilfering on medical personnel working in state hospitals, who allegedly sell the drugs to private pharmacies, clinics and vendors in Malawi’s four largest cities: Blantyre, Lilongwe, Mzuzu and Zomba.
National regulations restrict the dispensing of TB drugs to state hospitals. But, since Malawi’s economy was liberalised in the mid-1990s, private clinics have proliferated in the country. Most of them operate without proper licenses, a situation that alarms Wynn Chalira, registrar of the Pharmacy and Poisons Board.
”Such one-man clinics are very dangerous indeed,” he said, adding: ”The recommendation is that private clinics should have a dual license, one for dispensing drugs, which we issue, and another from the Medical Council for practising. Most either have one or none.”
Financial constraints prevent the board from conducting regular confiscations of illegal drugs, says Chalira.
Mwawa fears that illicit TB drugs could also be entering Malawi from neighbouring states, courtesy of the country’s porous borders.
At present, Malawi uses rifinah, pyrazinamide, ethambutol and streptomycin to treat TB under the internationally recommended directly observed treatment strategy (Dots). Amongst other things, Dots requires up to eight months of supervised TB treatment — and obliges patients to take their medication in front of doctors or nurses for the first two months.
Rifinah and streptomycin are said to be the TB drugs that are most abused in Malawi.
Donors such as the British Department for International Development, Norway and The Netherlands contribute 75% of the budget for TB drugs and the government finances the remainder.
TB is a contagious disease that is contracted when people inhale the germs — or bacilli — that cause it (although these may remain dormant for some time). Its symptoms include a cough, bloodstained sputum, chest pains and weight loss. According the World Health Organisation, one-third of the global population is infected with TB bacilli.
Government statistics put Malawi’s TB prevalence at between 5% and 7% of the population. — IPS