“I usually feel feverish and occasionally cough when I have malaria, so anytime I experience such symptoms I conclude it is malaria and rush to the nearest chemical shop to buy malaria drugs.”
The above statement was made by Esi Aubin, a 49-year-old resident of Chorkor, a suburb of Accra. She has lived in the community with her husband and three sons for almost fifteen years.
Throughout their stay, they hardly visit the hospital when they have symptoms of any illness. They handle the situation by themselves. If she would go to the hospital then she needs to see a dentist.
This has been the case for many years and according to the dressmaker, they have not faced any major consequence of self-medication, therefore, they see no reason to stop to the practice.
She recalls that the few times she went to the hospital to complain of illness, no tests were conducted but she was given drugs for malaria and the same medicine prescribed for her on subsequent visit.
Therefore, she reckoned that she would buy the same medicine and administer it to her family whenever they experienced same malaria symptoms.
“What is the use of visiting the hospital and being in a queue for long hours only to be given paracetamol, multivite and B.co plus a malaria drug when I can easily go to the drug store to buy them in a few minutes?” she quizzed.
Malaria is caused by a parasite which is mainly transmitted through an infected female anopheles mosquito, with common symptoms including headache, chills, fever, bodily pains and cough, according to the World Health Organisation (WHO).
Worldwide, the disease is known to have infected about 229million people with an estimated 409,000 in 2019 alone out of which, 94percent of the cases and deaths were recorded in Africa.
In Ghana, statistics from the Ghana Health Service (GHS) indicate that in the same year, malaria accounted for about 65 per cent of reported cases with 1.1 per cent of inpatients deaths of 4,799, according to the Ghana National Malaria Control Programme (GNMCP). In 2020 malaria deaths in the country were 308.
There were no definite statistics from the cases in 2020 but a Doctor with the GNMCP, Dr. Boakye-Yiadom Adomako, indicated that despite the reduction in malaria deaths, the malaria cases continue to be a challenge.
Pharmacy and chemical shops
Pharmacy and chemical shops popularly known as ‘drug stores’ in Ghana are supposed to serve as community pharmacists to assist in dispensing prescription, provide advice on drug selection and serve as the primary healthcare advisors.
However, they have unfortunately contributed to the challenge of self-medication.
Josephine Konadu is a pharmacy technician at Tohaba Pharmacy at Manet in Accra. She says majority of the people who visit the pharmacy come with various complaints hoping to get medication.
“Based on a person’s symptoms, I conduct a malaria test but the test is not 100 per cent effective especially when the malaria parasite is not enough in the bloodstream. When the test turns out negative, I explain to the client and provide malaria drugs,” she said.
A Medicine Counter Assistant at Sakaman, Akua Johnson, says she probes when people come buying drugs without prescriptions which helps her dispense drugs based on the client’s answers to her questions.
Test and Treat
Artesunate Amodiaquine and the Artemether Lumefantrine are currently the drugs being used for the treatment of malaria in Ghana.
The malaria test and treat require a doctor to ensure a test is done on a patent to confirm malaria before the drugs are administered. However, for reasons unknown, the tests are sometimes overlooked even by medical practitioners in the health facilities.
A health worker who prefers to remain anonymous has served as a community health nurse in one of the country’s rural health centres and says she does not ask for patients’ drug or health history before referring him or her to a doctor.
“I only ask for the symptoms so I am not able to determine a patient’s clinical history to determine if such a person has taken a malaria drug before visiting the hospital and until they are given the same drugs, they do not tell us”, she said.
According to her, “the few times where we have asked further questions, we have noticed that most patients treat malaria with herbal medicines even before visiting the hospital for a test to be done”.
WHO recommends confirmation of malaria by either microscopy or a rapid diagnostic test but a research by the GNMCP shows that Ghana’s current tests before treatment at the health centres stand at 95 per cent as of 2020 as compared to 30 per cent in 2012. This is due to the organisation’s training and education of health personnel on the need for tests to be conducted before prescriptions are given.
Effects of self-medication
The failure of health practitioners to test for malaria or the inability of patients to insist on tests to confirm malaria before taking medications have been known to have adverse effects on the individual.
According to Dr. Adomako, this could prevent health workers from identifying the real disease as against what the patient is being treated for.
He said there is also a possibility of the individual becoming anti-resistant to the malaria drug due to the constant intake of the drug. This, he said, was what led to the eventual eradication of the chloroquine drug which used to be the main treatment drug for malaria.
He was, however, quick to add that patients who have tested positive and given drugs do not complete the course which could also cause the parasite to become resistant to the drug.
“The plasmodium parasite is supposed to clear all the parasites from your body. If you don’t clear all, it may clear a greater majority and the few that are left will fight the anti-malaria and in trying to fight they may change their system and once they are able to win, they will build new strains to fight the anti-malaria drug,” he added.
Dr. Adomako advised medicine counter assistants who do not have the requisite knowledge and testing kits to direct patients to the health centres instead of giving malaria drugs for unknown diseases.
He indicated that most cases diagnosed as malaria were usually stress related diseases that could even be cured with a painkiller such as malaria or even water.
He stated that health practitioners are sometimes reluctant to test due to the increasing number of patients they need to attend to daily but condemned the practise of self-medication and urged patients to ensure they are diagnosed before taking prescribed medications.
Efforts to prevent malaria transmission
All over the country, audit is being done by the GNMCP to ensure effective testing and treatment is ongoing.
The GHS rolled out the Ghana Malaria Strategic Plan 2015-2020 to reduce the malaria burden by 75per cent.
Currently, one drug, the RTS, S/AS01 is being used for the malaria vaccination in the country but it is only 40 per cent effective.
Dr. Adomako said, the malaria vaccine is only to serve as an additional tool hence it is important that individuals use the Insecticide Treated Mosquito Nets, clear all poodles and stay indoors. He advised those in the northern parts of the country, where malaria is endemic, to stay indoors especially at night to prevent mosquito bites.
By Adwoa Adobea-Owusu