Corruption is the cause of counterfeit drugs in Nigeria —Prof Olutayo

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Sunday, 24 June 2012

Professor Alebiosu Christopher Olutayo is a Consultant Nephrologist and Provost, College of Health Sciences, Osun State University, Osogbo. He speaks on kidney diseases among Nigerians. Excerpts:

ACCORDING to the National Association of Nephrology (NAN), no fewer than 30 million Nigerians are said to have kidney problems. What do you think could be responsible for this?
Kidney problems are common, harmful and treatable but now occur in an epidemic manner globally. A huge variety of diseases can affect the function of the kidneys, from acute illnesses to drugs and chronic illnesses. Common causes of Chronic Kidney Diseases (CKD) include inflammatory diseases of the kidney, infections, obstruction in the urinary tract and inherited disorders like polycystic kidney disease. But in both developed and developing nations diabetes and hypertension are becoming the most common causes of CKD. The well-recognised risk factors for CKD include diabetes mellitus, hypertension, family history of kidney disease, cigarette smoking, and abnormal fat in the blood (dyslipidaemia). Others include exposure to heavy metals such as lead, low birth weight (with a reduction in the number of nephrons), and the use of herbal remedies, particularly in Africa. In Nigeria, the commonest causes of chronic kidney diseases are hypertension, glomerulonephritis, diabetes mellitus, and obstructive uropathy.

With the frightening figure released by the association, does it not mean that the nation is losing the battle against kidney disease?
No, the battle is not being lost; rather it calls attention to the gravity of the problem. Government may not be doing enough in respect of addressing the problem of kidney diseases in Nigeria. Non-communicable diseases (which account for the greater majority of the causes of chronic kidney diseases in Nigeria) have become a major health problem, not just in developed countries but also in developing countries. For instance, the prevalence of hypertension in Nigeria is between 15 to 27.7 per cent and studies have shown that blood pressure control rates are poor. It is, therefore, not surprising that hypertension is still the leading cause of CKD in Nigeria. A lot is needed to be done to fight the war against the rising occurrence of CKD.

What does it mean to have kidney failure or kidney-related disease(s)?
The first consequence of undetected Chronic Kidney Disease (CKD) is the risk of developing progressive loss of kidney function leading to kidney failure and the need for dialysis treatment or a kidney transplant. The second is premature death from associated cardiovascular disease. Individuals who appear to be healthy who are then found to have CKD have an increased risk of dying prematurely from CVD (coronary disease, stroke, peripheral artery disease, and heart failure).

Could self-medication be a cause of kidney problem in the country? If yes, how?
Nigerians should refrain from consumption of medications without prescriptions. Certain habit like the chronic use of pain killers, especially the group known as non-steroidal anti-inflammatory agents, is associated with the development of chronic kidney disease.

Can poverty and poor health care system in the country contribute to the rise of the disease in the country?
Health is recognised as an essential component of human development. Many Nigerians still live below the poverty line and do not have good and adequate access to health care. In sub-Saharan Africa, there is a double burden of diseases- infective diseases (such as malaria, gastroenteritis, pneumonia) co-existing with the non-infective diseases, in a resource poor environment characterised by inadequate and moribund healthcare delivery systems. Unfortunately, this dismal picture is further compounded with the emergence of another epidemic plague, HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) in the 80s, as well as the threat of avian and swine influenza infections. This leaves the country with a double burden of health problems – a new epidemic of infectious disease and unresolved infectious conditions, as well as a growing set of non-communicable diseases.

What other pharmacological and social factors could aid the rise of the disease?
Some socio-cultural practices can lead directly or indirectly to the development of chronic kidney disease. These include long-term ingestion of herbal concoctions/preparations, chronic analgesic abuse (certain pain killers) and the use of certain soaps/ creams/lotions used as bleaching agents. Chronic exposure to heavy metals such as lead (found in paints) could also aid the rise of the disease.

At what point does kidney problem become chronic kidney disease (CKD)?
Chronic kidney disease (CKD) is said to occur when there is an evidence of kidney damage based on abnormal urinalysis results (eg, proteinuria, hematuria) or structural abnormalities observed on ultrasound images of the kidneys or a Glomerular Filtration Rate (GFR) of less than 60 mL/min for three or more months.

How can the nation address issue of counterfeit drugs on sale in the market?
The consequences of counterfeit drugs are too grave for the country. The way out of ensuring that counterfeit drugs are done away with in the country lie with us all. First and foremost, the recent activities of the Pharmaceutical Society of Nigeria (PSN) are commendable. Government as well as corporate organisations as part of social responsibilities should, through the media, create continuous awareness amongst the populace on the dangers that such drugs can cause. NAFDAC over time has done a lot in this regard. Finally, corruption is one thing that has to be dealt with firmly and decisively as it relates to counterfeit drugs.

What can government and individuals do to stem the tide of this disease?
This can be achieved through targeted screening of people at risk for kidney diseases, imbibing positive lifestyle modification/behavioural changes as well as ensuring a healthy dietary pattern. Others include avoidance of infections – sexually transmitted infections and urinary tract infection as well as the need to cultivate positive attitude to pre-school and pre-employment screenings and routine medical checkup.

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