Millions predicted to die from noncommunicable diseases in Africa by 2020: Here’s how we can fight the scourge

By Bakani M Ncube

I remember a friend of mine sending me a meme that said: “Get your change stuck in a vending machine? Don’t mess with it. Vending machines kill more people per year than sharks do!” This was hilarious. However, along with the words of one of my influencers, Dr Matshidiso Moeti, this meme got me contemplating on the severity of noncommunicable Diseases (NCDs).

According to PubMed, a noncommunicable disease (NCD) is a medical condition or disease that is by definition non-infectious and non-transmissible among people. They claim 38 million lives per year. This simply means that it is a disease or condition that if I have, I cannot pass it onto the next person and it is mine and mine alone. The four main types of NCDs have been highlighted to include cardiovascular diseases, cancer, chronic lung diseases, and diabetes. With this in mind, the World Health Organization (WHO) African Region Office has stated that millions of people are predicted to die from NCDs by 2020 and by 2025, 55% of all deaths will be attributable to NCDs and injuries. Most of the African adult population has at least one of the NCD risk factors which increases the chances of developing an NCD. It is due to these findings that these death threats can be predicted. Worldwide, deaths from NCDs are to reach an estimated 44 million within the next four years (a 15% increment) and this will be an increase from the WHO’s 2010 estimates. WHO African Region Officer Director states that “In recent years, much of the world’s attention and resources have – deservedly – been directed toward the immediate threat posed by emerging viruses, including Zika and Ebola. What this report serves to highlight, however, is that amidst these emergencies we cannot lose sight of the enormous health dangers posed by non-communicable diseases, especially since many of these can be prevented through changes in behavior and lifestyle.’’

In Africa, we mostly focus on the communicable diseases such as malaria, tuberculosis, HIV/AIDS and the longest and most severe epidemic known in human history, Ebola Virus Disease (EVD), which was successfully eradicated in West Africa in December 2015. However, the NCDs do need attention too as these are diseases that can be life-threatening as well as debilitating. They place a significant hardship on the region, robbing people and families of those who otherwise should be enjoying their most productive years. We find ourselves as Pharmacy students in a very unique and important place. We can work together across the continent as the IPSF AfRO to raise awareness about NCDs as we have been doing in past years so as to combat the diseases and ensure that the next time we read the WHO Report of the Regional Director, these terrifying numbers may have significantly decreased. We must do everything we can to reverse these disturbing trends.

The prevention of NCDs is largely dependent on 4 major behavioural risk factors and these include:

  1. Tobacco use which is one of the most serious health risks globally, causing more than 70% of lung cancers, 40% of chronic lung diseases, and 10% cardiovascular diseases. In the African region, the prevalence of daily tobacco use among adults ranged from 5% to 26% (12% across the Region). Fortunately, some achievements have been made in the region with Botswana being the first country to introduce an additional levy on all tobacco products.

2. The harmful use of alcohol which most people consume for one reason or another.
3. A poor diet especially in Africa where some people are malnourished as a result of poverty and low income.
4. Low levels of physical activity within the region that have seen us being ranked worldwide as having the highest prevalence of hypertension, with about 46% of adults having high blood pressure.
Overall, there needs to be a paradigm shift within our beloved region where we become more conscious of the prevalence of NCDs and be bold enough to act on it, such that the alarming stats may decrease and we live long, healthy lives.

Mr. Bakani is a second year student at the University of Zimbabwe and has an interest in Public Health issues. He also serves as the Student Exchange Officer for the Zimbabwe Pharmaceutical Students Association.
zpsaseo@gmail.com

IPSF Story of Patricia Nyokabi- 2014/15 Best Contact Person in AfRO and 5th AfPS Chairperson

By Patricia Nyokabi

I was first introduced to the exemplary work of the International Pharmaceutical Students Federation (IPSF) during a Leaders-In-Training workshop organized by Kenya Pharmacy Students Association (KEPhSA) in November 2013. I had been invited together with some colleagues in our capacity as officials of the pharmacy students association in the Jomo Kenyatta University of Agriculture and Technology (JKUAT) chapter.

The training was intense yet seamless. It was deeply enlightening especially for an individual who was budding in this thing we call leadership. Just a month earlier, I had organized an ‘Induction to Pharmacy’ conference at my university. I was badly in need of some training especially in an environment where every participant can identify with the struggles of leadership.

In the course of the training, a presentation was made about an upcoming IPSF African Pharmaceutical Symposium (AfPS) in Victoria Falls, Zimbabwe. I knew I had to be there, if not for anything else, for the wonder of the world venue for this symposium.

I put my mind to it,  worked so hard and sure enough June/July 2014 found me in Zimbabwe. I was thoroughly impressed by the professionalism in the activities scheduled, the social cultural events, the General Assembly and the elections and of course the excursion to the mighty Victoria falls.

I knew deeply within myself that I had to plug into the work of the IPSF. I had experienced first hand the vital role that Contact Persons play in the running of the Federation.  I would vie for the position of the IPSF Contact Person to Kenya during the upcoming elections.

Serving in this capacity was thrilling. It was my year of firsts. Running public health campaigns, responding timely to all the emails that needed my attention- sometimes up to 20 per day, communicating professionally online and in person, Skype meetings, using Google docs, forms, spreadsheets were skills gained. All important skills for any individual in this digital age, yet no school quite teaches you these skills, you learn on the job.

My highlights were; having 30 Kenyan delegates attend the 4th IPSF AfPS in Rwanda, organizing the first ever forum that brought together pharmacy students from all the 6 universities in Kenya that offer a Bachelor Degree in Pharmacy (the annual event is now in its 3rd year) and receiving the IPSF Development Fund Grant to attend the 61st World Congress in Hyderabad, India. For the outstanding achievements, I got the award for the Best IPSF AfRO Contact Person in the year 2014/2015.


I had discovered my life’s purpose in leadership and IPSF was giving me a platform to live it out! I was on such a leadership roll; passion and zeal almost palpable.

My next role would be the most fulfilling yet. I had prepared a bid for KEPhSA, Kenya to host the 5th IPSF-AfPS and upon winning I applied to be the Chairperson for the committee that would organize an event of such magnitude.

Previous hosts had been Algeria, Tanzania, Zimbabwe, Rwanda. It was coming to my homeland, finally! First task was to get team members, then to identify a venue, get speakers, funds, delegates etc. It was such an intricate process for a period of almost a year.

I would look at everything through an AfPS set of glasses. All my friends and family were dragged into the AfPS planning process. I would be randomly walking in town, then I come across something that would feature in the symposium like speaker’s gifts, delegates notebooks etc then I frantically click away and bombard my team members with pictures of the ideas I had. I was in such an AfPS trance and I loved it! Plus with such dedicated team members that journey was truly worthwhile!

The event was held in June 2016 in the coastal city of Mombasa. The theme was: ‘Rewriting the African Narrative in Healthcare :Access, Quality and Innovation’.130 delegates from 10 countries in Africa took part. We had such a great variety of lectures, workshops, social cultural activities, an excursion to Mamba Village and a mentorship session at Allidina Visram High School.

Around that time I was also preparing for my final exams. I completed successfully and graduated in November last year.

IPSF has truly enriched my pharmacy school experience. The 15 semesters didn’t feel too long because I was always doing something on the side – organizing events, traveling etc. It gave me great exposure to pharmacy training and students from across the World. I made so many friends, some of whom now feel like family. I travelled the World from the Country of a thousand hills, Rwanda to the Wonder of the World, Victoria Falls, the Pharmaceutical city Hyderabad, India and finally to one of the few cities that bring together all the nations of the World- Geneva, Switzerland for the 69th World Health Assembly.

Towards the end of last year, I felt I had completed that part of my service to IPSF as I had pharmacy school and as with all the positions I’ve held, I passed on that baton too, to allow for the many other batons that will be passed on to me in various other capacities. I serve subtlely in an advisory role, when called upon to especially by individuals within AfRO.

Looking forward to what the future holds, especially within the healthcare provision space.

Heartfelt gratitude to all my mentors within IPSF, to all the individuals that I got to work with; the 5th IPSF-AfPS Reception Committee, the Regional Working Group 2015/2016, KEPhSA executive 2014/2015 and to everyone that I got to meet through IPSF. We made such great memories that I’ll reminisce for a lifetime!

pnnyokabi@gmail.com

Editor’s note: Feeling inspired and you want to share your IPSF story with the world too? Write to rmpo@afro.ipsf.org

4 February 2017: World Cancer Day

By Our Regional Projects Subcommittee 

Introduction
Currently 8.2 million people die from cancer worldwide every year. Out of which 4 million people die prematurely between the ages 30 to 69 years. A report which relied on more than 100 cancer registries in 68 countries from 2001-2010, indicated that approximately 300,000 cases of cancer are diagnosed in children and teens under the age of 19 every year.

February 4th each year the world commemorates the world’s cancer day. Since 2016 it has been running under the tagline: ‘We Can, I Can’ and as IPSF AfRO, this year we will focus on cancer awareness by highlighting the types of cancer, possible causes, signs, and symptoms, and how everyone as a collective individual can be part of such a movement to help reduce the global burden of cancer.

Cancer is a group of diseases characterized by uncontrolled growth and abnormal cells. Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named according to the location in the body from which they originate. Eg. lung cancer starts in the lung, and breast cancer starts in the breast. The spread of cancer from one part of the body to another is called metastasis.

Types of cancer and their awareness colours

Signs & Symptoms

Type of Cancer Signs & Symptoms
Lung Cancer New cough, hoarseness, haemoptysis, dyspnoea, non- resolving pneumonias, chest wall pain and tracheal obstruction.
Breast Cancer Breast lumps, nipple retraction, dimpling, discharge and skin changes.
Cervical Cancer Abnormal vaginal bleeding and discharge, pain during sex and pain in the lower belly or pelvis.

 

Colorectal Cancer Occult bleeding, constipation, obstruction, and stool caliber.
Liver Cancer Loss of appetite, weight loss, nausea and vomiting, jaundice, pain or swelling of the abdomen, itchy skin,feeling very full even after eating a small meal and general body weakness.
Prostate Cancer Urinary hesitancy, nocturia, poor urine stream and terminal hematuria.
Ovarian Cancer Abdominal pain& discomfort or enlargement, postprandial flatulence, virginal bleeding, early satiety,constipation, dyspepsia and nausea

Risk factors leading to cancer

How you can help to reduce the global burden of Cancer

  • Improve access to cancer care by closing gaps in access to affordable cancer care.
  • Create healthy cities and working environments for example by prohibiting smoking in all indoor workplaces, increasing movement in workplaces through the use of stairs, so as to help build a healthier workforce.
  • Prevent cancer by educating individuals and communities with the latest knowledge of the links between lifestyle and cancer which will in return empower people to adopt healthy choices.
  • Challenge perceptions in societies where cancer remains a taboo and help improve knowledge of cancer where people are misinformed thus overcoming stigma and discrimination among cancer patients.
  • Shape policy change by implementing policies that can be used to minimize exposure to cancer risks including to tobacco, alcohol and unhealthy foods, as well as environmental exposures.
  • Understand that early detection can save lives since it has been shown that increasing awareness of signs and symptoms and the importance of timely treatment helps to improve survival from cancer.
  • Ask for support by mantaining social networks which can be an important coping mechanism for cancer patients and their loved ones for both in the short and long term.
  • Make healthy lifestyle choices by choosing to quit smoking, become physically active and eat healthy food and drinks.
  • Love and be loved by working together with family and friends through the challenges of cancer and never be alone in facing this “giant.”

There’s hope
Though cancer remains one of the leading causes of death and disability globally where it impacts more than 14 million people each year, most of cancer cases can be cured by surgery, radiotherapy or chemotherapy if there is early detection.

Mgambi Gamba Gideon, Mutabazi Claude, Anesu Adilwayo and Geofrey Beingana contributed to this article.
rpo@afro.ipsf.org

Technology in Healthcare System, the 8th RPSA Annual Symposium Focus

By Fabrice Humura

Rwanda Pharmaceutical Students Association (RPSA) is organizing its annual symposium slated for 17th-18th March 2017. This year’s inspiring theme falls into the world’s updated system known as technology. The theme is: “Navigating through a technological Healthcare system.”

The symposium happening for its 8th time,  will be held at Galileo Hotel in Huye District. Participants will convene to exchange ideas on how to incorporate technology for an improved health care service delivery.

Unlike other previous symposiums, this one will give room to all health care providers as technology captures everyone’s interest and quicken delivery of the expected service irrespective of the area one may be working at.

Side events will be a top innovation in this upcoming symposium. Participants will choose an event to be part of deep discussions on the topics of interest. This will undoubtedly enhance discussions and interaction among participants.

Participants at the 7th RPSA Symposium.

Moreover, such symposiums gathering multitude of participants does not end with only presentations, but also offering a privilege of networking where people get to know each other through sharing life and career experiences. Networking is normally charmed by the tea break as participants enjoy while getting relieved and a quite delicious food.

In the ICT century, being a student, professional, local or international participant is of less concern when one is eager to be smarter. This symposium will be an opportunity to sharpen knowledge in technology as Rwanda’s developing rate in embracing technology and innovation is loud.

On 14th October 2016, Rwanda became the first country in the world to launch drone delivery programme to transport medical products to remote parts of the country [Zipline Photo].

You can register for the symposium here.

Mr. Fabrice is the 8th RPSA Symposium coordinator.

humurafab@gmail.com 

 

Studying pharmacy is the best decision I ever made- Meet Aniekan Ekpenyong, FIP YPG Professional Innovation Grant Winner 2016

On October 27th 2016 social media was awash with news that Nigeria’s pharmacist and former IPSF AfRO Secretary, Mr. Aniekan Ekpenyong had won International Pharmaceutical Federation (FIP) Young Pharmacists Group (YPG) Professional Innovation Grant. IPSF AfRO Regional Media and Publications Officer, Kennedy Odokonyero had a chat with him about the research idea that made him win and much more. Here is the excerpt of the interview.

I believe a lot of people out there who were congratulating you on winning the grant don’t know about the research that made you win. So, let us start with your research idea that allowed you to emerge as the best. Can you share more details on it?  

Well, the aim of the project is to analyse the gaps in numbers, distribution and specialities and recommend a 5-10 year plan/policy in preventing a human resource crisis in pharmacy. The research will generate evidence based recommendations to solve the challenge, thereby improving access to medicines, responsible use of medicines and overall health outcomes for the patients/society. This work will generate data and basis for a scale up project on a sub-regional and regional basis, giving evidence for interventions and evaluating short and long term interventions. Results of this research will be the evidence for poor health outcomes in areas of low human resources, advocacy to stakeholders and improved investment in pharmacy education, thus promoting the indispensable essence of the profession and pharmacy professionals within the health sector.

Were you confident that you would win?

Hahaha that’s a tough one. Well, I had given up! The grant was supposed to be announced during the FIP conference in Argentina, but it wasn’t.    

How did you feel after you got the news that you won?        

Stunned! For the whole day, I wasn’t myself. In fact, I lost my appetite to eat. I was just surprised. Everything just came so fast, especially my timeline being flooded with good wishes.   Actually, I hadn’t seen the email. I was called at about 7am and told that I won the grant. Man, waking up to such awesome news? I had to calm myself down and make sense of what happened.

I understand the feeling.

Haha. I bet you do.

On a personal level, what does winning the grant mean to you?   

A deep sense of responsibility especially considering my project topic, and gratitude to God for being chosen.

I didn’t go to a journalism school but you can see my interview skills are on point.😀

Man, it really is!

Lastly, tell me about something readers of this interview don’t know about you. Your family, current work and future aspirations?       

I am the first of two born to amazing parents. I am 23 years old. Studying pharmacy was a personal choice. My parents wanted me to study medicine. I never loved the concept of a hospital. I decided to opt for pharmacy and I think that’s the best decision I have ever made. I graduated in July of this year and that’s when I was inducted to become a pharmacist. I was among the best five or ten students in my class. I currently work as local pharmacist i.e. a part time pharmacist. I am waiting for my internship that will start sometime soon.

My future inspiration is to pursue a master’s degree in global health on issues that are most relevant to pharmacy. I have also discovered a passion in supply chain and health logistics. Basically, I would love to help Africa discover herself in any way I can.

Aniekan during his graduation. (FACEBOOK PHOTO)

You can listen to Aniekan’s love story with pharmacy and IPSF here.

About YPG Grant for Professional Innovation

According to FIP’s website, YPG aims to support young pharmacist members from around the globe who have limited resources for professional organization involvement or their own research. The YPG Grant for professional innovation consists of € 1000 for the implementation of a project by a young pharmacist/pharmaceutical scientist. Projects can stem from any field of pharmacy (pharmacy practice, pharmaceutical science and/or pharmacy education) but should directly or indirectly benefit or improve health of communities and demonstrate the added-value of pharmacy on health. Pending the acceptance of a project report, the Grant recipient may additionally be awarded a complimentary  registration, a return APEX airfare and hotel accommodation. Did you know that the 2017 application is open? Visit http://fip.org/young_pharmacists_group for more details.  

WHEN BACTERIA DECIDE TO FIGHT BACK

By Edidiong Michael

UDOFA, 300Level, Faculty of pharmacy

Before the dreaded effects of global warming or the apocalypse, lays a more life threatening doom- ANTIBIOTIC RESISTANCE. This means that in anticipation of effects that would befall mankind when the ozone layer finally gives way, a whole lot of humans would suffer and eventually die from diseases as insignificant as boils , urinary tract infections or even sore throat.

Alexander Fleming in his Nobel Prize acceptance speech in 1945 said:

“The time will come when penicillin can be bought by anyone in the shop. Then there is the danger that the ignorant man may easily underdose himself and by exposing these microbes to nonlethal quantities of the drug, make them resistant.” As predicted 71 years ago by the man who first discovered antibiotics, drug resistance is upon us.

What is antibiotic resistance?

Antibiotic resistance, simply put, is the effect seen when bacteria decide to fight all medical efforts to terminate them. It is the ability of microorganisms to withstand the effect of antibiotics.                                   

The first global report on antibiotic resistance by the World Health Organization (WHO) shows alarming resistant levels of bacteria like pneumonia, diarrhea, urinary tract infection, gonorrhea and sepsis to drug treatment in 114 countries with some areas already out of treatment options for common infections.

KEY FACTS:

    • Antimicrobial resistance threatens the effective prevention of treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
    • A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
    • Treatment failures due to resistance to treatment of last resort for gonorrhea have been reported in 10 countries.
    • Resistance to one of the most widely used antibacterial drug for the treatment of urinary tract infection- fluoroquinolone- is very widespread.

How did the world let it get this far?

A new study suggests that antibiotic resistant bacteria may be tougher superbugs than previously thought: not only are they harder to treat, they appear ‘fitter’ in general by causing more deadly infections.

With respect to Mother Nature, antibiotic resistance arises as a result of environmental pressure. It is a consequence of evolution via natural selection. Hence the bacteria which have a mutation and survive long enough to reproduce, pass on these traits to their offspring which become a fully resistant generation. Nature being only but a secondary factor here can only achieve this with the immense help from humans.

Primarily, humans pave way for the secondary factor to kick in through:

  • Over dependence on antibiotics for modern medical benefits
  • Overuse of broad spectrum of antibiotics like the use of 2nd and 3rd generation cephalosporins
  • Incorrect diagnosis and unnecessary prescriptions; 50% of the time, antibiotics are prescribed when they are not needed like in the use of antibiotics in the treatment of viral diseases like cold and flu.
  • Improper use/abuse of antibiotics by patients through self-medication, non-compliance to dosage regimen (underdose and overdose).
  • The use of antibiotics as livestock food additives to promote growth.

When these human factors are sufficiently supplied, bacteria mutate and eventually become resistant to medical efforts in terminating them. The gravity of the situation might not be fully understood or taken as serious as required until we realize that if more bacteria become resistant, in no distant time from now:

  • Urinary tract infections might become more deadly than cancer.
  • Gonorrhea may soon become untreatable.
  • The biblical Egyptian boils might eventually become an untreatable world plague.
  • Sore throat and diarrhea will become more life incapacitating than paralysis.

Should we be scared and how can we overcome this?

Not yet. The ‘discovery’ does not mean that an otherwise healthy person with a urinary tract infection is in danger of dying from it, but the gene is mobile and can be picked up by other bugs and this can make them more resistant and untreatable. I would also say, just like the trending Nigerian epp (help) mantra; who fear don epp?

Although there is the need to be cautious and sagacious while handling antibiotics, there is no reason to fear. Newer improved drugs are being developed to fight bacteria which are resistant to the existing drugs. Still, the abuse of these newer drugs would land us in a much bigger mess and this implies the continuous loading of our bodies with stronger drugs that would overtime make the bacteria fitter. It is however, now left to us to tackle antibiotic resistance by

  • Consulting a drug expert- a pharmacist- before proceeding with any medication.
  • Taking antibiotics only when prescribed by a certified health professional.
  • Complying with prescriptions; completing the full prescription.
  • Not saving antibiotics for next illness: leftover medication should be returned to the pharmacy.
  • Practicing safer and more hygienic lifestyles to prevent bacterial infections: washing hands, cleaning our environment and employing vaccines where appropriate.
  • As healthcare professionals, only prescribe antibiotics after proper investigation of symptoms.

We are running out of time, let us join hands to tackle and win this fight against bacteria.

edisuzzy@gmail.com

The Genesis

By Okoli Muna Francis

*Coughs*

*Smiles faintly*

*Sighs*

My people, this is obviously not the best time for us and our generations to come. For quite sometime, ever since Alex committed that mistake in the laboratory, our society has been under intense attack, the enemy has sworn to exterminate us. We have lost thousands already. In fact, I am the only surviving elder but before I finally receive the final blow from the enemy this night, permit me to inform you all of the good old days.

We are the most important part of humanity. Long before Alex was born, we were thorns on the flesh of our enemies, we infiltrated our enemies camp unnoticed, burgled their defense mechanism with ease, kept them in agony and waited for them to accuse it on their supposed angry gods. Those were the good old days, we must work hard to return to such days.

Like an endangered species, we are going to take a retreat, we have to go back to the drawing board, we have to understand why a man’s mistake is causing us this havoc and making us lose our traditional powers. When we have successfully understood it, we shall take them unaware and attack them again. We shall go back to the good old days.

My time is almost at hand, but I have a dream that one day the younger generation will grow over Alex’s mistake and continue to thrive despite the many missiles Alex and his colleagues will hit at us. (He starts coughing) My time is now. I will have to go but remember to avenge my death.

Footnote-

They are back to avenge the death of their fallen heroes. They have taken advantage of our ignorance and abuse of Alex’s gift to humanity. Yes they are everywhere, they now defile the works of Alex and his newer generations. They are back to their good old days. They are ravaging us again. They are not our friends, for they are MICROBES.

superbugs4

Curbing ANTI-MICROBIAL RESISTANCE…

#PANSvsSuperbugs

Mr. Okoli studies pharmacy at Nnamdi Azikiwe University Awka, Nigeria.

okolifrancis17@yahoo.com

NAVIGATING THE PHARMACY PROFESSION: THE BEST SPECIALTIES THAT CAN IMPROVE PHARMACY PRACTICE IN AFRICA

By Johnson Wanjohi, Adeyemi Sylvester, Beingana Geofrey and Hirwa Brice

This article is aims at exploring various specialties of pharmacy and suggesting best practices that can improve pharmaceutical services in Africa.

Right from the days of apothecaries to our present time, the pharmacy profession has been humankind’s solution to pain and agony of sicknesses and diseases. A pharmacist is an expert on drug therapy and is best in optimizing the use of medications with the aim of improving patient outcome. The International Pharmaceutical Federation (FIP) and World Health Organization (WHO) developed the concept of “The seven-star pharmacist,” which stated that a well-rounded pharmacist should be a compassionate caregiver, decision maker, effective communicator, lifelong learner and a good manager. The pharmacist should also possess good leadership qualities and the ability to be a teacher and researcher. These diverse skills explain the reason why there are many specialties in pharmacy practice today.

pharmacy-profession1

Healthcare remains one of the biggest challenges in Africa. Access to healthcare has been on the rise in the recent past in Africa, and this increase in the provision of health services is attributed to the efforts of various countries in solving the problem. Pharmacists play an essential role in the delivery of healthcare in Africa and are considered to be on the frontline in the provision of healthcare. The role of pharmacists has evolved in most parts of the world, but the rate in Africa has been slow compared to rest of the world. The role of pharmacists in Africa has remained traditional mostly in dispensing and selling of drugs.  Specialization can enhance the rate of improving pharmacy practice in various fields in pharmacy that would have great impact.

The common specialties in this field in Africa mostly encompass clinical pharmacy. The practice of clinical pharmacy exhibits challenges brought up by the absence of most pharmacists in community pharmacy where pharmacy assistants who are less skilled than the pharmacists are left to run the pharmacies. The unequal distribution of pharmacies in rural regions is also a challenge that faces clinical pharmacy practice in the region. A study done by Marie Kassie (2016), suggest there is an increase of pharmaceutical industries in countries such as South Africa, Nigeria, Algeria, Kenya, and Ghana but a subtle number of companies offer innovative research and drug discovery.

One of the specialties that could help improve healthcare provision in the region is critical care pharmacy. In this field of study, the pharmacist acquires training on evaluating clinical information and provides pharmacologic and technologic intervention in critically ill patients. The pharmacist is also able to provide guidance in decision making where patients in very critical condition exhibit different pharmacodynamic and pharmacokinetic characteristics of non-critically ill patients. The critical care pharmacist can be a valuable addition to healthcare delivery owing to the fact that Africa lacks a sufficient number of such personnel.

 In addition, pharmacists can also play a key role as public health personnel where they can contribute to health education, promotion, prevention and also health policies in a local, international and global context by making effective use of their pharmaceutical care and analytical skills.

Oncology pharmacy is another specialty that would have a great impact in catapulting healthcare provision in the region. Cancer is now one the leading causes of death in Africa. One of the challenges experienced in the region is the lack of diagnosis and insufficient centers to provide treatment to the overwhelming number of cancer patients. An oncology pharmacist is equipped with immense knowledge in pharmacotherapeutic interventions that would help improve the outcomes in cancer patients. The oncology pharmacist is also able to provide guidance on how to manage intricacy and adverse effects of drug therapy in the management of cancer.

Industrial pharmacy is also a specialty that presents a huge need for personnel in Africa. An industrial pharmacist specializes in all manufacturing, marketing, and distribution processes of drugs. The pharmacist can employ the use of new processes and technology in the production of medicines. In addition to performing quality assurance of all manufacturing activities, the industrial pharmacist can also be involved in pharmacovigilance, waste management, and supply management. The specialty may include gaining knowledge in different fields such as engineering and economics.  

There are also various programs that offer specialization within the pharmaceutical industry where pharmacists gain knowledge on cutting edge research and innovation in drug discovery, development and regulation. Some of the specializations include pharmacogenomics, drug discovery and development, pharmaceutical modeling science, and regulatory science. The pharmacist is involved in pre-clinical and clinical studies that are essential for the creation of new drugs as well as improvement of existing medication. Africa exhibits untapped possibilities in drug discovery owing to a large number of undocumented, unregulated, and insufficient studies on traditional medicine. The specialty would help immediate research and innovation in drug discovery and development in the African continent.

Another key area is regulatory pharmacy, where pharmacists are saddled with the responsibility of ensuring compliance with ethics of pharmacy practice, standard pharmacy education, standard requirements for good manufacturing practice, and treatment guidelines.  There is also the need to support regulation through government policies to ensure that compliance is observed to safeguard all activities in the delivery of pharmaceutical services. Such policies are recommended and enforced by regulatory bodies in each country .

The present generation of pharmacists in Africa should consider the specialties mentioned above which would contribute in spearheading improvement of healthcare delivery in the region. Learning institutions should also take steps in introducing these specialties with the aim of providing current knowledge and training needed to solve the problems as well as fill the gaps in healthcare. An old African adage that states: “Learn from the person who knows the way.”  It is, therefore, expedient for us to make necessary adjustments to our curriculum and also collaborate with the developed countries where these specialties are being practiced in order to create opportunities for learning and paradigm shift.

The writers are members of Regional Projects Subcommittee of IPSF African Regional Office.

rpo@afro.ipsf.org

References

  1. bps. (n.d.). Board of Pharmacy specialties. Retrieved from http://www.bpsweb.org/
  2. Jamison, D. T., Makgoba, M. W., & Feachem, R. G. (2006). Disease and Mortality in Sub-Saharan Africa. Washington: The International Bank for Reconstruction and Development.
  3. Kassi, M. (2016). Retrieved from http://www.pharmacy.ohio-state.edu/sites/default/files/forms/outreach/intro2pharm/global-practices/Pharmacy-in-Africa_Kassi.pdf

ANTIBIOTIC DEVELOPMENT AND GLOBAL INTERVENTION IN COMBATING THE EMERGENCE OF ANTIBIOTIC RESISTANCE

By Adeyemi Sylvester

INTRODUCTION

Antibiotics were the wonder drugs of the 20th century because of their  ability to kill and inhibit bacterial growth. In the pre-antibiotic era, the treatment of infectious diseases in human and animals was almost impossible. Besides the use of herbal medicines, there was no way out of the death sentence. That was until 1928, which  marked the beginning of  the antibiotic era when Sir Alexander Fleming discovered penicillin from the mold penicillium. After this breakthrough in medicine, came the emergence of antibiotics.

Resistance to antibiotics could either be natural due to inherent characteristics or acquired when  bacteria undergo evolutionary changes that transform their cells. These changes that lead to bacterial resistance to antibiotics are caused by both bacterial and human factors.

CAUSES OF ANTIBIOTIC RESISTANCE

Primary causes of antibiotic resistance include wrong dosage, inappropriate prescription, inaccurate regimen, mechanical ventilation, multiple underlying diseases, poor hand hygiene.

In animals, antibiotics are used at subtherapeutic doses to promote growth. At subtherapeutic doses, bacterial population develops resistant strains. In research studies resistant bacteria can be transmitted from animals to humans in three ways: by consuming animal products (milk, etc.) from close or direct contact with animals or other humans, or through the environment. In the first pathway, food preservation methods can help eliminate, decrease, or prevent the growth of bacteria in some food classes.

ROLE OF PHARMA SECTOR IN ANTIBIOTIC DEVELOPMENT

The pharma sector undoubtedly plays a vital role in developing newer medicines as resistance emerge. Since 1945, newer antibiotic were being discovered to compete with the evolving bacterial population. According to an article published in the journal Clinical Infectious Diseases in January 2009, only 5 of the biggest pharma companies –GlaxoSmithKline, Novartis, AstraZeneca, Merck and Pfizer still had antibacterial discovery programmes in 2008. This is because of the commercial impact it has on the companies. The return on investment is poor and treatment of bacterial infection is usually short course regimen so patronage begins to reduce as soon as the infection is cured. That’s why companies have stopped developing antibiotics.

However, the launch of every antibiotic has been and will be followed by resistance in the targeted bacteria. Therefore, there is a constant need to develop new agents to keep up with the acquisition of resistance among pathogenic bacteria.

As a way to encourage drug-development, private-public partnership should be embraced to curtail financial burden of obtaining newer antibiotics.

sylvester-blog

GLOBAL ACTION PLAN AGAINST ANTIBIOTIC RESISTANCE

There have been increasing public calls for global collective action to address the threat. In 2014 WHO released preventive strategies to tackle resistance

The public can help tackle resistance by:

  • Using antibiotics only when prescribed by a health professional
  • Completing the full prescription, even if they feel better
  • Never sharing antibiotics with others or using leftover prescriptions

Health workers, including pharmacists, can help tackle the resistance issues by:

  • Enhancing infection prevention and control
  • Only prescribing and dispensing antibiotics when they are truly needed
  • Prescribing and dispensing the right antibiotic(s) to treat the illness

Policymakers and industries can help tackle the resistance by:

  • Strengthening resistance tracking and laboratory capacity
  • Regulating and promoting appropriate use of medicines
  • Fostering innovation and research and development of new tools
  • Promoting cooperation and information sharing among all stakeholders

On March 27, 2015, the White House released a comprehensive plan to address the increasing need for agencies to combat the rise of antibiotic-resistant bacteria.

The Action Plan was developed around five goals with focus on strengthening health care, public health, veterinary medicine, agriculture, food safety and research, and manufacturing. These goals, as listed by the White House, are as follows:

  • Slow down the emergence of resistant bacteria and prevent the spread of resistant infections
  • Strengthen national One-Health surveillance efforts to combat resistance
  • Advanced development and use of rapid and innovative diagnostic tests for the identification and characterization of resistant bacteria
  • Accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines
  • Improve international collaboration and capacities for antibiotic resistance prevention, surveillance, control and antibiotic research and development

The following are goals set to meet by 2020.

In 2015, WHO started the World Antibiotic Awareness week from 16–22 November to improve global awareness, promote rational use, and prevent further instances of resistance.

On 22nd September 2016, at the UN Meeting, collaboration between approximately 70 heads of state and ministers of health and foreign affairs demonstrated overwhelming political support to combat AMR. After the meeting, UN  decided to focus on rectifying the startling level of under-investment in AMR-related research; and a major new commitment by 13 of the world’s largest pharmaceutical companies, including giants of the generics industry, to take concrete actions to reduce the development and spread of drug resistance.

Mr. Sylvester a recent pharmacy graduate of Igbinedion University Okada, Nigeria.

adeyemisylvester1@gmail.com

REFERENCES

  1.  Pechère JC (September 2001). “Patients’ interviews and misuse of antibiotics”. Clin. Infect. Dis. 33 Suppl 3: S170–3. 
  2.  Arnold SR, Straus SE (2005). Arnold SR, ed. “Interventions to improve antibiotic prescribing practices in ambulatory care”. Cochrane Database of Systematic Reviews (4): CD003539. 
  3.  Antibiotic Resistance – Linking Human And Animal Health: Improving Food Safety Through a One Health Approach Workshop Summary. Wegener, Henrik C. Washington (DC): National Academies Press (US); 2012
  4. Todar’s online textbook of bacteriology by Kenneth Todar phD
  5. Race against time to develop new antibiotics: Bulletin of the World Health Organization 2011,89:88-89
  6. The bacterial challenge:time to react  A call to narrow the gap between multidrug-resistant bacteria in the EU and the development of new antibacterial agents
  7.  “FACT SHEET: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria”. whitehouse.gov. Retrieved 2015-10-30.
  8. WHO AMR newsletter 2016
  9. “WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health” Retrieved 2014-05-02

University of Zimbabwe Students Uniting To Fight Antimicrobial Resistance

By Bakani M. Ncube

The University of Zimbabwe College of Health Sciences student association bodies came together, united by one vision and goal, to join in a global campaign to combat antimicrobial resistance from November 14th to 20th. The World Antibiotic Awareness Week was marked by the public, policy-makers, human and veterinary health professionals and student engagement through social media and local awareness-raising events around the world.

The World Health Organization (WHO) defines Antimicrobial Resistance (AMR) as the resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials. Standard treatments become ineffective, infections persist and may spread to others. AMR is a consequence of the use, particularly the misuse, of antimicrobial medicines. It develops when a microorganism mutates or acquires a resistance gene.

There is a grave need for this global campaign as antibiotic resistance has become one of the biggest threats to global health and it endangers other major priorities such as development. It is escalating to dangerously high levels in all parts of the world, compromising our ability to treat infectious diseases and undermining many advances that have been made in the field of health and medicine in the past decades. As a result of this, the WHO in May 2015, came up with a global action plan to tackle antimicrobial resistance that was endorsed at the World Health Assembly. It was supported by the Food & Agriculture Organization of the United Nations (FAO) and World Organization for Animal Health (OIE). The first objective of this plan was to ‘improve awareness and understanding of antimicrobial resistance through effective communication, education and training’.

The objectives of the campaign are to make antibiotic resistance a globally recognised health issue as AMR lead to failure in the standard treatment, resulting in prolonged illness and greater risk of death. This further increases the cost of health care as infections that have become resistant to first-line medicines will need the intervention of more expensive therapies. The longer the duration of illness and treatment, often in hospitals, increases health-care costs and poses a financial burden to families and societies. Antibiotics are a precious resource that cannot be taken for granted. They have allowed many serious infections to become very treatable and have saved millions of lives and there needs to be a worldwide change in behaviour if their effectiveness is to be preserved. With this in mind, the second objective is to raise awareness of the need to protect antibiotics through appropriate use. To illustrate the severity of the situation, about 440, 000 new cases of Multidrug-Resistant Tuberculosis (MDR-TB) emerge annually, causing at least 150, 000 deaths and Extensively Drug-Resistant Tuberculosis (XDR-TB) has been reported in 64 countries to date. Another aim of the World Antibiotic Awareness Week is to increase recognition of the role that individuals, human and animal health professionals, agricultural professionals and governments must all play in tackling antibiotic resistance. To sum up, the main goal is to encourage the change in behaviour and to convey the message that simple actions can make a huge difference.

Although antibiotic resistance can occur naturally, the process is being accelerated by a number of factors which has led to record high levels of antibiotic resistance. The current worldwide antibiotic resistance crisis has been due to over-prescribing and dispensing of antibiotics, the misuse of antibiotics by patients as well as the overuse and misuse of antibiotics in livestock, fish farming and on plants. The pharmaceutical industry is not developing new antibiotics, vaccines, diagnostics and therapeutic options at a quick enough rate and this has also led to the current AMR crisis as well as poor infection control in hospitals, clinics and farms. In certain areas of the country, the lack of toilets and proper sewage disposal has propagated antibiotic resistance.

We are calling on you, all of you, to aid in the reduction of antimicrobial resistance by only using antibiotics when they have been prescribed by a certified health professional, to always follow your health worker’s advice when using antibiotics, to never share or use leftover antibiotics, prevent infections by regularly washing your hands, handling food in a safe and clean manner, limiting contact with sick people, practicing safer sex and keeping your vaccinations up to date. In Zimbabwe, one of the challenges we face are patients demanding antibiotics even when the health worker says we do not need them and this is especially seen when patients seek antibiotics to treat a cold or flu.

Without urgent action, the world is headed for a ‘post-antibiotic era’ in which common infections and minor injuries which have been treatable for decades can once again kill and the benefits of advanced medical treatments such as chemotherapy and major surgery will be lost. Without effective antibiotics, an ever increasing list of infections such as pneumonia, blood poisoning, gonorrhoea and tuberculosis are becoming harder to treat. The emergence of AMR is a complex problem driven by many interconnected factors and a global and national multi-sector response is urgently needed to combat the growing threat of AMR. It is not too late to reduce the impact of antimicrobial resistance. Remember, no action today will result in no cure tomorrow.

Mr. Bakani is the Student Exchange Officer of Zimbabwe Pharmaceutical Students Association, a member of IPSF African Regional Office.