The ICIR reporter visited drug stores in major towns within Abuja namely Gwarimpa, Kubwa, Kuje, Apo, Wuse, and Area One in four days, purchasing malaria drugs banned by the Federal government to find out if the restriction placed on the sale of these drugs has been effective or not.
ALONG Ademola Adetokunbo Cresent, a densely packed industrial street in Wuse II, Abuja is H – Medix Pharmacy and Supermarket, a notable pharmacy in this district. The one storey plaza serves not only as a pharmacy but also as a thriving grocery store.
The ICIR reporter joined the queue of customers waiting to buy drugs and asked for chloroquine.
“For an adult or for children?” the attendant asked.
“For adults,” I replied.
She brought out a pack of the medicine containing five tablets of chloroquine with 2, 2, 1 dosage written on the pack.
“You take two after your next meal, then another two and the remaining one,” she said.
I paid N650 in cash and left the building.
Section 17 (1) of the Nigerian Food and Drugs Act stipulates a fine not exceeding ₦500, 000 or a jail term of not less than five years and not more than fifteen years for the sale, manufacture, and importation of prohibited drugs.
Despite the law to discourage the circulation of these prohibited drugs, they could be purchased easily from drug vendors and pharmacies in the locations visited by the ICIR reporter.
In 2017, the News Agency of Nigeria (NAN) reported that the Nigerian Senate had mandated the health committee to launch an investigation into the circulation and sale of 42 anti-malaria drugs banned by the European Union (EU) in the country. This development was sparked by the continued sale of chloro-quine and artemisinin drugs as a mono-therapy in the treatment of malaria in the country. But pharmacy stores continue to sell these drugs without qualm as The ICIR investigation has revealed.
Prohibited Drug Sale in Nigeria’s Largest Housing Estate
At Sycamore Pharmacy & Sundries in Gwarimpa, the lady in a brown long sleeve gown inquired from the customer what he needed.
“I think I am feeling very feverish,” I said.
“Well, it could be malaria,” the attendant replied without hesitation.
She recommended chloro-quine among other anti-malaria drugs which she said was very effective in combating malaria attacks. I also requested for dipyrone, nimulide, and sibutramine which had been banned by NAFDAC but she appeared unfamiliar with the brand names.
“We don’t have those drugs currently but we might get them soon,” she said, oblivious of the government ban on the sale of such drugs. She instead advised that chloro-quine, when combined with paracetamol brings a quicker result.
“You have to take paracetamol with the chloro-quine because it works fast when you take them together,” she said.
I paid ₦700 and collected the drugs from the shop but I was not given instructions on how to take the medication and no receipt was issued.
It was a similar case in Pharmacare Place located at Games Village estate. The cashier in the supermarket also served as the attendant in the pharmacy.
“What can I do for you, sir,” she asked.
“I want to buy chloro-quine,” I replied.
She found a chloro-quine pack from the shelf, and handed it to me and led me to the cashier’s seat where I paid ₦550 and got a receipt for the payment. On the chloro-quine pack was NAFDAC registration number that certifies the originality of the medicine.
Other drugstores visited where chloroquine and other prohibited anti-malarial drugs are sold include: Life Care Patent Medicine Store, Juka Pharmacy, Alive Pharmacy all in Kuje; Sterling Pharmacy, Afarmar Pharmacy located in Area one, GYFTS Pharmacy Stores in Gwarimpa and Fadajoy Pharmacy in Kubwa. All the chloroquine drugs purchased from these drugstores bear NAFDAC numbers.
Why the ban was put in place
The Federal Government in 2005 banned the use of Chloroquine and Sulfadoxine – Pyrimethamine as first-line drugs in the treatment of malaria because of the increasing evidence of drug resistance, which had led to treatment failures.
This led to the removal of chloroquine as a first-line treatment for malaria in the Nigerian National Antimalarial Treatment Policy 2005.
This decision was in response to the sanctions placed on chloroquine by the World Health Organisation WHO in 2002, the global health body recommended that oral artemisinin-based monotherapies (chloroquine inclusive) be withdrawn from circulation after carrying its Therapeutic Efficacy Testing which revealed that the drug had an efficacy of 35 per cent against the standard 95 per cent in fighting malaria.
A WHO document updated in 2015 lists Nigeria as one of the countries that have taken regulatory measures to withdraw the marketing authorisation of oral artemisinin-based monotherapies (Chloroquine inclusive) but chloroquine tablets and capsules are still widely sold in Nigeria, with many manufactured as recently as 2018, and bearing authentic NAFDAC registration numbers.
How self-medication fuels the sale of banned anti-malaria drugs
In a 2015 National Guidelines for Diagnosis and Treatment of Malaria report released by the Federal Ministry of Health states that Artemisinin-based Combination Treatments (ACTs) adopted by Nigeria for the treatment of uncomplicated malaria still remains the best available antimalarial medicines globally and are very effective in fighting resistant strains of the malaria parasite. P.falciparum, the most prevalent malaria parasite on the African continent, is responsible for most malaria-related deaths globally.
Last year, the Minister of Health, Prof. Isaac Adewole, reminded Nigerians that chloroquine and artemisinin monotherapy used in the treatment of malaria remain banned.
This development does not resonate with a majority of the Nigerian populace who self-prescribe and request for these prohibited drugs over the counter from drug vendors.
Thirty-five year old, Gloria Eze (not real name), a mother of one and a businesswoman is one of the many Nigerians who take to self-medication when ill. Uche, who lives in Apo, an Abuja suburb, says the most effective drug for malaria is chloroquine which she has consistently used for several years.
“Any time I sense the symptoms of malaria I take chloroquine which works for me. I don’t think it is true that chloroquine is not effective against malaria, I’ve used it countless times and it works every time. Many people complain about its side effects mainly itching of the body but I’ve never experienced it,” she said.
For Benjamin Idoko, a banker, self-prescription is just a way to reduce the time and cost of going to the hospital.
He said he recognises the symptom of malaria and knows how to treat himself. “Often if I am not relieved after a few days, I usually go for a proper check-up in the hospital. Most people patronize medicine vendors to reduce the costs of going to the hospital,” he said.
Cost is not the only reason why some people do self-medication. There are several others who abuse the drug, and only buy without a doctor’s prescription.
The Chairman, Pharmaceutical Society of Nigeria, FCT chapter, Jelili Kilani said self-medication is on the increase, therefore leading to higher incidents of addiction.
“There is an increase in the number of people using drugs irresponsibly without realizing the dangers that could occur after using these drugs for a long time. Someone feels a headache and takes an analgesic maybe paracetamol and whenever the person feels that symptom he immediately takes paracetamol continuously increasing the quantity without regards for a proper medical checkup then abuse may set in,” he said.
When asked why many drugs banned by the Federal Government can still be found on the shelves of reputable pharmacies and patent medicine stores, Kilani responded that the demand for these drugs influences the manufacture and sale of these drugs.
“The manufacturers and vendors of these drugs are trying to satisfy available consumers. They might know that these drugs are ineffective and the risks of adverse drug reactions are high but will be unable to psychologically do without these drugs when they experience familiar symptoms,” he concluded.
The reporter placed a call to the call center of H – Medix Pharmacy to find out why they still continue the sale of chloroquine and other anti-malarial drugs banned by the Federal Government.
The sales representative was not aware chloroquine was no longer recommended for consumption.
“I am not aware that chloroquine and the other drugs you mentioned had been banned but I will inquire and we will do something about it,” he said.
Unfortunately, one week after, the reporter was still able to purchase the banned drugs from the pharmacy.
Placing a call to NAFDAC Pharmacovigilance Center
NAFDAC’S spokesperson, Abubakar Jimoh said he was in a meeting when the ICIR called, and he did not respond to text messages sent to him either.
The ICIR also reached another staff of NAFDAC who identified herself as Afouma. After the reporter informed the woman about chloroquine he bought from a pharmacy to the lady, she said:
“Well, you will have to visit any NAFDAC office close to you with the drug to know if it is original or not. We conduct daily raids on chemists and pharmacies to make sure fake drugs are removed from these shops,” she said.
Her response gave less hope than expected from an officer empowered to protect Nigerians from those who profit from selling prohibited drugs.
Amos Abba is a journalist with the International Center for Investigative Reporting, ICIR, who believes that courageous investigative reporting is the key to social justice and accountability in the society.