If you follow the Nigerian health “scene” you would no doubt have heard of the story of “My Pikin”…said to be a “teething mixture”.
This “mixture” (not sure where this term came from…) contains paracetamol and Diphenhydramine Hydrochloride – an antihistamine. NAFDAC (sorry website is “down” (12/12/08)) is said to have revealed that the a batch of the teething mixture included lethal doses of a toxic chemical; Diethylene glycol. This is an organic solvent, also used as an engine coolant which upon metabolic conversion is toxic to the kidney. The Vanguard reports that …the contaminated ingredient used in the formulation of the killer paracetamol drug, “My Pikin” was obtained in the open market at Ojota, Lagos. Dora Akunyili, director-general, National Agency for Food, Drugs Administration and Control, NAFDAC, confirmed that 15 children died at the Lagos University Teaching Hospital, LUTH, eight died at the Ahmadu Bello University Teaching Hospital, ABUTH, Zaria, and two deaths were recorded at the University College Hospital, UCH, Ibadan.
We had the “normal” responses from the concerned parties in our beloved country as we have come to expect….
- NAFDAC bans “My Pikin” Teething Mixture !!!!
- NAFDAC announced said it had arrested the chemical dealer who sold the chemical to Barewa Pharmaceuticals, makers of “My Pikin” (and I not even know that NAFDAC had powers to arrest!).
- Managing Director of Barewa Pharmaceuticals Limited, Mr. Kola Okunola, the manufacturer of the alleged contaminated teething mixture, My Pikin was himself arrested!
- An “antidote” has been ordered according to the BBC.
- There were calls for Professor Dora Akunyili, Director General of
NAFDAC perceived by many (and some say by herself) as a superhero to resign, siting the recent resignation of the Indian Security Chief in Mumbai the aftermath of the bombings there…now really that would be totally un-Nigerian! - Akunyili claimed that NAFDAC was not notified of the wave of kidney-failure related deaths in children early enough by LUTH…
Chairman of MDCAN, a Consultant Pediatrician Dr. Edasanmi Temiye, MDCAN described Akunyili’s response as “highly provocative, abusive and distractive to the course of finding a lasting solution to this current problem.”
….and while the arguing has continued..there are to many questions here that no one is really asking…
- Simple question? What is a “teething mixture”? Is “teething” a medical condition that requires treatment? What are the symtoms of “teething” that requires treatment? I have been asking around if any of my colleagues in Nigeria or anywhere else in the world has been taught this as a medical condition in medical school…have not found any yet! I am priviledged to have been taught pharmacology by the present DG of NAFDAC in medical school…I have gone back to my notes and found nothing! Finally the Medical and Dental Consultants Association of Nigeria…..is asking the same questions.
- What are the procedures by which NAFDAC actually registers new medicines. Clinical trials are how new medicines as tested and approved around the world. Does NAFDAC carry out independent clinical trials or do they rely on trials carried out in other settings with more resources. If this is the case where and when were the trials for My Pikin conducted. The name “My Pikin“…literally means “my child“. The bottle is a picture of a happy mother with her smiling baby. What regulatory agency will allow a medicine, any medicine be named “my child” ???
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When a child has fevers associated with teething, a most common condition in childhood he/she should be seen by at the very best a primary care physician and would not require anything more than paracetamol. What are our “best” tertiary institutions doing managing fevers during teething???
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Outbreaks are a fact of life…even in the most advanced countries. Often they result from infectious diseases but could be as a result of chemicals as in this case. Does the MoH have an emergency response plan, infrastructire and outbreak response capacity to investigate and respond to outbreaks beyond asking NEMA do deliver blankets.
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Finally….why is it that after the celebrated successes of NAFDAC are medicines still being openly sold in every open market in Nigeria.
I bet …it is only a matter of time before we find the next 25 children that have died in another cluster! …unless someone sits down to think of answers to the questions above…..
Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead
This interesting comment was sent tome by email:
One more Question needs an answer and quickly too….
1) what does a NAFDAC number represent. Does it confirm that the drug contains what it says it contains and not sawdust, etc. Or does it mean that the drug is efficacious and safe? or does it mean both.
What does NAFDAC number represent because it is common place now for every ‘drug’ peddler to clain even on radio and TV that they have NAFDAC number and therefore can cure every disease known to man
Who is responsible for the control of sale of drugs in Nigeria? Is it NAFDAC or Pharmaceutiucal council of Nigeria ( as some claim)( that will be strange!) .
Is there a ‘committee for the safety of medicines’ in Nigeria.?
Dora Akunyili is a noise maker simple and short. I have had no regards for her right from the first day she was given that job. Shouting and popping out one’s eyeball has never been known to be effective in fighting a major issue. She is more interested in politics than safeguarding the health of our people.I think i am right to say that she has blood on her hands.
Nigerian medical system is syndromic. I don’t mean to be rude to our professionals but a lot is lacking. Our medical system needs to be revamped. There is neither continuing medical education enforced nor public education implemented. People graduate from medical school without any training, they become medical directors. The medical practice is more of damage control without any place for preventive medicine. There is no provision for scheduled well visit so no screening nor anticipatory guidance. With well visits a lot of maladies emanating from ignorance will be prevented.
The government is faceless. There should be organized honest individual efforts to revisit medical issues. Some kind hearted people have tried giving free medical care, how far has it gone? It cannot go far because the lay people do not even understand that the essence of giving this free medical care is to create health awareness; instead they see the FOC (free of charge) side of it. People should be responsible for themselves, they should ask questions and make demands (hoping it spurs the “government” to improve the system). It is so painful that when health education is brought up, some lay people are interested but most focus on food. I may keep jumping from one point to another as the system is syndromic.
Let us hope that with this new generation that life might get better as more people are opting for residency programs (and one day everybody will). Hopefully one day we will have practice guidelines and policies (when people in ministries pay more attention to thier services to humanity not looting the treasury) and everyone decides to pitch in. Thanks.
Thanks once again for keeping us informed about health issues in Nigeria.
I am not a staff of the ministry of health nor NAFDAC, neither am I actively involved in the health sector. However, I have attempted to respond to some of the questions raised.
Although as mentioned.”teething” is not a medical condition that require treatment, due to the degree of ignorance about health issues in Nigeria,it has become one amongst nursing mothers. The average nursing mother in Nigeria would have had someone recommend or more teething mixtures or powders been to her in her life time.
Who do we blame for this level of ignorance? Do we blame the mothers for not been more aware? Do we blame the government agencies for not educating these mothers? or do we blame the various health practioners, whom though in regular contact with these women,might not educate them on the right things? How relevant is the information been passed in the various Ante-Natal Clinics (ANC) to the the health challenges facing nursing mothers today? Is the Medical and Dental Consultants Association of Nigeria just aware of the existence of teeting mixtures in Nigeria?
2. When a child has fevers associated with teething, a most common condition in childhood he/she should be seen by at the very best a primary care physician and would not require anything more than paracetamol. What are our “best” tertiary institutions doing managing fevers during teething???
Although this is the ideal,what exactly is reality. How many physcians advise mothers on first aid treatment for fevers? What is prescribed when the child is taken to a private hospital (the “better” alternative to Primary health care centres). These children were taken to the tertiary instituitions after they had developed complications from the poisonous My Pikin. Where were they taken befor been referred to these instituitions?
Finally….why is it that after the celebrated successes of NAFDAC are medicines still being openly sold in every open market in Nigeria.
Medicines will continue to be sold in open markets in Nigeria for various reasons such as: lack of adequate resources to exact required control, greed and corruption. It will continue for as long as vices such as Register and Go still persists i.e.(registered pharamcists permitting individuals who will not employ a pharmacist operate the pharmacy except when the relevant regulatory body might becoming for inspections to ).
For too long, we have focused on what the government is not doing or unwilling to do. It is about time, the various health practioners in Nigeria, focus on doing their best and stop using the government’s inefficiencies as excuses.
Practising in the health sector in Nigeria is very challenging, but more challenging is staying healthy and alive in Nigeria. If all health care practioners decide to always give at least 50% in all situations, we will be amazed at the reslts we will get.
Regards
Perhaps passing the buck will not help us we have all contributed one way or the other to the problem on hand which is just one of the many peoblems staring us as a nation. It is rather unfortunate that the government pays lip service to health care as it lacks the political will to improve health care services. The healthcare professional is distracted by many problems which include unfriendly prsctice environment, infightings, poor role definition and poor renumeration to mention a few. The masses find it very difficult to adopt positive behavioural changes even when they are the direct beneficiaries and the press would not make absolute sure ofv information before diseminating it thereby misinforming the public (permit me to point out that the pix in this article purported to be Dr Temiye’s is not his). Where do we start from? It seems to me that we need to work on ourselves and be determined to do our best irrespective of our limitations. We should fear God at all times and be our neighbours’ keepers