Nearly 90 per cent of all antibiotics in one rural upazila in Cox’s Bazar were prescribed by untrained ‘village doctors’ who are not legally permitted to prescribe them, according to an as yet unpublished report of a research undertaken by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).
Moreover, on the basis of an examination of all the treatments provided by village doctors in the upazila, the researchers estimate that 75 per cent of these illegal prescriptions were unsuitable and 7 per cent were downright harmful to the patients.
The researchers believe that the survey results are likely to reflect the situation in the rest of rural Bangladesh.
‘Although we conducted this research in a single upazila, we think that the findings are applicable to most other rural areas in Bangladesh,’ Mohammad Iqbal, senior operation researcher of the social and behavioural sciences unit of ICDDR,B, who was involved in the research, told New Age.
Village doctors have no formal training and the law does not allow them to prescribe antibiotics and other prescription drugs.
Allopathic village doctors who have no medical training, and who are not allowed to give prescription drugs, make up 65 per cent of the total health care providers in the Chakaria upazila where the survey was conducted. MBBS doctors make up only 14 per cent.
The research involved a household survey undertaken in 2007 of about 1,000 households in the upazila to seek information on medicines used in the previous two-week period.
It found that out of 5,308 antibiotics used by household members in two weeks, 4,671 or 88% were prescribed by village doctors.
The antibiotics were normally prescribed for treating patients suffering from viral cold, fever, pneumonia and diarrhoea, ignoring the standard treatment guidelines of the World Health Organisation and the government.
‘The usually unsuitable antibiotic drugs were most commonly prescribed for the treatment of common cold, fever, pneumonia, jaundice, tuberculosis, and bleeding during pregnancy and after delivery,’ said Iqbal.
He said that the unqualified village doctors commonly prescribe the antibiotic Metronidazole, which is only appropriate for amoebic dysentery, for viral diarrhoea.
‘They also prescribe Ciprofloxacin for the treatment of viral diarrhoea,’ said Iqbal. ‘In most of the cases they use a combination of Metronidazole and Ciprofloxacin, which is inappropriate and on many occasions harmful as well.’
The village doctors also prescribe other antibiotics including Amoxicillin, Flucloxacillin, Cephradine, Azythromycin, Cefexim/Cef-3, Doxycycline, Cotrimoxazole, Levofloxacin, Penicillin, Erythromycin, Ceftriaxone and Tetracycline, said Iqbal.
‘In the last two years in Bangladesh some drugs such as Ciprofloxacin are becoming ineffective for treating typhoid and bloody dysentery because of the improper use of antibiotics,’ he said.
He pointed out that most patients stop taking drugs in the middle of the course of antibiotics when they feel better, unaware that doing so increases the resistance of their bodies to antibiotics and makes them ineffective, thus making it difficult, if not impossible, to cure them.
Mohammad Iqbal says that it is very difficult to stop village doctors from prescribing antibiotics as they make a significant amount of their profits by selling them. ‘There is no incentive to get them to stop,’ he said.
People go to village doctors because they are close to their homes and the cost of the treatment is low, as shown by the research already published by the ICDDR,B.
Professor Rashid-e-Mahbub, former president of the Bangladesh Medical Association, said that there is no proper understanding of the use of antibiotics in the people of the country. ‘Antibiotics should not be sold in the medicine shops without a proper prescription, but this happens commonly in our country,’ he added.
The Directorate of Drug Administration is responsible for enforcing the rules on prescription, but its director-general, Abul Kalam Azad, claimed that the Bangladesh Medical and Dental Council is responsible for monitoring the doctors who prescribe unnecessary, and sometimes harmful, antibiotics.
‘The medicine shop owners, who sell antibiotics without prescriptions, should face punitive action. The pharmacies must be monitored by the law enforcement agencies,’ he added.
‘It is not our duty to monitor the pharmacies. We are suffering from severe manpower shortage and are unable to monitor many things, especially in the rural areas,’ he said.
Iqbal insisted that it was crucial to start monitoring the use of antibiotics and steroids in rural areas as pregnant mothers and children are at particular risk.
The detailed research report is due to be published next year.
