Resort facilities

Lack of laboratory facilities, others contributed to AKI deaths

By Kebba Ansu Manneh

As the nation seeks an answer to the deaths of sixty-nine (69) innocent children due to the alleged consumption of substandard pharmaceuticals purchased from Median Pharmaceutical Company in India, a medical and health expert who prefers the anonymity due to an ongoing witch-hunting game at the Ministry of Health observed that lack of laboratory facilities, equipment and medical supplies contributed significantly to the deaths of children diagnosed with acute kidney injury (ARI) in the country.

According to this expert, the results of clinical laboratory investigations are essential and critical for the successful management of patients, in the diagnosis and treatment, especially critically ill patients such as children with acute renal failure (ARI). Noted that it is very regrettable that there are no functional standard clinical laboratory facilities in the country that are adequately equipped in terms of human resources, equipment and reagents needed to effectively and efficiently manage the children with ARI at both Edward Francis Small Teaching (EFSTH) and the National Public Health Laboratory (NPHL) in Kotu.

The expert revealed that the country’s hematology, biochemistry and microbiology labs are under-resourced, adding that there is no genomic sequencing lab essential for identifying the true causative organisms in situations like the IRA.

“The lack of adequate functioning laboratories in the country is evident by the fact that patients are systematically referred from EFSTH to private laboratories in town to perform various tests. This was revealed during the AKI crisis by shipping biological samples such as stool and blood samples to laboratories in Dakar, Senegal for testing,” explained the medical and health expert.

Added that, “also evident by the fact that these samples were sent to the Medical Research Council (MRC) for assistance in performing genomic sequencing and other necessary tests not available at public health facilities. The results of the laboratory tests took more than a month to be received from Dakar and in addition to the time taken before the involvement of the MRC certainly caused a significant delay in the effective and efficient management of these patients.

The expert alleged that almost all ARI patients admitted to the Petit Edward Francis University Hospital (EFSTH) died before their test results came from Dakar. To say that most people with ARI were alive for a few days when admitted to the main referral hospital in the country and died only due to lack of adequate care.

“Due to these serious shortcomings in the provision of clinical laboratory services, the Ministry of Health contacted the World Health Organization (WHO) country office for assistance in procuring some of the essential and much needed laboratory supplies and some of these supplies have just been received by the Ministry of Health when seventy (70) children have already died.

“Fully equipped intensive care facilities are critical and essential for the effective and efficient management of children with ARI for better survival outcomes,” the medical and health expert emphasized.

This expert continued “again, there are very poor intensive care facilities at EFSTH and other public hospitals, especially for children, thus offering very low chances of survival for these children, resulting in a high mortality rate of more than 80%. Most of the children who survived showed up very early and their conditions were not bad.

Claiming that although there are good consultants in the pediatric ward of EFSTH, they are poorly equipped and under resourced leading to a situation of well trained and unarmed soldiers in a war field. This is evident by the fact that there was no pediatric hemodialysis machine at EFSTH and therefore only one seven-year-old patient received hemodialysis.

“EFSTH has just received a pediatric hemodialysis machine after the death of seventy (70) children. Doctors were also without peritoneal dialysis fluids and peritoneal dialysis catheters for use in peritoneal dialysis. Physicians had to resort to using locally manufactured or prepared peritoneal dialysis fluid, which was certainly not done under sterile conditions and based on WHO Good Manufacturing Practices, leading to a solution whose quality was not guaranteed and led to poor results because all the children who used the liquid died. the Expert revealed.

The expert went on to say, “During the administration of the locally produced peritoneal dialysis fluid, inappropriate catheters and feeding tubes were used instead of the peritoneal dialysis catheters (the correct material to use). Typically, patients with ARI, when properly dialyzed, a good number of them (more than 60%) should produce urine and thus survive the ARI.

Statistics of ARI patients who took various medications should also be provided to the public by the Department of Health, as it is misleading that the 70 deaths are linked to the four tainted cough syrups from Maiden Pharmaceuticals, as most of these children have never taken these products. .

The expert further observed that the WHO statement was misleading that the 66 children who died at the time were all linked to these products, arguing that the WHO was in a hurry to publish the results even before the ministry of Health does not (as reported by the Ministry of Health), they should have clarified with the Ministry of Health the actual number of children out of the 66 who took the contaminated syrups.

According to this expert, the death cannot be linked to a drug when the patient in question never took this drug, noting that some of the deceased ARI children were taking other drugs such as paracetamol, amoxicillin, etc. , which were found to be uncontaminated.

“It has also been reported that some of AKI’s deceased children did not take any medication when they fell ill before being admitted to hospital. It is the responsibility of the Ministry of Health to provide the public with the statistics of these different scenarios,” revealed the medical and health expert.

Further, “It should also be noted that all of these children were ill with high fever, vomiting and some also had diarrhea and cough before taking medication and being hospitalized.

“Information from the Ministry of Health also indicated that some of the samples taken from patients with ARI showed infection with two different species of bacteria that can also cause ARI. In addition, severe vomiting and diarrhea may in them alone cause acute kidney injury, as some doctors have suggested.

This medical and health expert therefore challenged the Ministry of Health to explain to Gambians what killed the AKI children. “There is no doubt that the lack of laboratory facilities, medical equipment and medical supplies contributed significantly,”



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