Drug pollution detected in Uganda water bodies
What you need to know:
- Health experts say humanity’s drugs have polluted water bodies in Uganda because of poor enforcement of policies.
Researchers have found disturbingly high levels of pharmaceutical pollutants in water bodies in the country, and warned that these heighten threats to environmental as well as human health.
The researchers said these active pharmaceutical ingredients (APIs) could be contributing to the growing crisis of antimicrobial resistance while also having deleterious effects on fish and other aquatic life.
This information is contained in a new study conducted in Uganda and 103 other countries by a team of 89 researchers led by John Wilkinson, a postdoctoral researcher at the Department of Environment and Geography in the United Kingdom’s University of York.
The researchers measured the concentration of 61 APIs at more than 1,000 sites along 258 rivers in all four corners of the globe. The report was published in February in the journal Proceedings of the National Academy of Sciences.
“Highest cumulative API concentrations were observed in sub-Saharan Africa [where Uganda falls], South Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing,” the report reads in part.
The contaminants with the highest concentrations were common drugs such as paracetamol (pain killer), caffeine, metformin (diabetes drug), fexofenadine (anti-allergy), sulfamethoxazole (antimicrobial), metronidazole (antimicrobial), and gabapentin, the report adds.
The researchers said the likely contributing factors to this large range in API concentrations among countries are the relative affordability and differences in regulatory oversight of the accessibility of these medicines.
“Regions with less regulated access to medicines generally revealed greater variability and range of API concentrations. This trend was most notable for antibiotic medicines in African countries, which showed both the highest variability (four orders-of-magnitude) and concentrations (three-fold higher on average than the next closest continent) worldwide,” the report reads further, adding, “This may, in part, be driven by a general lack of enforceable regulatory oversight for proper antibiotic sales and use in human and veterinary applications.”
Outlook in Uganda
Prof Nelson Ssewankambo, the President of Uganda National Academy of Sciences (UNAS), and Dr Andrew Kambugu, the director of Infectious Disease Institute (IDI), told Saturday Monitor that humanity’s drugs have polluted water bodies in Uganda because of poor enforcement of policies.
Dr Herbert Luswata, the secretary-general of the Uganda Medical Association (UMA), added that many clinics—especially those operated by unqualified medical workers—don’t have a clear system of disposing of pharmaceuticals deemed surplus to requirements and other biologically active compounds.
The vast bulk of medicines disposed of in garbage collection centres in Kampala end up in water bodies whenever downpours fill the gutters and drains. The medicines—majorly expired—either come from people or health facilities.
“Some medical centres and small hospitals—these ones around the city—don’t follow those procedures for disposing of drugs and biologicals. You find that they don’t have incinerators [for burning the medical wastes] and they don’t even have safety boxes for storing. These are the people who are throwing these biomedical wastes in garbage collection centres for everyone,” Dr Luswata said.
Dr Daniel Kyabayinze, the director of public health at the Ministry of Health, said the government is yet to undertake a study to determine the extent and vulnerabilities of the country to drug pollution. Global studies have however drawn a link between drug pollution and wildlife feeding less. Contraceptive drugs have also reduced fish populations. It is widely believed that these outcomes are also mirrored in Uganda
“There is a need to also manage the industries. In the past, some industries have been closed because of the emission of those chemicals to the water sources,” Dr Didacus Namanya, the health geographer at the Ministry of Health, said.
A recent study conducted in Uganda and other 203 countries indicates that infections with drug resistant-bacteria caused more than 1.2 million deaths in 2019. The deaths surpass those mustered by HIV/Aids (690,000) and malaria (409,000).
Drug resistance, according to health experts, occurs when changes in the infectious agent blunt the drugs used to treat infections.
Excessive and inappropriate use of antibiotics combined with the challenge of insufficient access to the medicines are the main reasons for the emergence of drug-resistant bacteria, according to the experts.
Exposure to a drug through drinking water contaminated with it or eating fish with heavy accumulation of the drug expose the infectious agents in the human body to the drug. Over time, this develops resistance to the drug.
A 2000 study that investigated the occurrence and removal of common prescription plus non-prescription APIs in wastewater and water bodies in Nakivubo wetland area and Inner Murchison Bay (Lake Victoria) found worryingly high drug concentrations.
“Chemical analysis of water samples revealed that trimethoprim (antibiotic) and sulfamethoxazole (antibiotic) were the dominant APIs in water from all sites except Lake Victoria,” the report reads.
Other APIs such as atenolol (anti-hypertensive), carbamazepine (antiepileptic) and diclofenac (anti-inflammatory) were also found at all study sites except Lake Victoria, the researchers further revealed in the report.
“Overall, this investigation demonstrated that APIs in wastewater enter Nakivubo water system. Thus, Bugolobi Wastewater Treatment plant needs to be upgraded to improve APIs removal from wastewater,” the researchers recommended, adding, “Considering the high occurrence of antibiotics in the water system in Kampala, development and spread of antimicrobial resistance within the area should also be investigated.”
These findings come nearly a month after researchers from Makerere University’s School of Public Health detected high levels of cancer-causing agents in the water near garbage collection points in the Kampala metropolitan area which resulted from poor garbage management.
Dr Kyabayinze, however, said: “As the government, we are looking at the whole environment to create better health, not necessarily just looking at one indicator; but also using one indicator as a proxy to make sure we tackle the whole issue. We want to have one health kind of set-up.”
He, nevertheless, admitted that there are still gaps in general waste management and called for collective responsibility to address the problem.
“Even the quality of water, we have to add to determinants of health because it is the vehicle for spreading diseases. Health is not only the responsibility of the Ministry of Health. The Ministry of Health is an agency to promote good policies, but completely managing your life is a personal responsibility. But we come in to help you manage your health by providing services,” he concluded.