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Health experts have warned against arbitrary use of aspirin in managing high blood pressure.
Responding to an emailed inquiry by this writer, Dr Loise Nyanjau of the Ministry of Health (MoH) said low-dose aspirin increases the risk of brain haemorrhage.
Long regarded as a wonder drug in the management of heart diseases, it is emerging that aspirin has no role in the routine treatment of hypertension.
WebMD defines bleeding in the brain (brain haemorrhage) as a type of stroke and attributes 13 per cent of strokes to such bleeding.
A stroke occurs when an artery in the brain bursts. The resulting bleeding kills the brain cells.
When blood from trauma irritates brain tissues, it causes swelling. This, WebMD says, is known as cerebral oedema.
“The pooled blood collects into a mass called a haematoma. These conditions increase pressure on nearby brain tissue, and that reduces vital blood flow and kills brain cells.”
Bleeding can occur inside the brain, between the brain and the membranes that cover it, between the layers of the brain’s covering or between the skull and the covering of the brain.
Dr Nyanjau, a medical officer at the cardiovascular diseases (CVD) desk in the Non-Communicable Diseases (NCD) Unit of MoH, based her comments on the Kenya National Guidelines for Cardiovascular Diseases Management 2018.
“Aspirin is used to prevent the occurrence of cardiovascular diseases such as heart attack and stroke (that often kill or cause permanent disability) by reducing the chances of a blood clot forming in vulnerable individuals,” Dr Nyanjau said.
She added, however, that not all hypertensives need aspirin, which is best for persons with prior history of cardiovascular disease like a heart attack or stroke.
The rationale here is that the benefit of preventing another heart attack or stroke outweighs the risk of bleeding.
Use of aspirin, Dr Nyanjau said, is considered for persons with very high risk of developing cardiovascular disease depending on the person’s risk of bleeding and following a discussion with their health provider.
Dr Juliet Makanga, a neuropharmacologist and lecturer at Kenyatta University’s School of Pharmacy, shared Dr Nyanjau’s view on discretionary use of aspirin.
“Regardless of its effect on blood pressure, studies have shown that low-dose aspirin effectively prevents cardiovascular events in patients,” she said.
“However, the benefits of aspirin in hypertensive patients in the prevention of cardiovascular events such as myocardial infarction, that is heart attack, must be balanced against the risk of bleeding in the gut and in the brain.”
She advised proper management and medical follow-up. “Low-dose aspirin is not for every patient, and only the physician, having compounded various patient parameters, is best placed to make the decision,” she said.
Kenya Network of Cancer Organisations chairman David Makumi noted that some studies have shown that aspirin also protects against colon cancer.
“However, the long-term side effects like bleeding in the stomach outweigh the decision to use it for colon cancer prevention,” he said.
In spite of the warnings, the reality on the ground is different, with Nairobi chemists dishing out low-dose aspirin over-the-counter without prescription.
CNN first raised the red flag on low-dose aspirin last September 17 when it reported three research findings in the New England Journal of Medicine.
The studies showed that “a daily low-dose aspirin regimen provides no significant health benefits for healthy older adults. Instead, it may cause them serious harm.”
It is “a waste of money for healthy older adults. At worst, it may raise their risk of internal bleeding and early death,” the international TV station said.
Perhaps due to the sensitivity of the subject and the clout of big pharma, the researchers fell short of telling healthy adults to stop routine ingestion of aspirin.
Instead, they said: “Always consult your doctor before starting or stopping any medication” — a tall order in Kenya, where astronomical healthcare costs force patients to choose over-the-counter shortcuts.
Earlier in 2017, Sayer Ji of GreenMedInfo cited a Dutch study published in the journal Heart, which found that, “among 27,939 healthy female health professionals (average age 54) randomised to receive either 100 mg of aspirin every day or a placebo, the risk of gastrointestinal bleeding outweighed the benefit of the intervention for colorectal cancer and cardiovascular disease prevention in those under 65 years of age”.
Heart is a British international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease.
While the Kenya Health Policy 2014-2030 seeks to attain the highest possible standard of health in a manner responsive to the population’s health needs, by among other things, halting and reversing the rising burden of NCDs, unregulated use of low-dose aspirin is proving to be counterproductive.
The Kenya Association of Pharmaceutical Industry (KAPI) has expressed its commitment to continue facilitating a progressive reduction in the cost of Non communicable diseases (NCDs) medicines locally.
In a swift response to a public call by President Uhuru Kenyatta to international pharmaceutical firms, to reduce the cost of NCD medicines, KAPI, has confirmed ongoing efforts to affordably deliver essential medicines in Kenya. The efforts, are rolling out under a stakeholder initiative dubbed: Access Accelerated.
Alongside the initiative, the Association, comprising of leading international and local pharmaceutical firms, is also collaborating with the Ministry of Health to address non-tariff barriers affecting the pricing of medicines in the local market.
KAPI Chairperson, Dr. Anastasia Nyalita said the Association’s members have been undertaking public awareness programmes geared at educating Kenyans to exercise healthy living and preventive strategies as the most cost-effective measures against disease; especially lifestyle NCDs.
Speaking from New York, when he addressed a plenary session on the prevention and control of NCDs at the ongoing 73rd session on United Nations General Assembly in New York, last Thursday, President Kenyatta said access to essential medicines and technologies is key for effective management of NCDs.
“I call on non-state actors including the pharmaceutical industries and private health service providers to partner with governments to bring down costs of treatment through fair pricing and ethical practices,” said President Kenyatta.
The President said Kenya aims to guarantee access to quality NCD care through an integrated primary health care approach that emphasizes preventive and promotive health intervention that encourages the adoption of healthy lifestyles.
Additionally, said the Head of State, the government has committed itself to investing in additional and sustainable domestic financing to halt and reverse the burden of NCDs.
“To this end, we are embracing strategic partnerships and harnessing innovations from the private sector and other non-state actors in the entire continuum of NCDs,” he said
According to KAPI Chairperson, Dr. Anastasia Nyalita, the Association is playing a leading role in the local rollout of the global Access Accelerated initiative. Access Accelerated is a first-of-its-kind, multi-stakeholder collaboration focused on improving NCD care.
“KAPI, is working closely with the Ministry of Health among other stakeholders to address causative factors to the local cost of essential medicine and other pharmaceutical products, Dr Nyalita said. She added that, “Channel inefficiencies and excessive markup charges which contribute immensely to the unsustainable cost of medicine are currently under review.”
Launched at last year’s World Economic Forum in Davos Switzerland, Access Accelerated is an initiative spearheaded by twenty-two leading biopharmaceutical companies that have joined hands to advance the access to non-communicable (NCD) prevention and care agenda in low and lower-middle income countries including Kenya.
The ‘Access Accelerated’ programme, Nyalita said is already providing much needed impetus to facilitate sustainable NCD management.
Access Accelerated companies operating in Kenya include: Bayer, Bristol-Myers Eli Lilly and Company, GlaxoSmithKline, Johnson & Johnson, Merck, MSD, Novartis, Pfizer, Roche and Sanofi, among others.
“At KAPI, we wish to confirm our member companies’ commitment to affordably deliver NCD medicines in Kenya as and we look forward to partnering with the government as we seek to foster a conducive environment to ensure that we reduce mortality incidents associated with NCD diseases,” Nyalita said and added: “The call by President Kenyatta will further provide a good platform to crystalize Access Accelerated goals which are squarely aligned to the Big Four Agenda on Universal Health Care.”
The goal of Access Accelerated, in partnership with the World Bank Group and the Union for International Cancer Control (UICC), is to work towards the United Nations Sustainable Development Goal (SDG) target to reduce premature deaths from NCDs by one-third by 2030.
“Through the commitment and expertise of the Access Accelerated partners, we will work towards a shared vision where no person dies prematurely from a preventable, treatable disease,” said Ian Read, Chief Executive Officer of Pfizer and President of The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), on behalf of the initiative last year, adding that: “If the current trend in NCDs in low- and lower-middle income countries is not reversed, there is a real possibility we will undermine the progress we have made in health around the world. To reach our goal, we need to catalyze new partnerships, learn quickly and advance the resources and knowledge that will enable countries to tackle NCDs.”
In New York, President Kenyatta called on the international community to consider putting in place an incentive fund to stimulate the development of national NCD and mental health interventions and policy coherence for low and middle-income countries.
He said under the Big-4 pillar , Universal Healthcare has prioritized early diagnosis, screening and treatment of chronic NCDs.
Kenya continues to make tremendous progress in implementing the 22 political commitments agreed upon seven years ago aimed at a 25 per cent reduction in premature mortality occasioned by NCDs in 2025.
The President said Kenya’s success in this regard has been achieved through the domestication of the previous political declaration that adapted the global action plan for the prevention and control of NCDs in the national development blue print.
Building on long-standing individual company investments in global health, Access Accelerated is addressing a variety of access barriers to NCD prevention, treatment and care. Efforts will be evaluated with the support of independent experts at Boston University to establish a framework for progress, measure effectiveness and deliver ongoing reporting.
With the World Bank Group, the initiative will identify solutions to address financing, regulatory and service delivery barriers at country level. Additionally, the World Bank Group is conducting pilots in primary care to improve NCD outcomes in several countries.
In 1897, a big ship docks in Mombasa from India. An Indian man gets off, stays a couple of years, finds Kenya too wild and gets on another ship and sails back to India. But the call of Africa doesn’t abate so he comes back in 1910, sets base and then invites some cousins over from India to join him.
One of the cousins who came is Vijai Maini’s grandfather.
The same Vijai who studied pharmacy in the UK and came back to start the very successful Surgipharm which now has an annual turnover of Sh700 million.
He started his company when he was 40 years, but before that he was playing badminton professionally and collecting a forest of trophies which he shows JACKSON BIKO in his boardroom in their offices in Westlands.
At 74 years, he reminisces about the young Vijai in sports, the current Vijai who has lived his life and raised his children in a way he is proud of.
Describe to me how it feels like to be 74 years old.
(Laughs) Well, it’s gratifying. (Pause) I played badminton until I was 40 years old and then I couldn’t play anymore because at that age, your energy levels are going down. I woke up and said, ‘I have to do something else with my life. So I started this business on a 4,000 square feet rental room in town.
Are you generally better at this age than you were at, say, 45?
I think one reasons better. You tend to be less aggressive, but at the same time you take less risks in business. The few you take pay off, some don’t. But I’m still very passionate, I have no intention of retiring.
What dreams do you have left that you plan to achieve now?
Well, my dream now is that this business that I created continues and thrive. The dream has always been to maintain the ethics of the business which is big for me. The drugs I sell are drugs that my own family would take. I have always prided myself to do things by the book and I would like that to be a dream that continues.
How is the experience of being a father different from being a grandfather?
We have a saying in our community: you love interest more than the capital. (Chuckles). The capital here is your children and the interest is your grandchildren.
When you have children, you’re so engrossed in trying to make your living and raising them. You don’t spend as much time with them because you are building something for yourself and for them. But with grandchildren, you have mellowed a bit and you have more time.
You tend to spoil them more than you did your children because anyway the responsibility to raise them is not mine. My responsibility was with my children and I already raised them so it’s their turn now. So yes, it’s a joy.
I have been blessed. I grew up in a joint family environment and my children grew up in the same joint family.
What is a joint family?
We’ve got four generations under one roof. When my sons grew up, there were four generations under one roof. My grandchildren until recently have grown with four generations under one roof with my mother who passed away three years ago at the age of 94.
Obviously, there are great advantages in having four generations under one roof in terms of cohesion but in terms of privacy, how does that work out especially when you are married and some people just can’t get along and they have to run into each other in the kitchen every day?
(Laughs) Privacy is not that much of a problem because we have been lucky to have reasonably sized accommodation. But generally it’s a give and take.
It’s usually the women who have to get more used to each other than the men. For instance, for the wives sharing a kitchen might not be the easiest thing. My mother was always the best cook and when my wife came in, she had to sort of get used to the way of life. But having been brought up in that environment, living with your grandfather, the uncles and the aunts sort of thing, it has just come naturally to me. It has not been difficult.
Now that you are here, an Indian patriarch, I might as well ask you this. How does the Indian community intend to integrate with the rest when they congregate as a community in specific areas away from the rest? Is this ever a need?
Integration comes in on the outside life, not where you live. It comes in when you’re a member of a private club or at school. I think a lot of integration happens in schools now more than ever. They don’t see colour. All my sons went to St Mary’s and they had more local Kenyan friends than Indian friends. My eldest is very good friends with an indigenous Kenyan, they ended up in the same university in the UK and he came back also and this guy has a very senior post in Standard Chartered.
What shakes your confidence now, at 74 years of age?
(Pause) Irregular business practices. The business practices now are not really what they were. In recent years, there has been a disturbing level of corruption that I’m not used to as a businessman. This is new to me, this is not how we have been doing business.
Sometimes when I visit an Indian shop, I see a very elderly Indian man seated at a small desk at the back, hunched over a stack of papers, poking at a calculator. An old man, probably 100 years old. I always wonder, why does that guy still come to the shop? Is it to keep his brain alive? Is it that that’s all he has done his whole life and knows nothing else? What’s his motivation? What’s your motivation to keep coming here at 74?
(Chuckles) So take me for example, I started in healthcare and I have never diverted from it. All profits made here have gone back into the business to build it. I have not had the desire to say ‘OK now let me go and start a hotel or put up my own buildings.’ I still rent here. I would rather keep the money in stocks and develop the business.
When you put everything in one thing, you want to preserve it. There is a bicycle shop in River Road started in the 1950s. The owners have diversified into the hotel industries in a big way but the old man, the owner, never sits in those many hotels. He sits in that shop where he started. This is a question of belief. Or luck.
When was the last time you were broke?
I cannot remember. (Laughs)
Uhm, 1969, probably?
(Chuckles loudly) No. I’ve been lucky. In the sense, I suppose I came into this world fortunately. My family has always been privileged, fortunately.
…As the global pharmaceutical industry advocates for even greater collaboration as critical to future global health progress
The International Federation of Pharmaceutical Manufacturers & Associations IFPMA has launched a report detailing milestones achieved in the health sector worldwide over the last 50 years.
The report launched today features Kenya as a key player in the formal pharmaceutical space in Sub-Sahara Africa.
Notably, the report by IFPMA affiliate –Kenya Association of Pharmaceutical Industry (KAPI)- highlights Kenya’s support for an ongoing World Health Organisation (WHO) pilot trial on a malaria vaccine scientifically code named RTS,S. RTS,S is an injectable vaccine that provides partial protection against malaria in young children.
Alongside Ghana and Malawi, Kenya has partnered with WHO in the Malaria Vaccine Implementation Programme (MVIP) that will make the RTS,S vaccine available in selected areas of the three countries. The two year clinical trial is expected to provide initial insights on the programmatic feasibility of delivering the RTS,S/AS01 vaccine (trade name Mosquirix™) in real-life settings and on the safety profile of RTS,S in the context of routine use.
Speaking when she confirmed the local launched of the IFPMA “50 Years of Global Health Progress” report, KAPI Chairperson Dr. Anastasia Nyalita said the report traces global health progress over the past 50 years. The report also catalogues the pioneering collaborative role the research-based biopharmaceutical industry has played not only to deliver prevention and treatment, but to strengthen health systems around the world.
“At KAPI, we salute the role played by our global affiliate IFPMA in collating a report that advances the body of knowledge on the role of pharmaceutical industry in development here in Kenya and beyond,” Dr. Nyalita said.
The report reviews some of the research-based biopharmaceutical industry’s major scientific advances, as well as acknowledging challenges the industry faces and areas of unfinished business. The industry’s track record of partnerships over recent decades demonstrates what can be achieved by uniting governments, civil society and business. The report concludes with a commitment to continue to innovate and partner with a shared goal to deliver better health for everyone, everywhere.
IFPMA President, Mr. Ian Read, who is also the Chairman and CEO of Pfizer in a global communique noted that advances in both prevention and treatment of disease have transformed healthcare. “Vaccines are widely recognized as the simplest, most cost-effective way to save lives. HIV/AIDS, once fatal, can now be treated as can many cancers. Cardiovascular disease sufferers benefit from simple-one-a-day solutions. We can now cure Hepatitis C. We have an experimental vaccine for Ebola,” he noted.
“The industry joined the earliest global health partnerships such as, in the 1970s, the Expanded Program on Immunization and, in the 1980s, the polio eradication and smallpox initiatives. These have been followed by partnerships as diverse as DNDi, MMV, Global Fund for AIDS, TB and Malaria, GAVI, the Vaccine Alliance, MPP, and, more recently, CEPI and Access Accelerated. “While the biopharmaceutical industry has been a key player in this progress, none of it would have been accomplished without partnerships. From patient advocates to our biotech and academic partners to individual governments, innovation is only as impactful as the partnerships that support it,” added Ian Read.
Partnerships are now the norm and the Sustainable Developments Goals serve to galvanize greater collaboration to confront new and remaining challenges as many people still lack access to essential health services, such as family planning, child immunization, antiretroviral therapy to combat HIV and AIDS, tuberculosis treatment, clean water and sanitation. Health systems struggle to respond effectively to burgeoning rates of non-communicable diseases; too many people still die prematurely from preventable diseases.
“Despite tremendous progress much more needs to be done to bring the fruits of our innovation to all. The research-based biopharmaceutical industry has learned that global health is about much more than medicines and vaccines – it requires building and supporting strong health systems, delivering education to communities to promote prevention, strengthening standards and regulations and creating innovative finance models. We will continue to evolve, learn and pioneer ways to do more to reach all patients. To do this we’ll need partnerships of all kinds to take on the challenges of Universal Health coverage (UHC). We need to continue to build bridges between key actors across the health system. More dialogue and action are musts” says IFPMA Director General, Thomas Cueni.
On the occasion of the 71st World Health Assembly and to celebrate its 50-year anniversary, IFPMA hosted an event on 23rd May in Geneva which featured a top-level panel to discuss priorities in delivering better health for everyone, everywhere.