Children hospitalised after Butebo drug mix-up out of danger

Kabwangasi, Uganda | URN | Experts investigating the administration of the wrong medication to 23 children during a health outreach in Butebo District have confirmed that all the children who were hospitalised with complications are now out of danger and are expected to be discharged.

The children were mistakenly given carbamazepine, an anticonvulsant medication, instead of mebendazole, which is used to treat worm infestations, during an Integrated Child Health Day (ICHD) outreach in Kabwangasi Town Council.

A situation report released by the Mbale Region Emergency Operation Centre last week indicated that each of the 23 children received five tablets of carbamazepine. The incident resulted in the death of a two-year-old boy on Thursday, while 16 other children were referred to and admitted at Mbale Regional Referral Hospital after developing complications, including drowsiness, reduced consciousness, convulsions and vomiting.

However, speaking to URN on Monday, Julius Mayengo, the National Drug Authority (NDA) Manager for Pharmacovigilance, said the hospitalised children had stabilised and were expected to be discharged.

Mayengo also revealed that the government had constituted a multidisciplinary committee of experts to investigate the circumstances surrounding the medication error. The committee is expected to release a scientific report by the end of the week.

His remarks followed an earlier statement by NDA Public Relations Officer Abiaz Rwamwiri, who said the Ministry of Health had dispatched a team of experts to Mbale and Butebo districts to establish how the incident occurred and identify measures to prevent a recurrence. Rwamwiri described the incident as a medical error originating from healthcare workers #involved in the outreach programme.

Meanwhile, the Pharmaceutical Society of Uganda (PSU) has raised concerns over the recurrence of similar medication errors, revealing that a related incident was reported in March this year.

In a statement issued last week, PSU Secretary Dr Stephen Lutoti said the recurrence points to persistent weaknesses in medicine management and dispensing procedures during community health outreaches.

Lutoti called for the preservation of drug samples to facilitate independent verification, warning that carbamazepine poses significant toxicity risks, particularly among children. Separately, the situation report indicated that seven children who received treatment at Kabwangasi Health Centre III had been discharged by Monday and were reported to be recovering well.