[e-drug] Unsafe injections in Pakistan

[hollowayk@who.ch]

E-drug: Unsafe injections in Pakistan
---------------------------------------------
Dear E-druggers,

Some of you may be interested in the message below on unsafe 
inappropriate injections from the SIGNPakistan digest discussion 
forum.

Kathy

Kathleen Holloway
Medical Officer, Policy, Access and Rational Use,
Dept. Essential Drugs and Medicines Policy,
World Health Organisation,
20, Avenue Appia, GenËve 27, CH-1211.
Tel: +41 22 791 2336; Fax: +41 22 791 4167
email: hollowayk@who.int
------------------------------
Date: Fri, 23 Feb 2001 15:10:58 +0500
From: "arshad.altaf" <arshad.altaf@aku.edu>
To: signpak@maillists.com
Subject: KARACHI: Use of ninety-five per cent injections irrational

KARACHI: Use of ninety-five per cent injections irrational
By Sarfaraz Ahmed
KARACHI, Feb 22: Ninety-five per cent of the injections given to
patients are irrational and over 80 per cent of these contribute to the
transmission of Hepatitis B, C, and HIV.
According to a survey conducted by the Sindh Aids Control Programme,
general practitioners and family physicians have been found to be using
injections when these are not necessarily needed.
In Pakistan, unsafe injection practices are on the rise and prevalent
rate is alarmingly high as compared to the neighbouring developing countries.

Most of these injections comprise B Complex supplements, anti-allergic
drugs and cortisone.

During the survey in Lyari, Orangi Town, Landhi, Korangi, Malir, Lines
Area, Liaquatabad, Federal-B Area, Saeedabad, New Karachi, North 
Nazimabad, Nazimabad, Pir Colony, Golimar, Lasbella and 
Gulshan-i-Iqbal, it was detected that general practitioners and 
family physicians had been
administering injections to their patients in cases where these were not
needed. This is because of two reasons.  First, a prescription 
containing the provision of injection increases the margin of profit 
for doctors as compared to the prescription containing simply tablets 
or suspension, according to Dr Sharaf Ali Shah, chief of Sindh Aids 
Control Programme.
Second, he says, there is a misconception among people, particularly
among the low-income groups, that the administration of medicine through
injection has more efficacy than given orally.

He says excessive use of injections is contributing to the spread of
Hepatitis B, C, HIV and other diseases, adding a recent survey has found
that 5-7 per cent of the population in the country has been suffering
from Hepatitis B because of irrational use of injections. Besides, he 
says, 2-3pc of people have been infected with Hepatitis C because of 
the wrong use of injections.  "If the use of injections in the 
country is taken into account, statistics shows that on average 8.5 
injections are consumed annually by one person in the country."

He said it had been observed that the majority of the GPs using glass
syringes did not follow the rule of cleaning them with sub-pathogens in
boiling water for 35-45 minutes.  In the absence of proper hygienic 
procedures, the reuse of these not- properly-sterilised syringes 
plays a havoc, causing infections.

About disposable syringes, he says, these syringes, which are required
to be disposed of once used, are reused with a wash in water. 
Besides, the used syringes are sifted from garbage and are again 
brought into use by the vested interest, he said adding the best way 
for the disposal of such syringes is the use of syringe-cutter.  He, 
however, said very few doctors had been found having this instrument 
which hardly cost Rs200 apiece.

He says it has been established that 89pc of the drug users using injections
have been suffering from Hepatitis C. They are found to have contracted
the infection through syringes, he adds.

In order to reduce the unsafe and unnecessary use of injections, effective
behavioural changes are required, he says.

Another study has shown that out of 203 patients interviewed, 165 were
given injections by the doctors and about 73 per cent did not know 
whether the injections were sterilised. About 135 patients gave blood 
for examination and it was found that 44 per cent had Hepatitis C.

Yet another study has shown that out of 198 patients interviewed, 91 per
cent said that it was the doctor who said that the injection was needed.

According to the WHO, a safe injection does not harm the recipient, does
not result in waste, is not dangerous to the community.  To achieve 
this, an injection needs to be prepared with clean hands in a clean 
area, using medication drawn from sterile vial.  The WHO recommends 
that injection must be administered using a sterile syringe and 
needle. After administration, sharp equipment such as needles need to 
be discarded.

http://www.dawn.com/2001/02/23/local2.htm

End of signpak V1 #42
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