[e-drug] Injection practices - Uganda study

[Kirsten Myhr <myhr@online.no>]

E-drug: Injection practices - Uganda study
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[Crossposted from the SIGN forum. KM]

To: SIGN Moderator <sign@acithn.uq.edu.au>
From: Gerardo Priotto <epi@imul.com>
Subject: Injections survey in Uganda

Attached is the final report on a survey performed by EPICENTRE in
Mbarara District, South-West Uganda, that measured the frequency
of injections and other related parameters in the general population.

This was an excercise to test the methodology proposed in the
SIGN toolbox. We were able to apply that methodology, having
adapted it to the local context, while detecting a series of weak
points for wich we issued recommendations in the report.

We also found a high frequency of injections in that district.

All the best,

Gerardo Priotto
EPICENTRE, Uganda
PO Box 2362, Kampala, Uganda
Tel: 256-41-269998
E-mail: epi@imul.com
_____________________________________________________________
ABSTRACT

Injection use in the population of Mbarara District, Uganda
Cross-sectional Population Survey Gerardo Priotto, Ana Ruiz
(EPICENTRE), Catherine Kyobutungi (Mbarara University)

This research was conducted by EPICENTRE with the collaboration
of the Mbarara University of Science and Technology, Medical
School. It was financed by WHO as a contribution to the Safe
Injections Global Network (SIGN).

BACKGROUND: Injections are a very popular practice in most
developing countries. Concern is rising in the public health
community about their role in the spread of bloodborne diseases,
the additional health risks such as post-injection abscesses and
provocation poliomyelitis, and their negative contribution to the
financial burden of health care. A network of international public
health institutions, the Safe Injection Global Network (SIGN), is
promoting the implementation of a strategy for the reduction of the
injection frequency and improvement of injection safety worldwide.
The application of such a strategy in any particular site requires the
previous assessment of the baseline situation in terms of injection
practices in the population, in order to design properly the specific
programs and to be able to monitor and evaluate results. There is,
therefore, a need of a methodology capable of producing
measurements that are replicable across countries and time.

We tested a methodology proposed by a consensus of SIGN
experts for the estimation of the frequency of injections and
identification of injection providers in Mbarara District,
South-Western Uganda.

OBJECTIVES: 1)To estimate the frequency of injections in the
population; 2)To quantify the main types of injections; 3)To identify
the providers who administer injections; 4)To explore the
importance of in-house injection practices; 5)To estimate the mean
cost of an injection in the district; 6)To describe the safety
circumstances and accidental needlestick injuries.

DESIGN: Cross-sectional, general population survey. Two-stage
cluster sampling.

RESULTS: Between the 6th and 14th February 2001, we
interviewed 752 persons, divided in 30 clusters across the district.
The overall frequency of injections was 5.3 injections/person/year,
and for children under five years it was 10.0 injections/person/year,
significantly higher than for the other age groups. No gender
differences were observed. The large majority of injections (97.8%)
were for therapeutic purposes. The formal health providers adminis-
tered 66.6% of the injections, though this classification should be
taken with caution. The majority (52.7%) of injections were admin-
istered at outpatient clinics, and 57.4% employed disposable,
sterile materials, according to the patient's perception. The mean
cost of one injection was estimated at 821 Ush (0.47 USD). The
data was weighted for age and gender to adjust for imbalances of
representation, namely the under-representation of adult males.
There is definitely a high rate of injections in the district, which
leads one to infer the occurrence of a steady rate of blood-borne
infections being transmitted silently in the community.


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