50% injections administered in Pakistan unsafe

[Naveed Yaseen]

Patients, providers responsible for overuse: Dr Ashraf
by Shahina Maqbool
Billions of injections - most of them unsafe and unnecessary - are being administered to patients globally, leading to serious diseases like Hepatitis and AIDS, and eventually to millions of deaths. Pakistan has the highest average of injections administered per year per person in the world i.e., up to 8.5 per person per year. At least 50% of these injections are unsafe.

These alarming facts were brought to light by Professor Dr Muhammad Ashraf Chaudhry, Head of the Department of Community Medicines at Islamabad Medical and Dental College, while talking to ‘The News’ here on Tuesday.

Dr Ashraf informed that at least 16 billion injections are annually being administered in the developing countries; around 95% in curative cure. “In some situations, as many as nine out of 10 patients presenting to a primary healthcare provider receive an injection, and 70% of these injections are unnecessary or could be given in an oral formulation,” he added.

It is therefore safe to state that unsafe injection practices are on the rise in Pakistan. An unsafe injection is one in which the syringe, needle, or both, have been re-used without sterilization. Worldwide, up to 40% of the injections are given with syringes and needles reused without sterilization.

Responding to a question about the current pattern of injection overuse, Dr Ashraf called it a “complex behavioural problem, caused in part by patients demanding injections, which they consider as the most powerful route of administering the substance concerned, and in part by economic and other incentives which lead providers, especially unqualified persons in pharmacies and in marketplaces, to prescribe unnecessary injections.” Typically, unsafe injections are delivered with reused disposable syringes. Doctors, especially quacks, over-prescribe injections because they believe that this best satisfies patients. In addition, prescription of an injection sometimes allows the charging of a higher fee for service.

Unsafe injection practices can result in severe infections, putting human lives at risk. “Each year, unsafe injections cause an estimated 1.3 million early deaths. Unsafe injection practices are a powerful engine for transmission of blood-borne pathogens, including hepatitis B and C viruses and Human Immunodeficiency Virus. As many as 21.7 million people become infected each year, representing 33% of new HBV infections worldwide,” Dr Ashraf shared.

Unsafe injection practices are most common cause of Hepatitis C Virus (HCV) infection in developing countries, causing 2 million new infections each year and accounting for 42% of all cases. Pakistan has 15 million carriers of hepatitis. Globally, nearly two percent of all new HIV infections are caused by unsafe injections. Hepatitis B and C and HIV cause chronic infections, which lead to disease, disability and death, a number of years after the use of unsafe injections.

Dr Ashraf recommended the adoption of a three-pronged strategy to achieve safe and appropriate use of injections. “It can be done by changing the behaviour of healthcare workers and patients, ensuring availability of safe injection equipment and supplies, and managing waste safely and appropriately,” he said. Furthermore, better communication between patients and providers can clarify misunderstandings about the effectiveness of injection therapy and help to reduce injection overuse.

Dr Ashraf also called for a national policy for management of healthcare waste; this policy should offer a comprehensive system for implementation, improved awareness and training of health workers at all levels. Technical solutions, such as auto-disable syringes that can be used only once, are available. The starting point of preventing overuse or misuse of injections is creation of awareness among the masses. “People should be advised to avoid unnecessary injections through media campaigns,” he stressed. To prevent injection overuse in the curative sector, the World Health Organization urges that the national drug policies of countries promote rational use of therapeutic injections. This may include removing unnecessary injectable medicines from the national essential medicines list. “The transition to safe injection practices in Pakistan should begin immediately,” Dr Ashraf warned in conclusion.

http://www.thenews.com.pk/daily_detail.asp?id=174802