Lessons learned from a community based intervention to improve injection safety in Pakistan

Abstract

BackgroundA national study in 2007 revealed that in Pakistan the prevalence of hepatitis B is 2.5% and for hepatitis C it is 5%. Unsafe injections have been identified as one of the reasons for the spread of these infections. Trained and untrained providers routinely perform unsafe practices primarily for economic reasons i.e. they reuse injection equipment on several patients. The patients, do not question the provider about the need for an injection because of social barriers or whether the syringe is coming from a new sterile packet due to lack of knowledge. The present paper represents an intervention that was developed to empower the community to improve unsafe injection practices in rural Pakistan.MethodsIn a rural district of Pakistan (Tando Allahyar, Sindh) with a population of approximately 630,000 a multipronged approach was used in 2010 (June to December) to improve injection safety. The focus of the intervention was the community, however providers were not precluded. The organization of interventions was also carefully planned. A baseline assessment (n=300) was conducted prior to the intervention. The interventions comprised large scale gatherings of the community (males and females) across the district. Smaller gatherings included teachers, imams of mosques and the training of trained and untrained healthcare providers. The Pakistan Television Network was used to broadcast messages recorded by prominent figures in the local language. The local FM channel and Sunday newspaper were also used to disseminate messages on injection safety. An end of project assessment was carried out in January 2012. The study was ethically reviewed and approved.ResultsThe interventions resulted in improving misconceptions about transmission of hepatitis B and C. In the baseline assessment (only 9%) of the respondents associated hepatitis B and C with unsafe injections which increased to 78% at the end of project study. In the baseline study 15% of the study participants reported that a new syringe was used for their most recent injection. The post-intervention findings showed an increase to 29% (n=87).ConclusionIt is difficult to assess the long-term impact of the intervention but there were several positive indicators. The duration of intervention is the key to achieving a meaningful impact. It has to be at least 18–24 months long.

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

“…In 2015, WHO launched new injection safety guidelines 184 , which included a recommendation that by 2020 all Member States should switch to exclusive use of safety engineered injection devices. Motivated by this recommendation, a study based in a large district in rural Pakistan showed that a communitybased intervention designed to improve knowledge and practice of safe medical injections could substantially improve both awareness of the association between unsafe injections and viral hepatitis and clinical practice (eg, an increase in reported use of new needles from 15% to 29between 2011 and 2012) 185 . In India, high-level political engagement has led to initiatives within the State of Punjab, including establishment of 40 model injection safety centres at district-level health facilities and medical and nursing institutes throughout the State, which also serve as a training resource for health workers on injection safety and reuse-prevention measures.…”

Reuse of syringes for therapeutic injections in Pakistan: rethinking determinants

“…Community approaches that reduce information asymmetry between providers and patients have been promising (28). One intervention in Tando Allah Yar improved patient awareness from 15% to 29% within 6 months (29). Other complementary approaches may be to brand as safe providers those that visibly do not reuse syringes.…”

Injection practices in 2011-2015: A rapid review using data from the Demographic and Health Surveys (DHS)

“…10,11 However, it also pointed to the absence of improvement in reducing the frequency of analgesics, vitamins or anti-histamines in the desire to meet user demand. 15,16 Reducing injection overuse would only be a matter of promoting rational use of medicines if injections were administered safely. 17 However, reuse of syringes frequently leads to transmission of bloodborne pathogens.…”