Injection practices in Sindh Province, Pakistan : a cross-sectional study

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Injections are highly popular and overused in developing countries. However, the international public health community has been increasingly concerned about their role in spread of blood-borne pathogens, post-injection abscesses, and poliomyelitis provocation paralysis. The increasing use of injections is putting financial burden on health care resources. Reducing the frequency of therapeutic injections is corner stone in improving the injection safety. Such a programme may be better conducted if initial assessments are made to estimate the frequency of injections and to identify the determinants of injection overuse among patients and health care providers. The objective of the study was to estimate the frequency of injections and identification of injection providers in a rural and urban community of Sindh province in Pakistan. We also identified the determinants of injection use. From 25ft July to 30fr September 2001 we interviewed 575 subjects each in rural and urban setting through cluster survey technique divided in 34 clusters. A structured questionnaire was administered to the respondent age >15 years and to the guardian below this age. Information was collected about encounters with providers, reason for encounter, type of medication prescribed, and number and types of injections during last three months. Respondents were also inquired about their beliefs regarding injections. Age and sex standardized estimates of injection frequency were calculated and determinants of receiving an injection during last three months were identified using multiple logistic regression analysis. The mean number of injections was 3.8 injections/person during last three months (15 injections/person/year). Sixty-eight percent of the subjects received at least one injection during the past three months. No gender difference was seen in frequency of injections. Most of the injections (96%) were for therapeutic purposes and were administered at general practitioner's clinic (74%) by a dispenser or a nurse (75%). Of those who remembered last injection, 5l% were administered with sterile injection equipment. Residents of rural area (adjusted OR=6.6; 95% Cl: 3.1-14.2), and those who visited a private GP (adjusted OR=3.5; 95% CI: 1.9-6.3) or dispenser (adjusted OR=6.2; 95% CI 2.8-14.2) were more likely to receive an injection. Those who had a belief that injections act faster than oral medication and symptoms are quickly relieved (adjusted OR= 1.4; 95% Cl: 1.l-1.7) or illness can only be treated with injectable medications (adjusted OR= 2.4; 95% Cl: 1.4-4.3) were also more likely to receive injections during past three months. Injections are overused in the Sindh province of Pakistan, with ratios of injection per capita among the highest ever reported. Beliefs of patients about injection superiority over oral drugs in treatment of their ailments are among the major contributors of injection use. Interventions are needed to obtain a reduction of injection prescription among private health care providers who prescribe most of the injections received by the population, and modifications of beliefs about injection among patients.

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