Injection use in a village in north India

Injections can transmit infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and precipitate poliomyelitis. Complications such as injection abscesses and nerve damage may also occur. It is estimated that 50% of the injections given in developing countries are unsafe. However, limited information is available from India. We planned a pilot study to assess the prevalence of injection use and the knowledge of the community and private medical practitioners (PMPs) about injection use.

One in every four houses in the village under study was selected by systematic random sampling. One adult (> 18 years) respondent in the family was asked questions about family members receiving injections in the past 6 months. Nine PMPs were interviewed about their knowledge and practices regarding injection use.

In the past six months, 1280 family members in 285 houses received 1575 injections (2.46 injections per person per year). About 35% had received at least one injection in the past 6 months. Children below 5 years received 3.1 injections/child/year of which about 60% were preventive. On their last visit to a health facility, 55% of the subjects were given injections using disposable syringes. About 45% of the 285 respondents knew that diseases could be spread by improper use of injections. While 18% of the respondents said they would prefer injections, 54% preferred oral medications if both were equally effective. After being told the average cost of disposable needles and syringes, 92% of the respondents were willing to buy them. None of the 9 PMPs practising in the village were formally trained in modern medicine. On the day of observation, 18 of 58 patients (30%) seen by PMPs were given injections. Three injections were observed and though they were all given with disposable syringes, the technique of administration did not follow standard guidelines in any. Two PMPs did not know of any disease transmitted by injections. The syringes were usually thrown in a nearby drain or outside the village. Four PMPs said that patients themselves did not ask for injections.

The use of injections in the study area was high. The PMPs were not only giving a high number of injections but the technique of administration was also wrong. The community was less likely to ask for injections on their own but was willing to buy disposable syringes and needles. The awareness about the risk of injections was low.