Download Improving injection practices in Nepal

Public Perceptions about Injections
and
Private Sector Injection Practices
in Central Nepal
Mahesh Bhattarai and Scott Wittet
Study Objectives
Use a qualitative, exploratory research
approach to:
• Investigate the attitudes and knowledge of the
general public and of private injection providers
regarding injections.
• Observe and document injection practices of private
providers.
Study Methods
Timing:
March-July, 2000
Location:
Seven districts of Nepal’s Central region
Methods:
Focus group discussions,
In-depth interviews, Direct Observation,
and “Secret Shopper” interactions
Respondents: Total of 204 private sector injection
providers and consumers
The respondents are diverse in terms of ethnicity, hill or
Terai location, urban/rural lifestyle, educational level,
gender, age, and experience.
Findings: The Good News
• The vast majority of providers and customers are
well aware that injections can cause health problems.
• Many providers and consumers say that injections
should not be used for “common illness.”
• Disposable syringes are commonly available (and
used) in the study area.
Findings: More Good News
• Most providers and consumers know that needles
and syringes should not be shared among people
without “cleaning.”
• Most providers and consumers know that medical
waste can be dangerous. They say that it should be
either buried or burned to reduce problems.
• Many providers and some consumers are critical of
unqualified injection providers in the community and
would like to see the situation improved.
Findings: Troubling News
Observed and reported consequences of
poor injection practices:
• Providers and consumers commonly report adverse
consequences following injection (including
abscesses, amputation, and death).
• They also report needle prick incidents resulting
from poorly disposed waste.
Findings: More Troubling News
Practices that put providers at risk:
• Unsafe handling of injection equipment and other
sharps is common.
• Storage of contaminated waste in easily accessible,
open containers is common. Reuse is also common.
• Adverse consequences of injections could result in
decreased business and even violence against the
provider.
Findings: More Troubling News
Practices that put consumers at risk:
• Medical services are being provided by unqualified
personnel.
• Reuse of non-sterile injection equipment with the
same patient is common.
• Use of non-sterile injection equipment among more
than one patient was observed.
Findings: More Troubling News
Practices that put the community at risk:
• Disposal of contaminated medical waste in public
areas, including needles and syringes, is common.
• Selling used injection equipment may be a problem.
Findings: More Troubling News
Unnecessary injections:
• Injections are valued by consumers and providers as
fast acting and necessary for a variety of complaints.
• Injections of vitamins, antibiotics, and painkillers are
common in spite of widespread acknowledgement
that oral medications should be used for less serious
complaints.
Recommendations
There is a serious gap between provider
knowledge about injection safety and
provider behavior.
• Policy initiatives, infrastructure development, and
provider and consumer behavior change strategies
should be considered.
Recommendations
Research which might be useful:
• Conduct an assessment of public sector practices.
• Gain a better understanding of hospital and
•
•
•
municipal handling and disposal of medical waste.
Investigate attitudes towards and practices related to
intravenous infusions and minor surgery.
Assess the safety of disposable syringes in the
market. Investigate syringe (and needle) sales
practices and the economics of recycling.
Determine whether providers support TT and
vaccination of pregnant women (and others) or not.
What’s Next
Early 2001
Dissemination meeting with SIGN partners in
Kathmandu to discuss findings and
brainstorm future research and
interventions.
Late 2001
Report to SIGN on new plans and progress.