(1994; 54 pages)
1.1 Problem statement
In many different cultures the belief that injections are the most powerful means of restoring and maintaining health is shared by both injection providers and users (WHO 1991; Reeler 1990; Wolffers and Bloem 1993; Whyte and van der Geest 1994). In Uganda, studies undertaken in the field of drug use invariably underline the popularity of injections among both users and providers (UEDMP 1990; Glenthøj 1991; Whyte 1991; Birungi and Whyte 1993). The studies also underline the high degree of misuse of drugs and injections; this includes under dosage as well as overuse or inappropriate use (Mburu 1984; Kalyesubula and Minde 1989; Glenthøj 1991; UEDMP 1990, 1992). Further, the studies show a high prevalence of administration of drugs in homes often without proper diagnosis, and emphasize the widespread use of certain drugs like Procaine Penicillin Fortified (PPF) and chloroquine (Christensen and Anokbongo 1991; Kinuka et al. 1985), In a country where the practice of medicine is not strongly controlled, a variety of untrained providers administer injections. For example, Whyte (1982, 1988) noted that in every neighbourhood in Bunyole, Eastern Uganda, there were curers who specialized in injections (‘ab’episyo’) with no formal Western medical training. Similarly, in a study in one municipality Birungi (1994) noted the sale of Western pharmaceuticals, including injectables, needles and syringes, by pedlars, hawkers and vendors in the central market, open stalls on verandas and the taxi and bus park. She noted an increase in family administered injections and also described itinerant injectionists whose livelihood depended on the provision of injections.
The current research was initiated by the Action Programme on Essential Drugs (WHO) as part of an international comparative research project into injection practices in developing countries. The initiative was mainly prompted by the growing concern about the widespread misuse of injections in developing countries, both from a public health and economic point of view:1
- Administration of injections without adequate medical knowledge or sterilization procedures would lead to increased risks of transmitting a range of potentially serious pathogens, including hepatitis B, Human Immunodeficiency Virus (HIV) and Streptococcus, the occurrence of abscesses and the provocation of poliomyelitis. Some of the drugs that are administered are not medically justified and hence potentially dangerous.
- Administration of injections is deemed undesirable especially if it causes poor families to spend scarce resources on injections when money could have been spent better (WHO 1991, 1992).
1 See the proceedings of the Informal Workshops on Injection Practices Research. These have been published by WHO for limited distribution: 1) WHO/DAP/91.8; 2) WHO/DAP/92.2; Combined in WHO/DAP/92.9.
In order to improve the use of injections it is important to know: who is administering them; how often they give injections and for what purpose; why they are used; if they are used, is there a medical justification for their use; and what hygienic measures are being undertaken. It is on the basis of such findings that intervention strategies geared to injection misuse can be developed, A problem in this endeavour is that although many studies have identified anddescribed the misuse of injections, most are anecdotal without a systematic description and quantitative assessment of the problem. In the same respect, few studies have been analytical in nature - in attempting to understand why it happens. None seem to have been designed to develop appropriate interventions. The present study provides baseline and qualitative data both from providers and users of injections, to guide the design of intervention studies.