The research data showed that in 26% of the households at least one person had received an injection in the past two weeks. By far the majority of these injections were therapeutic injections. Even more disturbing is the fact that almost 9% of all children between 1 and 6 years received an injection and four of these children were only one year old. In terms of the number of children who sought treatment, as many as 40% received an injection as part of their treatment. Another interesting point is that twice as many women as men received injections recently.
Based on earlier research (Cunningham 1970) and research from other developing countries, it was expected that the majority of injections would be administered by the informal health care sector. That is by “injection doctors”, pharmacies, and private individuals. However, in this research area at least, this is not the case. All the patients, at the level of first visited provider, received their injections from the formal health care system. Forty two percent of those patients who went to the health centre first were administered an injection. In the district hospital 33% of all patients received at least one injection. And in the private medical clinics the figure was as high as 79%.
When correlating the data for specific, trivial or vague illness conditions and the rate of injections, twenty three percent of the people who complained about a cold received an injection and 83% of the diarrhoea cases received at least one injection. People who had vague symptoms like tiredness and no appetite received an injection or IV fluid in 80% of the cases.
Some of these figures are small but seen in the context of the research study’s qualitative information they make sense. It is strongly believed that injections are the most powerful form of treatment, injections “run in the blood”. Although some people had actually experienced abscesses in connection with injections in the informal sector, most people denied that there was any risk in receiving injections. While aware that sharing needles could transmit HIV infection, consumers and providers alike were not aware that sharing a syringe could entail the same risk. Formal providers were well aware that there were other diseases like hepatitis which could be transferred through the injection equipment. Most of the providers were also conscious that injections were a very expensive form of treatment. But social pressure and/or business considerations resulted in the administration of injections anyway.
Injections are only part of the drug treatment which people receive. The average number of drugs per patient ranged from 1.09 in groceries to 4.17 in the district hospital and 3.42 in the private medical clinics. In the informal sector it was less than 2 drugs per customer. The health centre dispensed on an average 2.07 drugs per patient. Future studies could look at prescribing habits in the hospitals and the economic consequences of the over-prescribing of pharmaceuticals.
Respondents were also asked if they knew the names or characteristics of the drugs they had received. In general, knowledge was higher in the informal sector where the responsibility for diagnosis lies with the customer. In the formal sector (public hospitals and private clinics) 84 to 90% of the patients received unknown drugs.
To sum up, the data have shown a general over-consumption of drugs and injections. Contrary to expectations, the problem seems to be most pronounced in the formal sector, especially in the public hospitals and private clinics. Where there is a combination of a profit motive and formality, as in the private medical clinics, as many as 79% of first visit patients receive one or more injections. The lack of patient awareness of the received drugs reflects a lack of communication between patient and provider in the higher levels of the formal sector and possibly a protection of future business in the private, formal sector.