Understanding injection practices is crucial for evidence-based development
of intervention initiatives. This study explored the extent of injection use and injection
safety practices in primary care hospitals in Bangladesh.
The study employed both quantitative and qualitative research methods. The
methods used were - a retrospective audit of prescriptions (n = 4320), focus group discussions (six
with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation
of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24).
Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then
As many as 78% of our study sample (n = 4230) received an injection. The most
commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%),
analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed
antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general
weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick
injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of
injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health
providers’ safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n =
2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the
injection providers and 90% (n = 43/ 48) of the waste handlers were not trained in injection safety practices and
infection prevention. Qualitative data further confirmed that both providers and patients preferred injections,
believing that they provide quick relief. The doctors’ perceived injection use as their prescribing norm that enabled them to
prove their professional credibility and to remain popular in a competitive health care market. Additionally,
persistent pressure from hospital administration to use up injections before their expiry dates also influenced
doctors to prescribe injections regardless of actual indications.
As far as the patients and providers’ safety is concerned, this study
demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a
context where a high level of injection use and unsafe practices were reported, immediate prevention
initiatives need to be operated through continued intervention efforts and health providers’ training in primary care
hospitals in Bangladesh.