Injection Use and Practices in Uganda - EDM Research Series No. 014
(1994; 54 pages) Ver el documento en el formato PDF
Índice de contenido
Ver el documentoACKNOWLEDGEMENTS
Abrir esta carpeta y ver su contenido1. INTRODUCTION
Abrir esta carpeta y ver su contenido2. METHODOLOGY
Cerrar esta carpeta3. EXTENT OF INJECTION USE
Ver el documento3.1 Prevalence of injection use
Ver el documento3.2 Prevalence of specific types of injections
Abrir esta carpeta y ver su contenido3.3 Sources of injections
Ver el documento3.4 Prevalence of injections at various medical facilities
Ver el documento3.5 Evaluation of the appropriateness of injection use
Abrir esta carpeta y ver su contenido4. HYGIENE OF INJECTION PRACTICE
Ver el documento5. POPULARITY OF INJECTIONS
Abrir esta carpeta y ver su contenido6. CONCLUSIONS AND RECOMMENDATIONS
Ver el documentoREFERENCES
Abrir esta carpeta y ver su contenidoLIST OF APPENDICES
Ver el documentoOTHER DOCUMENTS IN THE DAP RESEARCH SERIES
 

3.5 Evaluation of the appropriateness of injection use

Our study adopted cough and common cold, diarrhoea of less than five watery stools per day, vomiting, intestinal worms and fever as tracer conditions which were to serve as a basis for the evaluation of the appropriateness of injection use.9 For these tracer conditions we did not consider the age of the person who was (hypothetically) ill with the exception of acute diarrhoea where we specified an illness case in a child under five. The tracer conditions were selected based on guidelines developed by WHO (WHO 1991, 1992) and the Uganda Essential Drugs Management Programme (UEDMP 1991). The WHO (1991, 1992) adopted cough and common cold, and acute diarrhoea of less than five stools a day in children under five years of age as tracer conditions that generally do not medically justify the use of injections, to be used in the countries participating in the study. Country specific guidelines drawn up by the UEDMP stipulate that injections should be used only when it is absolutely necessary. They should be used when life is threatened as in the case of a child with severe malaria, pneumonia, or meningitis; they should not be used to treat cough and common cold. The UEDMP also suggests that injectables should be avoided especially whenever there is a possibility for oral therapy.

9 These tracers conditions were selected because they are: common health problems in Uganda for which injections appear to be used often, while they are generally not medically justified; conditions that can be described accurately in local illness terms, and conditions that have a well defined treatment norm.

The tracer conditions were used twice in the household surveys: during the initial interview the respondents in the household surveys were presented with hypothetical cases and during the follow-up interview, respondents were questioned about actual illness episodes which had occurred during the confined two week recall period. These illness episodes were then classified according to the identified tracer conditions.

For the hypothetical cases, respondents were asked what form of medication they would use if any of the tracer conditions occurred in their households. Findings on the hypothetical cases are shown in Table 10. The findings reveal that, although these mild conditions do not medically justify the use of injections, a significant proportion of the respondents indicated that they would use injections and/or a combination of injection and oral therapy. In Busoga 38.3% of the respondents saw injections (either alone or combination with oral medication) as suitable treatment for cough and common cold. For the other tracer conditions injections were preferred by 52.2% for fever, by 28.6% for vomiting, by 30.6% for acute diarrhoea, and by 13.5% for intestinal worms. Likewise, in Ankole, 17.5% indicated preference for injection only or a combination of oral and injections as preferred treatment for cough and common cold, 78.1% for fever, 24.4% for vomiting, 16.7% for acute diarrhoea, and 5.3% for intestinal worms. Comparing the results for both regions, fever (defined as perceived rise in body temperature) was the condition for which injections were most commonly mentioned and they were least mentioned for intestinal worms.

Table 10: Percentage of preference for injections (either alone or in combination with oral therapy) in hypothetical tracer conditions, household survey in Busoga and Ankole Regions

 

Busoga
(Eastern Uganda) n=360

Ankole
(Western Uganda) n=360

Fever

52.2%
(188)

78.1
(281)

Cough and common cold

38.3%
(138)

17.5%
(63)

Acute diarrhoea

30.6%
(110)

16.7%
(60)

Vomiting

28.6
(103)

24.4%
(88)

Intestinal worms

13.3%
(48)

5.3%
(19)

During the follow-up visit cases of illness which had occurred in the household in the past two weeks were recorded. In Ankole, 252 (70.0%) households reported 397 illness episodes. In Busoga, 239 (66.6%) households reported a total of 358 illness episodes. It was discovered that in this two week confined period 103 (28.7%) illness cases in Busoga and 107 (27%) illness cases in Ankole had been treated with injections, in most cases in combination with oral therapy.10

10 The rate of injections here is different from the injection prevalence calculated in Table 3. While in Table 3 the households are the denominator, here reported illness cases are taken as the denominator. In several households more than one illness case treated with injections was reported during the two week recall period.

Symptoms often appear in combination and illness episodes are seldom discrete, making the tracer condition method difficult to apply for the evaluation of the appropriateness of actual treatment provided. For instance, only 99 of the 358 illness episodes in Busoga (27.6%) presented with a single tracer condition, 57 presented with other symptoms (15.9%), and 202 (56.4%) had a combination of conditions (tracer and others).

Data for both regions show that fever was the commonest condition diagnosed and that, whenever fever was present (in combination with other conditions), it was most often treated with injections (see Tables 11 and 12).

Table 11: Percentage of injection use (either alone or in combination with oral therapy) in episodes of illness in which tracer conditions were present in the confined two week recall period in Busoga Region

 

Illness episodes (n=358)

Percentage

Fever only

(12/39)

30.8%

Cough & common cold only

(0/46)

-

Acute diarrhoea only

(0/8)

-

Vomiting only

(0/3)

-

Intestinal worms only

(1/3)

33.3%

Combination of cough & fever

(7/28)

25.0%

Combination of diarrhoea & fever

(7/12)

58.3%

Combination of vomiting & fever

(10/13)

76.9%

Combination of diarrhoea & vomiting

(5/12)

41.7%

Other combinations and other symptoms

(61/194)

31.4%

Table 12: Percentage of injection use (either alone or in combination with oral therapy) in episodes of illness in which tracer conditions were present in the confined two week recall period in Ankole Region

 

Illness episodes (n=397)

Percentage

Fever only

(58/137)

42.3%

Cough & common cold only

(5/89)

5.6%

Acute diarrhoea only

(0/5)

-

Vomiting only

(2/6)

33.3%

Intestinal worms only

(2/15)

13.3%

Combination of cough & fever

(11/38)

28.9%

Combination of diarrhoea & fever

(2/6)

33.3%

Combination of vomiting & fever

(7/12)

58.3%

Combination of diarrhoea & vomiting

(2/3)

66.7%

Other combinations and other symptoms

(18/86)

20.9%

 

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