Injection Practices in the Developing World - Results and Recommendations from Field Studies in Uganda and Indonesia - EDM Research Series No. 020: 4. The prevalence of injection use in Uganda and Indonesia: 4.3 Illness-related injection use at the household level

Injection Practices in the Developing World - Results and Recommendations from Field Studies in Uganda and Indonesia - EDM Research Series No. 020
(1996; 157 pages)

Índice de contenido

Executive summary
Acknowledgements
1. Introduction
	1.1 Background to the injection practices research
	1.2 Injection practices research: objectives and approach
	1.3 Development of the injection practices research
	1.4 Contents of this report
2. Towards a rapid assessment methodology for injection practices research
	2.1 General considerations regarding methodology
	2.2 Sampling
	2.3 Use of indicators
	2.4 Use of tracer conditions
	2.5 Studying injection providers' practices
	2.6 Conclusion
3. Background: the social and cultural context of injections
	3.1 The prevalence of injection use: a literature review
	3.2 Injection use: explaining their popularity
	3.3 Injections and medical practice
	3.4 Injections and human relations
	3.5 Conclusion
4. The prevalence of injection use in Uganda and Indonesia
	4.1 Health care context in Uganda and Indonesia
	4.2 Prevalence of injection use at the household level
	4.3 Illness-related injection use at the household level
	4.4 Type of injections
	4.5 Injection use by age and sex
	4.6 Source of injections
	4.7 Injection rates at health facilities
	4.8 The distribution channels of injections
	4.9 Conclusion
5. The popularity of injections in Uganda and Indonesia
	5.1 Explaining the popularity of injections
	5.2 Conclusion
6. The appropriateness of injection use in Uganda and Indonesia
	6.1 Medical appropriateness of injection use
		6.1.1 Injection use in actual tracer conditions
		6.1.2 Preferences for injections in tracer conditions
		6.1.3 Popularity of specific medicines in tracer conditions
	6.2 Hygienic appropriateness of injection use
		6.2.1 Hygienic practices in Uganda
		6.2.2 Hygienic practices in Indonesia
	6.3 Conclusion
7. Conclusions and recommendations
	7.1 Summary of conclusions of the injection practices research
	7.2 Recommendations for interventions
		7.2.1 Discussion of the recommendations for interventions
		7.2.2 Next steps
References
Appendix 1: Indicators for injection use and for assessment of hygienic practices
	Appendix 1.A Specific research questions³⁵
	Appendix 1.B Indicators³⁶
	Appendix 1.C Revised/simplified WHO-Guidelines for evaluating the hygienic aspects of injection administration³⁷
Appendix 2: Methods applied in the injection practices research
	Appendix 2.A Overview and assessment of user-oriented methods
	Appendix 2.B Overview and assessment of provider-oriented methods
Appendix 3: Tools used in the injection practices research
	Appendix 3.A Household survey Uganda
	Appendix 3.B Household survey Indonesia
	Appendix 3.C Questionnaire for providers Indonesia
	Appendix 3.D Treatment form for providers Uganda
	Appendix 3.E Form for patient chart review, Indonesia
	Appendix 3.F Questionnaire for exit interviews at health facilities, Indonesia
	Appendix 3.G Standards for hygienic assessment Uganda

4.3 Illness-related injection use at the household level

The above figures are rough measures for injection prevalence. More meaningful is to assess to which extent illnesses, occurring in the research population, are being treated with injections. In both countries, one or more cases of illness were reported in some 70% of the households over the past two weeks. Injection rates, however, varied from some 40% of households with a report of illness (Uganda) to some 60% in Indonesia.

In Uganda, cases of illness which had occurred in the household in the past two weeks were recorded during the follow-up visit. In Busoga, 239 of 360 households (66%) and in Ankole 252 out of 360 households (70%) reported an illness case. There are no statistical differences in illness rates between the region (p=0.05). In Busoga, out of these 239 households with one or more ill subjects, 93 reported to have used injections (39%). In Ankole the injection rate in households with ill subjects is slightly higher: 43% (108/252), but this difference is not statistically significant (p=0.05).

In Indonesia, more households in Lebak (324 out of 407 households; 80%) reported illness in the past two weeks than in Lombok (287 of 409 households; 70%). The reported illness rates in Lebak are significantly higher than in Lombok (*p=0.01). This can be explained by the fact that households in Lebak have a larger number of members than in Lombok (*p=0.01), thereby increasing the chance of having one or more sick members in the household¹⁹.

¹⁹When the illness rates of the total research population in both regions were compared, no statistical differences could be found. The illness rates in Lebak is 24% of all household members; in Lombok 21% (p=0.05).

Injection rates in the ill population are significantly higher in Lombok than in Lebak. In Lebak, 172 out of 324 households with illness cases reported injection use (53%) and in Lombok 182/287 (63%) (*p=0.01). How can this be explained? More refined analysis of the Indonesian data reveals that when ill, people in Lombok attend health facilities more frequently, and that injection rates in these health facilities are significantly higher than in Lebak.