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: 4.4 Type of injections

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

4.4 Type of injections

The vast majority of all injections given in the households in both countries were therapeutic injections, as calculated with Indicator Ib:

The following categories of types of injections were identified:

• therapeutic injections
• infusions (large volumes)
• contraceptives
• immunizations

In Uganda, no infusions, contraceptive injections or immunizations were recorded to have been received in the households, the vast majority being therapeutic injections (Figure 6). Of the households in Busoga where one or more injections were received in the confined two week period, in 94% of the cases (87/93) the injections were of a therapeutic nature. In Ankole, data is only available for the first visit: 85% of these households (96/113) had received a therapeutic injection. In Ankole more immunizations (17/113; 15%) were reported than in Busoga (6/93; 6%) (p=0.05).

In Indonesia, data is available for all injections received in the households visited (Figure 7). In Lebak, 172 households reported 234 injections in the past two weeks. In Lombok, in 182 households a total of 240²⁰ injections were recorded. Over 90% of these injections were of a therapeutic nature, followed by some 3 to 4% of immunizations. Some infusions and contraceptive injections were also reported. There are no differences between the districts.

²⁰One patient was given two different types of injections. Therefore the number of patients injected in Lombok is 239, while the number of injections amounts to 240.

In Thailand, therapeutic injections also formed the majority of injections reported in the households (WHO/DAP/94.8:41). Interestingly, intravenous infusions were quite popular in the Thai village: in 12 of 63 households infusions (19%) were received. Many of the people who received IV fluid also received injections, either separately or together with the IV fluid.

Figure 6. Type of injections (Percentage of injections received by type - Household study - Uganda) - Busoga

Figure 6. Type of injections (Percentage of injections received by type - Household study - Uganda) - Ankole

N = all households which received injections in past two weeks
Busoga n=93; Ankole n=113

Figure 7. Type of injections (Percentage of injections received by type - Household study - Indonesia) - Lebak

Figure 7. Type of injections (Percentage of injections received by type - Household study - Indonesia) - Lombok

N = all households which received injections in past two weeks
Lebak n=234; Lombok n=240