Injection Practices in the Developing World - Results and Recommendations from Field Studies in Uganda and Indonesia - EDM Research Series No. 020: 5. The popularity of injections in Uganda and Indonesia: 5.2 Conclusion

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

5.2 Conclusion

When ill, Ugandans usually self-medicate with oral therapy first. When this brings no relief, or when a fast cure is desired, patients tend to solicit injections from providers. This preference for injections is guided by local ideas and beliefs of illness and concepts of efficacy of various treatment options. Injections are believed to go directly into the blood stream, unlike oral medications which have to pass the digestive system. Therefore, for diseases that are transmitted through the blood system such as malaria, the administration of injections is preferred. How strongly Ugandans are oriented towards injection use, is demonstrated by the fact that a majority of the households visited in Uganda kept a syringe and needle for injection at home and carry this equipment when visiting a provider, even on index visit (see Chapter 6.2.1). This set of preferences of the general population is strengthened by the profit motive, particularly among private providers. Injections bring in more money, but providers often justify their choice for injectables as a way to limit patient non-compliance in oral therapy.

Popular demand for injections is also enormous in Indonesia, although they are not a first resort. In the household survey it was found that most injections were given on request of the patients or their families (62% of all injected patients in Lebak and 52% in Lombok). Apart from injections, most patients were given oral medication as well. Furthermore, in the exit interviews at health facilities it was shown that the majority of injections had been given on request in Lebak, while the reverse was true for Lombok. The majority of users, when asked why this request for injections had been made, stated that injections were preferred because of their "fast action". The second most stated reason was that it was "customary" to receive injections, followed by reasons such as "injections are more appropriate"; "they are cheaper" and "more effective" and "I forget to take medicine". Not all injections are given on request - they are also part of a routine treatment procedure in health facilities over which customers have little say. In fact, in focus group discussions, mothers explained that it is usually the nurses who decide whether the children are injected or not. When the providers are asked why they give injections, they usually claim that this is because of patient demand. This vicious circle (health workers give injections because they think patients expect them; patients want injections because health workers give them) and the lack of communication between both parties, also demonstrated in this research, keeps the practice of routine administration of injections going.