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: 4.2 Prevalence of 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)

Table des matières

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

4.2 Prevalence of injection use at the household level

The results of the study reveal high rates of injection use during a two week recall period as calculated with Indicator Ia:

Uganda

In Uganda, injection prevalence was recorded twice. During the first visit the household respondents were asked who in the household had last received an injection and when. If this was within the past two weeks, the data was used to analyze the prevalence rate. The second follow-up visit was planned two weeks after the first. Respondents were asked if any member of the household had received an injection in this confined two weeks recall period. The rates of injection use prevalence for both recordings differ considerably; especially in Busoga. The confined two week recall period indicates lower and presumably more valid rates.

During the initial visit, 43% of households (154/360) in Busoga and 31% of households (113/360) in Ankole indicated to have received an injection during the past two weeks. In the confined two weeks recall period, 25% of households in Busoga and 30% of households in Ankole received an injection (Figure 2). For the initial visit, injection rates are significantly higher in Busoga (**p=0.001), but for the follow-up visit the differences are not significant (p=0.05).

Indonesia

In Indonesia, prevalence rates of injections were very high¹⁸. In Lebak 42% (172/407) and in Lombok 45% of the households (182/409) reported having had at least one household member injected in the past two weeks (Figure 3). Differences between Lebak and Lombok are not statistically significant (p=0.05).

¹⁸Unlike in Uganda, no follow-up visit was conducted in Indonesia. Hence, data on injection prevalence in a confined two week period are not available.

In the Indonesian household survey, detailed information was also collected on the total research population (i.e. all members belonging to the households in the study). In Lebak, a total of 234 injections were recorded in a total research population of 2330 subjects (10%); in Lombok, 239 injections were recorded in 2061 subjects (12%). This implies that in both study populations in Indonesia one in ten inhabitants received an injection in the past fortnight.

A survey of all 209 households in a rural village in Thailand revealed that in 55 households one or more members of the household had received at least one injection (or infusion) during a two week recall period; this amounts to 26% of all households (WHO/DAP/94.8: 40).

Urban-rural differences

The studies also aimed to assess differences between urban and rural settings in injection use. In Busoga, Uganda, injection use prevalence is significantly higher in the semi-rural and urban areas as compared to remote areas (*p=0.01). In Ankole, differences are not significant (p=0.05). Injection rates per area are presented in Figure 4.

In Indonesia, in both districts the differences between the urban, suburban and rural settings are not statistically significant (p=0.05) (Figure 5).

Figure 2. Injection use in households (Household survey - Uganda)

N = all households
Busoga n=360; Ankola n=360

Figure 3. Injection use in households (Household survey - Indonesia)

N = all households
Lebak n=407; Lombok n=409

Figure 4. Injection use and urban-rural differences (Household survey - Uganda)

N = all households
Urban: Busoga n=120; Ankole n=120. Semi rural: Busoga n=120; Ankole n=120
Remote: Busoga n=120; Ankole n=120

Figure 5. Injection use and urban-rural differences (Household survey - Indonesia)

N = all households
Urban: Lebak n=133; Lombok n=149. Suburban: Lebak n=136; Lombak n=125
Rural: Lebak n=135; Lombok n=135