Injection Practices in the Developing World - Results and Recommendations from Field Studies in Uganda and Indonesia - EDM Research Series No. 020
(1996; 157 pages) Voir le document au format PDF
Table des matières
Afficher le documentExecutive summary
Afficher le documentAcknowledgements
Ouvrir ce répertoire et afficher son contenu1. Introduction
Ouvrir ce répertoire et afficher son contenu2. Towards a rapid assessment methodology for injection practices research
Ouvrir ce répertoire et afficher son contenu3. Background: the social and cultural context of injections
Ouvrir ce répertoire et afficher son contenu4. The prevalence of injection use in Uganda and Indonesia
Ouvrir ce répertoire et afficher son contenu5. The popularity of injections in Uganda and Indonesia
Fermer ce répertoire6. The appropriateness of injection use in Uganda and Indonesia
Fermer ce répertoire6.1 Medical appropriateness of injection use
Afficher le document6.1.1 Injection use in actual tracer conditions
Afficher le document6.1.2 Preferences for injections in tracer conditions
Afficher le document6.1.3 Popularity of specific medicines in tracer conditions
Ouvrir ce répertoire et afficher son contenu6.2 Hygienic appropriateness of injection use
Afficher le document6.3 Conclusion
Ouvrir ce répertoire et afficher son contenu7. Conclusions and recommendations
Afficher le documentReferences
Ouvrir ce répertoire et afficher son contenuAppendix 1: Indicators for injection use and for assessment of hygienic practices
Ouvrir ce répertoire et afficher son contenuAppendix 2: Methods applied in the injection practices research
Ouvrir ce répertoire et afficher son contenuAppendix 3: Tools used in the injection practices research
 

6.1.1 Injection use in actual tracer conditions

Indicator IIa aimed at establishing the percentage of injection use in actual illness cases recorded in the households. This was expressed as:

In Uganda, the respondents were questioned on actual illness episodes which had occurred during the confined two week recall period. In Busoga 358 and in Ankole 397 illness episodes were recorded. During the analysis these illness episodes were then classified according to the identified tracer conditions (see also Chapter 2.4). In the majority of cases in Busoga, symptoms appeared in combination. Only 99 of these 358 households in Busoga (28%) presented with single tracer conditions, in the majority of illness episodes combinations of symptoms were recorded (Table 5). In Ankole, however, the majority of illness episodes (252/397) presented with single tracer conditions (63%).

Table 5: Injection use in tracer conditions - Household survey - Uganda27

 

Uganda Busoga

Uganda Ankole

 

Injections/illness episodes

Percentage of injection use

Injections/illness episodes

Percentage of injection use

Fever only

12/39

31%

58/137

42%

Cough & common cold only

0/46

0%

5/89

6%

Acute diarrhoea only

0/8

0%

0/5

0%

Vomiting only

0/3

0%

2/6

33%

Intestinal worms only

1/3

33%

2/15

13%

Combination of cough & fever

7/28

25%

11/38

29%

Combination of diarrhoea & fever

7/12

58%

2/6

33%

Combination of vomiting & fever

10/13

77%

7/12

58%

Combination of diarrhoea & vomiting

5/12

42%

2/3

67%

Other combinations and other symptoms

61/194

31%

18/86

21%

Total

103/358

29%

107/397

27%

27N=all illness episodes in households in past two weeks, in which tracer conditions were reported. Injection use: either alone or in combination with oral therapy.

Data for both regions show that fever was the most common condition diagnosed and that, whenever fever was present, it was most often treated with injections. Injection rates for fever, alone or in combination with other symptoms, range from 25 to 77%. The data further show that when cough & common cold or diarrhoea occur without fever, the condition is usually not treated with injections. When cough, diarrhoea or vomiting is accompanied by fever, the injection rates increase.

In Indonesia, actual illness episodes were recorded both in the household questionnaires (Table 6 and Figure 14) and in the exit interviews at health facilities (Table 7 and Figure 15). When one or more of the identified tracer conditions were present, this was recorded28. In most tracer conditions, injections are given in more than half of the cases. Comparing the two regions, the results again indicate that the overuse of injections is especially prevalent in Lombok. In Lombok, 55% of all cases with tracer conditions were treated with injections. In Lebak this rate was 41% (**p=0.001). The findings suggest that there is a gross overuse of injections in common, self-limiting conditions in Indonesia. The high injection rates in the treatment of skin diseases, already reported in the MSH study (1988), are confirmed in our study.

28This implies that when a combination of two tracer conditions occurred, it was counted twice. In Lebak, 553 sick individuals reported 617 tracer conditions; in Lombok, in 441 patients 518 tracer conditions were present. As a consequence, in Table 6 the total number of injections in illness episodes with tracer condition exceeds the actual number of injections received in the households.

Table 6: Injection use in tracer conditions - Household survey - Indonesia

 

Indonesia Lebak

Indonesia Lombok

 

Injections/illness episodes

Percentage of injection use

Injections/illness episodes

Percentage of injection use

Fever

84/210

40%

132/235

56%

Cough & common cold

82/245

34%

102/188

54%

Diarrhoea

42/84

50%

30/57

53%

Skin diseases

44/78

56%

23/38

61%

Total

252/617

41%

287/518

55%

In the interviews of patients visiting a health facility, the presence of tracer conditions was also recorded. The data confirm that injection overuse in Indonesia is very much a problem of the public sector. In Lombok, injection rates in the tracer conditions are again consistently higher than in Lebak (**p=0.001).

Table 7: Injection use in tracer conditions - Exit interviews - Indonesia

 

Indonesia Lebak

Indonesia Lombok

 

Injections/illness episodes

Percentage of injection use

Injections/illness episodes

Percentage of injection use

Fever

49/85

58%

112/124

90%

Cough & common cold

48/77

62%

100/120

83%

Diarrhoea

37/54

69%

49/60

82%

Skin diseases

32/42

76%

25/31

81%

Total

166/258

64%

286/335

85%

A comparison of the data gathered in the household questionnaire and the exit interviews at health facilities indicates that anyone presenting one or more tracer conditions at a health centre in Indonesia will have a high chance of being injected, even though, in the majority of cases, there is no medical justification for such a mode of treatment.


Figure 14. Injection use in tracer conditions (Household survey - Indonesia)

N = all illness episodes with tracer conditions in households in past two weeks
Lebak n=617; Lombok n=518
one patient may report more than one tracer condition

* The figure is based on the data for Table 6. It has been included to facilitate comparison with Figure 15.


Figure 15. Injection use in tracer conditions (Patient survey - Indonesia)

N = all illness episodes with tracer condition recorded in health facilities
Lebak n=258; Lombok n=335
one patient may report more than one tracer condition

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