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
 

6.1.3 Popularity of specific medicines in tracer conditions

One limitation of the use of data from household questionnaires and exit interviews is that respondents are often unable to specify which medicines they were provided with. To evaluate medical appropriateness this data is indispensable. Therefore, it was suggested that a review of medical charts also be included in research, as was done in Indonesia. This resulted in the following indicators:

(IIc) If prescription patterns of providers are monitored, then the percentage of injection prescription in the specified tracer conditions can also be calculated.

(IId) Frequency distribution of types of injections given per tracer condition. The injections can be categorized both by generic and by brand name.

Uganda

During the prescription analysis in the health facilities in the two regions of Uganda, a high prevalence of a few specific injectables was noted. In both regions, over 95% of all injections prescribed were Chloroquine, Penicillin Procaine Fortified (PPF) and Crystalline Penicillin. Fever is invariably treated as malaria. In Ankole, out of 132 bouts of fever reported in the household questionnaire as having been given injections in the past two weeks, 127 (96%) had received a chloroquine injection. In Busoga, providers often prescribe more than one drug in injectable form for patients who present with fever and cough. The combination given is invariably PPF and chloroquine. Some studies undertaken in Uganda in the recent years already pointed to the immense popularity and widespread use of certain drugs like Penicillin Procaine Fortified (PPF) and chloroquine. Kinuka et al.(1985) found that, in an out-patient facility on the outskirts of Kampala, sixty-five percent of all children received penicillin injections and fifty percent were given chloroquine injections. Christensen and Anokbongo (1990) report that forty percent of the patients at rural health units receive injections, almost exclusively of PPF and chloroquine.

The popularity of this combination is basically the result of poor diagnostic capacity: fever is treated as malaria and cough as a bacterial infection without laboratory confirmation. This is corroborated by the finding in Busoga that combined injection prescription constituted 20% of all injection prescriptions written in both remote and semi-rural communities, whereas the proportion was only 11% in the urban areas. The lower prevalence of combined injection prescriptions in the urban communities may be explained by the use of laboratory tests to confirm the diagnosis of malaria. In the remote and semi-rural areas these services are absent.

One disturbing finding of the Ugandan study concerns observed practices of drug reconstitution. In some health facilities, chloroquine (in solution) is used to reconstitute PPF or crystalline penicillin which is presented in powder. Some patients even request this cocktail and indicate to the providers that their fever can only be cured by this kind of mixture. The net effect of forming a hypertonic solution may predispose to injection abscesses.

Indonesia

Several types of data were collected in relation to the patients interviewed in health facilities. Many patient records were reviewed29 and the diagnosis/patient complaints plus the prescribed treatment were noted on the questionnaire (Appendix 3.E). In this way, not only injection rates in tracer conditions (Indicator IIc) could be calculated, but also the type of treatment (Indicator IId), thus providing interesting information on the popularity of certain injectables. Permission for the review of patient records could only be obtained in government health facilities.

29The exact number of patient records reviewed could not be established.

The review of patient records confirms the finding that the vast majority of tracer conditions presented in government health facilities is being treated with injectable therapy. Injection rates are higher in Lombok (with an average of 87% of all tracer conditions injected) than Lebak (average injection rate 61%) (**p=0.001). Which medicines are used in the treatment of these conditions? Table 8 clearly demonstrates the extent of unessential use of certain essential medicines for the treatment of self-limiting conditions30. Antibiotics such as penicillin, streptomycin and oxytetracycline are generally not indicated in any of these conditions - with the exception of fast breathing in young children in combination with fever (pneumonia). Vitamins are generally not indicated in any of these cases; and the use of injectable analgesics and antihistaminics should also be regarded as irrational use from the biomedical point of view. The popularity of oxytetracycline for the treatment of all tracer conditions is remarkable. It is the most commonly used antibiotic in Lebak, and is second only to penicillin in Lombok. It has been known for some years that antibiotics, and especially tetracyclines, are exceptionally popular in Indonesia (see MSH Report "Where does the tetracycline go" 1988). Unfortunately, it seems that the situation has changed little since this alarming report was first published.

30Our findings are in agreement with the observation of Sciortino (1993) that the nurses in Javanese puskesmas generally choose from five medicaments (Terramycin, Tetracyclin, Penicillin Procaine, Trisulfa and Xilodella) and Vitamin B-complex injections.

Table 8: Frequently used injectables in tracer conditions - Patient records (Indonesia)

 

Indonesia
Lebak

Indonesia
Lombok

Fever

Oxytetracycline
Vitamin B12

Penicillin

Cough & common cold

Naproxen (Antalgin)
Vitamin K
Oxytetracycline
Vitamin B1, B2, B12

Penicillin
Vitamin B1
Oxytetracycline
Dipenhydramine
Streptomycin
Calcium
Antalgin

Diarrhoea

Oxytetracycline
Penicillin
Papaverine

Oxytetracycline
Penicillin
Dipenhydramine
Papaverine
Vitamin B1

Skin diseases

Diphenhydramine
Oxytetracycline

Penicillin
Diphenhydramine
Papaverine
Antalgin
Vitamin B1, B12

vers la section précédente
vers la section suivante
 
 
Le Portail d'information - Médicaments essentiels et produits de santé a été conçu et est maintenu par l'ONG Human Info. Dernière mise à jour: le 1 décembre 2019