Injection practice in Kaski district, Western Nepal: a community perspective.
BACKGROUND
Previous studies have shown that unsafe injection practice is a major public health problem in Nepal but did not quantify the problem. The present community-based study was planned to: 1) quantify injection usage, 2) identify injection providers, 3) explore differences, if any, in injection usage and injection providers, and 4) study and compare people's knowledge and perception about injections between the urban and rural areas of Kaski district.


METHODS
A descriptive, cross-sectional mixed-methods study was conducted from July to November 2012, using a questionnaire based survey and focus group discussions (FGDs). A semi-structured questionnaire advocated by the World Health Organization was modified and administered to household heads and injection receivers in selected households and the FGDs were conducted using a topic guide. The district was divided into urban and rural areas and 300 households from each area were selected. Twenty FGDs were held.


RESULTS
In 218 households (36.33%) [99 in urban and 119 in rural] one or more members received at least one injection. During the three month recall period, 258 subjects (10.44%) reported receiving injection(s) with a median of two injections. The average number of injections per person per year was calculated to be 2.37. Health care workers (34.8%), staff of medical dispensaries (37.7%), physicians (25.2%), and traditional healers (2.3%) were consulted by the respondents for their basic health care needs and for injections. Compared to urban respondents, more rural respondents preferred injections for fever (p < 0.001). People preferred injections due to injections being perceived by them as being powerful, fast-acting, and longer lasting than oral pills. More than 82% of respondents were aware of, and named, at least one disease transmitted by using unsterile syringes during injection administration or when syringes are shared between people.


CONCLUSIONS
Less preference for injections and high awareness about the association between injections and injection-borne infections among the general population is encouraging for safe injection practice. However, respondents were not aware of the importance of having qualified injection providers for safe injections and were receiving injections from unqualified personnel.
Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal. sudeshgy@hotmail.com.
Sudesh
S
Gyawali
Department of Pharmacy, L.R. Institute of Pharmacy, Jabli-kyar, Solan, India. rathoredsp66@gmail.com.
Devendra Singh
DS
Rathore
Department of Pharmacology, Xavier University School of Medicine, Oranjestad, Aruba, Kingdom of the Netherlands. ravi.dr.shankar@gmail.com.
Pathiyil Ravi
PR
Shankar
Department of Statistics, PN Multiple Campus, Pokhara, Nepal. vkkc2001@gmail.com.
Vikash K C
VK
Kumar
Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal. manzasharma@gmail.com.
Manisha
M
Maskey
Department of Clinical Pharmacology & Therapeutics, KIST Medical College, Imadol, Nepal. nishajha32@gmail.com.
Nisha
N
Jha
D000328:Adult; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007267:Injections / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016602:Needlestick Injuries / Q000453:epidemiology / Q000517:prevention & control*; D009390:Nepal; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D017751:Safety Management / Q000379:methods*; D011795:Surveys and Questionnaires; D013594:Syringes / Q000009:adverse effects / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data