Injection is an important healthcare procedure for the administration of certain medicines. Billions of injections are used in healthcare for the prevention, diagnosis, and treatment of various illnesses. Through vaccination, we start receiving injections from the very first day, and may continue to do so till the last day of our lives. Right injections have saved many lives. But most of the 16,000 million injections administered in developing countries are unnecessary and unsafe. Studies have shown that the degree of unsafe use of injections is highest (75 percent) in South Asia which includes Nepal.
Though injections save lives, their unsafe use may result in the transmission of various blood borne diseases and subsequent complications. WHO estimates that in 2008 global burden of diseases due to unsafe injection practices was 340,000 HIV cases, 15,000,000 Hepatitis-B virus infections, 1,000,000 Hepatitis-C viral infections, 3,000,000 bacterial infections and 850,000 injection site infections. Furthermore, viral infections thus transmitted do not produce symptoms immediately. They remain silent (asymptomatic) for many years, due to which the threat of unsafe injection use is overlooked. But in reality, this practice is a menace to public health in developing countries.[break]
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Studies have shown that in developing countries, injections are popular and are regarded as a strong and efficient technology to cure diseases. The pain associated with injections is taken as a sign of efficacy. However, in most cases oral alternatives are not only safer but also more efficient and cost effective. According to WHO, these misconceptions induce the recipient to demand unnecessary injections, which is one of the most important reasons behind unnecessary injections in South Asia. As the need for injections is better assessed by a qualified personal, patients should not pressurize them.
If injection is essential, the recipient should receive it from well-trained and qualified health workers who follow proper procedures. In Nepal, there is no policy/law which governs the administration of injections or determines required qualifications of an injection provider. Studies claim that a significant number of people visit medical dispensaries without a prescription for their illness. People depend on such dispensaries for many injectable medicines like contraceptives, tetanus toxoid vaccine, single shot pain killer, etc. But are the personnel working in dispensaries qualified to administer injections? Injections provide monitory benefits to injection provider, due to which untrained people like traditional healers, unqualified paramedical persons (including staff of medical dispensaries) and quacks often administer them. But as per Nepal Drug Act 1978, pharmacists, assistant pharmacists, or vyabasai (professionals) can only do pharmacy practice in the medical dispensaries.
SIGN (safe injection global network), a global alliance under WHO, defines safe injection as one that does not harm the recipient, does not expose the provider to any avoidable risk, and does not result in waste that is hazardous to community. As responsible stakeholders, we must be aware of the practice of safe injection.
From a consumer’s point of view, safe injection can be assured if s/he receives the medications from qualified health workers with a new, sterile disposable injecting device (syringe, needle, cannula, etc).
The government for its part should ensure that the disposable (single use) injection devices available in Nepal are sterile and of required standards. Unfortunately, there is no legally authorized body or policy related to production, quality control and import of injection equipment in Nepal. Besides, a few studies indicate the commercialization of used disposable injectable equipment. The Department of Drug Administration, the only regulatory body in the country that monitors the quality of medicines in Nepali market, is not authorized to regulate/monitor the quality of injection devices. This provides sufficient ground to suspect the quality of available injection devices. Government interventions (proper policy and competent regulatory body to monitor the quality of injection devices) are urgently required to assure the quality of these devices. In addition, relevant laws, rules, guidelines and qualifications for persons who provide injections are urgently needed.
There are a number of grey areas in the administration of injections in Nepal, which should be addressed immediately to make the practice safer. Greater health awareness is must to achieve the desired objective. For their safety, people should receive injections from qualified health workers, ask the prescriber whether the injection is mandatory (or if there is alternative oral medicine) and ensure that the injection equipment is taken from a new sealed packet.
The author is PhD fellowship Scholar of University Grant Commission (UGC) Nepal