Unsafe Injection, Bane Of Health Care Systems

Each year, at least 16 billion injections are administered in developing and transitional countries, says the World Health Organisation.

 Injection is one of the most common health care procedures and the vast majority, around 95 per cent is given in curative care.

According to WHO definition, injections are a skin puncturing procedure performed with a syringe and needle to introduce a substance for prophylactic, curative, or recreational purposes.

Injections can be given intravenously, intramuscularly, intradermally, or subcutaneously. Injections are among the most frequently used medical procedures, with an estimated 20 billion injections administered each year world-wide.

A large majority (more than 90 per cent) of these injections are administered for curative purposes (for every vaccination injection, 20 curative injections are administered. Immunization accounts for around 3 per cent of all injections, with the remainder for other indications, including use of injections for transfusion of blood and blood products and contraceptives.

  However, the health body observed that in certain regions of the world, use of injections has completely overtaken the real need, reaching proportions no longer based on rational medical practice. In some situations, as many as nine out of 10 patients presenting in a primary healthcare provider receive an injection, over 70% of which are unnecessary or could be given in an oral formulation.

  According to findings by the WHO, patients tend to prefer injections because they believe them to be stronger and faster medications. They also believe that doctors regard injections to be the best treatment. In turn, doctors over-prescribe injections because they believe that this best satisfies patients, even though patients are often open to alternatives. In addition, prescription of an injection sometimes allows the charging of a higher fee for service.

During her tenure as Director- General of the National Agency for Food and Drug Administration and Control (NAFDAC), Prof Dora Akunyili was in the vanguard of campaign against over- reliance on injections.

Apart from the dangers involved in unsafe injection, she held that drugs or medications also serve the same purpose if not more efficient.

At the flag off of the National Sensitisation Campaign on Injection Safety last year, the Director General, NAFDAC, Dr Paul Orhii, said that some of the 20 billion injections given annually worldwide are unnecessary and unsafe.

 He averred that unsafe injections pose a threat to the patient, health workers and the community.

His words; “It exposes patients to pathogens either directly via contaminated equipment or indirectly via contaminated medication vials. Poor injection safety practices arise when unsterilized needles are used, dirty needles are mishandled and from inadequate sharp disposal practice”

  However, Orhii said that the risk posed  by patient to patient transmission of infection due to reuse of syringes or by patient to health worker transmission due to needle stick pricks can be brought to the barest minimum if all elements of injection safety are in force.

   He described a safe injection as one that does not harm the recipient, does not expose the provider to any avoidable risks and does not result in waste that is dangerous to the community.

The General Manager, First Medical and Sterile Products, Dr Isaac Nnamdi, said there was need to activate the urgency in joining the fight with the rest of the world against unhealthy use of injection as there are so many recorded deaths in the country through injection use which could have been avoided.

 Similarly, the Health Minister, Prof Onyebuchi Chukwu, maintained that because of the increasing dangers posed by unwholesome use of injection, there was need for awareness.

He said though injections are useful, they are unnecessary, saying, “A lot more needs to be done because the problems are monumental”

To prevent injection overuse in the curative sector, WHO urged countries’ national drug policies to promote the rational use of therapeutic injections. This may include removing unnecessary injectable medicines from the national essential medicines list.

 Similarly, the minister of Health has directed all federal government-owned health institutions to phase out conventional syringes by October 1st this year.

He issued this deadline at the signing of a memorandum of understanding (MoU) between the federal government and the Rivers State Government for bulk purchase of auto-disable syringes.

Chukwu said the migration from conventional to auto-disable syringes was in line with the National Health Policy, adding that this was affirmed by the highest decision making body on health in this country, the National Council on Health (NCH).

He said: ‘’ It is important for us to move away from conventional syringes to auto-disable syringes as a strategy to reduce transmission of infections particularly infections such as Hepatitis B, HIV and so many diseases that are blood borne.”

Prof. Chukwu urged all State Governments to begin to implement the decision of the National Council on Health regarding this issue, explaining that the National Council on Health is a forum where federal and state governments sit down and take decisions on matters that border on healthcare delivery in the country.

He also called on the private sector to buy into this decision to conform with international best practices and also enjoined other manufacturing companies to move from manufacturing conventional syringes to auto-disable syringes.

A safe injection does no harm. However, when safety control practices are not respected, severe infections can result, putting human lives at risk.

Reuse of syringes and needles in the absence of sterilization exposes millions of people to infections. Assessments carried out in numerous countries have revealed that syringes and needles are often just rinsed in a pot of tepid water between injections.

Worldwide, up to 40% of injections are given with syringes and needles reused without sterilization and in some countries this proportion is as high as 70%.

 The WHO puts other unsafe practices, such as poor collection and disposal of dirty injection equipment, expose healthcare workers and the community to the risk of needle stick injuries. In some countries unsafe disposal can lead to re-sale of used equipment on the black market. The proportion of non industrialized countries still reporting that they use open burning of syringes (considered unacceptable by WHO) was 50% in 2004.

According to the WHO, the most recent study indicates that each year, unsafe injections cause an estimated 1.3 million early deaths, a loss of 26 million years of life, and an annual burden of USD 535 million in direct medical costs.

Unsafe injection practices are a powerful engine to transmit blood-borne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Because infection with these viruses initially presents no symptoms, it is a silent epidemic. However, the consequences of this are increasingly recognized.

Hepatitis B virus: HBV is highly infectious and causes the highest number of infections: in developing and transitional countries 21.7 million people become infected each year, representing 33% of new HBV infections worldwide

Hepatitis C virus: Unsafe injections are the most common cause of HCV infection in developing and transitional countries, causing two million new infections each year and accounting for 42% of cases.

Human immunodeficiency virus: Globally, nearly 2% of all new HIV infections are caused by unsafe injections. In South Asia up to 9% of new cases may be caused in this way. Such proportions can no longer be ignored.

HBV, HCV, and HIV cause chronic infections that  lead to disease, disability and death, a number of years after the unsafe injection. Those infected with hepatitis B virus in childhood will typically present with chronic liver disease by the age of 30 years, at the prime of their life. This has a dramatic effect on national economies.
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