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SIGN Pakistan

SIGN Pakistan. Dr. Arshad Altaf . Objectives of the Presentation. Overview of burden of disease in Pakistan because of unsafe injection practices Present activities of SIGN Pakistan Future plan . Burden of diseases in Pakistan. Studies in Pakistan have found hepatitis C :

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SIGN Pakistan

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  1. SIGN Pakistan Dr. Arshad Altaf

  2. Objectives of the Presentation • Overview of burden of disease in Pakistan because of unsafe injection practices • Present activities of SIGN Pakistan • Future plan

  3. Burden of diseases in Pakistan • Studies in Pakistan have found hepatitis C : • 60% hepatitis among liver cancer patients (Ahmed et al., 1995) • 51% among beta thalassemia major patients (Ahmed et al., 1995) • 46% among chronic liver disease patients (Mujeeb et al., 1998) • 18% among cirrhotic patients (Mujeeb et al., 1998) • 20% among commercial blood donors (Mujeeb et al., 1998)

  4. Unsafe Injection Practices • 1993: Luby et. al. • 6.5% antibodies positive for hepatitis C in Hafizabad, Pakistan • 1994: Luby et al. • Follow up case control study to identify risk factors • Positive individuals were 8.2 times more likely to receive > 5 injections per year

  5. Unsafe Injections Practices • 1995: Aamir Javed Khan et al., • Investigated relationship between hep B & C and injections in peri urban Karachi • 44% hepatitis C positive • those who received more injections were more likely to be hepatitis C infected • 94% of the needles/syringes were reused

  6. Unsafe Injections Practices • 1995: Reaglow et al., KAP study • 49% received one or more injections at their last visit to health practitioner • 35% received 10 or more injections in the last year • 64% felt that injections are more powerful

  7. Creation of SIGN Pakistan FIRST NATIONAL SYMPOSIUM • First national symposium on Safe Injection and Blood Practices in Pakistan on Feb 15, 2000 • Objectives: • Provide a forum to discuss ideas • Identify persons and process to develop assessment protocol • Collect input for intervention from those who have conducted studies • Foster formation of Safe Injection working group

  8. Formation of SIGN Pakistan • SIGN Pakistan Working Group formed • Maillist created (signpak@maillists.com) • First national meeting “Partners in Injection Safety” on June 17, 2000 • Objectives: • Formal announcement of SIGN Pakistan • To identify national stakeholders

  9. SIGNPAK Working Group • The Aga Khan University • Sindh AIDS Control Programme, Government of Sindh • HOPE

  10. National Stakeholders • National Institute of Health, Islamabad • WHO • UNAIDS • World Bank • Becton Dickinson • EPI (Expended Programme of Immunization) • UNICEF • CIET International • PPHF (Pakistan Public Health Foundation)

  11. Development of Injection Assessment Tool • Training workshop organized in Karachi (collaborating with SIGN-Geneva) • Dr. Anne Reeler-Medical Anthropologist • Development and assessment of tool in Karachi • Capacity building

  12. Findings from Initial Assessment • Target groups: Community & patients, health care providers, dispensers, vaccinators • Findings: • Communities and patients knew about disposable syringes • Patients rely on doctor for prescription • They want fast relief • Cheaper to get injections • Not aware of hepatitis B or C, aware of pain/abscesses

  13. Findings continued • General practitioners: • Injections are important to stay in business • Cost of prescription with and without injection is the same • No consensus on who initiates injections • 80-100% patients get at least one injection • No health information given to patients

  14. Action Plan • Research • Qualitative assessment in all four provinces • Resources available for one province (SINDH) • Quantitative survey in an intervention area • Develop appropriate health messages

  15. Action Plan • Advocacy • Sensitize policy planners • Disposable medical devices ordinance 2000 • Manufacturers-cheap technologies • Advocacy seminars/workshops • NATIONAL COLLABORATORS

  16. Action Plan • Intervention: • Four Ps • Physicians • Patients • Population • Press

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