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Study Objectives

Public Perceptions about Injections and Private Sector Injection Practices in Central Nepal Mahesh Bhattarai and Scott Wittet. Study Objectives. Use a qualitative, exploratory research approach to:

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Study Objectives

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  1. Public Perceptions about Injectionsand Private Sector Injection Practices in Central NepalMahesh Bhattarai and Scott Wittet

  2. Study Objectives • Use a qualitative, exploratory research approach to: • Investigate the attitudes and knowledge of the general public and of private injection providers regarding injections. • Observe and document injection practices of private providers.

  3. Study Methods • Timing: March-July, 2000 • Location: Seven districts of Nepal’s Central region • Methods: Focus group discussions, In-depth interviews, Direct Observation, and “Secret Shopper” interactions • Respondents: Total of 204 private sector injection providers and consumers • The respondents are diverse in terms of ethnicity, hill or Terai location, urban/rural lifestyle, educational level, gender, age, and experience.

  4. Findings: The Good News • The vast majority of providers and customers are well aware that injections can cause health problems. • Many providers and consumers say that injections should not be used for “common illness.” • Disposable syringes are commonly available (and used) in the study area.

  5. Findings: More Good News • Most providers and consumers know that needles and syringes should not be shared among people without “cleaning.” • Most providers and consumers know that medical waste can be dangerous. They say that it should be either buried or burned to reduce problems. • Many providers and some consumers are critical of unqualified injection providers in the community and would like to see the situation improved.

  6. Findings: Troubling News • Observed and reported consequences of poor injection practices: • Providers and consumers commonly report adverse consequences following injection (including abscesses, amputation, and death). • They also report needle prick incidents resulting from poorly disposed waste.

  7. Findings: More Troubling News • Practices that put providers at risk: • Unsafe handling of injection equipment and other sharps is common. • Storage of contaminated waste in easily accessible, open containers is common. Reuse is also common. • Adverse consequences of injections could result in decreased business and even violence against the provider.

  8. Findings: More Troubling News • Practices that put consumers at risk: • Medical services are being provided by unqualified personnel. • Reuse of non-sterile injection equipment with the same patient is common. • Use of non-sterile injection equipment among more than one patient was observed.

  9. Findings: More Troubling News • Practices that put the community at risk: • Disposal of contaminated medical waste in public areas, including needles and syringes, is common. • Selling used injection equipment may be a problem.

  10. Findings: More Troubling News • Unnecessary injections: • Injections are valued by consumers and providers as fast acting and necessary for a variety of complaints. • Injections of vitamins, antibiotics, and painkillers are common in spite of widespread acknowledgement that oral medications should be used for less serious complaints.

  11. Recommendations • There is a serious gap between provider knowledge about injection safety and provider behavior. • Policy initiatives, infrastructure development, and provider and consumer behavior change strategies should be considered.

  12. Recommendations • Research which might be useful: • Conduct an assessment of public sector practices. • Gain a better understanding of hospital and municipal handling and disposal of medical waste. • Investigate attitudes towards and practices related to intravenous infusions and minor surgery. • Assess the safety of disposable syringes in the market. Investigate syringe (and needle) sales practices and the economics of recycling. • Determine whether providers support TT and vaccination of pregnant women (and others) or not.

  13. What’s Next • Early 2001 • Dissemination meeting with SIGN partners in Kathmandu to discuss findings and brainstorm future research and interventions. • Late 2001 • Report to SIGN on new plans and progress.

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