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

Study objectives
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.

Study methods
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.

Findings the good news
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.

Findings more good news
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.

Findings troubling news
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.

Findings more troubling news
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.

Findings more troubling news1
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.

Findings more troubling news2
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.

Findings more troubling news3
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.


  • 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.


  • 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.

What s next
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.