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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.
recommendations
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.
recommendations1
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.
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.
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