Injection use in two districts of Pakistan: implications for disease prevention

Objective. To estimate the annual number of injections per person in Sindh province of Pakistan and to describe their distribution with regard to prescribers, settings, and safety. Design. A population-based cross-sectional study in July-September 2001. Setting. Lyari, an urban town in Karachi district; and Digri, a rural subdistrict in Mirpur Khas district. Study participants. We selected a population-based cluster sample of 1150 individuals aged 3 months. We interviewed one person per household for the number of encounters they had with health care providers, number and types of injections received, safety circumstances, and cost of injections during the past 3 months. Main outcome measure. The number of injections per person per year. Results. After adjusting for age and sex, 68% of participants had received at least one injection in the previous 3 months (13.6 injections/person/year). The majority of the respondents received injections at the clinics of qualified general practitioners (n = 571, 67%) by dispensers (644, 76%). Most of the injections (n = 3446, 96%) were for curative purposes. A freshly opened syringe was used for only 454 (53%) of the injections. The average fee for receiving an injection was Rs. 51 (US$0.8). Conclusion. Injections are overused in Pakistan's Sindh province and the ratios of injection per capita that we found are among the highest ever reported. Interventions are needed to substantially reduce injection prescription among private health care providers who prescribe most of the injections received by the population.