172784 Assessment of injection practices in India: IndiaCLEN Program Evaluation Network (IPEN) study

Tuesday, October 28, 2008: 3:32 PM

Narendra K. Arora, MD, MPH , Executive Director, International Clinical Epidemiology Network (INCLEN), New Delhi, India
Ravindra M. Pandey, MSc, PhD , Biostatistics, All India Intitute of Medical Sciences, New Delhi, India
Hemant Kumar, MBBS, MBA , Health Management, Voxivo, India, Noida, India
Sanjay Chaturvedi, MD , Community Medicine, University College of Medical Sciences & GTB Hospital, New Delhi, India
Reema Devi, MA, Phd , Community Medicine, Medical College, Thiruvananthapuram, Thiruvananthapuram, India
Vivek Adhish, MD , Community Medicine, National Institute of Health & Family Welfare, New Delhi, New Delhi, India
Sunil Kumar Agarwal, MBBS , Epidemiology, University of North Carolina, Chapel Hill, NC
Objective: To estimate the burden and safety of injection use in all sectors across India

Methods: A population based cluster survey of household and health care facilities across India (divided into 15 socio-cultural and geographic zones) was done. A total of 24021 household interviews (94.2% participation) were conducted. In addition, 3562 health facilities, 17844 injection processes and 24030 client–provider interactions were observed. Injections with potential of transmitting blood borne infection or given using faulty technique were considered unsafe.

Results: In India, estimated 2.9–5.8 injections were administered per person per year. Over 80% of injections were for curative purposes, 77% of which were given in the private sector. More than 75% injections are health care provider driven and almost 50% of prescription at public/private health facilities included an injection. Overall 62.9% injections were considered unsafe. Almost 3/4th injections administered for immunization were unsafe. One third (32%) of all injections administered carried the risk for spread of blood born viruses. Lack of safety was high (>90%) with glass syringes.

Conclusion: Approximately 3-6 billion injections are administered annually in India; of these 1.9-3.8 billion injections can be considered unsafe. Safety recommendation including use of auto-disabled syringes and health care provider training was forwarded to policy makers.

Learning Objectives:
This multicentric study evaluates the burden of injection use and their safety in India. Describes the methods of rapid cluster sampling design in a large developing country. Emphasize the importance of public health research to act as catalyst for public practice changes.

Keywords: Practice-Based Research, Third World

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have received medical graduation from India and have contributed to research presented in this study. Currently, I am continuing my doctoral studies at University of North Carolina at Chapel Hill and have experience of teaching and presenting research findings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.