CHS Research Helps Shape Injection Safety Policy

It is a globally established fact that unsafe injections are the primary cause of the spread of hepatitis B and C infections. While Pakistan is one of several developing countries affected by this hazardous practice, it is one of the few where comprehensive data is also available.

Research conducted at AKU’s Department of Community Health Sciences (CHS) has provided the Government of Pakistan with concrete data on injection safety and has helped convince public health stakeholders of the need for legislation and a national policy to combat the prevalence of unsafe injections.

In 1997, CHS identified unsafe injections as a major risk factor in the transmission of hepatitis C. Since then, numerous studies, editorials and letters to the editor have been published in peer-reviewed journals by CHS faculty and students. Health safety apart, the financial cost of these infections places a colossal burden on the country’s cash-strapped health care system and economy at large. Besides research, CHS has been advocating safe injection practices in Pakistan ever since it organised the First National Symposium on Injection Safety in 2000. This sustained advocacy succeeded in exerting much-needed pressure on stakeholders to address the injection safety issue at the national level. The presence of strong and high-quality evidence relating to unsafe injections also helped persuade policy makers.

AKU has been working closely with the Geneva-based and WHO-affiliated Safe Injection Global Network (SIGN). “Today we are in a position to say that research conducted at CHS has contributed in a major way to the development of the national policy on injection safety and legislation on disposable medical devices,” says Dr Naveed Janjua, Senior Instructor at the Department. Dr Janjua’s study titled ‘Injection Practices in Sindh’ found that on average an individual receives 13.6 injections every year. Private general practitioners provide 67 per cent of injections, of which 94 per cent are administered for curative purposes. Only half of all injections are dispensed with a fresh syringe. In another study, Dr Arshad Altaf, who was a Senior Instructor at CHS at the time, identified that patients’ perception about efficacy of injections and material incentives for providers are major determinants of injection overuse.

These studies prompted WHO Pakistan to invite Dr Janjua and Dr Altaf to provide technical input in connection with formulating legislation pertaining to disposable medical devices. Ensuring the use of good quality, single-use disposable syringes is one of the primary goals of these proposed laws.

In August 2004, the Federal EPI (Expanded Programme on Immunisation) Cell, Ministry of Health, Pakistan, invited both Dr Altaf and Dr Janjua to the National Workshop on Injection Safety, which culminated in a draft national policy on injection safety and revisions to proposals aimed at developing disposable medical device regulations. As a first step towards preventing reuse of syringes, the Ministry of Health issued a directive to all hospitals and medical institutions operating under the aegis of the federal government to use autodisable (AD) syringes and to submit a compliance report to the federal Director General, Health.

“The prime objective of public health research is its translation into policy and practice,” stresses Dr Janjua. “It is heartening to see CHS research serving as the basis of a policy aimed at improving the health of the people of Pakistan.”