Injection practices in India

BACKGROUND: About 16 billion injections are administered each year worldwide, and at least half of them are unsafe. India contributes 25% to 30% of the global injection load. A majority of curative injections are unnecessary. The present study was undertaken to assess the burden of injections and prevalent injection practices in India. METHODS: A nationwide population-based cluster survey (1200 clusters; 24 021 subjects) at household level; along with observations, interview of prescribers (2402), and exit interview of the patients (12 012) at health facility level in the selected clusters was carried out -using probability proportionate to size (PPS) technique. Observations at health facility included generic observation (3592), observation of injection process (17 844), and observation of prescriber-client interaction (24 030). RESULTS: The frequency of injections was 2.9 (95%CI: 2.8-3.2) per person/year. Of the total injections, 62.9% (95%CI: 60.7-65.0) were unsafe. Injections administered for curative purpose constituted 82.5% and a large majorly of these were prescribed for common symptoms like fever/cough/diarrhoea. Use of glass syringes was consistently associated with potential risk of blood-borne viral transmission. Satisfactory disposal of injection waste was observed at 61.3% (95%CI: 58.2-64.3) of the health facilities, and at 50.9% (95%CI: 46.7-55.2) of the immunization clinics. Significant differences were observed in the injection prescription pattern in public and private facilities, and in rural and urban areas. CONCLUSIONS: Three billion injections were estimated to be administered annually in India; of them 1.89 billion were unsafe. Evidence suggests that the micro-level leadership for reducing injection overuse and making injections safer lies with the prescriber.