Academic journal article Bulletin of the World Health Organization

Anthropological Perspectives on Injections: A Review

Academic journal article Bulletin of the World Health Organization

Anthropological Perspectives on Injections: A Review

Article excerpt

Voir page 142 le resume en francais. En la pagina 142 figura un resumen en espanol.

Background

A recent issue of the Bulletin of the World Health Organization highlighted the extent of the problem posed by unsafe injections in developing countries (1). Not only are vast numbers of injections unnecessary and unsafe but they have also been linked to the possible transmission of millions of cases of viral hepatitis B and C and to as many as 150000 cases of human immunodeficiency virus (HIV) infection (2).

Clearly, the administration of injections in developing countries often leaves much to be desired. Many injections are given for the wrong indications, such as acute respiratory infections, diarrhoea, fever, skin infections and urinary tract infections (3-5). In some countries children seem to be receiving alarmingly large numbers of injections (1). Administration and sterilization practices are unsatisfactory in many places (1, 6) because health workers have insufficient knowledge or because there is a lack of equipment. In developing countries the epidemic of acquired immunodeficiency syndrome (AIDS) has persuaded many donors to provide disposable injection equipment (even though this sometimes means ignoring national policies), and disposable syringes are often reused despite their intended purpose. The disposal of used syringes and needles presents a problem that increases the risk of transmitting diseases. Health centres often dispose of used syringes and needles in nearby open pits, a practice which makes it possible for people to obtain and reuse the injection equipment.

The overuse and misuse of injections should be curbed. Of course, in designing effective interventions it has to be borne in mind that some injections are very useful. Vaccination, for example, has saved the lives of many children. In some cases the injection of penicillin may be the most rational way to treat certain conditions. If patients cannot swallow or are nauseated and vomit medicine that is given orally, as may happen with small children suffering from malaria, injection may be the best form of treatment. However, most injections given in developing countries are, from the medical standpoint, unjustifiable, and may even be dangerous. Furthermore, they represent a waste of scarce resources. It is necessary to prevent and limit the administration of harmful and unnecessary injections without damaging the public perception of useful injections. Non-useful injections may be unnecessary, contain harmful substances, or be administered in an unsafe way. Of these categories, the first and second are often hard to distinguish in the informal sector, where records are rarely kept. The third can be monitored and measured through observation and self-reporting.

The provision of injections takes place in the following sectors:

-- the formal, which includes public and private providers;

-- the informal;

-- the traditional;

-- the domestic.

The formal sector consists of providers who have been trained to give injections and have been authorized by the state to do so, including doctors, nurses and other health workers. Also included are other staff who provide injections within health facilities, such as orderlies and nursing aides. The informal sector is characterized by providers who are not sanctioned by the state and are not institutionalized; they have had no formal training and have mostly taught themselves how to administer injections. Traditional healers, who may be recognized by the state through associations, are often trained by apprenticeship to experienced healers; they are specialists who are frequently paid by their clients after the results of treatment are known. In the domestic sector, injections are administered at home by relatives and neighbours as a favour or an expression of care, and generally no payment is involved.

Perceptions of etiology

In developing countries the concepts of germs, bacteria, infections, disease vectors and antibiotic resistance are not familiar to most people who use biomedicine. …

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