Comparison of Injection Use and its Practice in an Urban and Remote Setting of Kaski District in Western Nepal

Abstract

Background: Understanding injection practices is imperative to propose evidence-based practical interventions for safe injection practice in developing countries like Nepal. Hence, the study was carried out to explore and compare injectable drug use and its practice in urban and rural areas of Kaski district and to propose interventional strategies. Methods: It was a descriptive, cross sectional, mixed (quantitative and qualitative) type of study. The study included interview with stakeholders, injection prescribers and injection providers, population survey, focus group discussions and observation of primary health care facilities and injection administration. Results: Injections were provided by formal and informal health providers as well as charlatans. All therapeutic and vaccine injections were given using single use disposable syringe and auto-disable syringe, respectively. Significantly (p<0.001) higher proportion of rural dwellers (8%) preferred injections compared to urban dwellers (2%). Higher number of urban dwellers was literate, had access to mass media and some knowledge about safe injection practice. But most of them were receiving injections from informal sector who were not trained for injection administration. The injection practice was safer in government health care facilities than in non-governmental facilities. Waste disposal practice in the studied health facilities was not satisfactory and was more haphazard in urban compared to rural areas. Conclusions: Lack of legal authority for quality control of injection equipment marketed in Nepal, guideline for waste management at the health care facilities and inadequate protection of HCWs are some of the areas to be addressed immediately to make injection practice safer. Integrated educational, managerial and regulatory interventions are required to improve injection safety. Keywords: government health facilities; Injectable drug use; practice; rural; safe injection practice; urban.