Embed Size (px)
Citation preview
SIGN Pakistan
Dr. Arshad Altaf
Objectives of the Presentation
Overview of burden of disease in Pakistan because of unsafe injection practices
Present activities of SIGN PakistanFuture plan
Burden of diseases in Pakistan
Studies in Pakistan have found hepatitis C : 60% hepatitis among liver cancer
patients (Ahmed et al., 1995)
51% among beta thalassemia major patients (Ahmed et al., 1995)
46% among chronic liver disease patients (Mujeeb et al., 1998)
18% among cirrhotic patients (Mujeeb et al., 1998)
20% among commercial blood donors (Mujeeb et al., 1998)
Unsafe Injection Practices
1993: Luby et. al. 6.5% antibodies positive for hepatitis C
in Hafizabad, Pakistan
1994: Luby et al. Follow up case control study to identify
risk factors Positive individuals were 8.2 times more
likely to receive > 5 injections per year
Unsafe Injections Practices
1995: Aamir Javed Khan et al., Investigated relationship between hep B
& C and injections in peri urban Karachi 44% hepatitis C positive those who received more injections were
more likely to be hepatitis C infected 94% of the needles/syringes were reused
Unsafe Injections Practices
1995: Reaglow et al., KAP study 49% received one or more injections at
their last visit to health practitioner 35% received 10 or more injections in
the last year 64% felt that injections are more
powerful
Creation of SIGN Pakistan
FIRST NATIONAL SYMPOSIUM FIRST NATIONAL SYMPOSIUM First national symposium on Safe Injection and
Blood Practices in Pakistan on Feb 15, 2000 Objectives:Objectives:
Provide a forum to discuss ideas Identify persons and process to develop
assessment protocol Collect input for intervention from those who
have conducted studies Foster formation of Safe Injection working
group
Formation of SIGN Pakistan
SIGN Pakistan Working Group formed Maillist created ([email protected])First national meeting “Partners in
Injection Safety” on June 17, 2000Objectives:
Formal announcement of SIGN Pakistan To identify national stakeholders
SIGNPAK Working Group
The Aga Khan University Sindh AIDS Control
Programme, Government of Sindh
HOPE
National Stakeholders
National Institute of Health, IslamabadWHOUNAIDSWorld BankBecton DickinsonEPI (Expended Programme of Immunization)UNICEFCIET InternationalPPHF (Pakistan Public Health Foundation)
Development of Injection Assessment Tool
Training workshop organized in Karachi (collaborating with SIGN-Geneva)
Dr. Anne Reeler-Medical Anthropologist
Development and assessment of tool in Karachi
Capacity building
Findings from Initial Assessment Target groups: Community & patients,
health care providers, dispensers, vaccinators
Findings:Communities and patients knew about
disposable syringesPatients rely on doctor for prescriptionThey want fast reliefCheaper to get injectionsNot aware of hepatitis B or C, aware of
pain/abscesses
Findings continued
General practitioners: Injections are important to stay in
business Cost of prescription with and without
injection is the same No consensus on who initiates injections 80-100% patients get at least one
injection No health information given to patients
Action Plan
Research Qualitative assessment in all four
provinces Resources available for one province
(SINDH) Quantitative survey in an intervention
area Develop appropriate health messages
Action Plan Advocacy Sensitize policy planners Disposable medical devices ordinance
2000 Manufacturers-cheap technologies Advocacy seminars/workshops NATIONAL COLLABORATORS
Action Plan
Intervention:Four Ps
Physicians Patients Population Press
