SIGN Rapid Assessment SurveySIGN Rapid Assessment Survey Northern Areas, Pakistan Northern Areas, Pakistan

Lubna Samad, MRCS, FCPSPediatric Surgeon

National Institute of Child Health

ObjectivesObjectives

provide information on existing injection practices among – prescribers– providers– general population

Demographic & Health IndicatorsDemographic & Health Indicators District Gilgit and Ghizar, Northern AreasDistrict Gilgit and Ghizar, Northern Areas

Indicators Total

Population 310,139

IMR 37

DPT3 Coverage 82-88%

Govt employed doctors ~45

Source: Based on 2000 Annual Report Aga Khan Health Service, PakistanProjected at 2.2% population growth rate

MethodsMethodsNorthern Areas Rapid Assessment, 2001Northern Areas Rapid Assessment, 2001

Urdu translation of

Instruments 2, 4, 5

13 physician prescribers

14 injection providers

26 general population

Physician Prescribers (Physician Prescribers (n= 13)n= 13)Northern Areas Rapid Assessment, 2001Northern Areas Rapid Assessment, 2001

Ave number of patients per week 318

Proportion to whom injections are prescribed

14%

Ave total injections in treatment 4

Injections preferred 31%

Oral preferred 46%

Either 23%

Physician Prescriptions (Physician Prescriptions (n= 280)n= 280)Northern Areas Rapid Assessment, 2001Northern Areas Rapid Assessment, 2001

• 15% (43/280) of all prescriptions sampled included at least one injection

• Most common illness for which injections prescribed: pneumonia, acute severe abdominal pain, gastroenteritis, enteric fever

Injection Provider Observations (Injection Provider Observations (n= 14)n= 14)Northern Areas Rapid Assessment, 2001Northern Areas Rapid Assessment, 2001

Use of new disposable syringes 14

Immediate discarding in sharp box 2

Two handed recapping 8

Appropriate destruction/

disposal of sharps

2

Injection Providers (Injection Providers (n= 14)n= 14)Northern Areas Rapid Assessment, 2001Northern Areas Rapid Assessment, 2001

Ave number of injections given per week 64

Ave number of needle sticks in 12 months 2

Proportion never received HBV vaccine 79%

Insufficient quantities of injection equipment available

57%

Insufficient quantities of sharp boxes available

86%

No access to waste disposal facility 79%

General Population (General Population (n= 26)n= 26)Northern Areas Rapid Assessment, 2001Northern Areas Rapid Assessment, 2001

Proportion received an injection/

infusion in past 3 months

19%

How many on average? 3

Needle and syringe came from plastic pack

67%

Proportion of injection cost paid for syringe/needle

6%

Proportion who prefer oral treatment 77%

Reported Associations Between Reported Associations Between Injection Reuse and InfectionsInjection Reuse and Infections

Northern Areas Rapid Assessment, 2001Northern Areas Rapid Assessment, 2001

PrescribersPrescribersN= 13

Providers Providers N= 14

General General Population Population

N= 26

HIVHIV 100% 43% 12%

HCVHCV 77% 7% 0

HBVHBV 92% 36% 0

othersothers 0 76% 46%

don't don't knowknow

0 7% 50% 

SummarySummary

• Frequent prescription and administration of injections (est. 2-3 per person per year)

• Lack of awareness regarding the transmissibility of hepatitis viruses and HIV

• Lack of safe injection equipment, waste disposal facilities

Progress Since Rapid AssessmentProgress Since Rapid Assessment

District Hospital, GilgitDistrict Hospital, Gilgit– Improved monitoring of injection equipment supplies – Improved health facility waste management– HCV screening introduced

Market surveyMarket survey of syringes planned for early 2003

– Healthy Minute– Expert interviews– Dramatization/serials