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Why Kenyans prefer jabs to drugs

By | June 5th 2009 at 00:00:00 GMT +0300

By Ally Jamah

Kenyans are getting far too many injections at hospitals than is necessary.

Even where oral medicine is prescribed, a survey shows that 60 per cent of Kenyans seeking treatment demand an injection instead of tablets.

Scores of doctors attending a health professionals’ workshop in Nairobi gave varied testimonies of the pressure they get from patients who want jabs instead of pills or syrups.

It also emerged from the workshop that of the injections classified as ‘unnecessary’, many are considered ‘unsafe’.

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National Aids and STIs Control Programme Head Nicholas Muraguri told an Injection Safety Workshop of Doctors and Nurses that 70 per cent of 65 million injections administered annually were not necessary.

Oral drugs

The doctors heard that a recent survey by John Snow Inc, a US medical research organisation, showed that about 60 per cent of Kenyans prefer injections to oral drugs when they fall sick.

Dr Muraguri blamed Kenyans for their preference for injections over drugs due to misconceptions that they work better.

A doctor attends to a patient. A recent survey by John Snow Inc, a US medical research organisation, shows about 60 per cent of Kenyans prefer injections to oral drugs when they fall sick.

"Kenyans should know that oral drugs are just as effective as injections in treating common diseases and people need to change their injection-addiction," he said.

Kenyatta National Hospital Chief Nurse said many Kenyans only felt "properly treated" when they received an injection. Many doctors and nurses at the workshop testified that they were often under pressure from patients to give injections "just to satisfy a patient’s conscience" even though oral drugs would work just as well.

"If you insist on not giving unnecessary injections, patients start losing faith in you. They go elsewhere and receive them. It is just a psychological issue," said one doctor from the Coast Provincial General Hospital, who refused to be named.

Injections are only necessary in a few cases of vaccines in the treatment of children.

Muraguri said the Government was trying to minimise the use of injections to cut HIV and Hepatitis B infections that could be the result of unsafe use of injections.

In Kenya, about five per cent of new HIV and Hepatitis infections are a result of unsafe use of injections during treatment or drawing blood.

Unsafe injections

"In many health facilities, patients come with infections and other complications picked from unsafe injections. The risks are real," said Muraguri.

Due to insufficient funding and rising population, the Government is struggling to keep up with the high demand for injection needles to avoid re-use, a key cause of disease transmission.

Muraguri warned that emphasis on testing for HIV, malaria and TB in Government hospitals is guaranteed to cause shortage of injection equipment.

Kenya relies heavily on a US-funded programme, the President’s Emergency Plan for Aids Relief (Pepfar) that supplies millions of self-retracting needles to eleven African countries. The needles collapse after use.

Muraguri said risks of infection from unsafe needles in Government hospitals were negligible, but warned against private clinics, which have no such guarantees.

In 2007, the Government released guidelines on injection safety and medical waste management to ensure safety of patients, health workers and the environment. But it appears that enforcement is proving a big challenge.

Safe disposal of used injections and syringes is a huge environmental issue that has attracted the attention of the National Environmental Management Authority (Nema).

A study in 58 hospitals in Nyanza, Western and Rift Valley provinces shows that poor disposal of used syringes is a common hazard.

Prof Paul Achola of Kenyatta University, the researcher, said: "Surgical waste is mostly disposed of in open pits behind health facilities or burnt openly, exposing surrounding communities to health risks."

Small, private clinics dump used injections in the back streets or at community dumpsites, where thousands of people are exposed to infection.

Ideally, hospitals should have very high temperature incinerators to destroy waste efficiently. Because the units cost at least Sh100 million, few can afford.

Expensive to fuel

Kenyatta National Hospital and other major Government hospitals rely on incinerators donated by Unicef in 2002 during the measles campaign. But they frequently break down and are expensive to fuel.

Nema blames the incinerators for polluting the air with cancer-causing toxins.

According to Muraguri, the cheapest option of minimising the effects of injection needles on patients, health workers and the environment is to discourage their use unless they are absolutely necessary.