sign rapid assessment survey northern areas, pakistan
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SIGN Rapid Assessment Survey Northern Areas, Pakistan. Lubna Samad, MRCS, FCPS Pediatric Surgeon National Institute of Child Health. Objectives. provide information on existing injection practices among prescribers providers general population. - PowerPoint PPT PresentationTRANSCRIPT
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