Without a doubt, the administration of injections is one of the most common healthcare procedures at health institutions across the country. But that is all the more reason for care because the World Health Organisation (WHO) says a safe injection is one that is given by means of appropriate equipment and does not harm the recipient, nor expose the provider to avoidable risks.
Figures from the WHO put the resultant infection profile resulting from unsafe injections at 250,000 HIV infections, 2,000,000 Hepatitis C infections and 21,000,000 Hepatitis B infections, leading to 1,300,000 deaths.
Even with the considerable improvement in immunisation services in Nigeria, medical experts insist that poor injection and sharp waste disposal practices pose an avoidable risk of transmission of deadly diseases such as HIV/AIDS, Hepatitis B and Hepatitis C to consumers, healthcare providers and the whole community.
Speaking with BusinessDay, Bennett Ogbokor, a practising pharmacist in Lagos, said that the normal disposable syringes are actually very dangerous and inimical to Safe Health and Safe Injection Practices, especially in a country like Nigeria where statistics of infections contracted from unsafe injections are lacking.
Ogbokor stated that the administration of injections have completely overtaken their real need, reaching an all-time proportion that is beyond Standard Medical Practice, as over 90 percent of patients visiting a primary healthcare centre receive at least one injection in developing countries including Nigeria.
According to Ogbokor, “Due to staggering WHO statistics and concern for the health of Nigerians, the then Director General, National Agency for Food and Drug Administration and Control (NAFDAC), Dora Akunyili, gave a 24-month deadline for discontinuation of the use of normal disposable syringes on July 27, 2007, at a forum organised by the Nigerian Medical Association (NMA) and Medical and Dental Council of Nigeria (MDCAN)
NAFDAC, NMA and MDCAN agreed the phase-out of the normal disposable plastic syringes for the auto disable syringes should be done in stages, and the importation of these syringes should stop in 18 months, beginning from August 1, 2007 and their usage should cease 24 months from same date. This move was targeted at aligning the country with the rest of the world in the use of Auto-Disable (AD) syringes. Sadly, though, months after the deadline, conventional syringes are still sold openly in the markets, pharmacies and used in hospitals across the country.
On his part, Emmanuel Okechukwu, chief executive, Action Family Foundation (AFF) , stated that there is an urgent need to use injections safely and appropriately to prevent nosocomial and HIV infections.
“In an Abuja study, it was found that 18 percent of healthcare facilities burnt their solid wastes in local brick incinerators, 36. 3 percent disposed their waste at municipal dumpsites; over 91 percent buried their solid waste. However, none practised waste segregation at source. Again, results of a baseline survey by AFF for National Action Committee Agency (NACA), three projects in four states, Lagos, Ebonyi, Enugu and Borno States, showed that Nigeria still has a long way to go," Okechukwu disclosed.
A close look at compliance with the utilisation of auto-disable syringes in the curative medical sector, as currently practised in many African countries including Uganda, reveal that the Ministry of Health embarked on large-scale sensitisation of health workers and the public across the country on the benefits of the use of auto-disable syringes.
The auto-disable syringes were developed to contribute to safer injection practices and prevent the re-use of syringes, thus the transmission of disease. Auto-disable (AD) syringes virtually eliminate the risk of patient-to-patient infection with blood borne pathogens (such as hepatitis B or HIV) because they cannot be reused. The private sector was also called upon to begin stocking syringes with re-use prevention features in order to respond to created demand.
Uganda’s Ministry of Health proactively advised all importers of syringes not to enter into any new procurement arrangement for the standard disable syringes. This, Nigeria can learn from since Ghana, Kenya, Tanzania and South Africa have also embraced Injection Safety Policy.
Proffering a solution to the current situation, Ogbokor urged the Director General NAFDAC, Paul Orhii, as well as his counterpart in the Federal Ministry of Health, to do their best to be the leaders for the advocacy of safe Injections Policy in West Africa, thus paving the way for its ECOWAS neighbours to follow suit.
He pointed out that NAFDAC would be seen as truly safeguarding the lives of Nigerians when the ban on re-usable spurious disposable syringes is enforced and the use of syringes with re-use prevention features becomes the norm.
It is pertinent to state that advocacy strategies for injection safety should be developed to target not only managers of immunisation services but also government decision-makers and managers, health workers, and the general population. However, promoting the safe use of injections requires a behavioural change strategy, which must involve consumers as well as public, private and traditional health workers.
While the use of AD syringes will greatly reduce the risk of transmitting blood-borne infections, their introduction alone will not ensure immunisation safety. Proper equipment must be accompanied by careful planning, management, training and supervision in the safe use and disposal of AD syringes.
Finally, the experience gained in ensuring injection safety should be used as a model to ensure that all medical injections, including those for preventive and therapeutic services, are safely administered and used injection equipment is safely disposed of after use.
BY Alexander Chiejina
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