SIGN Rapid Assessment Survey Northern Areas, Pakistan
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Transcript of SIGN Rapid Assessment Survey Northern Areas, Pakistan
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SIGN Rapid Assessment SurveySIGN Rapid Assessment Survey Northern Areas, Pakistan Northern Areas, Pakistan
Lubna Samad, MRCS, FCPSPediatric Surgeon
National Institute of Child Health
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ObjectivesObjectives
provide information on existing injection practices among – prescribers– providers– general population
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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
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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
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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%
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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
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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
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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%
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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%
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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%
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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
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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