Injection practices in the formal & informal healthcare sectors in rural north India.

BACKGROUND & OBJECTIVES Unsafe injections in health settings contribute to a large burden of preventable blood-borne diseases. Current strategies to enhance injection safety in India almost exclusively target the formal health sector. However, injections are provided not only by doctors and nurses in the formal sector, but also by practitioners from the informal sector, such as traditional healers, who are not necessarily trained or authorized to administer these. The present study was undertaken to determine the extent to which patients using formal healthcare services also consult and receive injections in the informal sector, quantify the injections received by these patients and their relatives, and assess knowledge and attitudes in relation to injections. METHODS A cross-sectional survey of 280 in patients and 120 of their relatives was undertaken between November 2004 and February 2005 in two rural hospitals in Bihar and Jharkhand states. RESULTS Sixty one per cent of patients had consulted a healthcare practitioner in the month prior to admission, and 39 per cent of these had consulted in the informal sector at least once. Forty three per cent had received at least one injection in the month prior to admission, and 43 per cent of these were given by informal practitioners. About 13 per cent of relatives had received at least one injection in the last three months, 69 per cent of which were given by informal practitioners. Thirty per cent did not know that unsafe injections can spread diseases. INTERPRETATION & CONCLUSION The findings of this survey highlight the fact that informal practitioners in India are commonly administering injections with clear implications for patient safety. There is a need to promote strategies for injection safety among both formal and informal practitioners.