Pubdate: Thu, 17 Feb 2005 Source: DAWN (Pakistan) Copyright: 2005 The DAWN Group of Newspapers Contact: http://www.dawn.com/ Details: http://www.mapinc.org/media/101 Bookmark: http://www.mapinc.org/find?143 (Hepatitis) KARACHI: REUSE OF SYRINGES SPREADING DISEASES KARACHI -- The Sindh health department has no paucity of funds, but it is mainly due to the wrong set of priorities that has led to non-sustainable projects at the expense of the extremely essential provision for auto-disable syringes as well as drugs at public sector hospitals. The observation was made by the Sindh health secretary, Prof Naushad A Sheikh, during a workshop on "Safe Injections - Prevention of Blood Borne Infections" organized by HOPE on Wednesday. The secretary, who had previously served as the medical superintendent of the Lyari General and Civil hospitals minced no words in reminding that major emphasis had been laid on construction of buildings and procurement of expensive equipment, but not on basic health care and prevention programmes. Agreeing with senior paediatrician Prof D.S. Akram, he said this was in the backdrop that injections were administered from one hourly to an eight hourly basis to patients under various pretexts with almost non-existent provision for needle cutters or auto-destructive syringes - the latter considered an expensive option for government hospitals. The health secretary agreed with speakers that the indifference was leading towards growing susceptibility of a large number of locals including patients as well as health care providers to a wide range of blood borne diseases particularly hepatitis B and C, and HIV. District health officers as well as medical superintendents were being authorized to make appropriate use of available funds in accordance to the very need of their areas of jurisdiction. "The Sindh health department is self-sufficient in funds and is trying to make rules and regulation for their adequate application in accordance with genuine and prioritized public needs," he elaborated. He also hinted at the inception of a mechanism under which executors of government-sponsored health care projects and disease prevention programmes would be held accountable. With regard to the irrational use of injections on part of general practitioners (GPs) as well as quacks practicing in rural areas and urban slums, he said concerted efforts were required to contain the trend, adding that the government was in the process of formulating a law to combat the menace of quackery. He on the occasion also mentioned that the Sindh health department would be announcing a provincial health policy on the lines of the national health policy by next week. He said its main focus would be on reorganizing the medico-legal system, making it transparent and checking elements of corruption. He also referred to measures being adopted to strengthen and implement anti-quackery law besides required modifications in the existing Sindh Safe Blood Transfusion Act, plugging all possible loopholes, which may be providing faulty blood banks the chance to avoid legal action. Responding to the presentation made by Dr Tahira Raza, revealing that the barber community was also among the groups to contract and transmit blood borne infections; he underscored the need for necessary awareness programmes and strategies to modify their professional approach with emphasis on sterilization of their tools. Earlier, Prof Dur-e-Sameen Akram recommended action beyond advocacy approach with major emphasis on legislation and health education for school going children. The seasoned professional diverted attention of her colleagues towards the significance of market economy, under which public demand compels medical professionals to go forward with irrational use of injections and administration of drips, and at times even compelling to go on with unwarranted blood transfusion. Dr Mobina Agboatwala, in her presentation 'Promoting Safe Injection Practices Globally', reminded that a safe injection did not harm the recipient, nor exposed the provider to any avoidable risk, and nor resulted in any waste that was dangerous for other people. Regretting that practitioners in general were indifferent towards the issue, she said that recent studies revealed that no less than 64 per cent of injections administered in the country were unsafe, consequently leading to transmission of blood borne pathogens. In Pakistan, some 1,900m injections were administered annually, Dr Mobina informed, adding that 75m of these were administered for immunization while the remaining were therapeutic. This was said to be in a global scenario where 16,000m injections were given annually in the developing countries of which 30 per cent were reused without prior sterilization. In the year 2000, injections given using contaminated injection devices may have caused 21m cases of Hepatitis B, two million cases of Hepatitis C and 260,000 cases of HIV infections, the speaker said, referring to available statistics. The situation was mainly attributed to misconceptions about injections among prescribers, which included the myth that injectable drugs were stronger than oral drugs, or that these had more rapid onset of action. Dr Mobina further reminded that even in private settings, sharp waste boxes were negligible, while only 10 per cent of public hospitals had them. Dr Asim Musarrat, speaking of 'Re-Use Prevention Syringes', highlighted seriousness of the problem. He mentioned that contaminated needles/syringes and unsafe blood transfusions were the second largest spreaders of HIV. "Over one quarter of a million of new cases of HIV/AIDS are traceable to reused syringes and needles," he said, mentioning that over 20m new cases of Hepatitis B (30 per cent of all cases) and two million new cases of Hepatitis C were registered due to unsafe injecting practices. The speaker mentioned that there were two types of reuse; downstream use and intentional use. The former was said to be the scenario where after appropriate discarding of the syringe by the injector, someone else takes the syringes for use. While under intentional reuse, the injector intentionally brings about the reuse of the syringe.