Safety of immunization injections in Africa: not simply a problem of logistics

In 1995, the WHO Regional Office for Africa launched a logistics project to address the four main areas of immunization logistics: the cold chain, tra nsport, vaccine supply and quality, and the safety of injections in the cou ntries of the region. The impact of this logistic approach on immunization injection safety was evaluated through surveys of injection procedures and an analysis of the injection materials (e.g. sterilizable or disposable syr inges) chosen by the Expanded Programme on Immunization (EPI) and those act ually seen to be used. Re-use of injection materials without sterilization, accidental needle-stick injuries among health care workers, and injection- related abscesses in patients were common in countries in the WHO African R egion. Few health centres used time-steam saturation-temperature (TST) indi cators to check the quality of sterilization and, in many centres, the inje ction equipment was boiled instead of being steam sterilized. Facilities fo r the proper disposal of used materials were rarely present. Although the o fficial EPI choice was to use sterilizable equipment, use of a combination of sterilizable and disposable equipment was observed in the field. Unsafe injection practices in these countries were generally due to a failure to i ntegrate nursing practices and public awareness with injection safety issue s, and an absence of the influence of EPI managers on health care service d elivery. Holistic rather than logistic approaches should be adopted to achi eve safe injections in immunization, in the broader context of promoting sa fe vaccines and safety of all injections.