Unsafe injections and the transmission of hepatitis B and C in a periurbancommunity in Pakistan

Following reports of frequent deaths associated with jaundice and chronic l iver disease among adults in a periurban community of Karachi, Pakistan, an investigation was conducted to evaluate the relationship between injection s and viral hepatitis infections, to identify the reasons why patients rece ived frequent injections, and to observe the injection practices employed i n clinics. Two hundred and three adult patients were interviewed as they le ft each of the 18 area clinics. Practitioners were interviewed and three co nsecutive injections were observed at each clinic. Eighty-one per cent of p atients received an injection on the day of the interview. Of the 135 patie nts who provided a serum sample, 59 (44%) had antibodies against hepatitis C virus and 26 (19%) had antibodies against hepatitis B virus. Patients who received more injections were more likely to be infected with hepatitis C. if oral and injected medications were equally effective, 44% of patients p referred injected medication. None of the practitioners knew that hepatitis C could be transmitted by injections. Non-sterile syringes and needles tha t had been used earlier in the day on other patients were used for 94% of t he observed injections. interventions to limit injections to those which ar e safe and clinically indicated are needed to prevent injection-associated infections in Pakistan and other low-income countries.