Therapeutic injections in Pakistan: from the patient's perspective

OBJECTIVE Toinvestigate the behaviour, knowledge of risks, and attitudes to wards injections among patients at a clinic in Karachi. METHODS In March 1995, trained staff administered a structured questionnair e to 198 consecutive new adult patients attending a university clinic in Ka rachi, Pakistan. RESULTS Half (97; 49%) of the patients received injections at their last vi sit to a health care provider. 35% had received 10 or more injections in th e last year. 64% fell that injections were more powerful and were willing t o pay more for them than for pills. 84% preferred pills or advice over inje ctions if told they were equally effective, 83% believed that a used needle could transmit a fatal disease, and 86% believed that it is usually possib le to get better without an injection. 91% reported that the doctor always recommends an injection; few patients (9%) ever asked for one. Injections w ere given without much regard for the chief complaint of the patient. Some needles (n = 21) for the injection came from bowls of water: of those from closed packets (n = 116), 68 were 'cleaned' by wiping or placing them in wa ter. 91% of patients (180) knew at least one risk of reuse of needles. Pati ents who knew three or more risks of using unclean needles were 0.14 times as likely to have had more than five injections per year in the last 5 year s but only if the patients had 8 or more years of education. CONCLUSION Patients receive injections from doctors in Pakistan frequently indiscriminately and often without proper safety precautions. They are awar e of both positive and negative-aspects of injections but are likely to do what the doctor suggests. Interventions to reduce risky overuse of injectio ns should focus on patients' general education and knowledge of the risks o f injections to empower them to choose healthier therapies.