|Year : 2012 | Volume
| Issue : 2 | Page : 99-102
Sudanese patients' perception on safe use and disposal of injections
Mirghani Yousif1, HassabElrasoul Elfadil1, Ahmed Eldalo2, Amre Nasr3
1 Department of Pharmaceutics, Faculty of Pharmacy, University of Gezira, Sudan
2 Department of Pharmacology, Faculty of Pharmacy, National Ribat University, Sudan
3 Department of Microbiology, Faculty of Science and Technology, Al-Neelain University, Sudan
|Date of Web Publication||13-Sep-2012|
Professor of Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Sudan, P.O. Box: 20, Medani
Source of Support: None, Conflict of Interest: None
Objective: Thousands of millions of injections are unsafely administered and disposed every year in developing countries, which may pose hazardous consequences to the environment as well as public. The prime objective of this study was to determine the perception and attitudes of the Sudanese patients about safe use and disposal of injections. Materials and Methods: A cross-sectional study was carried out. One thousand patients were randomly selected from different health settings in Sudan. Data collection was carried out during the period from September 2009 to March 2010. Results: The majority of the respondents (95.1%) admitted that they had received medicines in injection form through their lives. Nurses were the dominant injection administrators (42.5%), while the doctors formed 19.8%. Majority of the interviewed patients had their injections at homes (38.7%). In the present study, 72.9% of the patients used to take drugs in injection by using sterile disposable syringes. Unfortunately, around 90% of the used injections found their way to inappropriate disposal places. These unaccepted injection disposal practices led to a considerable rate of used injection sticks (26.1%). Conclusions: A set of recommendations was proposed in an attempt to educate patients on the safe use and disposal of injections.
Keywords: Injection disposal, patients, perception, provider, Sudan
|How to cite this article:|
Yousif M, Elfadil H, Eldalo A, Nasr A. Sudanese patients' perception on safe use and disposal of injections. Saudi J Health Sci 2012;1:99-102
| Introduction|| |
One of the biggest global concerns is the spread of the Human Immunodeficiency Virus (HIV), the hepatitis B virus (HBV), and the hepatitis C virus (HCV) due to the reuse of injection devices. This problem is worldwide, affecting developed countries as well as developing ones. Injection drug use accounts for approximately one-third of all AIDS cases in the United States and for 60% of new hepatitis C infections.  Inadequate management and disposal of waste generated by injection activities such as sharps and infectious waste can have negative impacts, either directly or indirectly on the waste handlers. Knowledge of prevalence of illegal drug injection can aid the design and evaluation of services for problem drug users. 
Thousands of millions of injections are unsafely administered and disposed every year in developing countries. The transmission of certain blood-borne pathogens via this pattern of use is thought to be a major public health problem.  The need for injection drug users (IDUs) to have access to sterile syringes for the prevention of injections' transmitted diseases and other health problems and to know the best way to deal with these injection medicines is a very important issue for the healthcare authorities. The main objective of this first Sudan attempt study is to determine the perception and attitudes of the Sudanese patients about safe use and disposal of injections .
| Materials and Methods|| |
A cross-sectional study was carried out to determine the Sudanese public's perception on the safe use and disposal of injections. One thousand patients were randomly selected from different health settings from Khartoum, Gezira, Gedarif, Sennar, and White Nile states to represent the central region of Sudan. Questionnaire was pretested in a similar health setting and the results were not included in the original study. Data collection was carried out during the period from September 2009 to March 2010. The questionnaire was composed of three parts: The first part was designed to determine information on respondents' demographic characteristics such as age, education level, residency, and occupation. The second part tested the public knowledge and behavior toward the safe use and disposal of injections, frequency of injection use, and on the preferred route of drug administration and the reasons of their preference. Also, they were questioned about diseases that are possibly transmitted by unsafe use and disposal of injections. The third part concentrated on the injections' providers, their practice toward the syringe disposal, and their place of administration. Data were analyzed using Statistical Package for Social Sciences (SPSS 16.0). Absolute frequencies were described as percentages. Chi-square analysis was used to evaluate the associations for different study characteristics. P value <0.05 was taken as a cutoff level for significant association.
| Results|| |
In the present study, females showed slight dominance [551 (55.1%)]. Middle-aged patients (21-40 years) numbered 541 (54.1%), while elders >60 years showed the least rate of participation [17 (1.7%)]. Most of the interviewed respondents were of urban residence [722 (72.2%)]. Students, housewives, and doctors showed the rate of responses 546 (54.6%), 82 (8.2%), and 55 (5.5%), respectively. Regarding the education level, most of the respondents were university educated [675 (67.5%)], while only 39 (3.9%) were illiterate. Other demographic characteristics are shown in [Table 1].
The majority of the respondents [951 (95.1%)] admitted that they had received medicines in injection form through their lives. The prevalence of use of injectable medicines was shown by the fact that 327 (32.7%) of the respondents in the present study were administered different types of medicines via injecting devices. In the last 3 months, 326 (32.6%) of the respondents had obtained injectable medicines, 263 (26.3%) of them were vaccinated ones, and only 562 (56.2%) of the participants had known the name of last taken injection medicines.
[Table 2] shows that the nurses were the dominant injection administrators [425 (42.5%)], while the doctors numbered 198 (19.8%). The study revealed a significant association between the place of residence and the provider's type preference. The urban residents preferred to be injected by doctors [155 (21.5%)], while 43 (15.5%) of the rural residents preferred the same (P = 0.049). Astonishingly, 164 (16.4%) of the respondents in this study did not recognize the job category of their injection administrators. Regarding gender preference, males in this study preferred to be injected by doctors [102 (22.8%)], while 96 (17.4%) females preferred the same. Females preferred injections by nurses [248 (45%)] more than males did [176 (39.3%)] (P = 0.005).
[Figure 1] illustrates the places where the respondents had their injections during the time of this study. The majority of interviewed patients [387 (38.7%)] had their injections at homes, while 228 (22.8%) and 201 (21.1%) were administered their injectable medicines at private clinics and hospitals, respectively. The respondents living in the urban areas used to have their injection medicines in the clinics [248 (24.8%)] and hospitals [176 (17.6%)], while those in the rural areas preferred to be injected at homes (41%), and a significant association was observed (P < 0.001).
The majority of the injections [724 (72.4%)] were freely administered ones, while 248 (24.8%) of the injections in the study were administered upon charging cost. The use of disposable syringes was prevalent among other types of injecting devices; 729 (72.9%) of the patients in the present study used to take drugs in injection by using a new, not peeled, and single-use sterile disposable syringes. The other old types of re-sterilized injecting devices showed a negligent rate of occurrence [Table 3].
One of the main objectives of this study was to determine the ways and the places where the Sudanese patients disposed the injecting devices after use [Figure 2]. Unfortunately around 90% of used injections found their way to inappropriate places other than the recommended ones. These unaccepted injection disposal practices led to a considerable rate of used injection sticks [261 (26.1%)] as revealed in the present study, which may have hazardous consequences to the environment as well as to public.
In reference to the preference of the route of administration, the majority of respondents preferred to be treated by oral route [640 (64.0%)]. The respondents living in rural areas had shown no preference to specific route of administration, while urban people used to prefer the oral one (69.4%), and a significant association was observed (P ≤ 0.001). Most of the patients who preferred to take oral medications attributed their preference to the easy intake [368 (36.8%)], psychological [134 (13.4%)] reasons, and safety reasons [79 (7.9%)].
Most of the interviewed patients [967 (96.7)] were well aware of the fact that unsafe disposal of used injections can lead to infectious diseases; 513 (51.3%) of the respondents had mentioned that HIV is the most possible infection caused as a result of unsafe disposal of injections, while 259 (25.9) and 206 (20.6%), respectively, mentioned tetanus and hepatitis B as the most prevalent infections due to unsafe disposal of injections. There were significant differences between males and females regarding awareness of infectious diseases transmitted by unsafe disposal of injections (P = 0.016).
| Discussion|| |
This study revealed that the majority of the respondents (95.1%) admitted that they had received medicines in injection form through their lives. In the last 3 months, 32.6% of the respondents had been treated by injectable medicines. This is in agreement with the WHO report on the increased pattern of injection use.  The majority of interviewed patients had their injections at homes (38.7%). This result was supported by a study carried out in the same area in 2002 by Yousif who illustrated that there was a liberal and growing practice of in-home injection use. 
The use of disposable syringes was more prevalent than other types of injecting devices; 72.9% of the patients in the present study used to take drugs in injection by using a new, not peeled, and single-use sterile disposable syringe. A survey conducted on USA healthcare workers who provide medication through injection found that only 1-3% reused the same needle and/or syringe on multiple patients.  On the other hand, the estimated proportion of syringe and needle re-use in Africa region was 17-19% as reported by Hutin et al. ,
This study revealed that unfortunately around 90% of the used injections found their way to inappropriate places other than the recommended ones. These unaccepted injection disposal practices led to a considerable rate of used injection sticks (26.1%); this may highly contribute to potential spread of infectious diseases. This unacceptable disposal rate was lagging behind when compared with an American published study where most of the participants had reported placing their syringes in a container before throwing them away. The second most common means of disposal was the sharps container at a syringe exchange program, utilized by 49% of the participants. , An earlier study in Burkina Faso showed that 88% of the healthcare facilities used sharps waste management measures. 
WHO, UNICEF, and UNFPA affirmed the need to supply auto disable syringes and safety boxes together for all consignments of vaccines.  Also, WHO recommends that injection device security is ensured in all healthcare facilities, including therapeutic services, so that injectable medicines, diluents, single-use injection devices, and safety boxes are supplied in a timely manner in adequate quantities. 
| Conclusions|| |
The present study revealed that most of the injection medicine administrators in Sudan were nurses and doctors. The in-home injection practice is common. Majority of the injections used are sterile, but most of them found their way to inappropriate disposal places, leading to injection sticks, and thus an increasing possibility for the spread of infectious diseases.
| Recommendations|| |
The findings encourage the investigators to recommend education and awareness programs to public, patients, as well the healthcare professionals about the safe use and disposal of injections. The development or setting of standard operation procedures for rational disposal of injections and sharp medical wastes is strictly recommended.
| Acknowledgments|| |
The authors would like to express their sincere gratitude to the Higher Ministry of Education and Scientific Research, Sudan, for providing the grant and offering the opportunity to come up with this first ever attempt in Sudan. We would like to thank Batch 29 students of the Faculty of Pharmacy, University of Gezira, for data collection. All authors read and approved the final version of the manuscript and the authors declare no conflict of interests.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]