Altaf Arshad, Shah Sharaf Ali, Shaikh Kulsoom, Constable Fiona M, Khamassi Selma
Bridge Consultants Foundation, 4-E, Block-6, PECHS, Off Sharahe-e-Faisal, Karachi 74500, Pakistan.
BMC Res Notes. 2013 Apr 22;6:159. doi: 10.1186/1756-0500-6-159.
A national study in 2007 revealed that in Pakistan the prevalence of hepatitis B is 2.5% and for hepatitis C it is 5%. Unsafe injections have been identified as one of the reasons for the spread of these infections. Trained and untrained providers routinely perform unsafe practices primarily for economic reasons i.e. they reuse injection equipment on several patients. The patients, do not question the provider about the need for an injection because of social barriers or whether the syringe is coming from a new sterile packet due to lack of knowledge. The present paper represents an intervention that was developed to empower the community to improve unsafe injection practices in rural Pakistan.
In a rural district of Pakistan (Tando Allahyar, Sindh) with a population of approximately 630,000 a multipronged approach was used in 2010 (June to December) to improve injection safety. The focus of the intervention was the community, however providers were not precluded. The organization of interventions was also carefully planned. A baseline assessment (n=300) was conducted prior to the intervention. The interventions comprised large scale gatherings of the community (males and females) across the district. Smaller gatherings included teachers, imams of mosques and the training of trained and untrained healthcare providers. The Pakistan Television Network was used to broadcast messages recorded by prominent figures in the local language. The local FM channel and Sunday newspaper were also used to disseminate messages on injection safety. An end of project assessment was carried out in January 2012. The study was ethically reviewed and approved.
The interventions resulted in improving misconceptions about transmission of hepatitis B and C. In the baseline assessment (only 9%) of the respondents associated hepatitis B and C with unsafe injections which increased to 78% at the end of project study. In the baseline study 15% of the study participants reported that a new syringe was used for their most recent injection. The post-intervention findings showed an increase to 29% (n=87).
It is difficult to assess the long-term impact of the intervention but there were several positive indicators. The duration of intervention is the key to achieving a meaningful impact. It has to be at least 18-24 months long.
2007年的一项全国性研究表明，在巴基斯坦，乙肝的患病率为2.5%，丙肝的患病率为5%。不安全注射已被确认为这些感染传播的原因之一。无论是经过培训的还是未经培训的医护人员，通常都会出于经济原因而进行不安全操作，即他们会对多名患者重复使用注射设备。由于社会障碍，患者不会向医护人员询问注射的必要性，或者由于缺乏相关知识，也不会询问注射器是否来自新的无菌包装。本文介绍了一项干预措施，旨在增强社区能力，以改善巴基斯坦农村地区不安全的注射行为。
2010年（6月至12月），在巴基斯坦一个约有63万人口的农村地区（信德省坦多阿拉亚尔），采用了多管齐下的方法来提高注射安全性。干预措施的重点是社区，但医护人员也未被排除在外。干预措施的组织也经过了精心规划。在干预之前进行了基线评估（n = 300）。干预措施包括在全区范围内针对社区（男性和女性）举行大规模集会。规模较小的集会包括教师、清真寺伊玛目以及对经过培训和未经培训的医护人员进行培训。利用巴基斯坦电视网络以当地语言播放知名人士录制的信息。当地调频电台和周日报纸也被用于传播有关注射安全的信息。2012年1月进行了项目结束评估。该研究经过了伦理审查并获得批准。
这些干预措施有助于纠正对乙肝和丙肝传播的误解。在基线评估中，只有9%的受访者将乙肝和丙肝与不安全注射联系起来，而在项目研究结束时这一比例上升到了78%。在基线研究中，15%的研究参与者报告称他们最近一次注射使用的是新注射器。干预后的调查结果显示这一比例上升到了29%（n = 87）。
虽然难以评估该干预措施的长期影响，但有几个积极指标。干预的持续时间是产生有意义影响的关键。其持续时间至少要有18至24个月。
