Injection that is just not right
Jun 12, 2011
FILLED with admiration, five-year-old Paul Otim watches his friends kick the ball. Otim cannot kick the ball because one of his legs is weak. In fact, the leg is smaller and shorter than the other.
By Agnes Kyotalengerire
FILLED with admiration, five-year-old Paul Otim watches his friends kick the ball. Otim cannot kick the ball because one of his legs is weak. In fact, the leg is smaller and shorter than the other.
According to Patrick Ndoboli, a medical officer in the orthopaedics department at Mulago Hospital, Otim’s condition is injection neuritis or post-injection paralysis. This is an inflammation or swelling of the sciatic nerve (which passes through, and supplies muscles in the thighs, feet and legs).
Injection neuritis is common in children. According to records at the Orthopaedic Clinic, Mulago Hospital, about two to four cases are registered every week.
Signs
Ndoboli says the commonest is a history of malaria and having walked normally prior to the paralysis. In addition, sensations are often altered, for example, there is loss of feel and touch, pain in the area, itching and pins and needles. Besides, a child develops a drop foot or walks with a high stepping gait.
Cause
Dr. Sabrina Kitaka, the president of Uganda Paediatrics Association, says the major cause of injection neuritis is not adhering to proper drug administration.
According to Ndoboli, for proper administration of injections, the gluteal area (buttock) is divided into four parts by two intersecting lines. The injection is then given in the upper outer quadrant, avoiding the inner quadrant that contains the sciatic nerve.
Who is at risk?
Ndoboli says children, especially those with thinner buttocks are at higher risk. The thinner the child’s buttocks the high the chances of damaging the sciatic never,†he affirms.
However, Kitaka notes that any child in the hands of an untrained medical personnel can develop injection neuritis. Naturally, children fear injections, so as they fight and twist, the needle may go to the wrong direction and end up in the sciatic nerve.
Precautions
Kitaka adds that it is not necessary to inject children often because most childhood sicknesses can be treated with oral medicines. “It is dangerous to inject medicine that can be taken orally†she cautions, adding that injections should be given only when necessary, for instance in emergencies, and should be given by trained medical personnel.
“Besides, even during emergency, children under two years should never be injected on the buttocks.†She encourages injecting on the upper outer part of the thigh.
Ndoboli partly blames parents for not restraining children while being injected. A child should be held firmly with the trunk (body) under the arm of the person restraining, while the other arm holds the back of the child to prevent him from jumping and twisting.
Though all drugs, when administered wrongly, can cause injection neuritis, Kitaka says the common drug known to cause injection neuritis is quinine. She says when administered as an intra-muscular injection, it kills the nerves in the area where it is deposited.
Ndoboli notes that all drugs with quinine inclusive when administered wrongly (on the sciatic nerve) can cause paralysis.
However, quinine is reportedly notorious for causing dip punched out ulcer, especially when administered as an intra-muscular injection.
When administered near the skin, it causes sores or may turn into an ulcer. Kitaka encourages giving quinine as an intravenous injection.
If a child is limping or has acute paralysis, he should be taken to hospital. Ndoboli says correction of paralysis depends on how much damage had been done.
To help correct the paralysis, the patient is given drop foot screen (plastic modelled on the leg, foot and ankle to prevent the foot from dropping
FILLED with admiration, five-year-old Paul Otim watches his friends kick the ball. Otim cannot kick the ball because one of his legs is weak. In fact, the leg is smaller and shorter than the other.
According to Patrick Ndoboli, a medical officer in the orthopaedics department at Mulago Hospital, Otim’s condition is injection neuritis or post-injection paralysis. This is an inflammation or swelling of the sciatic nerve (which passes through, and supplies muscles in the thighs, feet and legs).
Injection neuritis is common in children. According to records at the Orthopaedic Clinic, Mulago Hospital, about two to four cases are registered every week.
Signs
Ndoboli says the commonest is a history of malaria and having walked normally prior to the paralysis. In addition, sensations are often altered, for example, there is loss of feel and touch, pain in the area, itching and pins and needles. Besides, a child develops a drop foot or walks with a high stepping gait.
Cause
Dr. Sabrina Kitaka, the president of Uganda Paediatrics Association, says the major cause of injection neuritis is not adhering to proper drug administration.
According to Ndoboli, for proper administration of injections, the gluteal area (buttock) is divided into four parts by two intersecting lines. The injection is then given in the upper outer quadrant, avoiding the inner quadrant that contains the sciatic nerve.
Who is at risk?
Ndoboli says children, especially those with thinner buttocks are at higher risk. The thinner the child’s buttocks the high the chances of damaging the sciatic never,†he affirms.
However, Kitaka notes that any child in the hands of an untrained medical personnel can develop injection neuritis. Naturally, children fear injections, so as they fight and twist, the needle may go to the wrong direction and end up in the sciatic nerve.
Precautions
Kitaka adds that it is not necessary to inject children often because most childhood sicknesses can be treated with oral medicines. “It is dangerous to inject medicine that can be taken orally†she cautions, adding that injections should be given only when necessary, for instance in emergencies, and should be given by trained medical personnel.
“Besides, even during emergency, children under two years should never be injected on the buttocks.†She encourages injecting on the upper outer part of the thigh.
Ndoboli partly blames parents for not restraining children while being injected. A child should be held firmly with the trunk (body) under the arm of the person restraining, while the other arm holds the back of the child to prevent him from jumping and twisting.
Though all drugs, when administered wrongly, can cause injection neuritis, Kitaka says the common drug known to cause injection neuritis is quinine. She says when administered as an intra-muscular injection, it kills the nerves in the area where it is deposited.
Ndoboli notes that all drugs with quinine inclusive when administered wrongly (on the sciatic nerve) can cause paralysis.
However, quinine is reportedly notorious for causing dip punched out ulcer, especially when administered as an intra-muscular injection.
When administered near the skin, it causes sores or may turn into an ulcer. Kitaka encourages giving quinine as an intravenous injection.
If a child is limping or has acute paralysis, he should be taken to hospital. Ndoboli says correction of paralysis depends on how much damage had been done.
To help correct the paralysis, the patient is given drop foot screen (plastic modelled on the leg, foot and ankle to prevent the foot from dropping