Injections should be a last resort â€" health ministry
Jan 18, 2009
INJECTIONS have always been used to administer medicines in prevention or treatment of illness. However, when precautions are not taken, these jabs can expose you to infection and disability.
By Vision Reporter
INJECTIONS have always been used to administer medicines in prevention or treatment of illness. However, when precautions are not taken, these jabs can expose you to infection and disability.
This is common with quinine injections, the reason the anti-malarial jabs are recommended as a last resort. Unfortunately, due to the widespread problem of malaria and its resistance to first choice treatments, many health care providers use quinine injections as a first level medication to the detriment of many.
“Our policy discourages injections. They should be given when everything else has failed. For instance, Quinine is supposed to be given in a hospital when first and second level drugs have failed,†says Dr. Kenya-Mugisha.
“We are trying to phase out quinine injections because we realised they were a common cause of disability,†he adds.
Mugisha explains that injections are administered through the intramuscular route — on the buttocks, or through intravenous fluids (drips). “Even then the medicine has to be diluted first and administered in small doses by trained personnel,†he warns.
Besides, injections are costly both for the health system and the patient. “If I give you a syrup or tablet, I cut out the cost of syringes, needles, cotton wool and antiseptic,†he says.
Injections are applied to parts of the body with a thick muscular layer, like the buttocks, the thighs and the shoulders. In sick children, however, the muscle in these areas may not be thick and this predisposes the child to developing post-injection complications.
Other challenges include inadequate expertise, lack of awareness and the type of drug administered.
An advocacy toolkit for patients’ organisations, titled Addressing Global Patient Safety Issues says injections are not only traumatic but also transmit diseases like Hepatitis B, C and HIV. The booklet says unsafe injections cause an estimated 1.3 million deaths annually, worldwide.
“We passed the injection policy in 2004 but the guidelines are not being followed. Some health workers and patients believe that the more painful the injection is, the more effective it is,†Mugisha says.
Quinine can cause paralysis if accidentally injected into a nerve and is toxic if an overdose is given. Below are some of the complications:
Gluteal fibrosis
This is a muscle disorder in the buttocks. It results from multiple quinine injections. Patients with this condition walk with difficulty, cannot sit properly and usually have scars on the buttocks.
Dr. John Ekure, an orthopaedic surgeon at Kumi Hospital, says gluteal fibrosis cases are increasing. “By November 2007, over 60 children with the condition had been operated on,†he says.
Paralysis of the sciatic nerve
Dr. Antonio Loro, an orthopaedic surgeon at Mengo Hospital, says post-injection paralysis is the most common complication in this clinic.
He explains that the sciatic nerve in the buttocks controls foot movements. The nerve is protected by the gluteal muscles in the buttocks.
“In newborns and infants, this cover can be thin and the nerve can be injured by the needle of a syringe or by the effects of a drug,†he says.
The child then loses function in the foot, a condition known as “drop-footâ€. The child is unable to walk or run properly and the foot becomes deformed. He says although surgery can improve foot function, it will never return to normal.
Dr. Edward Naddumba, a consultant surgeon at the orthopaedic department, Mulago Hospital echoes similar concerns, noting that quinine is especially dangerous if given undiluted on the buttocks. “It has toxic effects on nerves and muscles causing body tissues to die,†he says.
What can be done?
Loro urges people to refrain from requesting for, or giving injections, unless it is necessary. “Injections should be used when a patient cannot take drugs because of vomiting, unconsciousness, or inability to swallow,†he says.
“If there is need for repeated injections, use different sites or switch to other safer routes of drug administration. People should know that they can be prosecuted in case of malpractice.â€
Mugisha advises the community to avoid getting injections from untrained people. “Local leaders should discourage untrained people from giving injectable medicines. Oral medication is effective,†he says.
Health ministry’s role
“Ideally monitoring is the job of bodies like the National Drug Authority and the medical and pharmaceutical practitioners’ councils,†Mugisha says.
“We are also training health workers to administer injections and sensitising people to accept oral treatment as an effective route of administration of drugs.â€
INJECTIONS have always been used to administer medicines in prevention or treatment of illness. However, when precautions are not taken, these jabs can expose you to infection and disability.
This is common with quinine injections, the reason the anti-malarial jabs are recommended as a last resort. Unfortunately, due to the widespread problem of malaria and its resistance to first choice treatments, many health care providers use quinine injections as a first level medication to the detriment of many.
“Our policy discourages injections. They should be given when everything else has failed. For instance, Quinine is supposed to be given in a hospital when first and second level drugs have failed,†says Dr. Kenya-Mugisha.
“We are trying to phase out quinine injections because we realised they were a common cause of disability,†he adds.
Mugisha explains that injections are administered through the intramuscular route — on the buttocks, or through intravenous fluids (drips). “Even then the medicine has to be diluted first and administered in small doses by trained personnel,†he warns.
Besides, injections are costly both for the health system and the patient. “If I give you a syrup or tablet, I cut out the cost of syringes, needles, cotton wool and antiseptic,†he says.
Injections are applied to parts of the body with a thick muscular layer, like the buttocks, the thighs and the shoulders. In sick children, however, the muscle in these areas may not be thick and this predisposes the child to developing post-injection complications.
Other challenges include inadequate expertise, lack of awareness and the type of drug administered.
An advocacy toolkit for patients’ organisations, titled Addressing Global Patient Safety Issues says injections are not only traumatic but also transmit diseases like Hepatitis B, C and HIV. The booklet says unsafe injections cause an estimated 1.3 million deaths annually, worldwide.
“We passed the injection policy in 2004 but the guidelines are not being followed. Some health workers and patients believe that the more painful the injection is, the more effective it is,†Mugisha says.
Quinine can cause paralysis if accidentally injected into a nerve and is toxic if an overdose is given. Below are some of the complications:
Gluteal fibrosis
This is a muscle disorder in the buttocks. It results from multiple quinine injections. Patients with this condition walk with difficulty, cannot sit properly and usually have scars on the buttocks.
Dr. John Ekure, an orthopaedic surgeon at Kumi Hospital, says gluteal fibrosis cases are increasing. “By November 2007, over 60 children with the condition had been operated on,†he says.
Paralysis of the sciatic nerve
Dr. Antonio Loro, an orthopaedic surgeon at Mengo Hospital, says post-injection paralysis is the most common complication in this clinic.
He explains that the sciatic nerve in the buttocks controls foot movements. The nerve is protected by the gluteal muscles in the buttocks.
“In newborns and infants, this cover can be thin and the nerve can be injured by the needle of a syringe or by the effects of a drug,†he says.
The child then loses function in the foot, a condition known as “drop-footâ€. The child is unable to walk or run properly and the foot becomes deformed. He says although surgery can improve foot function, it will never return to normal.
Dr. Edward Naddumba, a consultant surgeon at the orthopaedic department, Mulago Hospital echoes similar concerns, noting that quinine is especially dangerous if given undiluted on the buttocks. “It has toxic effects on nerves and muscles causing body tissues to die,†he says.
What can be done?
Loro urges people to refrain from requesting for, or giving injections, unless it is necessary. “Injections should be used when a patient cannot take drugs because of vomiting, unconsciousness, or inability to swallow,†he says.
“If there is need for repeated injections, use different sites or switch to other safer routes of drug administration. People should know that they can be prosecuted in case of malpractice.â€
Mugisha advises the community to avoid getting injections from untrained people. “Local leaders should discourage untrained people from giving injectable medicines. Oral medication is effective,†he says.
Health ministry’s role
“Ideally monitoring is the job of bodies like the National Drug Authority and the medical and pharmaceutical practitioners’ councils,†Mugisha says.
“We are also training health workers to administer injections and sensitising people to accept oral treatment as an effective route of administration of drugs.â€