• Arshad Altaf
  • Zafar Fatmi
  • Agha Ajmal
  • Tanweer Hussain
  • Henna Qahir
  • Mubina Agboatwalla


Background: Unsafe injections including reuse of disposable syringe is very common in developing countries including Pakistan.  Healthcare providers unnecessarily prescribe injections to patients suggesting that patients ask for injections. We conducted this qualitative study to determine the reasons of overuse of therapeutic injections by the communities in Sindh province of Pakistan. Methods: Using field-tested focus group guides of World Health Organization, eighteen focus group discussions (FGDs) were conducted with community members of rural Sindh, peri-urban and urban Karachi during January-February 2001. Results: Injections are overused in Sindh, Pakistan, because patients prefer them, believing that they provide quick relief, and perceive them as a therapeutic norm and standard practice. According to community members initiative of prescription of injections are taken by doctors.  Overuse of injections is of particular concern as patients are not aware of the risks associated with reuse of injection equipment.  Doctors and television are considered as the most credible source of providing healthcare information. Conclusion: There is a need to educate communities regarding rationale use of therapeutic injections. Open discussion and frequent communication between doctors and patient should be encouraged. Mass media could play a vital role in educating communities about risks of unsafe injections. Key words: Overuse, unsafe injections, focus groups, patient’s awareness, hepatitis B, hepatitis C


Hutin YJ, Hauri AM, Armstrong GL. Use of injections in healthcare settings worldwide, 2000: literature review and regional estimates. BMJ 2003;327(7423):1075-6.

Aide Memoire Injection Safety. Secretariat of Safe Injection Global Network, Blood Safety and Clinical Technology, World Health Organization.

Raglow GJ, Luby SP, Nabi N. Therapeutic injections in Pakistan: from the patients' perspective. Trop Med Int Health 2001;6(1):69-75.

Das N, Khan AN, Badini ZA, Baloch H, Parkash J. Prescribing practices of consultants at Karachi, Pakistan. J Pak Med Assoc 2001;51(2):74-7.

Pasha O, Luby SP, Khan AJ, Shah SA, McCormick JB. Household members of hepatitis C virus-infected people in Hafizabad, Pakistan: infection by injections from healthcare providers. Epidemiology Infection 1999;123:515-8.

Luby SP, Qamruddin K, Shah AA, Omair A, Pahsa O, Khan AJ et al. The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan. Epidemiol Infect 1997;119(3):349-56.

Khan AJ, Luby SP, Fikree F, Karim A, Obaid S, Dellawala S et al. Unsafe injections and the transmission of hepatitis B and C in a periurban community in Pakistan. Bull World Health Organ 2000;78(8):956-63.

Baig MAA. Status Paper on Urban Environment of Sindh, 2002.

Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bull World Health Organ 1999;77(10):789-800.

Talaat M, el-Oun S, Kandeel A, Abu-Rabei W, Bodenschatz C, Lohiniva AL et al. Overview of injection practices in two governorates in Egypt. Trop Med Int Health 2003;8(3):234-41.

Hadiyono JE, Suryawati S, Danu SS, Sunartono, Santoso B. Interactional group discussion: results of a controlled trial using a behavioral intervention to reduce the use of injections in public health facilities. Soc Sci Med 1996;42(8):1177-83.