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Friday, 7 November, 2003
Jabs in developing world 'unsafe'
Many injections given in the developing world are unsafe, a British Medical Journal study finds.

Needles soaked in tepid water
Needles can be kept in unhygenic conditions

World Health Organization researchers found up to 75% of injections were given with re-used, unsterilised equipment, increasing infection risk.

Re-use was highest in South East Asia, the Middle East and the Western Pacific.

The researchers are calling for greater efforts to hammer home the importance of good hygiene.

They also say single use injection devices must be made more easily accessible.

It is thought the use of unsafe injections is a major cause of the spread of viruses which cause a range of serious diseases, including hepatitis B and C, HIV, absceses, septicaemia, malaria and haemorrhagic fevers.

The researchers found that overall almost one in three injections in developing and transitional countries were administered using re-used and unsterilised equipment.

Too many jabs

They also found too many injections were routinely administered, with each person in these countries receiving an average of 3.4 injections per year.

This is partly due to public demand, the researchers accept, but also stress that health workers seem too keen to offer injections when other, potentially safer methods are available.

They put this down to misconceptions that patients prefer injections, and that they are the best way to deliver treatment.

Lead researcher Dr Yvan Hutin told BBC News Online: "A common scenario is that a patient goes to a doctor with fever or a body pain, and the doctor mixes up a number of antibiotics and vitamins and administers them as an injection when an oral preparation or no treatment at all would be the best option."

The researchers found that injection practices are safer in sub-Saharan Africa than in other parts of the developing world, such as the Middle East and South Asia.

They believe this may be due to an increased awareness of the risk of HIV transmission in sub-Saharan Africa, which has been particularly hard hit by the virus.

Research has shown that the proportion of the population aware of the potential risk of HIV infection through unsafe injections was 24% in Pakistan in 1998, 19% in India in 1999, but 52% in Burkina Faso in 2001.

Writing in the BMJ, the researchers say: "An urgent need exists to use injections safely and appropriately, to prevent healthcare associated infections with HIV and other bloodborne pathogens."

Thursday, 25 September, 2003
Vaccine rates are overestimated
Vaccination is vital to control disease

Official data on global vaccination rates may exaggerate how many people are immunised against common diseases, say experts.

A team from the World Health Organization examined data on the diphtheria-tetanus-pertussis vaccine.

They found official coverage rates were much higher than those recorded in house-to-house surveys.

Writing in The Lancet, they warn effective public health programmes depend on accurate data.

The researchers examined vaccination records for 45 countries in the developing world between 1990 and 2000.

They compared official data submitted by health centres and workers who give out vaccines, with that collected by researchers who asked individual people whether or not they had been vaccinated.
It's all about locating children who have not been vaccinated
Dr Maureen Birmingham

Consistently, the household surveys showed that fewer people had been vaccinated than the numbers suggested by the official returns.

The discrepancy was so large that the researchers calculated that an official vaccination rate as high as 16.3% could in reality mean that no effective vaccinations took place on the ground.

Practical problems

The researchers believe that part of the problem is that data collection systems are not up to the job.

For example, official data often fails to record whether children received their jabs at the proper age, or whether follow-ups were given at the correct intervals.

It may be that lumping "valid" and "invalid" vaccinations together inaccurately inflates the coverage rate.

However, they also warn that it is possible that incentive schemes designed to boost vaccine rates may lead to the figures being inflated.

In addition, they point out that it can be very difficult to keep track of vaccinations delivered outside the public sector.

Although house-to-house surveys appear to give a more accurate picture, they are extremely labour intensive and expensive to carry out, and therefore can only be done on a very limited basis.

Lead researcher Dr Bakhuti Shengelia told BBC News Online: "Reliability of data is important in order to keep a better track of how well we are doing in terms of protecting children from infectious disease."

Dr Maureen Birmingham, of the WHO's vaccine assessment and monitoring team, told BBC News Online that a system of audit had recently been introduced to try to improve the way vaccination programmes were reported.

However, she said it was not fair to suggest that official records always overestimated coverage rates. In fact some countries, such as Kenya, probably underestimated the scope of their vaccination programmes.

"It's all about locating children who have not been vaccinated," she said. "If we don't have accurate local data then we cannot do that."



For archive purposes, this article is being stored on website.
The purpose is to advance understandings of environmental, political,
human rights, economic, democracy, scientific, and social justice issues.