Why you should avoid your next injection

Dar es Salaam. Seven out of every 10 patients seeking treatment in private health clinics today are most likely given a n injection that they do not need.

According to research findings, some private health facilities are cashing in on ignorant patients by prescribing injections they could have avoided altogether. Health experts say the trend runs counter to medical ethos and exposes patients to deformity and death.

Studies in Tanzania show that over 70 per cent of patients attending out-patient clinics at private dispensaries receive at least one injection per consultation--higher than the WHO recommended target of 10 per cent.

Local researchers told The Citizen on Saturday that mushrooming of private health clinics is more a public health threat than an advantage, with owners of some of the facilities accused of raising their revenues by over-prescribing injections.

A medical practitioner can only suggest an injection when it is within the “standards of medical practice”. Not every medical condition is treated by administering injectables. But studies have uncovered a rising trend of careless prescription practices, mostly in private health facilities.

WHO says 70 per cent of the injections given in clinics in many developing countries could have been avoided. In certain regions of the world, the agency cautions, the use of injections has completely overtaken the real need--rising to proportions that are no longer based on rational medical practice.

In an exclusive interview, a researcher on Substances of Abuse at the University of Dodoma affirmed that many patients believe that injectable medicine is very effective in treatment. This has created loopholes for unethical medical conduct.

“Injectable medicine indeed works very fast and is effective,” says Dr Steven Nsimba. “What is worrying is that unscrupulous medics are over-prescribing injections and this has its dangers.” Dr Nsimba, also a senior lecturer at UDOM’s School of Medicine, collaborated with experts from the University of Botswana in publishing a study on the overuse of injections in developing countries.

According to the study, published in the Asian Pacific Journal of Tropical Medicine, the demand and use of injections is driven both by health care providers and patients. “...even if the clinicians refuse to provide them, the same patients can still buy them from drug shops without the doctors’ prescription and get injected in their households by untrained people,” the study says. “On the other hand, clinicians, especially in the private health facilities, gain some money from additional charging of the injections prescribed or administered.”

The study, titled “Dangers of injection overuse in developing countries with a high HIV/Aids prevalence”, says better interventions have yet to be found. It says injection safety can be improved by switching the mindset of health care providers who think that patients want injections all the time.

Another study, “Reducing therapeutic injection overuse through patients-prescribers Interaction Group Discussions”, warned of the likelihood of adverse effects of possible use of unsafe syringes and the added cost to the patient and the healthcare system.

The study was conducted in 2011 in Kinondoni municipality in Dar-es-salaam. It aimed at investigating the impact of behavioural change on injection-prescribing practices in 10 selected public dispensaries in Kinondoni District. It was carried out by experts from Ocean Road Cancer Institute and the University of Dar es salaam and Kinondoni Municipal Council.

Speaking on condition of anonymity for fear of being sacked, doctors who have worked in private dispensaries in Dar es Salaam and Dodoma said that while the practice is unethical, they are not in a position to confront their employers. “This is rather confidential, but over-prescription was part of my orientation programme at the private facilities where I have worked,” said a dentist who has worked in a number of private clinics in Dar es Salaam. “It’s meant to raise the revenues of the health facility and this is how we survive.”

The preferred injections tend to be the expensive kind, said another doctor at a private hospital in Dodoma. “Injections for multivitamins, antibiotics as well as painkillers, for instance, are overprescribed because they are less likely to kill the patient when you overdose,” he confided.

Dr Samuel Ogillo, the chief executive officer at the Association of Private Health Facilities in Tanzania (APHFT), argues that private health facilities are not the only culprits. He told The Citizen on Saturday: “This happens in both private and public health care facilities.It also happens in developed countries and those caught usually face legal action.

APHFT advocates medical ethics and we are very strict about ethical standards of practice. Those who contravene them do not deserve to be called medical professionals and are conmen.”