Abstract

ObjectiveSince 1999, substantial efforts have been made by the international community to reduce the risks associated with unsafe injections, through ministries of health, international donors, the World Health Organization and the Safe Injection Global Network. The present study attempted to measure the progress, or lack thereof, made over the 2000–2010 decade in reducing unsafe injections in ten regions of the world corresponding to developing and transitional economies.MethodsData about the number of injections per person per year and the proportion of re-use of syringes and needles were obtained for 2010, mainly from population surveys, and compared with previous estimates for 2000 which had used various sources of information including injection safety assessments, population surveys and published studies on injection practices.ResultsFrom 2000 to 2010, in developing countries and transitional economies, the average number of injections per person per year decreased from 3.40 to 2.88, while the proportion of re-use of injection devices dropped from 39.8% to 5.5%. Combining both factors the number of unsafe injections per person per year decreased from 1.35 to 0.16. Even if substantial progress has been made, the Eastern Mediterranean region remains problematic, with 0.57 unsafe injections per person per year. In sub-Saharan Africa and Latin America, people now receive on average only 0.04–0.05 unsafe injections per year.ConclusionSubstantial progress has been made in reducing the number of unsafe injections in developing countries and transitional economies, essentially through a reduction in the re-use of injection devices. In some regions, elimination of unsafe injections might become a reasonable goal.

Highlights

  • The World Health Organization (WHO) defined a safe injection as one which does not harm the recipient, does not expose the provider to any avoidable risk and does not result in waste that is dangerous for the community [1]

  • Such re-use carries a risk of transmission of bloodborne viruses and represents the overwhelming majority of ‘unsafe healthcare injections’ or ‘unsafe injections’

  • In the year 2000, WHO estimated that unsafe healthcare injections accounted for 5% of HIV infections, 32% of hepatitis B virus (HBV) infections and 40% of hepatitis C virus (HCV) infections acquired in developing and transitional countries [3,4,5]

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Summary

Introduction

The World Health Organization (WHO) defined a safe injection as one which does not harm the recipient, does not expose the provider to any avoidable risk and does not result in waste that is dangerous for the community [1]. Unsafe injections are linked to overuse of injections for mild conditions where oral drugs would be as effective (in Pakistan for instance, more than 90% of injections are thought to be unnecessary [2]), and to the reuse of injection equipment on several patients without adequate sterilization. Such re-use carries a risk of transmission of bloodborne viruses and represents the overwhelming majority of ‘unsafe healthcare injections’ or ‘unsafe injections’. The present study addressed the first of the above-mentioned strategies and attempted to document the impacts of these efforts, by measuring the relative reduction or increase, from 2000 to 2010, in unsafe injections in various regions of the world

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