Abstract
BackgroundIatrogenic injection injury is a major cause of disability in Ugandan children. Two injuries thought to result from injection of medications into the gluteal region include post-injection paralysis (PIP) and gluteal fibrosis (GF). This study aimed to describe perceptions of local health care workers regarding risk factors, particularly injections, for development of GF and PIP. Specifically, we examine the role of injection practices in the development of these injuries by interviewing a diverse cohort of individuals working in the health sector.MethodsWe conducted a qualitative study in the Kumi and Wakiso Districts of Uganda in November 2017, utilizing 68 key informant interviews with individuals working in healthcare related fields. Interviews were structured utilizing a moderator guide focusing on injection practices, gluteal fibrosis and post-injection paralysis.ResultsWe identified six themes regarding perceptions of the cause of GF and PIP and organized these themes into a theoretical framework. There was a consensus among the individuals working in healthcare that inadequacies of the health care delivery system may lead to inappropriate intramuscular injection practices, which are presumed to contribute to the development of GF and PIP. Poor access to medications and qualified personnel has led to the proliferation of private clinics, which are often staffed by under-trained practitioners. Misaligned economic incentives and a lack of training may also motivate practitioners to administer frequent intramuscular injections, which cost more than oral medications. A lack of regulatory enforcement enables these practices to persist. However, due to limited community awareness, patients often perceive these practitioners as appropriately trained, and the patients frequently prefer injections over alternative treatment modalities.ConclusionThis qualitative study suggests that inappropriate intramuscular injections, may arise from problems in the health care delivery system. To prevent the disability of GF and PIP, it is important to not only address the intramuscular injections practices in Uganda, but also to examine upstream deficits in access, education, and policy enforcement.
Highlights
Iatrogenic injection injury is a major cause of disability in Ugandan children
A recently performed retrospective cohort study in Kumi, Uganda demonstrated that gluteal fibrosis (GF) and post-injection paralysis (PIP) comprise over 30% of clinical hospital visits for musculoskeletal conditions and 40% of outreach visits for disabling conditions in Kumi District [14]
We developed the interview guide based on formative in-country research, information regarding injection practices, GF and PIP from community leaders, and literature reviews on GF and PIP
Summary
Iatrogenic injection injury is a major cause of disability in Ugandan children. Two injuries thought to result from injection of medications into the gluteal region include post-injection paralysis (PIP) and gluteal fibrosis (GF). This study aimed to describe perceptions of local health care workers regarding risk factors, injections, for development of GF and PIP. We examine the role of injection practices in the development of these injuries by interviewing a diverse cohort of individuals working in the health sector. In addition to infectious complications, disabling musculoskeletal conditions including GF and PIP have been linked to intramuscular injections. These have been reported to occur throughout the world including Uganda, where these disabling impairments have become common health problems in children [4, 7,8,9,10,11,12,13]. A recently performed retrospective cohort study in Kumi, Uganda demonstrated that GF and PIP comprise over 30% of clinical hospital visits for musculoskeletal conditions and 40% of outreach visits for disabling conditions in Kumi District [14]
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