SIGN Pakistan

1
SIGN Pakistan

• Dr. Arshad Altaf

2
Objectives of the Presentation

• Overview of burden of disease in Pakistan because
  of unsafe injection practices
• Present activities of SIGN Pakistan
• Future plan

3
Burden of diseases in Pakistan

• Studies in Pakistan have found hepatitis C
• 60 hepatitis among liver cancer patients (Ahmed
  et al., 1995)
• 51 among beta thalassemia major patients (Ahmed
  et al., 1995)
• 46 among chronic liver disease patients (Mujeeb
  et al., 1998)
• 18 among cirrhotic patients (Mujeeb et al.,
  1998)
• 20 among commercial blood donors (Mujeeb et al.,
  1998)

4
Unsafe Injection Practices

• 1993 Luby et. al.
• 6.5 antibodies positive for hepatitis C in
  Hafizabad, Pakistan
• 1994 Luby et al.
• Follow up case control study to identify risk
  factors
• Positive individuals were 8.2 times more likely
  to receive gt 5 injections per year

5
Unsafe Injections Practices

• 1995 Aamir Javed Khan et al.,
• Investigated relationship between hep B C and
  injections in peri urban Karachi
• 44 hepatitis C positive
• those who received more injections were more
  likely to be hepatitis C infected
• 94 of the needles/syringes were reused

6
Unsafe Injections Practices

• 1995 Reaglow et al., KAP study
• 49 received one or more injections at their last
  visit to health practitioner
• 35 received 10 or more injections in the last
  year
• 64 felt that injections are more powerful

7
Creation of SIGN Pakistan

• FIRST NATIONAL SYMPOSIUM
• First national symposium on Safe Injection and
  Blood Practices in Pakistan on Feb 15, 2000
• Objectives
• Provide a forum to discuss ideas
• Identify persons and process to develop
  assessment protocol
• Collect input for intervention from those who
  have conducted studies
• Foster formation of Safe Injection working group

8
Formation of SIGN Pakistan

• SIGN Pakistan Working Group formed
• Maillist created (signpak_at_maillists.com)
• First national meeting Partners in Injection
  Safety on June 17, 2000
• Objectives
• Formal announcement of SIGN Pakistan
• To identify national stakeholders

9
SIGNPAK Working Group

• The Aga Khan University
• Sindh AIDS Control Programme, Government of Sindh
• HOPE

10
National Stakeholders

• National Institute of Health, Islamabad
• WHO
• UNAIDS
• World Bank
• Becton Dickinson
• EPI (Expended Programme of Immunization)
• UNICEF
• CIET International
• PPHF (Pakistan Public Health Foundation)

11
Development of Injection Assessment Tool

• Training workshop organized in Karachi
  (collaborating with SIGN-Geneva)
• Dr. Anne Reeler-Medical Anthropologist
• Development and assessment of tool in Karachi
• Capacity building

12
Findings from Initial Assessment

• Target groups Community patients, health care
  providers, dispensers, vaccinators
• Findings
• Communities and patients knew about disposable
  syringes
• Patients rely on doctor for prescription
• They want fast relief
• Cheaper to get injections
• Not aware of hepatitis B or C, aware of
  pain/abscesses

13
Findings continued

• General practitioners
• Injections are important to stay in business
• Cost of prescription with and without injection
  is the same
• No consensus on who initiates injections
• 80-100 patients get at least one injection
• No health information given to patients

14
Action Plan

• Research
• Qualitative assessment in all four provinces
• Resources available for one province (SINDH)
• Quantitative survey in an intervention area
• Develop appropriate health messages

15
Action Plan

• Advocacy
• Sensitize policy planners
• Disposable medical devices ordinance 2000
• Manufacturers-cheap technologies
• Advocacy seminars/workshops
• NATIONAL COLLABORATORS

16
Action Plan

• Intervention
• Four Ps
• Physicians
• Patients
• Population
• Press