Excessive use of avoidable therapeutic injections in the upazilla health complexes of Bangladesh.

Injection use problem in the hospitals of upazilla health complexes (UHCs) of Dhaka and Noakhali districts was studied through small group discussion with the health personnel of each the UHCs. The group discussion revealed that in the hospitals of UHCs of Dhaka, the antibiotic injections were used in 70% to 100% of the encounters in ARI/pneumonia. In dehydration, I.V. fluid and antimicrobial injections were used in 60% to 100% of the encounters. Similarly 60% to 70 % of the encounters received analgesic and antibiotic injections in injury. Injections were used in > or =30% of the encounters in pyrexia of unknown origin. The use of injections in the hospitals of the UHCs of Noakhali was comparatively less than that of Dhaka, but was still too high. In ARI/pneumonia antibiotic injections were used in 60% to 80% of the encounters. In dehydration, I.V. fluid and antimicrobial injections and in injury, analgesic and antibiotic injections were used in 60% to 80% of the encounters in each of the health conditions. In weakness, I.V. fluid and amino acid injections were used in 100% and 50% of the encounters respectively. In undiagnosed fever antibiotic injections were use in 60% of the encounters. The findings of the retrospective prescribing survey in those health complexes of the two districts corroborated the findings of the small group discussion. In the UHCs of Dhaka districts excessive injections were used in (i) ARI/pneumonia, (ii) dehydration and (iii) in injury. In ARI/pneumonia antibiotic injections were used in 100%, 94%, and 75% of the encounters in Dohar, Savar and Nawabgonj UHCs respectively. In dehydration, I.V. fluid was used in 100% and 89% of the encounters in Dhamrai and Keranigonj UHCs respectively. The I.V. fluid was also used in 76% of the encounters in injury. In the UHCs of Noakhali the injection use was somewhat less than that of Dhaka. Ceftriaxone injection was used in 87% and 77% of the encounters in ARI/pneumonia in Companygonj and Sonaimuri UHCs respectively. In the other three UHCs, analgesic injections were used in 80%, 67% and 67% of the encounters in Subarnochar, Chatkhil and Senbag respectively.