SIGN Pakistan
Dr. Arshad Altaf
Objectives of the
Presentation
Overview of burden of disease in Pakistan
because of unsafe injection practices
Present activities of SIGN Pakistan
Future plan
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)
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 > 5 injections per year
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
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
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
Formation of SIGN Pakistan
SIGN Pakistan Working Group formed
Maillist created (signpak@maillists.com)
First national meeting “Partners in Injection
Safety” on June 17, 2000
Objectives:
Formal announcement of SIGN Pakistan
To identify national stakeholders
SIGNPAK Working Group
The Aga Khan University
Sindh AIDS Control Programme,
Government of Sindh
HOPE
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)
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
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
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
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
Action Plan
Advocacy
Sensitize policy planners
Disposable medical devices ordinance 2000
Manufacturers-cheap technologies
Advocacy seminars/workshops
NATIONAL COLLABORATORS
Action Plan
Intervention:
Four Ps
Physicians
Patients
Population
Press