CORRESPONDENCE

A particularly dangerous unethical practice


Dr. H. V. Wyatt and colleagues (1, 2, 3) have highlighted the dangers following unnecessary injections to children. In a survey of children attending the outpatient clinic of a hospital in south India they found that half the children had been given injections by private doctors for illnesses during the preceding rnonth. ‘We consider rnost of these injections to have been unnecessary.’*. They refer to other studies with similar conclusions. 40% of babies (in their first year) with diarrhoea were given an intramuscular injection.

Apart from the well-known complications such as infection from unsterile needles, abscesses at the site of injection and the transmission of the hepatitis virus, they highlight the incidence of paralytic poliomyelitis following injections, Such ‘provocative paralysis’ has been known since the late 1940s. Of 262 children with acure paralytic poliomyelitis in and around Pondicherry, 75% were found to have received an injection just before paralysis. The injections given included antihistamines, prostigmine, gentamycin, tetracycline, penicillins, other antibiotics and vitamin B. ‘There was little clinical justification either for the drugs or giving the injection.’ (3)

The situation is so bad that Wyatt and Mahadevan (3) suggest the maintenance of ‘an abscess record book’ in every primary health centre to be used as a marker for the spread of other infectious diseases with a much longer incubation (eg. hepatitis).

Dr. Anant Phadke’s findings (4) on faulty prescriptions also deserve careful study. Analysis of over 3500 prescriptions in Satara district showed unnecessary drugs in every alternate prescription. One in five prescriptions included a harrnful drug. One in four patients was given an unnecessary injection.

References

  1. Wyatt HV, Mahadevan S: Unnecessary injections and poliomyelitis. Indian Journal of Pediatrics 60, 327-329, 1993.
  2. Aswath D, Latha C, Soudarssanane MB, Wyatt HV Unnecessary injections given to children under five years. Indian Journal of Pediatrics 60, 451-454, 1993
  3. Wyatt HV, Mahadevan S: Unnecessary injections in developing countries: the risk and costs. International Journal of Risk & Safety in Medicine 4, 167-176,1993.
  4. Phadke A, Sharada L: Unpublished findings. Details available frorn Foundation for Research in Community Health, Bombay.
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