ARIVA - Projet d'Appui au Renforcement de l'Indépendance Vaccinale en Afrique

This study was financially supported by the European Union through CATR/ARIVAS project.

To assess injection practices
To assess the reported accidental needle-stick injuries among the health care workers
To assess the disposal of used syringes and needles
To assess the availability of sufficient quantities of injection material in the health facilities
To make recommendations to ensure safety of injections in the Gambia

The type of study was a cross sectional observation study utilising a standardized questionnaire (staff interviews). The questionnaire consisted of three parts:

We proceeded to a convenience sampling of the health facilities. We selected all the public health facilities of the country, and a random sampling of 10% of the privates clinics (all located in the WD) and the out-reaches. Our sample was composed of :

The supervisors and the interviewers have been trained two days and a pre-test to standardize the data collection was held in two health centres of Banjul. During the training and pre-test, the questionnaires were further reviewed by the consultant, the EPI staff and the participants (supervisors and interviewers).

For the field work, there were 6 teams each consisting of a supervisor and 2 interviewers. If a health facility was unavailable it could be replaced by a clinic from a list of alternative clinics.

The purpose of the study has been explained to each heath worker involved in the survey. They all gave their approval before the beginning of the investigation in each health facility.

Data were entered in EPI info®. The proportions and the confidence intervals were calculated with EPI info. The denominator was the health centre where the observations have been done or where people answered the question. The observations of injection were analysed by health facility rather than by injection.

A total of 81 questionnaires were collected (90%). Three clinics were replaced by alternative clinics, because of a refusal (1 case), 1 clinic (a pharmacy) doesn't give injections and in the third case the clinic had closed.

The survey teams observed 210 injections (86 vaccinations and 124 treatments). 151 injection providers have been observed. A number of 140 injection providers (60 vaccinators and 80 for curative) responded to the questionnaire and 100% (81) of supervisors responded to the questions.

Number of syringes	Number of health facilities	%	CI 95%
None	14	17.3	9.8%-27.3%
1-4	8	9.9	4.4%-18.5%
5-9	4	4.9	1.4%-12.2%
10-20	4	4.9	1.4%-12.2%
>=20	46	56.8	45.3%-67.8%
Cannot be assessed	5	6.2	2.0%-13.8%
Total	81	100.0

Number of syringes	Number of health facilities	%	CI 95%
None	41	50.6	39.3%-62.9%
1-4	21	25.9	16.8%-36.9%
5-9	4	4.9	1.4%-12.2%
10-20	6	7.4	2.8%-15.4%
>=20	7	8.6	3.5%-17.0%
Cannot be assessed	2	2.5	0.3%-8.6%
Total	81	100.0

Table 3 : Number of vaccinations and therapeutic injections per health facility/week

Table 4 : Accidental needle stick injuries in the last 12 months to the injection provider

The profile of investigators (all PHO) could have influenced the evaluation of the number of vaccination found more elevated than that of the curative injections, what is in contradiction with what is usually observed elsewhere.
The main problems identified at the end of this survey :

The absence of injection safety and waste disposal policy
The insufficiency of disposable syringes and needles in the health facilities. Indeed, 17.3% of the surveyed health facilities did not have any disposable syringe at the time of the investigation
The health facilities lack sure means of waste disposal. Only 17.3% of the health facilities had incinerators
The availability of safety boxes in the health facilities is weak (50.6% did not have any safety box at the time of the survey
Injections continue to be practised with nonsterile material. Indeed, in 8.6% of the health facilities, injections with nonsterile syringes or needles failed to be done
Accidental needle stick injuries of the health care workers were frequent. Indeed, 70.9% of the curative injection providers reported accidental punctures in the last 12 months. Re-capping of the needles after injection was particularly frequent

To implement a plan of action for the improvement of the safety of EPI injection
To purchase safe injection equipment in sufficient supplies
To ensure safe disposal of used injection equipment: a practical guideline should be developed for the disposal of used syringes and needles
To promote safe and appropriate use of injections among health workers and population by information, education and communication (IEC) activities
To provide appropriate training for staff involved in the EPI at all levels
To institute monitoring and supervision procedures to ensure adequate supplies at all level and correct practices by health workers.

(WHO, UNICEF, NGO, associations, programs and projects working in the field of health, private and confessional sector etc.)

NB : Le rapport de cette étude est disponible auprès de la CATR à l'adresse suivante :

Projet régional FED ARIVA
08 BP 11030 Ouagadougou 08
Tél. : +226 31 69 16
Fax : +226 31 69 18
E-mail : catr@fedariva.org

ou auprès du Service de la Direction Nationale du PMI et du PEV à l'adresse ci-après :

National EPI Manager Banjul Gambie
Tél. : +220 22 73 90
Fax : +220 22 58 73
E-mail : Alphanjie@hotmail.com