The INFO Project Blog

From Maxine Eber at Population Services International:

We are seeing an extremely strong bias among providers against DMPA in favor of NET-EN. The reasons are the issues of bone mineral density,delayed return to fertility, and amenorrhea. Return to fertility and overall safety seem to be the 2 biggest issues. It is believed that DMPA is less reversible and less safe than NET-EN. I understand that there are some differences in the time it takes to return to fertility, but that these are minor and I’m afraid that they are getting blown out of proportion.

Sanjay Chaturvedi from the IndiaCLEN Programme Evaluation Network writes:

Sir,

This is regarding the Jan-Feb 2007 issue of Population Reports – “Expanding services for injectables”. While agreeing with the sentiment and some of the technical assertions made, we wish to register our reservations on the broad messages that (may be inadvertently) go with the cover story, its title, and accompanying photograph.

We, in partnership with Govt. of India and World Bank, have recently conducted a nation-wide study on injection practices.1 It would be relevant to place some of the findings here. The burden of injections was 5.8 injections (95% CI 5.3-6.3) per person per year. Overall 44.1% of all outpatient clients were prescribed injections, and in nearly 80% of them, the oral alternatives were available. Of all the injections administered in India, 31.6% [95% CI 29.4-33.0] carried a potential risk of transmitting Blood Borne Virus. Unsafe injection due to faulty technique was observed in 53.1% [95% CI 50.8-55.4]. This made nearly two third (62.9 %; 95%CI 60.7-65.0) of the injections unsafe.

This is to be emphasized here that we are also striving for the provision of quality injection services in all settings. Our network is engaged in country-wide ‘Model Injection Centre Project’ in program mode for last 2 years (http://www.ipen.org.in/index.php?option=content&task=view&id=237&Itemid=287&parent=225). Nevertheless, our primary objective is to reduce the burden of injections, at the first place. All the health organizations and functionaries working in developing countries need to be extra careful in promoting injectables, wherever effective oral alternatives are available.

We are afraid that while your aim is to stress upon the importance of quality services for injectables (if opted), the message that sticks is – ‘Just go for the injectables!’ This is worrisome, particularly in the context of low and middle income countries.

With best regards,

Yours sincerely,

Sanjay Chaturvedi
on behalf of:
IndiaCLEN Programme Evaluation Network (IPEN), New Delhi

Sanjay Chaturvedi from the IndiaCLEN Programme Evaluation Network writes:

Sir,

This is regarding the Jan-Feb 2007 issue of Population Reports – “Expanding services for injectables”. While agreeing with the sentiment and some of the technical assertions made, we wish to register our reservations on the broad messages that (may be inadvertently) go with the cover story, its title, and accompanying photograph.

We, in partnership with Govt. of India and World Bank, have recently conducted a nation-wide study on injection practices.1 It would be relevant to place some of the findings here. The burden of injections was 5.8 injections (95% CI 5.3-6.3) per person per year. Overall 44.1% of all outpatient clients were prescribed injections, and in nearly 80% of them, the oral alternatives were available. Of all the injections administered in India, 31.6% [95% CI 29.4-33.0] carried a potential risk of transmitting Blood Borne Virus. Unsafe injection due to faulty technique was observed in 53.1% [95% CI 50.8-55.4]. This made nearly two third (62.9 %; 95%CI 60.7-65.0) of the injections unsafe.

This is to be emphasized here that we are also striving for the provision of quality injection services in all settings. Our network is engaged in country-wide ‘Model Injection Centre Project’ in program mode for last 2 years (http://www.ipen.org.in/index.php?option=content&task=view&id=237&Itemid=287&parent=225). Nevertheless, our primary objective is to reduce the burden of injections, at the first place. All the health organizations and functionaries working in developing countries need to be extra careful in promoting injectables, wherever effective oral alternatives are available.

We are afraid that while your aim is to stress upon the importance of quality services for injectables (if opted), the message that sticks is – ‘Just go for the injectables!’ This is worrisome, particularly in the context of low and middle income countries.

With best regards,

Yours sincerely,

Sanjay Chaturvedi
on behalf of:
IndiaCLEN Programme Evaluation Network (IPEN), New Delhi