THE news item 'Sindh Assembly has banned disposable syringes' (Jan 13) reports a welcome move. If this bill is implemented as a law and the use of auto-disable or reuse prevention device (RUP) syringes become common, it will certainly lead to safer injection practices and prevent the spread of hepatitis B and C.
Reuse of single use disposable syringe by trained and untrained healthcare providers or commonly called GPs (general practitioners) is common in urban slum and rural areas of Sindh.
Unfortunately, across Pakistan, including Sindh, one syringe is used multiple times on several patients before being thrown away when the needle becomes blunt and patients complain of extraordinary pain.
Unnecessary injections are prescribed, and research studies show that in Pakistan a person receives eight to nine injections a year, one of the highest in the world.
And if immunisation, family planning and insulin injections are added, this number further goes up.
Resources of hepatitis control programmes are drained on treatment of hepatitis C and B whereas they should have focused more on prevention efforts.
I am not undermining the importance of treatment but since it is extremely expensive, focus should be on prevention, including laws like this one, sensitising the communities as well as the GPs.
Even in this day and age many GPs are not fully aware of transmission risks of hepatitis B and C. In Pakistan transmission of hepatitis C has been particularly associated with reuse of syringes.
Injection safety advocates have been working and pressuring the government to pass a law to ensure safer injection practices.
But these efforts were diluted either in the political milieu or influenced by local syringe manufacturers because they would have to invest to upgrade their plants. And most plants do not meet the international standard.
The key function of an auto-disable syringe is that when the plunger is pushed all the way, there is a light click sound after which it is locked and the syringe becomes disabled.
While this is fine with most injections but in some cases reconstitution, i.e. two or three movements of the plunger, is required to mix the medicine and that's where the importance of training and awareness will come in for procurement managers or physicians, nursing and paramedical personnel.
With devolution in hand and health actually becoming a provincial matter the Health Department of Sindh and all related persons of this bill deserve congratulations for taking the lead.
DR ARSHAD ALTAF Karachi
