Therapeutic injections are overused in Cambodia, exposing health workers to needlestick injuries and a higher risk of blood-borne infections, according to a new survey of injection practices conducted by Sirenda Vong of CDC and collaborators at the World Health Organization and Cambodian Ministry of Health.

In 2002, researchers surveyed injection-related knowledge, attitudes and practices of a random sample of the general population in Takeo Province and convenience samples of injection prescribers and providers in Takeo Province and Phnom Penh. Providers were observed administering injections.

Among 500 people surveyed from the general population, the injection rate was 5.9 injections per person-year, and 40 percent had received one or more injections within the previous six months. Among the injections, 74 percent were therapeutic; 16 percent were intravenous infusions; and 10 percent were vaccinations. More than 85 percent of injections were received through the private sector.

Of participants who recalled their last injection, all reported it was administered with a newly opened disposable syringe and needle. Prescribers surveyed (n=60) reported that 47 percent were therapeutic injections or transfusions. Among 60 people who administered injections, 58 percent recapped the syringe after use and 13 percent failed to properly dispose of the syringe and needle. Fifty-three percent of providers reported a needlestick injury in the previous 12 months. Among prescribers and providers, 90 percent were aware that HIV, hepatitis B and C can be transmitted through injection practices. Among the general population, 95 percent were aware that "dirty" syringes could transmit HIV.

"Our data suggest that Cambodia has one of the world's highest rates of overall injection usage, despite general awareness of associated infection risks," concluded researchers. "Although there was little evidence of reuse of needles and syringes, support is needed for interventions to address injection overuse, healthcare worker safety and appropriate waste disposal."

The full report, "Rapid Assessment of Injection Practices in Cambodia, 2002," was published in BMC Public Health (2005;5:56).

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