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Reducing injection overuse through consumers’–prescribers’ interactional group discussions in Dar es Salaam region, Tanzania

Stephen ED Nsimba, Amos Massele and Edmund J Kayombo

Aims: This study aimed to assess the efficacy of an innovative behavioral intervention, interactional group discussions (IGDs), for reducing the overuse of injections.
Materials & methods: This study involved ten public (randomized into five control and five intervention groups) and ten private (randomized into five control and five intervention groups) dispensaries. Prescribers in the intervention group were each invited to one IGD, which consisted of six prescribers and six consumers (of whom the majority were mothers with sick children under 5 years of age); a total of five IGDs were held in a 4-week period. All invited prescribers participated. Outcome measures were assessed in relation to a pre- and post-change using STATISTICA to analyze quantitative data, whereas qualitative data were analyzed using socioanthropological approaches. In control public dispensaries, the percentage of prescriptions that were for injections was 32% at baseline, compared with 31% in the intervention groups.
Results: Using time series in the intervention facilities, the rate of injections prescribed fell from 31% at baseline to 22% 3 months post-IGDs (p < 0.05). In the private control dispensaries the rate of injection use was not significantly different (43 and 47%, respectively; p > 0.05). In the control dispensaries, there was a significant drop in the rate of injection use from 43% at baseline to 38% 3 months post-IGD (p < 0.05). This rose significantly to 49% 9 months post-IGD (p < 0.05). In the control facilities, the percentage of appropriate prescriptions of injections fell from 15% at baseline to 11% 3 months post-IGD, and rose to 16% 9 months post-IGD. Furthermore, the rate of injection use in the intervention group fell significantly from 44% at baseline to 35% 3 months post-IGD. This rose to 37% 9 months post-IGD. In addition, there were changes in the prescription of generic drugs, but no changes in injection use or prescriptions.
Conclusion: The IGDs significantly reduced the overuse of injections, but the reduction was not sustained as prescriptions of injections soon returned to the original numbers. There was an overall reduction in the prescription of injections 3 months after intervention. However, injection use did not improve 9 months post- IGD, indicating that the prescribers did not practice what they had learnt. To sustain this practice, periodic training, monitoring and supervision are required in these facilities on a regular basis.