Systematic Reviews
Copyright ©The Author(s) 2016.
World J Gastroenterol. Jul 7, 2016; 22(25): 5837-5852
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5837
Table 1 Human development statistics for South Asia: Human development report 2015[18]
IndicatorsYearSri LankaMaldivesIndiaBhutanPakistanNepalBangladesh
Total population (millions)201421.40.41267.40.8185.128.1158.5
GDP per capita (US$)201194261128352387167445421732853
Population living below $1.25 a day (%)2002-2012-1.523.62.412.723.743.3
Adult literacy rate (% ages ≥ 15)2005-201391.298.462.852.854.757.458.8
Public health expenditure (% of GDP)20133.
Stunting (moderate or severe) (% under age 5)2008-201314.720.347.933.645.040.541.4
Infant Mortality rate per 1000 live births2008-20138.28.441.429.769.032.233.2
Overall human development index201573.0104130132147145142
Table 2 Search and retrieval of information for injection use in South Asia 1995-2016
Key wordsIndiaPakistanBangladeshNepalSri LankaMaldives
PubMed - RetrievedInjection and country/state189511214135
PubMed - selected/relevant25255800
Google Scholar1Unsafe injections, injections, country31 (419)2 (329)1 (242)0 (40)
GoogleUnsafe injections, injections, country2100
WHO website000000
In country assessments by MoH1
Unpublished reports12
Other circumstantial evidence2
Risk factors studies suggesting injection useRisk factors, HBV (HCV), country1
Hepatitis B/CHepatitis B, Hepatitis C, Country19 (38)13 (36)
Health care utilizationHealth care seeking, Health care utilization, Private practice, Country15 (32)6 (16)
Private practitioners health seeking (retrieved)Health care seeking, Private practice, Country5 (8)3
Prescribing practices (retrieved)Prescription practices, Country5 (5)1
Table 3 Characteristic of injection use studies in South Asia 1995-2016
Ref.Study typeSettingStudy baseCity/provincenSamplingYearYear
Rajasekaran et al[37]Population surveyBoth3 areasTamil Nadu175Convenience20012003
IPEN study group[40]Population surveyBothWhole countrywhole country23997Cluster sampling2002-20032004
IPEN study group[40]Patients exit interview and observationsBothWhole countrywhole country6015Cluster sampling2002-20042004
Murhekar et al[36]Population surveyIslandNicobar Island210Cluster sampling-2004
Kotwal et al[34]Population surveyBothCityDelhi150Cluster sampling random20032004
Anand et al[38]Population surveyRural1 villageHaryana State1280Systematic sampling-2001
Lakshman et al[35]Patients exit interview and observationsBoth15 miles around a townTamil Nadu400Consecutive patients-2000
Becker et al[66]Population surveyBoth1 districtKarnataka4949Cluster sampling20032005
Kermode et al[67]Population surveyUrban2 citiesNew Delhi and Imphal200Convenience20042006
Kermode et al[41]Patients and relatives surveyRural2 hospitalsBihar and Jharkhand280 patients,Systematic sampling, convenience2004-20052006
120 relatives
Pandit et al[42]Population surveyBoth1 DistrictAnand182 HF1Stratified and simple random20042008
Shah et al[68]Providers interviewBoth1 districtGujarat251Random sampling2012-20132014
Bhargo et al[43]Providers interviewUrban1 districtGwalior30Convenience2012-20132014
Garapati et al[44]Providers interview and observationBoth1 districtAndhra Pradeh300Convenience2010-20112014
Bendale et al[69]Hospital surveyUrban1 districtMaharashtra20 sitesRandom sampling2015
Raglow et al[22]Survey of OPD patientsUrbanPatientsKarachi198Consecutive patients19952001
Janjua et al[23]Population surveyBoth2 districtsSindh1150Cluster sampling random20012005
Janjua et al[29]Population surveyBoth2 districtsSindh1150Cluster sampling random20012006
Janjua et al[26]Patients exit interview and observationsBoth3 districtsSindh2124Random sample of clinics2004-2005UP
Janjua et al[27]Population surveyBothWhole countryWhole country10023Cluster sampling2006-20072014
Yousafzai et al[25]Provider surveyUrbanCityKarachi317Convenience20062013
Khan et al[6]Patients exit interview and observationsPeri-urban1 villageSindh203consecutive patients19952000
Mantel et al[70]2Patients exit interviewBoth8 districts3 provincesRandom sample of clinics2002UP
PDHS 2012-13[24]Population survey 15-49 years of ageBothNationalF: 13558Cluster sampling random2012-20132014
M: 3134
Gibney et al[71]Risk factor studyUrbanTruck standDhaka387Cluster sampling random19992001
Shill et al[51]Provider interviews and facility recordsRuralPrimary Health Care CentresDhaka6Convenience sample20092011
Chowdhury et al[50]Provider interviews, FGD, observations and prescription reviewPrimary Health Care CentresNationalPrescription: 4320Cluster sampling2008-092013
Injection events: 480
Sri Lanka
Rannan-Eliya et al[59]Patients exit interviewBothNationalSri Lanka2100Random sample of clinics20002003
Gyawali et al[54]Survey of pharmaciesUrbanCityPokhara54Convenience sample20122014
Gyawali et al[52]Population surveyBoth1 districtKaski2470Stratified sampling20122014
Table 4 Injection use and safety of injections in South Asia 1995-2016
Ref.Annual ratio of injections per capitaReceived an injectionTherapeuticInjection reuse byinterview7Injection reuse byobservingOverall unsafe
Rajasekaran et al[37]2.460.6%187%64.6%
IPEN study group[40]2.91-5.827.1%1/44.1%382.5%31.6%62.9%
Murhekar et al[36]321.9%191%6.5%
Kotwal et al[34]5.145.6%171.2%56.5%77.5%
Anand et al[38]2.4535%440%-100%45%
Lakshman et al[35]89%3100%73%-99%99%
Becker et al[66]3.567.7%6
Kermode et al[67]8.615%268%31%
Kermode et al[41]43%2 (Patients)100%7.6%
13.3%1 (Relatives)
Pandit NB0.221.6%677%
Shah et al[68]64.1%
Bhargo et al[43]76.7%
Garapati et al[44]0.7214.3%
Raglow et al[22]8.451%5100%48%16%
Janjua et al[23]13.668%194%46%
Janjua et al[26]74%1
Janjua et al[23]55%347%
Janjua et al[27]51%64%
Yousafzai et al[25]87%
Khan et al[6]81%390%94%
Mantel et al[70]12%65%
PDHS 2012-13[24]F:5.4/M:4.9F:61%/M: 53%6F:15%/M:10%
Gibney et al[71]39.7%6100%
Shill et al[51]4.88
Chowdhury et al[50]77.7%15.5%
Sri Lanka
Rannan-Eliya et al[59]3%3
Gyawali et al[54]
Gyawali et al[52]2.3710.4%197.1%
Table 5 Prescribers, providers, and preference of patients and practitioners for injections in South Asia 1995-2016
Ref.Prescribed by GPPrescribed by unqualified practitionerProvided at private clinicProvider dispenserPatient prefers InjectionPractitioner prefers injectionPractitioner says patient demand it
Rajasekaran et al[37]59%37.6%40%87.2%
IPEN study group[40]42.6%57.5%77%1/34%293.5%10.2%70.6%388.6%
Murhekar et al[36]50.8%54.8%
Kotwal et al[34]13.8%58.8%30%
Anand et al[38]18%
Lakshman et al[35]65%
Kermode et al[67]8%35%
Kermode et al[41]55% (patients)24.8% (patients)7.7% (patients)9.3% (relatives)
Pandit et al[42]57%55%17%
Garapati et al[44]48.7%
Bendale et al[69]8.16%35%65%
Raglow et al[22]94%94%
Janjua et al[23]63%28%69%76%16%
Janjua et al[26]63%28%63%32%
Janjua et al[23]
Janjua et al[27]52%16%
Yousafzai et al[25]7.9%8.8%71%
Khan et al[6]44%
Gibney et al[71]
Shill et al[51]50%
Sri Lanka
Rannan-Eliya et al[59]
Gyawali et al[54]92.6%
Gyawali et al[52]12.6%21.4%5%