Comparison of need and supply of syringes for therapeutic injections in Pakistan

Objectives: To determine the extent of shortfall in syringes by measuring the need from nationally validated sources and comparing it with position on the supply side. This was done in order to contribute to the ongoing national discussions that have focused on increasing syringe supply to curtail syringe reuse. Methods: Using 'Injections received' data from the Pakistan Demographic Health Survey 2006-7 (N: 5429) and the National Hepatitis Survey (N: 47,043), the study estimated the number of injections received in Pakistan. We matched these against the local syringe production figures from the syringe manufacturers' association and import figures from the Federal Board of Revenue (FBR). Results: Approximately 731±867 million injections (5.1±12 injections per head) are received annually in Pakistan and around 861±961 million syringes are supplied to the open market. Overall, 52-77% Pakistanis receive at least one injection in any given year. Conclusions: Injection need in Pakistan is among the highest worldwide but is completely matched by available syringe supplies, suggesting lower reuse than previously considered. However, highly prevalent Hepatitis B and C viruses suggest that even this reuse is a major public health concern and measures directed at both providers and recipients of injections are needed to curtail high injection need and syringe reuse.