Anthropological Perspectives on Injections: a Review

Excerpt from opening statement

"Qualitative studies from developing countries have pointed to the widespread popularity of injections. In addition to their use by formal and informal providers and traditional healers, there is now increasing evidence of the use of injections and injection equipment by lay people. Epidemiological research links the large number of unsafe injections to serious bloodborne infections such as viral hepatitis B and C and acquired immunodeficiency syndrome (AIDS). The present article examines the reasons behind the demand for injections by consumers and the administration of unnecessary or unsafe injections by different types of providers. Interventions aimed at reducing the risk of unsafe injections are discussed in relation to cultural and social factors as well as those factors associated with health systems. Suggestions are made for approaches to the design of such interventions."

Reeler offers some background to the issue of unsafe injections and states, "Clearly, the administration of injections in developing countries often leaves much to be desired. Many injections are given for the wrong indications, such as acute respiratory infections, diarrhoea, fever, skin infections and urinary tract infections. In some countries children seem to be receiving alarmingly large numbers of injections. Administration and sterilzation practices are unsatisfactory in many places because health workers have insufficient knowledge or because there is a lack of equipment. In developing countries the epidemic of aqcuired immunodeficiency syndrome (AIDS) has persuaded many donors to provide disposable injection equipment (even though this sometimes means ignoring national policies), and disposable syringes are often reused despite their intended purpose."

In describing perceptions of etiology, the author writes "Most cultures in the developing world have their own explanations for the occurrence of disease, which may involve supernatural forces or ideas about balance between different elements." She points out that treatment strategies may depend on many factors, among them the following:

• whether patients and their social group perceive an illness to be serious;
• whether they regard it as caused by natural or supernatural forces;
• perceived accessibility of treatment;
• efficacy of treatment.

Under the title "Perceptions of Efficacy" the author states that "the principal reason for the popularity of injections as reported from many developing countries seems to vary with the culture concerned. Injections are seen as the outstanding symbol of biomedicine and have often been portrayed as such in health and vaccination campaigns. Since health professionals frequently use injections to treat serious illness, it is understandable that injections have been perceived as powerful and technologically advanced. However, injections are often classified and used in ways that are markedly at variance with biomedical intentions, and may even be irrational from the biomedical point of view. This is because injections have been introduced into cultural contexts where other explanatory models for illness prevail."

The author points to body-piercing as an example of meddling with the body and "intervening in its processes." She continues with other examples such as "putting things under the skin (Indonesia), scarification (parts of Africa), and different forms of acupuncture (Bhutan, China, Thailand)." The author suggests that "the pain associated with inserting a needle may be perceived as a sign of strong medicine. She also mentions that age plays a role in what is appropriate for injections. For instance, "Children under 5 years of age have been reported to receive an inordinate number of injections." It may occur because "of a belief" or because it is easier than having children "swallow medicine."

The author points to the fact that social value systems are changing as well as the perceptions of providers. "There is a trend towards treating illness and psychosocial problems with substances rather than through the ritual manipulation of social relationships." Drugs and injections are tangible expressions of healing, giving the impression that illness is a concrete entity to which a substance can be applied."

In conclusion, the author states that "in each setting, injection is associated with specific meanings and interpretations depending on medical traditions and ideas about contamination, causes of disease, perceptions of providers and their institutions, and local responses to the advice and behaviour of biomedical practitioners. This does not mean that people's perceptions of injections or their safety measures cannot be changed. Perceptions and behaviours have changed already, although not always in desirable directions. Interventions should be continuously adapted to specific contexts in accordance with people's responses.