Training to sustain safe injections in Kenya

Linus Ndegwa integrates injection safety into the lessons of Kenya’s future health care workers to reduce transmission of HIV/AIDS and other bloodborne disease through unsafe injection practices.

Linnus Ndegwa knows that too many cases of HIV and hepatitis are caused by unsafe injection practices. As a lecturer in the department of clinical medicine at Kenya Medical Training College (KMTC), one of Central Africa’s largest training institutions, Mr. Ndegwa hopes to share that lesson with the country’s future nurses, clinical technicians, physical and occupational therapists, and other mid-level health care providers taught there.

According to the World Health Organization, every year unsafe injections account for an estimated 8 to 16 million cases of hepatitis B and 80,000 to 160,000 cases of HIV around the World—all of which could be prevented through better injection equipment, improved practices, and proper disposal of contaminated medical waste, including needles and syringes.

To ensure that injections are only beneficial and do not cause harm to patients, heath care providers, or communities, Making Medical Injections Safer (MMIS), a PEPFAR-funded project managed by John Snow, Inc., worked with Kenya’s medical training institutions like KMTC to incorporate injection safety modules into the curricula of medical and nursing schools in Kenya. The project aimed to reduce transmission of bloodborne disease by institutionalizing injection safety and making safe injections a professional and social norm as common as washing one’s hands. To achieve this, MMIS played an integral role in developing a curriculum that have made providers aware of the over-prescription of injections and how to safely administer only the injections that are medically necessary.

“We owe the MMIS project quite a lot,” said Mr. Ndegwa. “Through the project we now have trainers that are reoriented to the new injection technology and how to appropriately prescribe so as to avoid unnecessary injections.”

In addition to working with the country’s public sector training institutions, MMIS also included the country’s faith-based organizations (FBO) to promote injection safety throughout Kenya’s faith-based health facilities. FBOs provide over 30% of the health care in Kenya. To capitalize on the reach of such organizations, the MMIS/Kenya team worked with Kenya’s leading FBO, the Christian Health Association of Kenya (CHAK), to train health care instructors on injection safety. Those instructors, in turn, trained the nurses, doctors and waste handlers that were in CHAK’s expansive network on emerging safe injection technology, such as auto-disable and retractable syringes, infection prevention and control measures, and proper waste management techniques. CHAK works in 23 hospitals, some of which are among the largest in the country, as well as 43 health centers, 55 church health programs and over 300 dispensaries in every district in Kenya.

Joseph Oyongo, a training officer with CHAK, attended an MMIS training of trainers in May 2006. “This is important information and valuable to us as trainers,” Oyongo said of the injection safety training he received. “With the high rates of HIV and hepatitis, it is very important to protect health care workers, and to be protected, they need to know this information as soon as possible. When they know it from the very beginning, they can minimize their risk of infection though a needle prick.”

Injection safety curriculum did not escape the educational system entirely in years’ past, but with the recent spike in prevalence rates of HIV in Kenya, policy makers have re-examined prescribing practices and now encourage oral medications instead of injections for many illnesses. By targeting prescribers, the MMIS project aimed to reduce the incidents of needlestick injuries that cause preventable cases of HIV in people that the taxed health care system need most—providers who care for the many suffering from AIDS.

“In this era of HIV and hepatitis prevalence in the health care system, safe injections are an effective means of prevention,” said Mr. Ndegwa. In four of Mr. Ndegwa’s classes for prescribers of medication, all 139 students admitted to having had at least one needlestick injury; in another two classes, sixty-nine students, including two American trained practitioners, said they had been stuck by a used needle.

Mr. Ndegwa is one of 25 lecturers at the college trained by the MMIS project. The lecturers often teach classes of 80 to 90 students and their coverage extends to 25 satellite teaching facilities, making their reach widespread across different disciplines of medical care and geographic area.

“Imparting knowledge on my students and seeing them put into practice what I have taught is extremely satisfying,” Ndegwa said. “Through MMIS I was able to train my first class of 119 students on injection safety.” Teachers like Ndegwa are most effective because they train not only medical students in the capital, Nairobi, but also health care providers in dispersed districts who have been practicing for years and may have missed current injection safety lessons or could use a refresher on the topic.

Additionally, teaching teachers required little support from MMIS once the faculty was trained, freeing valuable resources for the project’s other interventions, including commodity management, behavior change communication, and health care waste management.