A prefilled injection device for outreach tetanus immunization by Bolivian traditional birth attendants

[Vacunación antitetánica extrainstitucional por parteras empíricas bolivianas mediante dispositivos desechables de una sola dosis]

Authors: Quiroga, Rosario1; Halkyer, Percy2; Gil, Fernando3; Nelson, Carib4; Kristensen, Debra4

Source: Revista Panamericana de Salud Pública/Pan American Journal of Public Health, Volume 4, Number 1, July 1998 , pp. 20-25(6)

Publisher: Pan American Health Organization (PAHO)

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Abstract:

This study evaluated the performance, acceptability, and appropriateness of a new, single-use, prefilled injection device called UniJect for an outreach immunization application. Between April and June 1995, UniJect devices were used by 36 traditional birth attendants to administer tetanus toxoid injections to 2 240 pregnant women during routine, antenatal home visits in the Northern, Ichilos, and Warnes Districts of Santa Cruz, Bolivia. Because tetanus toxoid is relatively heat stable, the traditional birth attendants were able to keep the tetanus toxoid-filled UniJect devices in their homes for up to one month without refrigeration. The devices were stored, transported, and disposed of in an outreach carrier designed to reduce the risks of improper handling and disposal.

Data were collected from injection recipients, traditional birth attendants, and supervisors via observation, questionnaires, and post-study interviews. The performance of the UniJect device and its acceptability among all groups was very high. The traditional birth attendants used UniJect properly and safely; there were no reports or observations of device misuse, reuse, or needle-stick. Advantages cited included the fact that the device required no assembly, offered assured sterility, and reduced vaccine wastage sometimes associated with multi-dose vials. The ability to store and transport the vaccine-filled devices without ice also greatly simplified logistics.

Spanish
RESUMEN

En este estudio se evaluaron el rendimiento, la aceptabilidad y la conveniencia de la inmunización antitetánica extrainstitucional con un nuevo dispositivo hipodérmico de una sola dosis, el UniJect®. De abril a junio de 1995, el dispositivo UniJect aprestado de fábrica con una sola dosis de toxoide tetánico fue utilizado por 36 parteras tradicionales para vacunar a 2 240 mujeres embarazadas durante las visitas domiciliarias prenatales de rutina en los distritos Norte, Ichilos y Warnes de Santa Cruz, Bolivia. Ya que el toxoide tetánico es termoestable, las parteras pudieron mantener los dispositivos UniJect sin refrigeración en sus hogares por un período de hasta un mes. Los Uni- Ject se guardaron, transportaron y desecharon en portadores extrainstitucionales diseñados para reducir los riesgos de manipularlos y desecharlos de forma inadecuada.

Se recolectaron datos de las mujeres vacunadas, las parteras tradicionales y sus supervisores, mediante observación, cuestionarios y entrevistas realizadas después del estudio. Todos los grupos consideraron muy satisfactorios el rendimiento y la aceptabilidad del dispositivo UniJect. Las parteras tradicionales lo usaron de forma apropiada y cuidadosa; no hubo informes ni observaciones de mala utilización, reúso o puntazos accidentales. Se mencionaron, como ventajas del dispositivo, que no requiere montaje, asegura la esterilidad y reduce el desperdicio de vacuna que a veces ocurre con las ampollas de dosis múltiples. Además, todo el procedimiento se simplifica porque los dispositivos pueden almacenarse y transportarse sin necesidad de hielo.

Document Type: Research article

Affiliations: 1: Ministerio de Desarrollo Humano, Secretaría Nacional de Salud, La Paz, Bolivia 2: Consultant, Expanded Program on Immunization, Pan American Health Organization, La Paz, Bolivia 3: Consultant, Expanded Program on Immunization, Pan American Health Organization, Santa Cruz, Bolivia< 4: Program for Appropriate Technology in Health, Seattle, Washington 98109, U.S.A.

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