Knowledge, Attitude, and Practices of Parents Regarding Injections Use for Their Children-A Study from Outpatient Clinics of a Tertiary Care Hospital in Pakistan

Introduction: Injections are frequently used in developing countries as a perceived potent medical treatment. However, unsafe injection practices, including the reuse of syringes without proper sterilization, can transmit infectious diseases like hepatitis B, hepatitis C, and HIV. In Pakistan, the average injection rate is 8.5 per person annually, with a significant proportion deemed unnecessary. Cultural beliefs and mutual reinforcement between healthcare providers and patients contribute to frequent injection use, further escalating infection risks. This study aims to assess parents' knowledge, attitudes, and practices (KAP) regarding safe injection practices in the pediatric outpatient setting at Aga Khan University Hospital. Methods: This cross-sectional study was conducted over six months at Aga Khan University Hospital’s pediatric outpatient clinics. A total of 266 parents of children under 18 years were recruited using convenience sampling. Data were collected through interviewer-administered questionnaires focused on parental knowledge, attitudes, and practices regarding injection use. Knowledge scores were based on six questions, attitudes on another six, and practices on ten questions, with defined scores indicating adequate levels in each domain. Statistical analysis was performed using SPSS version 23.0, with Chi-square and Fisher exact tests applied for stratified variables and a significance level of p<0.05. Results: While the majority of parents (93.6%) demonstrated sound knowledge about safe injection practices, only 44.7% showed a positive attitude, and 29.3% engaged in adequate practices. Urban residency and higher education levels correlated with safer practices and better understanding (p=0.001). However, cultural influences, particularly Sindhi, Balochi, and Pashto-speaking families, were associated with more negative attitudes and suboptimal practices (p=0.005). A notable gap was observed between parental knowledge and practice, with financial incentives for healthcare providers and traditional beliefs about injections contributing to this discrepancy. Discussion: The study reveals a critical gap between awareness and behaviour, emphasizing the need for targeted educational interventions. Socioeconomic factors like education and urban residency play a vital role in shaping safe injection practices. Cultural norms around injection use reinforce demand for injections, complicating efforts to reduce unnecessary use. These findings mirror trends seen in similar studies on immunization practices in Pakistan, where socioeconomic and cultural factors influence healthcare behaviours. Conclusion: This study highlights the need to bridge the gap between parental knowledge and safe injection practices in Pakistan. Despite high levels of awareness, unsafe injection use persists due to cultural beliefs and reinforcement of injection overuse between patients and providers. To reduce infection risks, public health initiatives should focus on training healthcare providers in safe injection protocols, promoting the use of auto-disable syringes, and increasing parental awareness, particularly in underserved communities. These measures are essential to improve public health and prevent disease outbreaks related to unsafe injections. Clinical Trial Number: Not Applicable