Public Health (2006) 120, 824–833 ORIGINAL RESEARCH Population beliefs about the efficacy of injections in Pakistan’s Sindh province Naveed Z. Janjua a,d,Ã , Yvan J. Hutin b , Saeed Akhtar a,e , Khabir Ahmad c a Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi 74800, Pakistan b Department of Essential Health Technologies (ETH), World Health Organization, Geneva, Switzerland c Department of Surgery, Aga Khan University, Karachi, Pakistan d Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Building, RPHB 430, Birmingham, AL 35294, USA e Department of Community Medicine & Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait Received 27 May 2005; received in revised form 29 March 2006; accepted 4 May 2006 Available online 28 July 2006 KEYWORDS Unsafe injections; Blood-borne patho- gens; Hepatitis C virus; Hepatitis B virus; Health beliefs; Pakistan Summary Objective: Reused syringes have been identified as a major risk factor for hepatitis B and C in Pakistan, a country facing a growing epidemic of these infections. We conducted this study to identify factors associated with receiving at least one injection during the past 3 months in an urban and a rural area in the Sindh province of Pakistan. Methods: A population-based cross-sectional study of individuals aged X3 months was conducted in 34 clusters in an urban and a rural setting. Information was obtained on the number of contacts with healthcare providers and the number of injections received during the past 3 months. Beliefs about the efficacy of injections were also tested. Multivariable logistic regression analysis was performed to identify factors associated with receiving at least one injection during the past 3 months. Results: Of 1150 subjects who participated in the study, 848 (74%) reported having received at least one injection during the past 3 months. Seventy-one percent (815/ 1150) believed that injections act faster than oral drugs and relieve symptoms quickly. There was a lack of risk perception among the participants: 19% (222/1150) believed that injections involve less risk than do oral drugs. Multivariable logistic regression analysis revealed that individuals who had visited unqualified practi- tioners (adjusted OR ¼ 6.1; 95% CI: 2.6–14.1) or general practitioners (adjusted OR ¼ 3.4; 95% CI: 1.9–6.0) were more likely to have received an injection. Belief that ‘injections act faster and relieve symptoms quickly’ had a multiplicative interaction with the area of dwelling: people in rural areas who held this belief were more likely to receive injections than people who did not hold this belief and were living in urban areas. ARTICLE IN PRESS www.elsevierhealth.com/journals/pubh 0033-3506/$ - see front matter & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2006.05.004 Ã Corresponding author. Tel.: +1 205 934 5803; fax: +1 205 934 7154. E-mail address: naveed@uab.edu (N.Z. Janjua).