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

Knowledge, Attitude, and Practices of Parents Regarding Injections Use for Their Children-A Study from Outpatient Clinics of a Tertiary Care Hospital in Pakistan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, Attitude, and Practices of Parents Regarding Injections Use for Their Children-A Study from Outpatient Clinics of a Tertiary Care Hospital in Pakistan Bushra Rehman, Abida Akbar, Aneela Pasha, Kashmala Hussain, Muhammad Nasheet Sagri, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5860157/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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 knowledge attitude practice parents unsafe injections children Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION The WHO states that a safe injection is one that does not harm the recipient, expose the provider to any avoidable risk, or result in hazardous waste( 1 ). Worldwide, 12 billion injections are administered annually, with 5% for immunization and 95% for curative purposes. With increasing numbers of injections, the probability of exposure to infectious agents also rises. In developing countries, injection is regarded as a powerful healing tool( 2 , 3 ). Patients frequently report higher satisfaction and perceive better care when they receive injections for treatment( 4 ). Healthcare workers receive financial incentives and gain prestige, which establishes a cycle where patients and providers mutually encourage the overuse of injections( 4 , 5 ). The use of injections in low-income countries averages 3.4 injections per person per year. The estimated number of injections per person per year ranges from 1.2 in Tanzania and India to 8.5 in Pakistan. Approximately, 25–96% of outpatient visits result in at least one injection, and 70–99% of injections are deemed unnecessary( 6 ). Many injections in developing countries are given with reused equipment due to lack of sterilization. Unsafe injection practices can transmit diseases like hepatitis B, hepatitis C and HIV. In developing countries, the reuse of unsterilized injection devices in 2000 alone caused millions of infections as per the WHO Global Burden of Disease study. In response, international organizations like WHO, UNICEF, UNFPA and the IFRC have advocated for the exclusive use of auto-disable syringes to eliminate the reuse of injecting equipment. According to one Demographic Health Survey, approximately 9% of injections given to patients in Pakistan are unsafe( 6 , 7 ). In developing countries, injections are administered across three sectors: the formal sector by trained healthcare professionals, the informal sector by traditional healers and unlicensed medical shopkeepers offering low-cost services without training, and the illegal sector solely for financial gain. These last two sectors pose major public health risks due to unsafe practices and inadequate monitoring( 8 ). The domestic sector involves injections given without payment by relatives or neighbours, adding to the complexity( 9 ). Unsafe injection practices in Pakistan had devastating consequences, as evidenced by the HIV outbreak in Larkana, Pakistan in April 2019. A private healthcare provider initially identified 14 children with HIV infection. Subsequently, Pakistan faced its largest HIV outbreak in children, where more than 930 individuals, primarily under 16 years old, tested positive for the virus. Two previous HIV outbreaks in Pakistan occurred in 2008 and 2018. These incidents emphasize the crucial role of safe injection practices in curbing the transmission of infectious diseases and safeguarding public health( 10 ). There is a notable scarcity of research on parental understanding and perspectives regarding injection practices in Pakistan. This gap underscores the pressing need for further investigation in this field. The HIV outbreak among children highlights the urgency of increasing awareness among parents. This involves educating parents about the risks associated with unnecessary injections, promoting oral medications, emphasizing precautions, addressing financial implications, and stressing the importance of verifying healthcare providers and facilities. Thus, the objective of this study was to assess the knowledge, attitude and practices of parents of children under 18 years of age visiting outpatient clinics of Aga Khan University Hospital regarding safe injections. MATERIALS AND METHODS Study design A prospective quantitative cross-sectional study design was employed. Study Period and Area : This study was conducted over six months, from January 1, 2021- June 31, 2021, after obtaining approval from the ethical review committee of Aga Khan University Hospital. The Aga Khan University Hospital in Pakistan is a private tertiary care hospital that serves a diverse patient population, welcoming individuals from all ethnic backgrounds and economic standings. In its pediatric outpatient clinics, parents from varying income levels seek care for their children. Notably, the hospital's welfare system ensures accessibility for low-income families too. AKUH’s pediatric department offers a wide range of specialized services, including fetal and neonatal medicine, cardiopulmonary care, neurology, child development, gastroenterology, nutrition, endocrinology, rheumatology, nephrology, genetics, and metabolic and infectious diseases. The pediatric outpatient clinics at Aga Khan University Hospital (AKUH) operate from 9:00 AM to 5:00 PM. This study was conducted in general pediatric outpatient clinics of AKUH. Study Population Parents of children under 18 years of age, regardless of gender, visiting general paediatric outpatient clinics of AKUH were included in the study. I nclusion criteria consisted of parents who consented to be involved in the study. Exclusion criteria included parents who did not understand Urdu or English, non-consenting parents, and children brought by caretakers other than parents. Sample Size : The sample size was calculated using openEpi for all 3 variables, showed n = 233, n = 266, and n = 218 for knowledge, attitude and practices respectively taking a two-sided significance level (1-alpha):95 and Power(1-beta, % chance of detecting):80. Highest sample size was taken as 266, hence a sample size of 266 parents of children under 18 years of age would require to produce estimates at 5% precision and 95% level of confidence. Sampling Technique A non-probability, convenience sampling technique was used, approaching parents of children presenting in outpatient clinics at Aga Khan University Hospital and a total of 266 parents of children under 18 years were enrolled in this study using non-probability convenience sampling. Variables Dependent variables included knowledge, attitude, and practice while independent variables included age, gender, ethnicity, residence, education, monthly income and relation to the child. Data Collection Tools and Procedure : Data was collected through a structured and interviewer-administered questionnaire developed after an extensive literature search. Data was collected by the interviewers who were fluent in English and Urdu languages. The interview was conducted in a specified space in the clinic and the questionnaires were stored in lock and key. The questionnaire tool was adapted from the study "Therapeutic Injections in Pakistan: From the Patients' Perspective," originally conducted in an adult population in Karachi( 11 ). It was modified to suit pediatric contexts and was made available in both Urdu and English languages. The questionnaire consisted of the following themes: 1. Demographics, which included age, gender, ethnicity, area of residence, relation with the child, education of parents and monthly income, 2. Knowledge about injections, 3. Attitudes towards injection use and 4. Practices regarding injection use for their children. Questions included in the questionnaire were focused on the patient's last encounter with a health care provider, use of injections over the previous 6 months, knowledge of risks of diseases transmitted by unsafe injections, and the necessity of authenticity of prescribers, dispensers, and settings where injections were administered. The questionnaire was developed with 22 multiple-choice questions. Knowledge was evaluated using six questions, with a score of 4 or higher out of 6 was considered good knowledge. The attitude was similarly assessed by six questions, each with a maximum score of 4, and a total attitude score of 18 or above out of 24 was considered a positive attitude towards injection use. Practice was measured using ten questions, with a score of 7 or more out of 10 considered adequate practice. Data Processing and Analysis Statistical analysis of data was performed using SPSS version 23.0. Median was used for quantitative variables. Frequency and percentage computed for qualitative variables. The quantitative data like age, and family income were expressed as mean with standard deviation, and qualitative data like gender, ethnicity, relationship with the child, family income, geographical location, education of parents, knowledge, attitude, and practice were expressed as frequency or percentage. Effect modifiers like age of the child, sex of the child, relationship with the child, ethnicity, geographical location, family income, and education level of parents were addressed through stratification. Post Stratification, the Chi/ Fischer exact test was applied, and a p-value of < 0.05 was considered significant. Ethical Considerations : This study was conducted in adherence to the highest ethical standards as outlined in the Declaration of Helsinki and Good Clinical Practice (GCP) principles, with approval from the Ethical Review Committee of the Aga Khan University Hospital with approval ID: 2021-5621-17423. All participants received a comprehensive explanation of the study’s goals through an informed consent form, emphasizing their voluntary participation and the freedom to withdraw at any time without any consequences. No participant IDs were collected to protect anonymity, and all data obtained through the questionnaire was kept confidential. There were no associated risks or benefits for participation. The study strictly followed all regulatory requirements to uphold ethical conduct, integrity, and trust in scientific research. RESULTS Socio-Demographic Characteristics of the Respondents : Table 1 . shows that most respondents (84.2%) reside in urban areas, while a smaller portion (15.8%) live in rural settings. The children’s median age is 3.4 years. The percentage of boys in our study was 55.3% compared to girls 44.7%. Regarding the relationship to the child, most respondents were fathers (54.9%) while mothers were (45.1%). The ethnic composition of the sample is diverse: Muhajir parents made up the largest group (43.6%), followed by Sindhi (16.9%), Punjabi (15.4%), Pakhtoon (10.5%), Balochi (4.5%), and other ethnicities (9%). Education levels varied between mothers and fathers, though both groups show high educational attainment overall; among mothers, 55.6% had higher education, 20.3% had secondary education, 7.5% had primary education, and 16.5% had no formal education. Fathers tend to have even higher education levels, with 64.3% having higher education, 14.3% secondary, 13.5% primary, and 7.9% lacking formal education. Financially, almost all families (97.4%) earn more than 30,000 per month, with only 2.6% earning below this amount. Table 1 Socio-Demographic Characteristics of Parents of children under 18 years of age (n = 266) Variable Category Frequency Percentage Area of residence Urban 224 84.2% Rural 42 15.8% Gender of child Male 147 55.3% Female 119 44.7% Age of child in years 3.4 1–7 (Median [IQR]) 54.9 45.1 Relation with the child Father 146 54.9% Mother 120 45.1% Ethnicity Muhajir 116 43.6% Pakhtoon 28 10.5% Punjabi 41 15.40% Sindhi 45 16.90% Balochi 12 4.5% Other 24 9.0% Education of mother None 44 16.5% Primary 20 7.5% Secondary 54 20.3% Higher 148 55.6% Education of father None 21 7.9% Primary 36 13.5% Secondary 38 14.3% Higher 171 64.3% Monthly Income 30K 259 97.4% Knowledge of Parents regarding Injection Use : Table 2 . shows the responses to knowledge questions among parents reveal a strong awareness of safe injection practices and the risks associated with improper handling. An overwhelming majority (91.4%) of respondents recognize that HIV and Hepatitis B/C can be transmitted through unsafe injections, while a small portion (8.6%) did not share this awareness. Additionally, most participants (94.4%) agree that injections should be prescribed only by certified individuals, and 94% believe that certified personnel should administer injections. A very high percentage (97%) of respondents understand that reusing injections poses a serious infection risk for children. There is also widespread agreement (92.1%) that overuse of injections is a significant problem in the country, indicating awareness of the potential health risks related to unnecessary injections. Furthermore, 96.2% of respondents acknowledge that used sharps should be disposed of immediately in designated sharp boxes to prevent accidental injuries or infections. Table 2 Frequency of responses to knowledge questions (n = 266) Variables Categories Frequency Percentage HIV/ Hepatitis B/C can be transmitted through unsafe injections No 23 8.60% Yes 243 91.4% Injections should be prescribed by a certified person No 15 5.60% Yes 251 94.4% Injections should be administered by a certified person No 16 6.0% Yes 250 94.0% Reuse of injections can put your child at risk of serious infections No 8 3.0% Yes 258 97.0% Overuse of injections is a problem in our country No 21 2.05% Yes 245 92.1% Sharps should be immediately disposed of in sharp boxes after use No 10 3.80% Yes 256 96.2% Attitude of Parents regarding Injection Use : Table 3 . presents the responses to attitude questions among parents, offering insights into their preferences and perceptions of oral versus injectable medications. When asked if they have ever insisted a physician prescribe injectables over oral medications, nearly half (46.6%) responded "never," indicating no preference for oral medication over injections. However, 42.9% said they "sometimes" prefer the injectable route, suggesting an equal proportion believe the injectable route to be better comparatively. Most parents (62%) believe that the injectable route is "sometimes," preferable to the oral route with 21.4% holding this view "most of the time" and 6.4% "always." Only 10.2% believe that the injectable route is “never” preferable, indicating the overall preference of the parents towards injections. Parental safety concerns regarding injections for their children appear limited; 81.6% have "never" refused injections due to safety concerns, while only 13.5% have done so "sometimes." Regarding returning to a practitioner who refused an injection they requested, most parents (59.4%) would "never" return, reflecting a strong expectation for practitioners to accommodate their preferences, which could be a reason for the number of injections prescribed each day. Additionally, 45.1% of respondents think injectable medications "sometimes" cost more than oral options, and 39.1% believe this "most of the time. "Finally, more than half (55.3%) "always" leave the choice between oral and injectable routes to the physician, with 36.8% doing so "most of the time." Table 3 Frequency of responses to attitude questions (n = 266) * Variables Categories Frequency Percentage Have you ever insisted a physician prescribe injections compared to oral medications Always 7 2.60% Most of time 21 7.90% Sometimes 114 42.90% Never 124 46.60% Do you think the injectable route is better than the oral route? Always 17 6.40% Most of time 57 21.4% Sometimes 165 62.0% Never 27 10.2% Have you ever refused injections for your child considering them not safe Always 2 0.8% Most of time 11 4.1% Sometimes 36 13.5% Never 217 81.6% Would you return to a practitioner who refused an injection that you insisted to prescribe Always 10 3.80% Most of time 35 13.2% Sometimes 63 23.7% Never 158 59.4% Does injectable medicines cost more compared to oral medicines Always 34 12.8% Most of time 104 39.1% Sometimes 120 45.1% Never 8 3.0% Do you leave it to the physician to decide about the oral or injectable route of medicines Always 147 55.3% Most of time 98 36.8% Sometimes 19 7.1% Never 2 0.8% *Score for questions of attitude: For questions # 1 and 2: the scores are as follows: Always ( 1 ), Most of the time ( 2 ), Sometimes ( 3 ), Never ( 4 ) For questions 3–6: the scores are as follows: Always ( 4 ), Most of the time ( 3 ), Sometimes ( 2 ), Never ( 1 ) Practices of Injections Use Reported by Parents The responses to practice-related questions in Table 4 highlight key insights into the use of injections in the past 6 months among parents with children. A majority of parents (86.1%) reported that their child received an injection in the last 6 months, while 13.9% did not. Most of these children had fewer than four symptoms (75.2%), with 24.8% having four or more symptoms for which injections were administered. The primary reasons for administering injections include fever (53.2%), vomiting and/or diarrhoea (53.4%), and cough (21.1%). Vaccination was also a common reason (46.2%), while urinary symptoms (1.9%) were less frequently reported. In terms of the duration of symptoms, 75.2% of injections were given for symptoms lasting less than 5 days, with 24.8% given for symptoms persisting for 5 days or more. When considering the frequency of injections, 36.5% of children received two or more injectable courses in the past 6 months, while 63.5% had fewer. Injections were mainly administered for non-antibiotic treatments (66.9%), including vaccinations, fluids, antiemetics, and antipyretics, whereas 33.1% were for antibiotics. Regarding the injection prescriber, most injections were prescribed by a qualified professional, with 52.6% prescribed by a private physician and 31.6% by a public physician. However, 13.3% of injections were prescribed by unqualified individuals, including nurses (7.1%), chemists (5.2%), and homoeopaths (0.8%). For the administration of injections, most were given by nurses (55.6%) or physicians (15.4%), while a quarter of injections (25.6%) were administered by unqualified dispensers. In terms of the setting, 39.8% of injections were administered in clinics, 30.1% in private hospitals, and 13.5% in public hospitals. However, 16.6% of injections were administered in inappropriate settings, such as at home (9.8%) or public dispensaries (6.8%). Finally, when parents observed practices in their last encounter, 42.9% noted inadequate practices, primarily in inappropriate settings. A smaller percentage (23.7%) did not witness the administration, while 33.5% observed adequate practices. Table 4 Frequencies of responses to practice questions n = 266 Variables Categories Frequency Percentage Injection received in last 6 months Yes 229 86.1 No 37 13.9 Number of symptoms less than 4 200 75.2 4 or more 66 24.8 Symptoms for which injections were given Fever 142 53.2 Pain 27 10.2 Cough 56 21.1 Vomiting and/or diarrhoea 142 53.4 Vaccination 123 46.2 Cough and/or chest congestion 64 24.1 Urinary symptoms 5 1.9 Duration of symptoms less than 5 days 200 75.2 5 or more days 66 24.8 No of injectable courses in 6 months 2 or more 97 36.5 less than once 169 63.5 Type of injection antibiotics 88 33.1 *other than antibiotics 178 66.9 Injection prescriber Qualified person •Private physician 140 52.6 •Public physician 84 31.6 Unqualified person •Nurse 19 7.1 •Chemist 14 5.2 •Homeopath 2 0.8 •Others 7 2.6 Injection administrator Qualified person •Physician 41 15.4 •Nurse 148 55.6 Unqualified person •Dispenser 68 25.6 •Others 9 3.4 Setting where injection was received Appropriate •Public hospital 36 13.5 •Private hospital 80 30.1 •Clinic 106 39.8 Inappropriate •Home 26 9.8 •Public dispensary 18 6.8 Last encounter practices observed Inadequate Practice •**Inappropriate 114 42.9 •Not witnessed 63 23.7 †Adequate practice 89 33.5 *other than antibiotics include vaccination, fluids, antiemetics, antipyretics **Inappropriate practices include opening syringe behind counter, open syringe picked from tray, syringe cleaned with alcohol swab †Adequate practices include opening syringe in front of the patient from sealed packet, not touching opened needle, disposing it immediately after use, not using same needle on another patient, not using same needle multiple times The knowledge scores of parents regarding injection practices reveal that a significant majority (93.6%) of parents have a good understanding of injection practices, while a small proportion (6.4%) have poor knowledge. This indicates that most parents are well-informed about safe injection practices, though there is a small group with inadequate knowledge in this area. (Table 5 ) Table 5 Knowledge scores of parents regarding injection practices (n = 266) Variable Categories Frequency Percentage Knowledge Poor 17 6.40% Good 249 93.60% The attitude scores indicate that 55.3% of parents demonstrated a positive attitude towards safe injection practices, while 44.7% exhibited a negative attitude. (Table 6 ) Table 6 Attitude scores of parents regarding injection practices (n = 266) Variable Categories Frequency Percentage Attitude Negative 147 55.30% Positive 119 44.70% The practice scores of parents regarding injection practices show that a significant portion (70.7%) exhibit inadequate practices, while only 29.3% demonstrate adequate practices. This suggests that, despite having a good understanding of injection practices (as seen in the previous knowledge scores), many parents still fall short when it comes to properly implementing these practices. (Table 7 ) Table 7 Practices scores of parents regarding injection practices (n = 266) Variable Categories Frequency Percentage Practice Inadequate 188 70.7% Adequate 78 29.3% Table 8 shows the association of knowledge scores with sociodemographic variables in parents regarding injection practices revealing several significant findings. Ethnicity had a significant impact on knowledge scores (p = 0.0005), with parents from the Sindhi (20%) and Balochi (16.7%) ethnic groups showing a higher proportion of poor knowledge, while Muhajir (2.5%) and Pakhtoon (3.5%) parents had the highest proportion of good knowledge (97.5% and 96.4%, respectively). Area of residence was also significantly associated with knowledge scores (p = 0.001), with only 71.4% of rural parents having good knowledge compared to 97.8% of urban parents. Table 8 Association of knowledge with sociodemographic variables in parents having children aged < 18 years regarding injection practices (n = 266) Variables Categories Knowledge Score P Value Poor n (%) Good n (%) Relation to the child Mother 7 (5.9) 113 (94.1) .470 Father 9 (6.4) 131 (93.6) Other 1 (16.6) 5 (83.3) Childs gender Male 10 (6.8) 137 (93.2) .482 Female 7 (5.9) 112 (94.1) Ethnicity Muhajir 3 (2.5) 113 (97.5) 5.000 Pakhtoon 1 (3.5) 27 (96.4) Punjabi 2 (4.8) 39 (95.2) Sindhi 9 (20) 36 (80) Balochi 2 (16.7) 10 (83.3) Other 0 24 (100) Area of residence Urban 5 (0.2) 219 (97.8) .001 Rural 12 (28.5) 30 (71.4) *For cell counts less than 5 Fisher exact values have been reported Variables Categories Knowledge Score P Value Poor n (%) Good n (%) Age *0.516 Education of mother None 14 (31.8) 30 (68.2) .001 Primary 1 ( 5 ) 19 (95) Secondary 1 (1.8) 53 (98.2) Higher 1 (0.7) 147 (99.3) Education of father None 7 (33.3) 14 (66.7) .001 Primary 6 (16.7) 30 (83.3) Secondary 3 (7.9) 35 (92.1) Higher 1 (0.58) 170 (99.4) Monthly Income 30k 16 (6.2) 243 (93.8) *For cell counts less than 5 Fisher exact values have been reported, for age t-test applied Parental education levels were strongly correlated with knowledge scores. Among mothers, 31.8% of those with no formal education had poor knowledge, while 99.3% of those with higher education had good knowledge (p = 0.001). Similarly, 33.3% of fathers with no formal education had poor knowledge, while 99.4% of those with higher education had good knowledge (p = 0.001). Table 9 . shows that the association of attitude scores with sociodemographic variables in parents regarding injection practices revealed several significant trends. Ethnicity played a notable role, with Sindhi parents showing a significantly higher proportion of negative attitudes (80%) compared to other ethnic groups (p = 0.005). Muhajir and Pakhtoon parents had more positive attitudes, with 54.3% and 42.8%, respectively. Area of residence also had a significant impact on attitudes (p = 0.001), with rural parents exhibiting a much higher proportion of negative attitudes (78.6%) compared to urban parents (50.9%). Parental education levels were strongly associated with attitudes (p = 0.001). Mothers with no formal education had the highest proportion of negative attitudes (81.8%), while those with higher education showed a more balanced attitude, with 45.9% negative and 54.1% positive. Similarly, fathers with no formal education exhibited more negative attitudes (71.4%) compared to those with higher education, who showed a more balanced distribution (48% negative and 52% positive). However, income per month did not significantly influence attitudes (p = 0.704), as both low- and high-income parents demonstrated similar patterns of positive attitudes. Table 9 Association of attitude with sociodemographic variables in parents having children aged < 18 years regarding injection practices (n = 266) Variables Categories Attitude Score P Value Negative n (%) Positive n(%) Relation to the child Mother 58(48.3) 62 (51.7) .121 Father 85 (60.7) 55 (39.2) Other 4 (66.7) 2 (33.3) Childs gender Male 86 (58.5) 61 (41.5) .238 Female 61 (51.2) 58 (48.7) Ethnicity Muhajir 53 (45.7) 63 (54.3) .005 Pakhtoon 16 (57.1) 12 (42.8) Punjabi 23 (56.1) 18 (43.9) Sindhi 36 (80) 9 (20) Balochi 7 (58.3) 5 (41.7) Other 12 (50) 12 (50) Area of residence Urban 114 (50.9) 110 (49.1) .001 Rural 33 (78.6) 9 (21.4) *For cell counts less than 5 Fisher exact values have been reported Variables Categories Attitude Score P Value Negative n (%) Positive n(%) Age *0.505 Education of mother None 36 (81.8) 8 (18.2) .001 Primary 16 (80) 4 (20) Secondary 27 (50) 27 (50) Higher 68 (45.9) 80 (54.1) Education of father None 15 (71.4) 6 (28.6) .001 Primary 30 (83.3) 6 (16.7) Secondary 20 (52.6) 18 (47.4) Higher 82 (48) 89 (52) Income per month 30k 144 (6.2) 6 (92.1) *For cell counts less than 5 Fisher exact values have been reported for age t-test applied Table 10 shows that the association between practice scores and sociodemographic variables revealed several significant patterns. Ethnicity was significantly linked to injection practices (p = 0.019), with Sindhi and Balochi parents displaying a higher proportion of inadequate practices (84.4% and 91.6%, respectively). In contrast, Muhajir and Punjabi parents showed more balanced practices, with 62% and 63.4% having inadequate practices. Area of residence also had a strong impact (p = 0.001), with rural parents reporting 100% inadequate practices, while urban parents showed a more even distribution, with 65.2% exhibiting inadequate practices and 34.8% demonstrating adequate practices. Parental education emerged as a key determinant (p = 0.001), as those with no formal education, particularly mothers and fathers, had the highest proportion of inadequate practices (97.7% and 95.2%, respectively). On the other hand, parents with higher education showed more adequate practices, with 39.9% of mothers and 38.1% of fathers demonstrating proper practices. Income per month did not show a significant association with practices (p = 0.085), though all parents with a monthly income less than 30k had inadequate practices, while a larger proportion (70.4%) of parents with an income above 30k exhibited inadequate practices. Table 10 Association of practice with sociodemographic variables in parents having children aged < 18 years regarding injection practices (n = 266) Variables Categories Practice Score P Value Inadequate n (%) adequate n(%) Relation to the child Mother 85(70.8) 35 (29.2) 1.000 Father 99 (70.7) 41 (29.3) Other 4 (66.7) 2 (33.3) Childs gender Male 101 (68.7) 46 (31.3) .499 Female 87 (73.1) 32 (26.9) Ethnicity Muhajir 72 (62) 44 (40) .019 Pakhtoon 22 (78.5) 6 (21.5) Punjabi 26 (63.4) 15 (36.6) Sindhi 38 (84.4) 7 (15.6) Balochi 11 (91.6) 1 (8.4) Other 19 (79.1) 5 (20.9) Area of residence Urban 146 (65.2) 78 (34.8) .001 Rural 42 (100) 0 *For cell counts less than 5 Fisher exact values have been reported Age *0.565 Education of mother None 43 (97.7) 1 (2.3) .001 Primary 18 (90) 2 ( 10 ) Secondary 38 (70.4) 16 (29.6) Higher 89 (60.1) 59 (39.9) Education of father None 20 (95.2) 1 (4.8) .001 Primary 35 (97.2) 1 (2.8) Secondary 27 (71) 11 (29) Higher 106 (61.9) 65 (38.1) Income per month 30k 181 (70.4) 76 (29.6) *For cell counts less than 5 Fisher exact values have been reported for age t-test applied DISCUSSION The study reveals significant insights into parental knowledge, attitudes, and practices concerning injection use for children, highlighting a disconnect between high awareness and actual practices. While a majority of parents (93.6%) demonstrated sound knowledge about safe injection practices, a considerable proportion still exhibited a negative attitude (55.3%) and engaged in inadequate practices (70.7%). The influence of media and healthcare workers may contribute to the high awareness levels. Similarly, in a study on vaccination practices, while most parents showed a solid understanding of vaccination protocols, many still held negative attitudes and followed suboptimal practices( 12 ). Both studies underscore a critical gap between parental knowledge and actual behavior, highlighting the need for targeted educational efforts to bridge this gap and improve health-related practices among parents. We included vaccinations in our study as it is equally important to ensure safe practices while vaccines are being administered as discussed above, however, we did not ask questions like the choice between oral vs injectables, duration of symptoms, efficacy of oral vs IV route from the parents whose children got only vaccinations. Urban residency and parental education were positively associated with better understanding and practices (p = 0.001), suggesting that socioeconomic factors significantly shape healthcare behaviors. Higher education levels enable parents to gain a thorough understanding of their child's health, making it easier for them to comprehend safe injection practices and their importance. Additionally, education enhances communication with healthcare providers, reducing the likelihood of adopting incorrect beliefs about injection practices. Healthcare access disparities typically exist in rural areas due to limited infrastructure, fewer healthcare providers, and financial constraints which may account for why parents in urban residency had better understanding of safe injection practices. Cultural and ethnic influences, particularly among Sindhi, Balochi, and Pashto-speaking families, were also linked to negative attitudes and suboptimal practices (p = 0.005), emphasizing the need for culturally sensitive interventions( 13 ). These findings on injection practices align with trends observed in studies on immunizations in Pakistan, where socioeconomic and cultural factors similarly impact healthcare behaviors. Despite high levels of awareness among urban, educated parents, the study indicates that traditional beliefs about injections as potent treatments persist, driven by social norms and reinforcement from healthcare providers. This aligns with research showing that patients and healthcare workers often mutually reinforce the demand for injections, complicating efforts to reduce unnecessary use. These findings are particularly concerning in light of Pakistan's high injection rates—up to 8.5 per person annually, with a substantial percentage deemed unnecessary( 14 ). Unnecessary injection use in Pakistan is widespread, particularly in private clinics and dispensaries where prescribers, often doctors or untrained personnel, administer injections and IV drips for conditions that could be treated with oral medications. The drive for these unnecessary injections stems from a desire for quick relief, as well as financial incentives for healthcare providers. Patients, often unaware of the health risks associated with reused syringes and IV equipment, rarely question the need for these treatments, leaving them vulnerable to unsafe practices( 15 ). Similarly, unsafe practices, including the reuse of injection equipment, have previously led to severe public health crises, such as the 2019 HIV outbreak in Larkana where more than 750 people were diagnosed with HIV, with children making up 80% of the number( 16 ). Furthermore, unsafe practices are often underreported. While some healthcare workers are aware of safe procedures, they struggle to implement them effectively, with heavy workloads being a significant contributing factor( 17 ). Infection prevention and control (IPC) practices are minimal or altogether lacking in many private healthcare settings, and this issue extends to government facilities across all levels—primary, secondary, and tertiary hospitals. Even at tertiary hospitals, sterilization processes for minor and major surgeries are often insufficient. Significant gaps exist in healthcare waste and sharps management. Although some government hospitals are equipped with incinerators, these are frequently found to be non-operational. The study’s single-center design and focus on a relatively privileged urban population however limit the generalizability of its findings to broader rural or underserved communities, where healthcare access and attitudes may differ. Additionally, data collection from outpatient clinics, including follow-up patients, may have influenced results by over-representing frequent injection prescriptions. The use of injections can save many lives, but they also carry a risk of transmission of infectious diseases. To address these issues, comprehensive public health initiatives are essential. Training programs for healthcare providers should focus on promoting evidence-based alternatives and safe injection protocols, including the use of auto-disable syringes. Additionally, public awareness campaigns targeting parents could encourage safer decision-making, particularly in regions where cultural factors drive high injection use. By fostering a healthcare environment that emphasizes safety and alternative treatments, these interventions could substantially reduce injection overuse, mitigate infection risks, and improve overall public health outcomes in Pakistan. CONCLUSION This study highlights the need to improve parental understanding and safe injection practices in Pakistan. Although many parents are aware of safe practices, cultural beliefs and the reinforcement of injection overuse between patients and providers contribute to unsafe behaviors. To reduce infection risks and unnecessary injections, public health efforts should focus on training healthcare providers, promoting auto-disable syringes, and increasing parental awareness, especially in underserved communities. These interventions are vital to safeguard public health and prevent outbreaks. Declarations Ethics approval and consent to participate: Ethical approval was taken from The Aga Khan University Ethical Review Committee. Informed consent : Before data collection, all parents willing to participate were asked to sign a written consent form to be included. The children of non-consenting parents did not participate in data collection. Consent for publication: All authors have read and approved the final manuscript. This manuscript has not been published and is not under consideration for publication elsewhere. Availability of data and materials: The data that support the findings of this study are available on request from the corresponding author. Competing interests: The authors declare that they have no competing interests. The authors report no conflict of interest. Funding: This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector. Author Contributions: BR, AA, NS: These authors made a significant contribution to the work reported, whether that is in the conception, study design, execution or data collection. AP and AN contributed to data analysis, critical review and interpretation of data collected. KH, AA and BR took part in drafting, writing and revising the manuscript. FM and BR critically reviewed the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted. BR as the corresponding author is accountable for all aspects of the work. References World Health Organization. WHO best practices for injections and related procedures toolkit. World Health Organization; 2010. Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bulletin of the World Health Organization. 1999;77(10):789. Hauri AM, Armstrong GL, Hutin YJ. The global burden of disease attributable to contaminated injections given in health care settings. International journal of STD & AIDS. 2004 Jan 1;15(1):7-16. Rouet F, Nouhin J, Zheng DP, Roche B, Black A, Prak S, Leoz M, Gaudy-Graffin C, Ferradini L, Mom C, Mam S. Massive iatrogenic outbreak of human immunodeficiency virus type 1 in rural Cambodia, 2014–2015. Clinical Infectious Diseases. 2018 May 17;66(11):1733-41. Murhekar MV, Rao RC, Ghosal SR, Sehgal SC. Assessment of injection-related practices in a tribal community of Andaman and Nicobar Islands, India. Public Health. 2005 Jul;119(7):655–8. Kermode M. Unsafe injections in low-income country health settings: need for injection safety promotion to prevent the spread of blood-borne viruses. Health Promot Int. 2004 Mar;19(1):95–103. Mubashir SA, Kiyani T. National Institute of Population Study (NIPS)[Pakistan] and ICF International. PakistanDemographic and Health Survey (2012-13). Islamabad, Pakistan, and Cleverton, Maryland, USA: NIPS and ICF International. 2013. Reeler A V. Anthropological perspectives on injections: a review. Bull World Health Organ. 2000;78(1):135–43. Riaz H, Kamal SW, Riaz T, Aziz S, Rajper J, Noorulain W. Methods of disposal of used syringes by hepatitis B and C patients at an urban and rural setting. J Pak Med Assoc. 2012 Jan;62(1):81–4. Zaid M, Afzal MS. HIV outbreak in Pakistan. Lancet Infect Dis. 2018 Jun;18(6):601. Raglow GJ, Luby SP, Nabi N. Therapeutic injections in Pakistan: from the patients’ perspective. Tropical Medicine & International Health. 2001 Jan 28;6(1):69–75. Shahzadi A, Saddique H, Tasneem Kousar S, Jabeen R, . KU. Knowledge Attitude and Practice Factors on Parents Regarding Immunization. NURSEARCHER (Journal of Nursing & Midwifery Sciences). 2022 Dec 31;07–11. Mitchell S, Andersson N, Ansari NM, Omer K, Soberanis JL, Cockcroft A. Equity and vaccine uptake: a cross-sectional study of measles vaccination in Lasbela District, Pakistan. BMC Int Health Hum Rights. 2009 Oct 14;9 Suppl 1(Suppl 1):S7. Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bull World Health Organ. 1999;77(10):789–800. Altaf A, Fatmi Z, Ajmal A, Hussain T, Qahir H, Agboatwalla M. Determinants of therapeutic injection overuse among communities in Sindh, Pakistan. Journal of Ayub Medical College Abbottabad. 2004;16(3). Hermez J, Ismail M, Morgan O, Pasha MS, Schenkel K, Doherty M, et al. A pediatric HIV outbreak in Pakistan. East Mediterr Health J. 2024 Jan 21;30(1):60–7. Chowdhury AKA, Roy T, Faroque ABM, Bachar SC, Asaduzzaman M, Nasrin N, et al. A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh. BMC Public Health. 2011 Oct 10;11:779. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5860157","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":410374526,"identity":"c84103a1-92bf-4a06-8246-31a3af86089d","order_by":0,"name":"Bushra Rehman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYBACAwYGNhiDgeHjPxsGBglStDDOYEsjUQszD9thwlrMJdKfPa6ouSdnLnb42cMZPOcT+2c3H3zAUGMTjUuL5Ywcc8Mzx4qNLWenmRt8kLidOOPOsWQDhmNpuQ24HHYjh02ygS0hccPtBDPJGQa3Extu5JhJMDYcxqMl/Zlkw7+E+g23079J8yScS5xPWAvQ8Ma2hASD2zlm0jwHDiRuIKTFsucNUEtfguGG2zllkjMbko033khLNkjA4xdzdpDDviXIG9xO3ybxscFOdt6N5IMPPtTY4NSCARzBKhOIVQ4C9qQoHgWjYBSMgpEBAIn/YFZYIbBgAAAAAElFTkSuQmCC","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Bushra","middleName":"","lastName":"Rehman","suffix":""},{"id":410374527,"identity":"496dfa0a-b7b8-4977-a0ff-d69f7d6bc3c5","order_by":1,"name":"Abida Akbar","email":"","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abida","middleName":"","lastName":"Akbar","suffix":""},{"id":410374528,"identity":"746b5b86-0dc3-4a8a-a8d3-458e666f8a98","order_by":2,"name":"Aneela Pasha","email":"","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Aneela","middleName":"","lastName":"Pasha","suffix":""},{"id":410374529,"identity":"5384dc9d-f434-4d0a-9a67-583c28322da7","order_by":3,"name":"Kashmala Hussain","email":"","orcid":"","institution":"Medical College, Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Kashmala","middleName":"","lastName":"Hussain","suffix":""},{"id":410374530,"identity":"120bde75-f9b5-4c8f-99e5-52dfdbcf065c","order_by":4,"name":"Muhammad Nasheet Sagri","email":"","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Nasheet","lastName":"Sagri","suffix":""},{"id":410374531,"identity":"8a81d891-70ca-4d4d-a9d2-0a12237ddd4b","order_by":5,"name":"Apsara Nathwani","email":"","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Apsara","middleName":"","lastName":"Nathwani","suffix":""},{"id":410374532,"identity":"546e93c6-a448-43da-a848-1a51cd5778ac","order_by":6,"name":"Fatima Mir","email":"","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fatima","middleName":"","lastName":"Mir","suffix":""}],"badges":[],"createdAt":"2025-01-19 15:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5860157/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5860157/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75502697,"identity":"9349a36a-54de-4ed2-b2a0-b58ff742bb7b","added_by":"auto","created_at":"2025-02-05 09:13:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25218,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5860157/v1/023ecd3261da8a660478ddc4.png"},{"id":75502698,"identity":"6883f57c-21e7-4f5b-8f18-443f3d3c5529","added_by":"auto","created_at":"2025-02-05 09:13:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":49770,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge scores of Parents regarding Injections for their children (n= 266)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5860157/v1/1d3f51e3b84a54dc8ce75158.png"},{"id":75503122,"identity":"a58a0a2e-d26e-4622-8fd9-5c27f4f2c641","added_by":"auto","created_at":"2025-02-05 09:21:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":47546,"visible":true,"origin":"","legend":"\u003cp\u003eParents Attitudes towards Injections for their children (n= 266)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5860157/v1/441079ea3fef7772027f9f28.png"},{"id":75502707,"identity":"35b8ef0a-aabf-4827-9628-621b9eed3afc","added_by":"auto","created_at":"2025-02-05 09:13:39","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":47914,"visible":true,"origin":"","legend":"\u003cp\u003ePractices of Parents regarding Injections for their children (n= 266)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5860157/v1/a004cb597f8c2eb320d9e5bb.png"},{"id":75502704,"identity":"fd444acf-ef83-4c6d-abcf-44cfb0c4ec89","added_by":"auto","created_at":"2025-02-05 09:13:38","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":52330,"visible":true,"origin":"","legend":"\u003cp\u003eParents Knowledge, Attitude and Practices regarding Injections Use for their Children (n=266)\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5860157/v1/cb54b9e046eafae4e134cc0d.png"},{"id":75504886,"identity":"64e9cad9-7a7f-4d51-ae83-7fd6b159848b","added_by":"auto","created_at":"2025-02-05 09:37:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1678119,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5860157/v1/eabddd73-4f36-4293-aba9-84bd3a8705fa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, Attitude, and Practices of Parents Regarding Injections Use for Their Children-A Study from Outpatient Clinics of a Tertiary Care Hospital in Pakistan","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe WHO states that a safe injection is one that does not harm the recipient, expose the provider to any avoidable risk, or result in hazardous waste(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Worldwide, 12\u0026nbsp;billion injections are administered annually, with 5% for immunization and 95% for curative purposes. With increasing numbers of injections, the probability of exposure to infectious agents also rises. In developing countries, injection is regarded as a powerful healing tool(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Patients frequently report higher satisfaction and perceive better care when they receive injections for treatment(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Healthcare workers receive financial incentives and gain prestige, which establishes a cycle where patients and providers mutually encourage the overuse of injections(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe use of injections in low-income countries averages 3.4 injections per person per year. The estimated number of injections per person per year ranges from 1.2 in Tanzania and India to 8.5 in Pakistan. Approximately, 25\u0026ndash;96% of outpatient visits result in at least one injection, and 70\u0026ndash;99% of injections are deemed unnecessary(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Many injections in developing countries are given with reused equipment due to lack of sterilization. Unsafe injection practices can transmit diseases like hepatitis B, hepatitis C and HIV. In developing countries, the reuse of unsterilized injection devices in 2000 alone caused millions of infections as per the WHO Global Burden of Disease study. In response, international organizations like WHO, UNICEF, UNFPA and the IFRC have advocated for the exclusive use of auto-disable syringes to eliminate the reuse of injecting equipment. According to one Demographic Health Survey, approximately 9% of injections given to patients in Pakistan are unsafe(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn developing countries, injections are administered across three sectors: the formal sector by trained healthcare professionals, the informal sector by traditional healers and unlicensed medical shopkeepers offering low-cost services without training, and the illegal sector solely for financial gain. These last two sectors pose major public health risks due to unsafe practices and inadequate monitoring(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The domestic sector involves injections given without payment by relatives or neighbours, adding to the complexity(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnsafe injection practices in Pakistan had devastating consequences, as evidenced by the HIV outbreak in Larkana, Pakistan in April 2019. A private healthcare provider initially identified 14 children with HIV infection. Subsequently, Pakistan faced its largest HIV outbreak in children, where more than 930 individuals, primarily under 16 years old, tested positive for the virus. Two previous HIV outbreaks in Pakistan occurred in 2008 and 2018. These incidents emphasize the crucial role of safe injection practices in curbing the transmission of infectious diseases and safeguarding public health(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is a notable scarcity of research on parental understanding and perspectives regarding injection practices in Pakistan. This gap underscores the pressing need for further investigation in this field. The HIV outbreak among children highlights the urgency of increasing awareness among parents. This involves educating parents about the risks associated with unnecessary injections, promoting oral medications, emphasizing precautions, addressing financial implications, and stressing the importance of verifying healthcare providers and facilities. Thus, the objective of this study was to assess the knowledge, attitude and practices of parents of children under 18 years of age visiting outpatient clinics of Aga Khan University Hospital regarding safe injections.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e \u003cstrong\u003eStudy design\u003c/strong\u003e \u003cp\u003eA prospective quantitative cross-sectional study design was employed.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eStudy Period and Area\u003c/b\u003e: This study was conducted over six months, from January 1, 2021- June 31, 2021, after obtaining approval from the ethical review committee of Aga Khan University Hospital. The Aga Khan University Hospital in Pakistan is a private tertiary care hospital that serves a diverse patient population, welcoming individuals from all ethnic backgrounds and economic standings. In its pediatric outpatient clinics, parents from varying income levels seek care for their children. Notably, the hospital's welfare system ensures accessibility for low-income families too. AKUH\u0026rsquo;s pediatric department offers a wide range of specialized services, including fetal and neonatal medicine, cardiopulmonary care, neurology, child development, gastroenterology, nutrition, endocrinology, rheumatology, nephrology, genetics, and metabolic and infectious diseases. The pediatric outpatient clinics at Aga Khan University Hospital (AKUH) operate from 9:00 AM to 5:00 PM. This study was conducted in general pediatric outpatient clinics of AKUH.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Population\u003c/strong\u003e \u003cp\u003eParents of children under 18 years of age, regardless of gender, visiting general paediatric outpatient clinics of AKUH were included in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eI\u003cb\u003enclusion criteria\u003c/b\u003e consisted of parents who consented to be involved in the study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion criteria\u003c/b\u003e included parents who did not understand Urdu or English, non-consenting parents, and children brought by caretakers other than parents.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSample Size\u003c/b\u003e: The sample size was calculated using openEpi for all 3 variables, showed n\u0026thinsp;=\u0026thinsp;233, n\u0026thinsp;=\u0026thinsp;266, and n\u0026thinsp;=\u0026thinsp;218 for knowledge, attitude and practices respectively taking a two-sided significance level (1-alpha):95 and Power(1-beta, % chance of detecting):80. Highest sample size was taken as 266, hence a sample size of 266 parents of children under 18 years of age would require to produce estimates at 5% precision and 95% level of confidence.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSampling Technique\u003c/strong\u003e \u003cp\u003eA non-probability, convenience sampling technique was used, approaching parents of children presenting in outpatient clinics at Aga Khan University Hospital and a total of 266 parents of children under 18 years were enrolled in this study using non-probability convenience sampling.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eVariables\u003c/strong\u003e \u003cp\u003eDependent variables included knowledge, attitude, and practice while independent variables included age, gender, ethnicity, residence, education, monthly income and relation to the child.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eData Collection Tools and Procedure\u003c/b\u003e: Data was collected through a structured and interviewer-administered questionnaire developed after an extensive literature search. Data was collected by the interviewers who were fluent in English and Urdu languages. The interview was conducted in a specified space in the clinic and the questionnaires were stored in lock and key. The questionnaire tool was adapted from the study \"Therapeutic Injections in Pakistan: From the Patients' Perspective,\" originally conducted in an adult population in Karachi(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). It was modified to suit pediatric contexts and was made available in both Urdu and English languages. The questionnaire consisted of the following themes: 1. Demographics, which included age, gender, ethnicity, area of residence, relation with the child, education of parents and monthly income, 2. Knowledge about injections, 3. Attitudes towards injection use and 4. Practices regarding injection use for their children.\u003c/p\u003e \u003cp\u003eQuestions included in the questionnaire were focused on the patient's last encounter with a health care provider, use of injections over the previous 6 months, knowledge of risks of diseases transmitted by unsafe injections, and the necessity of authenticity of prescribers, dispensers, and settings where injections were administered. The questionnaire was developed with 22 multiple-choice questions. Knowledge was evaluated using six questions, with a score of 4 or higher out of 6 was considered good knowledge. The attitude was similarly assessed by six questions, each with a maximum score of 4, and a total attitude score of 18 or above out of 24 was considered a positive attitude towards injection use. Practice was measured using ten questions, with a score of 7 or more out of 10 considered adequate practice.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Processing and Analysis\u003c/strong\u003e \u003cp\u003eStatistical analysis of data was performed using SPSS version 23.0. Median was used for quantitative variables. Frequency and percentage computed for qualitative variables. The quantitative data like age, and family income were expressed as mean with standard deviation, and qualitative data like gender, ethnicity, relationship with the child, family income, geographical location, education of parents, knowledge, attitude, and practice were expressed as frequency or percentage. Effect modifiers like age of the child, sex of the child, relationship with the child, ethnicity, geographical location, family income, and education level of parents were addressed through stratification. Post Stratification, the Chi/ Fischer exact test was applied, and a p-value of \u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e: This study was conducted in adherence to the highest ethical standards as outlined in the Declaration of Helsinki and Good Clinical Practice (GCP) principles, with approval from the Ethical Review Committee of the Aga Khan University Hospital with approval ID: 2021-5621-17423. All participants received a comprehensive explanation of the study\u0026rsquo;s goals through an informed consent form, emphasizing their voluntary participation and the freedom to withdraw at any time without any consequences. No participant IDs were collected to protect anonymity, and all data obtained through the questionnaire was kept confidential. There were no associated risks or benefits for participation. The study strictly followed all regulatory requirements to uphold ethical conduct, integrity, and trust in scientific research.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cb\u003eSocio-Demographic Characteristics of the Respondents\u003c/b\u003e: Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. shows that most respondents (84.2%) reside in urban areas, while a smaller portion (15.8%) live in rural settings. The children\u0026rsquo;s median age is 3.4 years. The percentage of boys in our study was 55.3% compared to girls 44.7%. Regarding the relationship to the child, most respondents were fathers (54.9%) while mothers were (45.1%). The ethnic composition of the sample is diverse: Muhajir parents made up the largest group (43.6%), followed by Sindhi (16.9%), Punjabi (15.4%), Pakhtoon (10.5%), Balochi (4.5%), and other ethnicities (9%). Education levels varied between mothers and fathers, though both groups show high educational attainment overall; among mothers, 55.6% had higher education, 20.3% had secondary education, 7.5% had primary education, and 16.5% had no formal education. Fathers tend to have even higher education levels, with 64.3% having higher education, 14.3% secondary, 13.5% primary, and 7.9% lacking formal education. Financially, almost all families (97.4%) earn more than 30,000 per month, with only 2.6% earning below this amount.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics of Parents of children under 18 years of age (n\u0026thinsp;=\u0026thinsp;266)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eArea of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender of child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of child in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(Median [IQR])\u003c/p\u003e \u003cp\u003e54.9\u003c/p\u003e \u003cp\u003e45.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRelation with the child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuhajir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePakhtoon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePunjabi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSindhi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBalochi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation of mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation of father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMonthly Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eKnowledge of Parents regarding Injection Use\u003c/b\u003e: Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. shows the responses to knowledge questions among parents reveal a strong awareness of safe injection practices and the risks associated with improper handling. An overwhelming majority (91.4%) of respondents recognize that HIV and Hepatitis B/C can be transmitted through unsafe injections, while a small portion (8.6%) did not share this awareness. Additionally, most participants (94.4%) agree that injections should be prescribed only by certified individuals, and 94% believe that certified personnel should administer injections. A very high percentage (97%) of respondents understand that reusing injections poses a serious infection risk for children. There is also widespread agreement (92.1%) that overuse of injections is a significant problem in the country, indicating awareness of the potential health risks related to unnecessary injections. Furthermore, 96.2% of respondents acknowledge that used sharps should be disposed of immediately in designated sharp boxes to prevent accidental injuries or infections.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of responses to knowledge questions (n\u0026thinsp;=\u0026thinsp;266)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHIV/ Hepatitis B/C can be transmitted through unsafe injections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInjections should be prescribed by a certified person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInjections should be administered by a certified person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReuse of injections can put your child at risk of serious infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOveruse of injections is a problem in our country\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.05%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSharps should be immediately disposed of in sharp boxes after use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.80%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eAttitude of Parents regarding Injection Use\u003c/b\u003e: Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. presents the responses to attitude questions among parents, offering insights into their preferences and perceptions of oral versus injectable medications. When asked if they have ever insisted a physician prescribe injectables over oral medications, nearly half (46.6%) responded \"never,\" indicating no preference for oral medication over injections. However, 42.9% said they \"sometimes\" prefer the injectable route, suggesting an equal proportion believe the injectable route to be better comparatively. Most parents (62%) believe that the injectable route is \"sometimes,\" preferable to the oral route with 21.4% holding this view \"most of the time\" and 6.4% \"always.\" Only 10.2% believe that the injectable route is \u0026ldquo;never\u0026rdquo; preferable, indicating the overall preference of the parents towards injections. Parental safety concerns regarding injections for their children appear limited; 81.6% have \"never\" refused injections due to safety concerns, while only 13.5% have done so \"sometimes.\" Regarding returning to a practitioner who refused an injection they requested, most parents (59.4%) would \"never\" return, reflecting a strong expectation for practitioners to accommodate their preferences, which could be a reason for the number of injections prescribed each day. Additionally, 45.1% of respondents think injectable medications \"sometimes\" cost more than oral options, and 39.1% believe this \"most of the time. \"Finally, more than half (55.3%) \"always\" leave the choice between oral and injectable routes to the physician, with 36.8% doing so \"most of the time.\"\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of responses to attitude questions (n\u0026thinsp;=\u0026thinsp;266) *\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHave you ever insisted a physician prescribe injections compared to oral medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost of time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDo you think the injectable route is better than the oral route?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost of time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHave you ever refused injections for your child considering them not safe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost of time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWould you return to a practitioner who refused an injection that you insisted to prescribe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.80%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost of time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDoes injectable medicines cost more compared to oral medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost of time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDo you leave it to the physician to decide about the oral or injectable route of medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost of time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Score for questions of attitude:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eFor questions # 1 and 2: the scores are as follows:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAlways (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), Most of the time (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), Sometimes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), Never (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eFor questions 3\u0026ndash;6: the scores are as follows:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAlways (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), Most of the time (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), Sometimes (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), Never (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePractices of Injections Use Reported by Parents\u003c/strong\u003e \u003cp\u003eThe responses to practice-related questions in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e highlight key insights into the use of injections in the past 6 months among parents with children. A majority of parents (86.1%) reported that their child received an injection in the last 6 months, while 13.9% did not. Most of these children had fewer than four symptoms (75.2%), with 24.8% having four or more symptoms for which injections were administered. The primary reasons for administering injections include fever (53.2%), vomiting and/or diarrhoea (53.4%), and cough (21.1%). Vaccination was also a common reason (46.2%), while urinary symptoms (1.9%) were less frequently reported. In terms of the duration of symptoms, 75.2% of injections were given for symptoms lasting less than 5 days, with 24.8% given for symptoms persisting for 5 days or more. When considering the frequency of injections, 36.5% of children received two or more injectable courses in the past 6 months, while 63.5% had fewer. Injections were mainly administered for non-antibiotic treatments (66.9%), including vaccinations, fluids, antiemetics, and antipyretics, whereas 33.1% were for antibiotics. Regarding the injection prescriber, most injections were prescribed by a qualified professional, with 52.6% prescribed by a private physician and 31.6% by a public physician. However, 13.3% of injections were prescribed by unqualified individuals, including nurses (7.1%), chemists (5.2%), and homoeopaths (0.8%). For the administration of injections, most were given by nurses (55.6%) or physicians (15.4%), while a quarter of injections (25.6%) were administered by unqualified dispensers. In terms of the setting, 39.8% of injections were administered in clinics, 30.1% in private hospitals, and 13.5% in public hospitals. However, 16.6% of injections were administered in inappropriate settings, such as at home (9.8%) or public dispensaries (6.8%). Finally, when parents observed practices in their last encounter, 42.9% noted inadequate practices, primarily in inappropriate settings. A smaller percentage (23.7%) did not witness the administration, while 33.5% observed adequate practices.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequencies of responses to practice questions n\u0026thinsp;=\u0026thinsp;266\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInjection received in last 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eSymptoms for which injections were given\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVomiting and/or diarrhoea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCough and/or chest congestion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrinary symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than 5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 or more days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo of injectable courses in 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than once\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eantibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*other than antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eInjection prescriber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eQualified person\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Private physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Public physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnqualified person\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Chemist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Homeopath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInjection administrator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eQualified person\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnqualified person\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Dispenser\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eSetting where injection was received\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAppropriate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Public hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Private hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eInappropriate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Public dispensary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eLast encounter practices observed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eInadequate Practice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;**Inappropriate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull;Not witnessed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026dagger;Adequate practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*other than antibiotics include vaccination, fluids, antiemetics, antipyretics\u003c/p\u003e \u003cp\u003e**Inappropriate practices include opening syringe behind counter, open syringe picked from tray, syringe cleaned with alcohol swab\u003c/p\u003e \u003cp\u003e\u0026dagger;Adequate practices include opening syringe in front of the patient from sealed packet, not touching opened needle, disposing it immediately after use, not using same needle on another patient, not using same needle multiple times\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/p\u003e \u003cp\u003e The knowledge scores of parents regarding injection practices reveal that a significant majority (93.6%) of parents have a good understanding of injection practices, while a small proportion (6.4%) have poor knowledge. This indicates that most parents are well-informed about safe injection practices, though there is a small group with inadequate knowledge in this area. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge scores of parents regarding injection practices (n\u0026thinsp;=\u0026thinsp;266)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe attitude scores indicate that 55.3% of parents demonstrated a positive attitude towards safe injection practices, while 44.7% exhibited a negative attitude. (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitude scores of parents regarding injection practices (n\u0026thinsp;=\u0026thinsp;266)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe practice scores of parents regarding injection practices show that a significant portion (70.7%) exhibit inadequate practices, while only 29.3% demonstrate adequate practices. This suggests that, despite having a good understanding of injection practices (as seen in the previous knowledge scores), many parents still fall short when it comes to properly implementing these practices. (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractices scores of parents regarding injection practices (n\u0026thinsp;=\u0026thinsp;266)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e shows the association of knowledge scores with sociodemographic variables in parents regarding injection practices revealing several significant findings. Ethnicity had a significant impact on knowledge scores (p\u0026thinsp;=\u0026thinsp;0.0005), with parents from the Sindhi (20%) and Balochi (16.7%) ethnic groups showing a higher proportion of poor knowledge, while Muhajir (2.5%) and Pakhtoon (3.5%) parents had the highest proportion of good knowledge (97.5% and 96.4%, respectively). Area of residence was also significantly associated with knowledge scores (p\u0026thinsp;=\u0026thinsp;0.001), with only 71.4% of rural parents having good knowledge compared to 97.8% of urban parents.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of knowledge with sociodemographic variables in parents having children aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years regarding injection practices (n\u0026thinsp;=\u0026thinsp;266)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eKnowledge Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGood n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRelation to the child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113 (94.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.470\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131 (93.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChilds gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137 (93.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.482\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112 (94.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuhajir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113 (97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e5.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePakhtoon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (96.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePunjabi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (95.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSindhi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBalochi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (83.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eArea of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e219 (97.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (71.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*For cell counts less than 5 Fisher exact values have been reported\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eKnowledge Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGood n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*0.516\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation of mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (98.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147 (99.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation of father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (83.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (92.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170 (99.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMonthly Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (85.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.374\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e243 (93.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*For cell counts less than 5 Fisher exact values have been reported, for age t-test applied\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParental education levels were strongly correlated with knowledge scores. Among mothers, 31.8% of those with no formal education had poor knowledge, while 99.3% of those with higher education had good knowledge (p\u0026thinsp;=\u0026thinsp;0.001). Similarly, 33.3% of fathers with no formal education had poor knowledge, while 99.4% of those with higher education had good knowledge (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e. shows that the association of attitude scores with sociodemographic variables in parents regarding injection practices revealed several significant trends. Ethnicity played a notable role, with Sindhi parents showing a significantly higher proportion of negative attitudes (80%) compared to other ethnic groups (p\u0026thinsp;=\u0026thinsp;0.005). Muhajir and Pakhtoon parents had more positive attitudes, with 54.3% and 42.8%, respectively. Area of residence also had a significant impact on attitudes (p\u0026thinsp;=\u0026thinsp;0.001), with rural parents exhibiting a much higher proportion of negative attitudes (78.6%) compared to urban parents (50.9%). Parental education levels were strongly associated with attitudes (p\u0026thinsp;=\u0026thinsp;0.001). Mothers with no formal education had the highest proportion of negative attitudes (81.8%), while those with higher education showed a more balanced attitude, with 45.9% negative and 54.1% positive. Similarly, fathers with no formal education exhibited more negative attitudes (71.4%) compared to those with higher education, who showed a more balanced distribution (48% negative and 52% positive). However, income per month did not significantly influence attitudes (p\u0026thinsp;=\u0026thinsp;0.704), as both low- and high-income parents demonstrated similar patterns of positive attitudes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of attitude with sociodemographic variables in parents having children aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years regarding injection practices (n\u0026thinsp;=\u0026thinsp;266)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAttitude Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNegative n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRelation to the child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58(48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (39.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChilds gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61 (41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (51.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (48.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuhajir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003e.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePakhtoon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e16 (57.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (42.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePunjabi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (43.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSindhi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e36 (80)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBalochi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e7 (58.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (41.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eArea of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e110 (49.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e33 (78.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (21.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*For cell counts less than 5 Fisher exact values have been reported\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCategories\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAttitude Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eP Value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNegative n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePositive n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*0.505\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation of mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e36 (81.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e80 (54.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation of father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e15 (71.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (47.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e89 (52)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIncome per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (85.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.704\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (92.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*For cell counts less than 5 Fisher exact values have been reported for age t-test applied\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e shows that the association between practice scores and sociodemographic variables revealed several significant patterns. Ethnicity was significantly linked to injection practices (p\u0026thinsp;=\u0026thinsp;0.019), with Sindhi and Balochi parents displaying a higher proportion of inadequate practices (84.4% and 91.6%, respectively). In contrast, Muhajir and Punjabi parents showed more balanced practices, with 62% and 63.4% having inadequate practices. Area of residence also had a strong impact (p\u0026thinsp;=\u0026thinsp;0.001), with rural parents reporting 100% inadequate practices, while urban parents showed a more even distribution, with 65.2% exhibiting inadequate practices and 34.8% demonstrating adequate practices. Parental education emerged as a key determinant (p\u0026thinsp;=\u0026thinsp;0.001), as those with no formal education, particularly mothers and fathers, had the highest proportion of inadequate practices (97.7% and 95.2%, respectively). On the other hand, parents with higher education showed more adequate practices, with 39.9% of mothers and 38.1% of fathers demonstrating proper practices. Income per month did not show a significant association with practices (p\u0026thinsp;=\u0026thinsp;0.085), though all parents with a monthly income less than 30k had inadequate practices, while a larger proportion (70.4%) of parents with an income above 30k exhibited inadequate practices.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of practice with sociodemographic variables in parents having children aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years regarding injection practices (n\u0026thinsp;=\u0026thinsp;266)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePractice Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInadequate n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eadequate n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRelation to the child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85(70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (70.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (29.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChilds gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.499\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (26.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuhajir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePakhtoon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (78.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (21.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePunjabi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (63.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (36.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSindhi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (84.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (15.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBalochi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (91.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (79.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (20.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eArea of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*For cell counts less than 5 Fisher exact values have been reported\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*0.565\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation of mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (97.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (70.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (29.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (60.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (39.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation of father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (97.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (38.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIncome per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181 (70.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (29.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*For cell counts less than 5 Fisher exact values have been reported for age t-test applied\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe study reveals significant insights into parental knowledge, attitudes, and practices concerning injection use for children, highlighting a disconnect between high awareness and actual practices. While a majority of parents (93.6%) demonstrated sound knowledge about safe injection practices, a considerable proportion still exhibited a negative attitude (55.3%) and engaged in inadequate practices (70.7%). The influence of media and healthcare workers may contribute to the high awareness levels. Similarly, in a study on vaccination practices, while most parents showed a solid understanding of vaccination protocols, many still held negative attitudes and followed suboptimal practices(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Both studies underscore a critical gap between parental knowledge and actual behavior, highlighting the need for targeted educational efforts to bridge this gap and improve health-related practices among parents. We included vaccinations in our study as it is equally important to ensure safe practices while vaccines are being administered as discussed above, however, we did not ask questions like the choice between oral vs injectables, duration of symptoms, efficacy of oral vs IV route from the parents whose children got only vaccinations.\u003c/p\u003e \u003cp\u003eUrban residency and parental education were positively associated with better understanding and practices (p\u0026thinsp;=\u0026thinsp;0.001), suggesting that socioeconomic factors significantly shape healthcare behaviors. Higher education levels enable parents to gain a thorough understanding of their child's health, making it easier for them to comprehend safe injection practices and their importance. Additionally, education enhances communication with healthcare providers, reducing the likelihood of adopting incorrect beliefs about injection practices.\u003c/p\u003e \u003cp\u003eHealthcare access disparities typically exist in rural areas due to limited infrastructure, fewer healthcare providers, and financial constraints which may account for why parents in urban residency had better understanding of safe injection practices. Cultural and ethnic influences, particularly among Sindhi, Balochi, and Pashto-speaking families, were also linked to negative attitudes and suboptimal practices (p\u0026thinsp;=\u0026thinsp;0.005), emphasizing the need for culturally sensitive interventions(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These findings on injection practices align with trends observed in studies on immunizations in Pakistan, where socioeconomic and cultural factors similarly impact healthcare behaviors.\u003c/p\u003e \u003cp\u003eDespite high levels of awareness among urban, educated parents, the study indicates that traditional beliefs about injections as potent treatments persist, driven by social norms and reinforcement from healthcare providers. This aligns with research showing that patients and healthcare workers often mutually reinforce the demand for injections, complicating efforts to reduce unnecessary use. These findings are particularly concerning in light of Pakistan's high injection rates\u0026mdash;up to 8.5 per person annually, with a substantial percentage deemed unnecessary(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Unnecessary injection use in Pakistan is widespread, particularly in private clinics and dispensaries where prescribers, often doctors or untrained personnel, administer injections and IV drips for conditions that could be treated with oral medications. The drive for these unnecessary injections stems from a desire for quick relief, as well as financial incentives for healthcare providers. Patients, often unaware of the health risks associated with reused syringes and IV equipment, rarely question the need for these treatments, leaving them vulnerable to unsafe practices(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, unsafe practices, including the reuse of injection equipment, have previously led to severe public health crises, such as the 2019 HIV outbreak in Larkana where more than 750 people were diagnosed with HIV, with children making up 80% of the number(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, unsafe practices are often underreported. While some healthcare workers are aware of safe procedures, they struggle to implement them effectively, with heavy workloads being a significant contributing factor(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Infection prevention and control (IPC) practices are minimal or altogether lacking in many private healthcare settings, and this issue extends to government facilities across all levels\u0026mdash;primary, secondary, and tertiary hospitals. Even at tertiary hospitals, sterilization processes for minor and major surgeries are often insufficient. Significant gaps exist in healthcare waste and sharps management. Although some government hospitals are equipped with incinerators, these are frequently found to be non-operational.\u003c/p\u003e \u003cp\u003e The study\u0026rsquo;s single-center design and focus on a relatively privileged urban population however limit the generalizability of its findings to broader rural or underserved communities, where healthcare access and attitudes may differ. Additionally, data collection from outpatient clinics, including follow-up patients, may have influenced results by over-representing frequent injection prescriptions. The use of injections can save many lives, but they also carry a risk of transmission of infectious diseases.\u003c/p\u003e \u003cp\u003eTo address these issues, comprehensive public health initiatives are essential. Training programs for healthcare providers should focus on promoting evidence-based alternatives and safe injection protocols, including the use of auto-disable syringes. Additionally, public awareness campaigns targeting parents could encourage safer decision-making, particularly in regions where cultural factors drive high injection use. By fostering a healthcare environment that emphasizes safety and alternative treatments, these interventions could substantially reduce injection overuse, mitigate infection risks, and improve overall public health outcomes in Pakistan.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study highlights the need to improve parental understanding and safe injection practices in Pakistan. Although many parents are aware of safe practices, cultural beliefs and the reinforcement of injection overuse between patients and providers contribute to unsafe behaviors. To reduce infection risks and unnecessary injections, public health efforts should focus on training healthcare providers, promoting auto-disable syringes, and increasing parental awareness, especially in underserved communities. These interventions are vital to safeguard public health and prevent outbreaks.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Ethical approval was taken from The Aga Khan University Ethical Review Committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e: Before data collection, all parents willing to participate were asked to sign a written consent form to be included. The children of non-consenting parents did not participate in data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll authors have read and approved the final manuscript. This manuscript has not been published and is not under consideration for publication elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests. The authors report no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eBR, AA, NS: These authors made a significant contribution to the work reported, whether that is in the conception, study design, execution or data collection. AP and AN contributed to data analysis, critical review and interpretation of data collected. KH, AA and BR took part in drafting, writing and revising the manuscript. FM and BR critically reviewed the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted. BR as the corresponding author is accountable for all aspects of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization. WHO best practices for injections and related procedures toolkit. World Health Organization; 2010.\u003c/li\u003e\n \u003cli\u003eSimonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bulletin of the World Health Organization. 1999;77(10):789.\u003c/li\u003e\n \u003cli\u003eHauri AM, Armstrong GL, Hutin YJ. The global burden of disease attributable to contaminated injections given in health care settings. International journal of STD \u0026amp; AIDS. 2004 Jan 1;15(1):7-16.\u003c/li\u003e\n \u003cli\u003eRouet F, Nouhin J, Zheng DP, Roche B, Black A, Prak S, Leoz M, Gaudy-Graffin C, Ferradini L, Mom C, Mam S. Massive iatrogenic outbreak of human immunodeficiency virus type 1 in rural Cambodia, 2014\u0026ndash;2015. Clinical Infectious Diseases. 2018 May 17;66(11):1733-41.\u003c/li\u003e\n \u003cli\u003eMurhekar MV, Rao RC, Ghosal SR, Sehgal SC. Assessment of injection-related practices in a tribal community of Andaman and Nicobar Islands, India. Public Health. 2005 Jul;119(7):655\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eKermode M. Unsafe injections in low-income country health settings: need for injection safety promotion to prevent the spread of blood-borne viruses. Health Promot Int. 2004 Mar;19(1):95\u0026ndash;103.\u003c/li\u003e\n \u003cli\u003eMubashir SA, Kiyani T. National Institute of Population Study (NIPS)[Pakistan] and ICF International. PakistanDemographic and Health Survey (2012-13). Islamabad, Pakistan, and Cleverton, Maryland, USA: NIPS and ICF International. 2013.\u003c/li\u003e\n \u003cli\u003eReeler A V. Anthropological perspectives on injections: a review. Bull World Health Organ. 2000;78(1):135\u0026ndash;43.\u003c/li\u003e\n \u003cli\u003eRiaz H, Kamal SW, Riaz T, Aziz S, Rajper J, Noorulain W. Methods of disposal of used syringes by hepatitis B and C patients at an urban and rural setting. J Pak Med Assoc. 2012 Jan;62(1):81\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eZaid M, Afzal MS. HIV outbreak in Pakistan. Lancet Infect Dis. 2018 Jun;18(6):601.\u003c/li\u003e\n \u003cli\u003eRaglow GJ, Luby SP, Nabi N. Therapeutic injections in Pakistan: from the patients\u0026rsquo; perspective. Tropical Medicine \u0026amp; International Health. 2001 Jan 28;6(1):69\u0026ndash;75.\u003c/li\u003e\n \u003cli\u003eShahzadi A, Saddique H, Tasneem Kousar S, Jabeen R, . KU. Knowledge Attitude and Practice Factors on Parents Regarding Immunization. NURSEARCHER (Journal of Nursing \u0026amp; Midwifery Sciences). 2022 Dec 31;07\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eMitchell S, Andersson N, Ansari NM, Omer K, Soberanis JL, Cockcroft A. Equity and vaccine uptake: a cross-sectional study of measles vaccination in Lasbela District, Pakistan. BMC Int Health Hum Rights. 2009 Oct 14;9 Suppl 1(Suppl 1):S7.\u003c/li\u003e\n \u003cli\u003eSimonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bull World Health Organ. 1999;77(10):789\u0026ndash;800.\u003c/li\u003e\n \u003cli\u003eAltaf A, Fatmi Z, Ajmal A, Hussain T, Qahir H, Agboatwalla M. Determinants of therapeutic injection overuse among communities in Sindh, Pakistan. Journal of Ayub Medical College Abbottabad. 2004;16(3).\u003c/li\u003e\n \u003cli\u003eHermez J, Ismail M, Morgan O, Pasha MS, Schenkel K, Doherty M, et al. A pediatric HIV outbreak in Pakistan. East Mediterr Health J. 2024 Jan 21;30(1):60\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eChowdhury AKA, Roy T, Faroque ABM, Bachar SC, Asaduzzaman M, Nasrin N, et al. A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh. BMC Public Health. 2011 Oct 10;11:779.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"knowledge, attitude, practice, parents, unsafe injections, children","lastPublishedDoi":"10.21203/rs.3.rs-5860157/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5860157/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e\u003cbr\u003e\n 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\n 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\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\n 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e\u003cbr\u003e\n 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\n 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number: \u003c/strong\u003eNot Applicable\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitude, and Practices of Parents Regarding Injections Use for Their Children-A Study from Outpatient Clinics of a Tertiary Care Hospital in Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-05 09:13:34","doi":"10.21203/rs.3.rs-5860157/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5af83c79-6d25-447c-b51a-f9ad38d78631","owner":[],"postedDate":"February 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-05T09:13:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-05 09:13:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5860157","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5860157","identity":"rs-5860157","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}