Syringe Reuse in Pakistan: A Systematic Review of Unsafe Injection Practices and Their Public Health Consequences

Unsafe injection practices, particularly syringe reuse, remain a pervasive public health issue in Pakistan. Despite international guidelines advocating single-use injection equipment, a significant portion of injections administered across various healthcare settings involve reused syringes, contributing to the spread of bloodborne infections such as Hepatitis B, Hepatitis C, and HIV. This review systematically assesses the prevalence of syringe reuse in Pakistan, explores the underlying factors promoting such practices, examines the associated health consequences, and evaluates current interventions and policy responses. A comprehensive literature search was conducted using PubMed, Scopus, Google Scholar, PakMediNet, and WHO IRIS databases for studies published between 2005 and 2025. Studies were selected based on predefined eligibility criteria and evaluated using PRISMA guidelines, JBI, and STROBE checklists. Data extraction focused on prevalence, settings, health outcomes, contributing factors, and policy measures. Twenty-six studies met the inclusion criteria. The prevalence of syringe reuse ranged from 17 to 67%, with the highest rates in rural and informal healthcare settings. Contributing factors included poor regulatory enforcement, economic constraints, lack of healthcare worker training, and patient misconceptions. Syringe reuse was significantly associated with outbreaks of Hepatitis C and HIV. Limited but notable interventions include WHO-supported safety campaigns and national-level policies that lack consistent enforcement. Syringe reuse in Pakistan is a major but preventable public health concern. Targeted policies, public education, and provider training are urgently needed. Stronger government regulation, grassroots advocacy, and improved surveillance are essential to eliminate this high-risk practice.