http://hdl.handle.net/10386/185 2026-04-07T07:24:07Z http://hdl.handle.net/10386/674 Acute poisoning in three African countries: Botswana, South Africa and Uganda Malangu, Ntambwe Acute poisoning constitutes one of the main reasons why patients visit emergency departments of hospitals. However, the burden and pattern of acute poisoning in African countries are not well established, hence the need for this study. This study was conducted in order to compare the patterns of acute poisoning in three countries, namely, Botswana, South Africa, and Uganda. Specifically, this study examined the similarities and differences in the patterns of occurrence of acute poisoning based on the sociodemographic characteristics of the victims, the toxic agents involved, and the circumstances of the incidents. The study was based on six papers published on the topic. Papers I and II about Botswana covered a period of 24 months (January 2004 - December 2005) and six months (January - June 2005) respectively. The data from Uganda, as reported in Paper III, covered a six-month period (January-June 2005); while studies in South Africa, Papers IV to VI, covered respectively six (January-June 2005) and 18 months (January 2000-June 2001). A re-analysis of data from Papers II to IV was conducted after recoding age category and the grouping of toxic agents. In total, the six Papers reported data on 1780 patients; 54.8% of them were male. The median age was 24 years in Uganda, but as low as 17 years in Botswana and South Africa. In Botswana and South Africa, acute poisoning incidents occurred mostly in children younger than 12 years old, then decreased among teenagers, and increased again among young adults, before decreasing among patients over 30 years old. On the contrary, in Uganda there was that less than 5% of children younger than 12 years who were victims of poisoning. There was an increase in the prevalence of acute poisoning among teenagers and young adults before a decrease occurred among adults over 30 years old. The overall case fatality rate was 2.1 %, ranging from 1.4% in Uganda, 2.4% in South Africa, to 2.6% in Botswana. With regard to similarities across the three countries, it was found that among teenagers, girls committed more deliberate self-poisoning than boys; while in young adults, men committed more self-poisoning than women. With regard to toxic agents, household products were involved in fatal Page 9 of 136 outcomes in all three countries; while agrichemicals were more involved in deliberate than accidental poisonings; food poisoning affected more females than males. With regard to disparities across the three countries, the age and gender of the victims, the circumstances of the incidents and the types of toxic agents played a significant role. With regard to gender, the majority of the victims were males in Uganda, females in South Africa; while in Botswana, females and males were affected equally. Among teenagers, the toxic agents most involved in the poisoning incidents were pharmaceuticals in Botswana; household chemicals in South Africa; but agrichemicals in Uganda. While the majority of incidents happened by accident in Botswana and South Africa, being respectively 76.7% and 59.1%; in Uganda, 64.5% of acute poisoning cases were deliberate self¬poisoning. Deliberate self-poisoning was responsible for 50% of deaths in Uganda, 30% in South Africa, but no death in Botswana. The majority of deaths occurred among teenagers in South Africa; in Uganda it was among adults over 30years; while in Botswana, the majority of deaths were distributed almost equally amongst children younger than 12years old and young adults. Diverse products were involved in fatal outcomes. In South Africa, pharmaceuticals, particularly drugs of abuse, cocaine and marijuana; as well as carbon monoxide, and organophosphates were involved in fatalities. While, in Botswana, the products involved were paraffin, traditional medicines, pharmaceuticals, food poisoning, plants, and snake envenomation. In contrast, in Uganda, alcohol intoxication, organophosphates, carbon monoxide, and some unspecified household products lead to fatalities. Household chemicals were involved in the deaths of victims in all three countries; but the extent of their involvement differed from country to country. This group of products was responsible of 75% of deaths in Uganda, half of deaths in South Africa, and in a third of deaths in Botswana. Agrichemicals were involved in the deaths of victims in Uganda and South Africa, but not in Botswana. They were involved in a quarter of deaths in Uganda and 10% of deaths in South Africa. Page 10 of 136 Plants and traditional medicines were involved in two-thirds of the deaths only in Botswana; while pharmaceuticals were involved in 40% of fatal outcomes only in South Africa. In conclusion, the contextual factors of each country led to a pattern of acute poisoning that showed some similarities with regard to the distribution of deliberate self-poisoning among females, teenagers, and young adult victims. However, there were disparities relating to the differential access to toxic agents, based on the age and gender of the victims. Moreover, though the case fatality rate was similar across the three countries, the distribution of deaths based on age, gender, circumstances of poisoning and types of toxic agents involved differed among the three countries. These findings suggest that multifaceted interventions should be implemented including policy development, enforcement of the existing legislation, and the establishment of a surveillance mechanism, in-service training of clinicians and revision of treatment guidelines. These interventions should be tailored to meet the specific realities of each country. Thesis (PhD (Epidemiology)-- University of Limpopo, 2011. 2011-01-01T00:00:00Z http://hdl.handle.net/10386/541 A mortality profile of patients admitted to Dr George Mukhari Hospital in 2008 Chauke, Bafedile Evah Introduction: Mortality profiles form very important components of the public health information system and are used widely to inform important planning decisions at managerial level. Aim: To determine and describe the mortality profile of patients admitted to Dr George Mukhari Hospital in 2008. Methods and quality: Cause of death information was collected from the death notification register situated in the hospital mortuary. A representative sample of 6 months out of the 12 months of the year was chosen in such a way as to represent all the seasons of the year to minimize bias from seasonal variation that could influence cause of death patterns. A total of 3790 deaths were captured in the death register for 2008 and 1968 deaths (52%) of the deaths were analyzed. 53% of the deaths occurred in males while 47% were in females. Most of the records captured were complete with very minimal missing data variables for analysis. Findings: Non-communicable conditions contributed to the highest burden of mortality at 43%, followed by communicable diseases at 38%. HIV and AIDS seemed to be prominently contributing to mortality in Dr George Mukhari Hospital. In keeping with global statistics, cancer was also a leading cause of death in the older age groups. The neonatal period was the highest risk period for death in children under 5 years of age. Post neonatal children die more from pneumonia, diarrhoeal conditions and malnutrition. Discussions and conclusions: Routine statistics collected by the hospital should be modified to include some important variables such as additional information on the broad causes of death or even utilization of the National Injury Surveillance System to assist with decision making. There should be strategies to improve more accurate capturing of HIV and AIDS deaths and Injury related deaths. Based on the similarity of the mortality profile to the rest of the province and the country, existing national and provincial programme strategies can be used for better planning for the illustrated health service needs. Thesis (M. Med. (Community Health))--University of Limpopo (Medunsa Campus), 2010. 2010-01-01T00:00:00Z http://hdl.handle.net/10386/427 Assessment of health promotion content in undergraduate physiotherapy curricula in South Africa Phetlhe, Koketso Background: Tuberculosis is one of the major public health problems in Lesotho. With the occurrence of multi-drug resistant tuberculosis, little is known about the views of health care workers on this disease. The aim of this study was to investigate the knowledge, attitudes, and practices of healthcare professionals about prevention and control of MDR-TB at Botsabelo hospital, situated in Maseru, Lesotho. Methods: This study was conducted by means of a semi-structured, anonymous, and self-administered questionnaire that was sent to health care workers. Returned questionnaires were collected through designated boxes stationed at selected places at the study site from 23rd September to 13th October 2010. The investigator and his assistants collected the returned questionnaires on the 15th October 2010. Results: The results of this study indicate that, overall, less than half (47.3%) of respondents had good level of knowledge about MDR-TB; but the overwhelming majority of them held negative attitude towards patients with MDR-TB. Further analysis showed that the level of knowledge did not affect the attitude towards patients suffering from MDR-TB but it influenced their practices. Having good level of knowledge about MDR-TB was associated with good practices such as the use of protective masks and MDR-TB guidelines and involvement in educating patients about MDR-TB. Moreover, the findings of this study showed also that the attitude of respondents towards patients suffering from MDR-TB did not influence their practices. Conclusion: In conclusion, less than half of respondents had good level of knowledge about MDR-TB, but over 85.5% of them held negative attitude towards patients suffering from MDR-TB. Although the level of knowledge about MDR-TB was found not to have influenced the attitude of respondents towards patients suffering from MDR-TB; and that xi their attitude did not influence practices, good level of knowledge was positively associated with safer practices such as using protective masks, educating patients on MDR-TB, and referring to the MDR-TB guidelines manual. An educational remedial intervention is recommended. Thesis (MPH)--University of Limpopo,2010. 2010-01-01T00:00:00Z http://hdl.handle.net/10386/424 Knowledge, attittudes and practices of healthcare professionals towards adverse drug reaction reporting in Mafikeng Provincial Hospital Segomotso, Nametso Patience Abstract Background: Prevention, monitoring and reporting of adverse drug reactions is still a challenge among healthcare professionals. Even though some adverse drug reactions are minor and can be resolved quickly some can cause permanent disability or death. A recent South African study in a secondary hospital found that 6.3% of medical admissions were due to adverse drug reactions, which is similar to proportions found in developed countries. It is the responsibility of the healthcare professionals to detect, investigate, manage and report adverse drug reactions. Aim of the study: This study aimed to determine knowledge, attitudes and practices of healthcare professionals (doctors, nurses and pharmacists) regarding the reporting of patients‟ adverse drug reaction at Mafikeng Provincial Hospital. Methods: This was a descriptive quantitative study. A questionnaire was used to collect data from 29 doctors, 88 nurses and 5 pharmacists. Data was collected on demographic characteristics of the healthcare professionals, their knowledge, attitudes and practices towards ADR reporting. Data analysis was conducted using STATA (version 11) and Epi info (version 6). A test of association of selected variables was done using Pearson chi–square and logistic analysis to measure the association. Results: More than half of the participants were male (56.3%) and 53.8% percent of them were younger than 40 years. Majority of the respondents (72.27%) indicated that they do not know how to report ADRs. There was no significant difference in terms of knowledge by age category. None of the healthcare professionals have ever sent their ADR forms to the pharmacovigilance centre. Ninety-one percent (91.53%) felt that reporting of ADR can benefit the public health, 78.63% felt that filling of the ADR yellow form is useful and 98.29% felt that ADR should be compulsory. There was no significant association between knowledge of how to report and attitude towards reporting (X²=1.0, p= 0.317), no association between knowledge and practice (X²=0.974, p= 0.324). iv Conclusions: This study revealed that more than a third of the respondents (72.29%) did not have the knowledge of the procedure for reporting ADRs. Healthcare professionals had a positive attitude towards ADR; 98.29% of them said that ADR reporting should be compulsory. There was no significant association between knowledge, attitude and practice toward ADR reporting. Healthcare professionals' knowledge can be improved through educational interventions and trainings. Thesis (MPH)--University of Limpopo, 2011. 2011-01-01T00:00:00Z