Ntambwe Malangu

Acute poisoning at two hospitals in Kampala–Uganda

BACKGROUND The aim of this study was to characterize acute poisoning cases admitted to two hospitals in Kampala, Uganda. STUDY DESIGN All cases admitted to the two hospitals, from January 2005 to June 2005, were evaluated retrospectively. Data obtained from the hospital medical records included the following: demographic characteristics, toxic agents, length of stay, circumstances of poisoning, and mortality information on the victims. RESULTS Of the total 276 patients admitted for treatment, whose mean age was 26.6 (+/-12.2) years, 71.0 % were males. The age category of 20-29 years old most affected (42.8%), while only 5.1% of those affected were younger than 13 years old. Toxic agents involved in the incidents were, in descending order, agrochemicals (42.4%), household chemicals (22.1%), carbon monoxide (20.0%), snakebites (14.1%), and food poisoning (1.4%). There was a statistically significant difference with regard to gender, females were more victims of poisoning by snake bites (25.0% vs. 9.7%) and food poisoning (2.5% vs. 1.0%), while males were more affected by carbon monoxide (25.5% vs. 6.3%). Moreover, 61.2% patients spent less than 2 days in hospital, the mean length of stay was 2.1 days, with a range of 1 to 26 days. The overall case fatality rate was 1.4%; of those who died, 75% were males, and the toxic agents responsible for the death were alcohol (50%), carbon monoxide (25%), and organophosphate (25%). CONCLUSION Acute poisoning involved more men, who spent more than 2 days being hospitalized, and resulted in a case fatality rate of 1.4% due to alcohol, carbon monoxide, and organophosphates. These findings suggest that further studies are warranted in order to understand the motivation(s) for this emerging problem, and plan appropriate interventions.

Self-Reported Adverse Effects as Barriers to Adherence to Antiretroviral Therapy in HIV-Infected Patients in Pretoria

Abstract Background: Adherence is the key to the effectiveness of antiretroviral therapy. However, many factors have been identified as facilitating or hampering adherence. The aim of this study was to determine barriers and facilitators of adherence with particular emphasis on adverse effects. Methods: A survey of patients, who started antiretroviral treatment between July 2004 and August 2005, was conducted by means of a semi-structured questionnaire. Those who consented to participate were interviewed for the collection of information on sociodemographic characteristics and clinical and other data. Results: The 180 patients who participated had a mean age of 36.7 (±8.1); 68.8% were female, 86.7% unemployed, 73.9% had a high school level of education, and 77.8% were single. Some 8.9% of the respondents used at least one non-prescribed medicine, while 34.4% received disability grants. Overall, 94% of the respondents reported at least one side effect; the mean number of self-reported side effects was 2.6 (±1.4). With regard to adherence, the mean number of doses missed during the last seven days prior to the interview was 2.7 (±3.9), ranging from 0 to 18. The mean adherence level was 92.3%, ranging from 48.6% to 100.0%; overall, only 57.2% reported taking at least or over 95% of their prescribed doses. The two most common reasons for missing doses were forgetting (26.6%) followed by being away from home (15.6%). In the bivariate analysis, the only facilitator or factor that was significantly associated with at least or over 95% self-reported adherence was eating well (80.6% vs 64.5%; p = 0.025), whereas barriers or factors more likely and significantly associated with with self-reported adherence of at least or over 95% included having used non-prescribed medicines (15.6% vs 3.9%; p = 0.008), having suffered from headaches (28.6 vs 14.6%; p = 0.026) and reported symptoms such as insomnia (27.3% vs 12.6%; p = 0.013) and abdominal pain (20.8% vs 9.7%; p = 0.037). In the multivariate analysis, the facilitators or factors that were significantly associated with self-reported adherence of at least or over 95% were having an initial bodyweight of less than 50 kg (p = 0.026) and viral load of >33 000 copies/ml (p = 0.047). Conclusions: In conclusion, self-reported barriers to optimal adherence included the use of non-prescribed drugs, and the presence of side effects such as insomnia, headaches and abdominal pain; while eating well was a facilitator. These findings emphasise the need for better communication between patients and clinicians, and the need for integrating pharmacovigilance concepts in clinical practice.

Causes of Deaths in Children under-Five Years Old at a Tertiary Hospital in Limpopo Province of South Africa

Objective: Accurate and timely information on the causes of child deaths is essential in guiding efforts to improve child survival, by providing data from which health profiles can be constructed and relevant health policies formulated. The purpose of this study was to identify causes of death in children younger than 5 years-old in a tertiary hospital in South Africa. Methods: Death certificates from the Pietersburg/Mankweng hospital complex, for the period of January 1, 2008 through December 31, 2010, were obtained for all patients younger than 5 years and were retrospectively reviewed. Data were collected using a data collection form designed for the study. Information abstracted included: date of death, age, sex, and cause of death. Results: A total of 1266 deaths were recorded, the sex ratio was 1.26 boys per girl. About 611 (48%) of deaths were listed as neonatal deaths (0-28 days), 387 (31%) were listed as infant deaths (29 days-11 months), and 268 (21%) as children’s death (1-4 years). For neonates the leading causes of death were: prematurity/low birth weight, birth asphyxia and pneumonia. For the infant death group, the leading causes of death were pneumonia, diarrhea, and HIV/AIDS; and in the children’s group, the leading causes were injuries, diarrhea and pneumonia. There was no statistical significant difference in the proportions of causes of death based on the sex of children. Conclusion: The top 10 leading causes of death in children under-5 years old treated at Pietersburg/Mankweng Hospital Complex were in descending order: prematurity/low birth weight, pneumonia, diarrheal diseases, birth asphyxia, and severe malnutrition, HIV/AIDS, hydrocephalus, unintentional injuries, meningitis and other infections. These ten conditions represent 73.9% of causes of death at this facility. A mix of multi-faceted interventions is needed to address these causes of death in children.

Analysis of occupational infections among health care workers in Limpopo province of South Africa.

Objective: Occupational infections particularly hospital-acquired infections (HAIs) are a serious problem in the healthcare industry worldwide. This study purported to investigate their prevalence and risk factors among healthcare workers from Limpopo province of South Africa. Methods: Cases about occupational infectious diseases of healthcare workers from Limpopo province that were submitted to the Compensation Commissioner from January 2006 to December 2009 were reviewed. Results: The total number of cases of infectious diseases reported during the study period was 56; of these, 83.9% (47) of cases were for tuberculosis, 10.7% (6) for cholera, and 5.4% (3) for chickenpox. Nurses were the most affected. Risk factors associated with the acquisition of infection diseases were as follows. The majority of those infected were female (67.9%), aged over 40 years (57.1%), and who had worked for over 10 years (59.2%). With regard to length of time it took for one to be infected, overall it took 13.6±9.7 years from the year of employment to being infected. This duration was just 5.7±4.2 years in HCWs younger than 40 years versus 18.4±9.0 years in those 40 years and over (p=0.001); and 11.4±10.3 years in nurses versus 17.1±7.8 years in non-professional staff members (p=0.046). Mopani district, situated in a rural setting was the most affected as 24 of the 47 cases of tuberculosis occurred there. Conclusion: In conclusion, the most common occupational infection or hospital acquired infection among healthcare workers in Limpopo province of South Africa was tuberculosis. It infected mainly nurses from the rural health district of Mopani. Younger age and being a nurse were significant risk factors associated with being infected early.

Predictors of topical steroid misuse among patrons of pharmacies in Pretoria

Abstract Background: The misuse of topical steroids, i.e. the usage of these products for skin lightening, is a widespread phenomenon among African men and women. Studies have reported prevalence rates of 18.5% to 70% among participants. Though women constitute the majority of users, people of various age groups, socioeconomic status, employment and marital status practise skin lightening. Besides topical steroid products, other commonly used products include preparations containing hydroquinone or mercury derivatives. The misuse of these products is associated with skin problems such as cellulitis, contact eczema, bacterial and fungal infections, Cushings syndrome, acne, skin atrophy and pigmentation disorders. Although these effects are well documented, it seems that there is little awareness of them among the general public. Other less commonly reported problems include delaying the diagnosis of leprosy, and erythrodermic psoriasis. Data on the misuse and side effects of topical steroids have been gathered primarily from prescriptions, despite the fact that these products could be obtained over the counter, shared between relatives or friends, or come from other informal sources. Moreover, we found no community-based study that investigated the prevalence of the misuse of topical steroid products in South Africa. This survey was therefore conducted to examine the misuse of topical steroid products for skin lightening, among patrons of pharmacies in Pretoria and to determine the potential predictors of misuse. Methods: The aim of this study was to examine the misuse of topical steroid products for skin lightening by patrons of pharmacies in Pretoria and to determine the potential predictors of misuse. Exit interviews were conducted at 21 randomly selected pharmacies by trained interviewers using a structured questionnaire. A total of 1 228 patrons were approached, of which 225 gave verbal consent to be interviewed. Results: Of the 225 participants, 83% were female, 50.7% were 20–40 years old, 56% were employed, and 53.3% were married. The majority of participants (75.1%) were black Africans. About half of them (50.2%) had high school education. The prevalence of topical steroid misuse for skin lightening was 35.5%. A logistic regression analysis revealed that being a black female African and initially being advised to use the products by a friend were the only parameters that significantly correlated with topical steroid misuse. Conclusion: In conclusion, the prevalence of the misuse of topical steroid products among the respondents was 35.5%. The following predictors were associated with topical steroid misuse: being a black female African, not being aware of the side effects of these products, and initially being advised to use the products by a friend. In a logistic regression model, the last two predictors were the only parameters that significantly correlated with topical steroid misuse.

Paraffin poisoning in children: what can we do differently?

Abstract Background: The purpose of this study was to describe the occurrence, health cost and management of paraffin poisoning in a rural South African hospital. Methods: A retrospective study was undertaken of 145 children admitted with a diagnosis of paraffin poisoning at Philadelphia Hospital, Mpumalanga from January 2000 to June 2001. A pre-tested form was used to collect data from the admission files. Where applicable, the Chi-square test or t-test was used to determine statistical significance. Results: Children younger than five years of age were affected significantly more than those older than five years of age (91% vs. 9%, p<0.001), and boys were affected more than girls (58% vs. 42%, p=0.034). The average length of stay and cost of treatment were 2.5±2 days and R617.24 respectively. Prophylactic antibiotics were prescribed in 86% of cases (125/145) and the average number of medications prescribed per child was 3.5±1.8. Conclusions: Although no mortality was reported, paraffin poisoning contributed substantially to the morbidity of, health expenditure for and antibiotic overuse in these children. Provision of child-resistant paraffin container caps, retraining of doctors on appropriate antibiotic use and community education are necessary and crucial in reducing the occurrence of paraffin poisoning in children.

Characteristics of Acute Poisoning at Two Referral Hospitals in Francistown and Gaborone

Abstract Background: The epidemiology of acute poisoning in Botswana is not well established due to the limited availability of published data.In an attempt to fill this gap, this study aimed to characterise acute poisoning cases admitted to two urban hospitals in Francistown and Gaborone, Botswana. Methods: This study followed a descriptive methodology involving 116 patients with the primary diagnosis of acute poisoning admitted to two referral hospitals in Botswana from January to June 2005. Data were collected by means of a pre-tested data-collection form. Results: Overall, 58 (50%) of the victims of acute poisoning were female, accidental poisoning occurring in 89 (76.9%) of the cases. Intentional poisoning was reported in 33.3% of the females versus 13.5% of the males. With regard to demographic distribution, the majority of the victims were in the age category of 13 to 19 (20.7% versus 5.2%) for the females and in the 30-year-old group for the males (24.1% versus 10.3%). Poisoning by household chemicals, particularly paraffin, affected mainly children under 12, while poisoning by pharmaceuticals involved mainly teenagers. With regard to outcomes, three of the female victims died, representing a case fatality rate of 2.6%. One death was due to paraffin poisoning and two to traditional medicine. Those who died were two children in the 0 to 12-year group and one adult in the age category of 20 to 30. Conclusion: The acute poisoning involved a variety of toxic agents of which household chemicals and pharmaceuticals predominated. Differences based on age category, sex, the types of toxic agents involved and the outcomes of the poisoning incidents were noted. Future interventions should take these differences into account.

Knowledge and practices about multidrug-resistant tuberculosis amongst healthcare workers in Maseru

Background To date, no study has been found that described the knowledge and practices of healthcare workers surrounding multidrug-resistant tuberculosis (MDR-TB) in Lesotho. Aim and setting This study was conducted to fill this gap by investigating the knowledge level and practices surrounding MDR-TB amongst healthcare workers at Botsabelo Hospital in Maseru, Lesotho. Method This was a cross-sectional survey conducted by means of a questionnaire designed specifically for this study. Data collected included sociodemographic and professional details; and responses to questions about knowledge and practices regarding MDR-TB. The questions ranged from the definition of MDR-TB to its treatment. Respondents’ practices such as the use of masks, guidelines and patient education were also assessed. Results A response rate of 84.6% (110 out of 130) was achieved. The majority of participants were women (60%), married (71.8%) and nursing staff (74.5%). Overall, less than half (47.3%) of the participants had a good level of knowledge about MDR-TB. With regard to practice, about 83% of participants stated that they used protective masks whilst attending to MDR-TB patients. About two-thirds (66.4%) reported being personally involved in educating patients about MDR-TB; whilst about 55% stated that they referred to these guidelines. Conclusion The level of knowledge about MDR-TB amongst healthcare workers at the study site was not at an acceptable level. Unsafe practices, such as not wearing protective masks and not referring to the MDR-TB treatment guidelines, were found to be associated with an insufficient level of knowledge about MDR-TB. An educational intervention is recommended for all healthcare providers at this facility.

An Investigation of the Stillbirths at a Tertiary Hospital in Limpopo Province of South Africa

Objective: To determine the stillbirth rate and identify the causal factors associated with it in a tertiary hospital. Methods: A retrospective review of records of women who had stillbirths at a tertiary hospital of the Limpopo Province was conducted. The study period was two years from January 1, 2009 to December 31, 2010. The hospital maternity registers were used to identify the women who gave birth during the study period. Data were collected using a data collection form designed for the study. The data collected included maternal age, parity, gestation, mode of delivery, obstetric complications, infant or foetal’s gender and weight; whether the birth was fresh stillbirth or macerated and cause of stillbirth. Results: There were 5597 deliveries during the two years period of the study. The hospital-based stillbirth rate was 38.4 per 1000 births, with 71% being macerated. The majority of women with stillborn infant in this study were in the age group (24%) 20-34 years, followed by (23%) aged 35 years and older. Nulliparity was associated with stillbirth. Unexplained intrauterine foetal death, hypertensive disease, placenta abruptio was the leading causes of stillbirth. Conclusion: In this study stillbirth rate seems to be unacceptably high, though less than those reported in other settings. The causal factors associated with it were identified as nulliparity, unexplained intrauterine foetal deaths, hypertensive disease, and placenta abruptio. Because of the high rate of stillbirths reported in this study, it is recommended that interventions be made to introduce fetal autopsies at the tertiary healthcare facilities and that an educational intervention aimed teaching pregnant women be instituted.

Impact of adverse events of antiretroviral treatment on regimen change and mortality in Ugandan children

ABSTRACT Background Outcomes of antiretroviral treatment have been documented in both developed and developing countries. It has been reported consistently that the treatment is associated with many adverse events. However, little is known about their impact on the quality of life, clinical management, and survival in children aged less than 6 years in Uganda. Objectives The purpose of this study was to determine the prevalence of the adverse events of antiretroviral treatment, their impact on mortality and the change in regimens prescribed to children treated at Mildway Centre in Uganda. Method A retrospective chart review was performed for children younger than 6 years, treated since the Mildway Centre was opened in 1999. In order to achieve a larger sample, the records of children treated from January 2000 to July 2005 were included in the study. A pre-tested data collection form was used to collate socio-demographic and clinical data of the patients. These included the documented adverse events, causes of death, stage of infection, duration of treatment, regimen prescribed, year of enrolment into the treatment program, as well as whether or not they were still alive. Descriptive statistics were used in the analysis of data. Results Of the 179 children, the majority were males and had a median age of 4 years. The majority (58.8%) of children had suffered from severe immune depression since they met the WHO clinical stage III and IV, 73.8% had a baseline CD4T of less than 15%. Four regimens were prescribed to the children. The most common was a regimen containing zidovudine, lamivudine, and nevirapine (34.6%), followed by a regimen containing stavudine, lamivudine, and nevirapine (27.9%). Eleven children (6.1%) had their regimen changed, of which six (54.5%) were due to adverse events. The prevalence of adverse events was 8%; of the 14 documented adverse events, the most common were severe anaemia (3), vomiting (3), and skin rashes (3). After 12 months on treatment, 8% of the patients had died. The most common causes of death were infectious diseases (28.6%), severe anaemia (21.4%), and severe dehydration (21.4%). Conclusion The prevalence of adverse events was 8%; they were responsible for 54.5% of regimen changes and 21.4% of deaths in children treated at the study site. These findings suggest the need for incorporating pharmacovigilance practices into the provision of antiretroviral treatment.