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

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. South African Family Practice Vol. 50 (3) 2008: pp. 67-67

Outbreak investigation and control case report of brucellosis: experience from livestock research centre, Mpwapwa, Tanzania.

This research article published by AOSIS, 2014Brucellosis screening was conducted between 2005 and 2010 at the National Livestock Research Institute headquarters, Mpwapwa, Tanzania, following an abortion storm in cattle. The initial screening targeted breeding herds; 483 cattle were screened using the Rose Bengal Plate Test (RBPT) followed by the Competitive Enzyme-linked Immunosorbent Assay (c-ELISA) as a confirmatory test. The seropositivity on c-ELISA was 28.95% in 2005; it subsequently declined to 6.72%, 1.17%, 0.16% and 0.00% in 2006, 2007, 2009 and 2010, respectively. Brucella seropositivity was not detected in goats. Seropositivity declined following institution of stringent control measures that included: gradual culling of seropositive animals through slaughter; isolation and confinement of pregnant cows close to calving; proper disposal of placentas and aborted foetuses; the use of the S19 vaccine; and restricted introduction of new animals. It was thought that the source of this outbreak was likely to have been from the introduction of infected animals from another farm. Furthermore, humans were found with brucellosis antibodies. Out of 120 people screened, 12 (10%) were confirmed seropositive to brucella antigen exposure by c-ELISA analysis. The majority of the seropositive individuals (80%) were milkers and animal handlers from the farm. Nine individuals had clinical signs suggestive of brucellosis. All cases received medical attention from the district hospital. This achievement in livestock and human health showed that it is possible to control brucellosis in dairy farms, compared to pastoral and agro-pastoral farms, thus providing evidence to adopt these strategies in dairy farms thought to be at risk

The epidemiology of tuberculosis in health care workers in South Africa: a systematic review

Background: In South Africa, workplace acquired tuberculosis (TB) is a significant occupational problem among health care workers. In order to manage the problem effectively it is important to know the burden of TB in health care workers. This systematic review describes the epidemiology of TB in South African health care workers. Methods: A comprehensive search of electronic databases [MEDLINE, EMBASE, Web of Science (Social Sciences Citation Index/Science Citation Index), Cochrane Library (including CENTRAL register of Controlled Trials), CINAHL and WHO International Clinical Trials Registry Platform (ICTRP)] was conducted up to April 2015 for studies reporting on any aspect of TB epidemiology in health care workers in South Africa. Results: Of the 16 studies included in the review, ten studies reported on incidence of active TB disease in health care workers, two report on the prevalence of active TB disease, two report on the incidence of latent TB infection, three report on the prevalence of latent TB infection and four studies report on the number of TB cases in health care workers in various health care facilities in South Africa. Five studies provide information on risk factors for TB in health care workers. All of the included studies were conducted in publicly funded health care facilities; predominately located in KwaZulu-Natal and Western Cape provinces. The majority of the studies reflect a higher incidence and prevalence of active TB disease in health care workers, including drug-resistant TB, compared to the surrounding community or general population. Conclusions: There is relatively little research on the epidemiology of TB in health care workers in South Africa, despite the importance of the issue. To determine the true extent of the TB epidemic in health care workers, regular screening for TB disease should be conducted on all health care workers in all health care facilities, but future research is required to investigate the optimal approach to TB screening in health care workers in South Africa. The evidence base shows a high burden of both active and latent TB in health care workers in South Africa necessitating an urgent need to improve existing TB infection, prevention and control measures in South African health care facilities

Self-Reported Use of Traditional, Complementary and Over-the-Counter Medicines by HIV-Infected Patients on Antiretroviral Therapy in Pretoria, South Africa

Current management of HIV involves the use of conventional prescription medicines, called ‘antiretroviral drugs’ (ARV), over-the-counter (OTC), complementary and alternative medicines (CAM), as well as African traditional medicine (ATM). The aim of this study was to determine the prevalence of use of traditional, complementary and over-the-counter medicines. A cross-sectional survey of HIV-infected patients who started ART between July 2004 and August 2005 at Dr George Mukhari Hospital (Pretoria), who consented to be interviewed, was conducted. Using a pre-tested structured questionnaire, data were collected by two trained interviewers on sociodemographic characteristics, and on non-prescribed medicines used of three sources: African traditional medicine (ATM), complementary and alternative medicine (CAM), and over-the-counter (OTC) medicines. The 180 patients who consented to be interviewed had a mean age of 36.7 (±8.1) years old; 68.8% were female, 86.7% unemployed, 73.9% with high school level of education, 77.8% single. Some 8.9% of respondents used at least one non-prescribed medicine. In descending order, 4.4% of respondents used ATM, 3.3% CAM, and 1.7% OTC medicines. The ATM products used included unspecified traditional mixtures, and those made of the African potato (Hypoxis hemerocallidea), and coconut (Cocos nucifera); OTC products used were paracetamol and sennosides (Senokot®) tablets as well as a soap containing triclosan 1.5%; CAM products used were “sex booster” capsules of unknown composition, mercury-containing soaps (Mekako®), and the Zion Church of Christ special tea, a mixture of Rooibos tea (Aspalathus linearis) plus sunflower oil (Helianthus annuus) and prayed for. In conclusion, only 8.9% of HIV-infected patients on ART in this study used a limited range of over-the-counter products as well as those from traditional, complementary and alternative medicine practices

Predictors of topical steroid misuse among patrons of pharmacies in Pretoria

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, Cushing's 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. Keywords: topical steroid, misuse, abuse, skin lightening, peer pressure, black female African For full text, click here:South African Family Pract 2006;48(1):14-14

Acute poisoning in the Rift Valley Provincial General Hospital, Nakuru, Kenya: January to June 2012

Background: Information on the patterns of acute poisoning in Kenyan hospitals is limited, and yet such information is crucial for the appropriate management of poisoning. This study attempted to address this knowledge gap by examining admissions in a regional hospital in Kenya.Method: This was a retrospective review of the hospital records of 96 acute poisoning patients in Rift Valley Provincial General Hospital, Nakuru, in the first six months of 2012. A pretested data collection form was used to obtain data on important variables.Results: The prevalence of acute poisoning was 0.07% (96 of 141 769 cases). The average age of the patients was 22.6 years ± 11.20 years, the majority of whom were males [odds ratio (OR) 2.06]. The most prevalent toxic agent was pesticide (50, 52.08%). The majority of cases were intentional poisoning (48.96%) versus unintentional poisoning (43.75%), and involved mainly males (OR 3.06). Conversely, females were the majority with respect to accidental poisoning (25%) versus males (17.7%). However, accidental poisoning was most prevalent in patients aged 12 years and younger (23, 23.96%). Overall, acute poisoning was most prevalent in the age category of 20–30 years (40, 41.66%), in which intentional poisoning was predominant (26, 27.08%). The majority of cases of acute poisoning were incorrectly diagnosed (OR 1.79). The three patients who died were males (3.13%).Conclusion: This study showed that the majority of acute poisoning cases affected males and were intentional. The study also showed that the most prevalent acute toxic agent was pesticide and that acute toxic agents were often misclassified and hence misdiagnosed. These observations should be included when designing focused hospital poison management protocols