4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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Subject: search.filters.subject.Organophosphate

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    Presentation and outcomes of children admitted with organophosphate and carbamate poisoning at Rahima Moosa mother and child hospital
    (University of the Witwatersrand, Johannesburg, 2023) Dlamini, Sibongile; De Maayer, Tim
    BACKGROUND: Children are a vulnerable population for organophosphate and carbamate poisoning (OP/CBM). The World Health Organization reports mortality up to 10%. These agents then cause muscarinic, nicotinic and central nervous system collapse. OBJECTIVES: To describe the demographics and clinical features of OP/CBM poisoning, document the treatment given and the response thereof. Observe the acetylcholinesterase levels in relation to clinical features and assess outcomes of the participants. METHODS: A retrospective cross-sectional record review of patients (<14 years) presenting with OP/CBM poisoning at Rahima Moosa Mother and Child Hospital (RMMCH) from the 1st of February 2016 to the 31st of March 2018. Demographics, poisoning circumstances, clinical features, investigations, management and outcomes were analysed. RESULTS: Over the two-year period, 28 participants were included in the study. Gender distribution was equal, and the median age was 31,5 months (Interquartile range [IQR]: 17.5-32.0). Majority was due to accidental poisoning (85%). On arrival to RMMCH, 42.9% were unconscious, displaying mostly Nicotinic (85.7%) vs Muscarinic (71.4%) symptoms. All the participants received Atropine as part of their initial treatment. Participants that had poor outcomes (i.e., demised, n=6/28, 4.7%) were more likely to require inotropes (p=0.02), suffer seizures (p=0.003) and have metabolic acidosis (p=0.02). CONCLUSION: OP/CBM poisoning can have devastating outcomes. Improvement on trade, storage and legislation of these agents is of importance. Research on long-term effects of poisoning would be beneficial.
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    Knowledge, attitudes and practices of clinician management of adults presenting with acetylcholinesterase inhibitor poisoning
    (University of the Witwatersrand, Johannesburg, 2024) Redant, Dean Patrick
    Background: Acetylcholinesterase inhibitor (AChE-I) poisoning is a common cause of deliberate self-harm in South Africa (SA). Whilst there is existing literature on the epidemiology and management of AChE-I poisoning, there is a lack of research on the South African clinician’s knowledge, attitudes and clinical practice when managing these patients. Objectives: To describe the knowledge, attitudes and practices (KAP) of clinicians when managing adult patients with AChE-I poisoning in academic emergency departments (ED) in Southern Johannesburg, Gauteng. To describe the correlation between the clinician’s demographics and experience to their knowledge, attitudes and practices in this setting. Methods: One hundred and forty-five clinicians completed a structured questionnaire used to gather data on clinicians’ knowledge, attitudes and practices (KAP) with regards to their management of patients with AChE-I poisoning. Descriptive and inferential statistics were used to analyse the data and to infer correlation between clinician’s KAP vs clinician’s demographics and experience. Results: One hundred and forty-five questionnaires from 5 EDs were completed and analysed. Of which 86 (59%) of participants were female and 59 (41%) were male. The majority of participants were under the age of 40 (84%) and employed as Grade 1 Medical Officers (39%). Years of experience were divided into <2 years, 2 – 5 years and ≥5 years with each group representing a third of the sampled population. Clinician average knowledge scores on AChE-I poisoning were good (77.9% n= 12.46/16) with scores improving predictably with years of experience (72.5% in <2 years to 83% in ≥5 years). Attitudes towards managing patients with AChE-I poisoning were overall neutral. Clinician practices varied greatly, particularly with adjustment of atropine infusions and adjunctive treatments used. Conclusion: Clinicians had an overall good knowledge of AChE-I poisoning which improved predictably with greater experience managing these patients. Practices were highly varied across all demographic groups despite access to protocols in most departments studied. Attitudes were generally neutral with no clear impacting factors. Clinicians agreed unequivocally that the public health system did not provide sufficient primary preventative care in order to address the underlying factors driving patients to self-harm. This research revealed that the medical and psychosocial management of adult patients with AChE-I poisoning can be improved upon through specific clinician training.