Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian's model.

BACKGROUND: Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors' experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda. METHODS: Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent to ensuring quality of care. RESULTS: Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases that improved the quality of care they provided. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors' knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide active ingredient responsible for the poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients. CONCLUSION: Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance in improving management of pesticide poisoning cases in hospitals in Kampala, Uganda.

Determinants of Exposures to Hazardous Materials among Nail Cosmeticians in the Kampala City, Uganda.

Globally, nail salons represent a fast expanding industry and often with low-income cosmeticians. In general, cosmeticians have limited access to safety information about the hazardous materials they handle, which would potentially enable them to minimize workplace exposures. The problem is much pronounced in low- and middle-income countries due to weaknesses in regulation of the industry. We investigated determinants of exposures to hazardous materials among nail cosmeticians in Kampala District, Uganda. We employed a cross-sectional study design among a random sample of 243 participants. The sociodemographic characteristics, education and training status, knowledge about routes of exposure to hazardous chemicals, and personal protective material use of cosmeticians were assessed through face-to-face interviews. Most cosmeticians were aged 18-34 years, and more males were engaged in this work than females. Also, 82.7% believed inhalation was the major exposure route for the chemicals they handled. Participants who had attained secondary-level education and above were over three times more likely to wear masks (AOR = 3.19, 95% CI 1.58-6.41) and gloves (AOR = 3.48, 95% CI 1.55-7.81) and over two times more likely to use aprons (AOR = 2.50, 95% CI 1.18-5.32). Participants who had ever received safety training on hazardous chemicals were more likely to wear all four personal protective equipment: masks (AOR = 3.21, 95% CI 1.61-6.42), gloves (AOR = 4.23, 95% CI 2.05-8.75), goggles (AOR = 4.14, 95% CI 1.25-13.65), and aprons (AOR = 2.73, 95% CI 1.25-5.96). Participants who had spent more than two years in the nail cosmetics business were more likely to wear masks (AOR = 3.37, 95% CI 1.64-6.95). With the increasing demand for nail cosmetics, and many people in urban areas of low-income countries engaging in this industry, there is need for training and better workplace policies to promote a healthier urban workforce dealing in cosmetics.

Prevalence, Circumstances, and Management of Acute Pesticide Poisoning in Hospitals in Kampala City, Uganda.

This study was aimed at assessing prevalence, circumstance, and management of acute pesticide poisoning in hospitals in Kampala. It was a retrospective cross-sectional study that involved reviewing of 739 poisoning patient records from 5 hospitals in Kampala. Of the 739 patients, 212 were due to pesticide poisoning resulting in a prevalence of 28.8%. About 91.4% (191/210) of the cases were due to organophosphate poisoning, 63.3% (133/210) were intentional, and 98.1% (206/210) were exposed through ingestion. Diagnosis was majorly based on poisoning history 91.2% (187/205), and clinical features such as airways, breathing, and circulation examination 48.0% (95/198); nausea and vomiting 42.9% (91/212); muscle weakness 29.7% (63/212); excessive salivation 23.1% (49/212); and confusion 20.3% (43/212). More than half of the patients admitted were treated using atropine 52.3% (113/212). The prevalence of acute pesticide poisoning was high with most managed based on physical and clinical examination.