| Summary: | A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfillment of the requirements for the degree
of
Master of Medicine in Emergency Medicine.
Johannesburg, 2016 === Background
Overdose is an important health care problem, a subject under-researched in South
Africa. The aims of this study are to investigate the demographics, to identify
common substances and to ascertain the burden of disease at a tertiary hospital in
Gauteng. Data can be used to reduce morbidity, mortality and the substantial costs
to health care services related to overdose.
Materials and methods
A retrospective, observational study based on hospital records (16 weeks). The
analysis was purely descriptive. Categorical data were compared using the Chisquare
test. P value < 0.05 was considered significant.
Results
Of the total of 176 records with a primary diagnosis of overdose, 133 were included.
The frequency of overdose was found to be 1.1 cases per day. Females accounted
for 64.7%, 82.8% were single, 85% were Black, 78.9% were unemployed and 54.2%
resided in poor socio-economic areas. Overdose was highest in the 20-29 years
(55.6%) age group with a mean age of 28.1 years. Overdose was intentional in 91%
and 12% of the subjects had overdosed previously. A previous medical history was
found in 22.6% and HIV was prevalent in 66.7%. The most common substance
groups were analgesics (32.3%), pesticides (21.1%), anxiolytics (11.3%), household
chemicals (10.5%), vitamins (8.3%), antibiotics (7.5%) and anti-retrovirals (ARV’s)
(5.3%). In 99.3% the substance was ingested orally and in 23.3% there was
concurrent alcohol consumption. Common precipitating factors were relationship
problems, depression, domestic problems and financial. The median delay to
hospital presentation was 3.5 hours and patients tended to present during the
afternoon and the night with a significant association between time of presentation
and age group (p=0.043). An antidote was employed in 35.3% and in 97% of cases,
symptomatic treatment was by far the most common. No patients were discharged
directly from the ED and in 42.1% the median length of hospital stay was 2 days and
a case fatality rate of 1.5%.
Conclusion
The introduction of management protocols is of uttermost importance. Awareness,
education and regulations will form part of strategies for the prevention of overdose. === MT2017
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