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Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Medicine Johannesburg, August 2013 / Asthma control is a central focus of the updated version of the GINA Guidelines, in which clinicians are encouraged to concentrate on assessment of control, defined by symptoms, lung function and the presence or history of exacerbations. Control is of critical importance in asthma and is now more important than the actual level of severity. Measures of asthma control do not necessarily perform well and all of them need to be looked at as a whole as studies have shown. Many factors have been found to be associated with poor asthma control ranging from concomitant rhinitis and co morbidities to poor compliance with medications or inappropriate inhaler technique in addition to home or environmental factors. Several factors around the home of asthmatic patients contribute to poor asthma control which includes parental smoking or smoking by other relatives within the home, biomass fuel exposure, exposure to aeroallergens and animal danders which all leads to failure in achieving control despite adequate drug therapy. This cross sectional study was conducted in 115 asthmatics children with the aim of determining the level of asthma control and home circumstances that contributes to poor asthma control. Most patients were males and blacks with 55.65% of patients having controlled asthma. Use of biomass fuel was uncommon in this study and none of the home circumstances was found to be associated with poor asthma control in this study. Day time and nocturnal asthma symptoms were significantly associated with poor asthma control. Good adherence to medications was found to be associated with asthma control similar association was not seen with good inhaler technique. The higher the FEV1 percent predicted the better the asthma control. Day time and nocturnal asthma symptoms were associated with FEV1. Results from this study need confirmation in a representative population study. Further longitudinal study is required to see if home circumstances may affect asthma control in patients that had controlled asthma.

A Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Medicine in the Department of Pharmacy and Pharmacology / Accidental poisoning amongst children is a common childhood injury worldwide, attributed commonly to household substances and medications stored within the immediate environment of the child. The incidence of childhood poisonings in South Africa’s most populated and urbanized province of Gauteng is unknown, due to poor record-keeping at medical facilities regarding the incidence and classification of poisoning, coupled with the lack of a local Poison’s Information Centre (PIC). A mixed-methods, case-study design was used to investigate the occurrence of poisonings and poisons management by parents/guardians and healthcare practitioners in the urban suburb of Gauteng, Lenasia. A cross- sectional, self-administered survey was administered to parents/guardians of children attending a random sample of crèches and primary schools in Lenasia, questioning the number of poisonous household substances stored and storage level of these substances, the occurrence of poisoning incidents amongst children and the associated management and knowledge of PIC's. Semi-structured interviews were used to explore the local practice of healthcare practitioners regarding accidental childhood poisoning. A total of 4530 questionnaires were handed out, 1730 (38.2%) were returned completed and 256 cases of accidental poisoning were reported. Medications were the most common substances stored, followed by cosmetics and household detergents. More than half (63.26%) of all substances were stored at a level of accessibility to children, with pesticides most commonly stored out of reach of children. The occurrence of a poisoning was significantly associated with the employment status of the mother (p=0.031) and the general non-drug chemical category of household substances (p<0.001) The categories of household substances were significantly associated with the level of storage (p=0.021) and the management of poisoning (p<0.001). There is a lack of knowledge of PIC’s and the prevention and management of poisonings amongst parents/guardians. Semi-structured interviews with healthcare practitioners revealed few cases of poisoning presented at healthcare practitioners, however there is a need for improving health literacy amongst caregivers through community awareness programmes and inter-professional development in addressing this preventable phenomenon amongst children. / GR2018

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