Idea Transcript
Perak
2006 - 2009
Health System Research
㻾㼑㼟㼑㼍㼞㼏㼔㻌 㼀㼛㻌㼙㼍㼗㼑㻌㼍 Difference
Perak
2006 - 2009
Health System Research
Research To make a Difference
July 2013
Health System Research (HSR) in Perak 2006-2009 Using Research to Make a Difference ©
July 2013, Clinical Research Centre Perak, Level 4, Ambulatory Care Centre, Raja Permaisuri Bainun Hospital, Jalan Hospital, 30990 Ipoh, Perak, Malaysia.
Editorial Committee Amar-Singh HSS Ooi Qing Xi Lionel Chia Dick Hua Lim Wei Yin Lina Hashim Arvinder Singh Harbaksh Singh Advisors Datin Dr Ranjit Kaur Praim Singh Deputy Director of Perak State Health Department (Public Health) Sondi Sararaks Head Health Outcomes Research Division, Institute for Health Systems Research (IHSR) Dr Asmah Zainal Abidin Head of Assistant Director of Public Health Division (Non-Communicable Disease Centre, NCDC) Perak State Health Department Disclaimer The views, interpretations, implications, conclusions, and recommendations expressed in this book are those of the authors of individual reports and do not necessarily represent the opinions, the views or policy of the Ministry of Health Malaysia. Acknowledgement The authors wish to thank the Director-General of Health Malaysia for giving permission to publish these reports.
Contents Home Safety Practices for Prevention of Poisoning in Young Children
1
Effective Implementation of a Structured Psychoeducation Programme Among Caregivers of Schizophrenia Patients in the Community
41
Improving Asthma Care in Ministry of Health Primary Care Clinics
89
The Involvement of Lay Educators in Diabetic Control of Type 2 Diabetic Patients
123
Improving Knowledge of Type 2 Diabetes Mellitus Patients on Oral Hypoglycaemic Agents
163
Health Seeking Behaviour Towards Communicable Diseases Among Foreign Workers in Industrial & Agriculture Sectors of Selected Districts in Perak, Malaysia
205
Improving Blood Pressure Controls in Primary Care Settings
249
An Intervention Programme Among Overweight Primary School Children
281
Effectiveness of the Diabetic Foot Care Programme in a Primary Care Setting
321
Home Safety Practices for Prevention of Poisoning in Young Children Health Systems Research 2008/2009 Authors
Shoba Pathmanathan
Paediatric Department, Hospital Raja Permaisuri Bainun Ipoh, Perak
Lina Hashim
Clinical Research Centre Perak
Affendi Yusuf
Manjung District Health Office
Vishanthri Kulasingam Greentown Health Clinic
Hooi-Meng Puah
Kinta District Health Office
Amar-Singh HSS
Clinical Research Centre Perak, Department of Paediatrics, Hospital Raja Permaisuri Bainun Ipoh, Perak
Sondi Sararaks
Institute for Health Systems Research
Ranjit Kaur Praim Singh
Perak State Health Department
Asmah Zainal Abidin
Perak State Health Department Clinical Research Centre (CRC) Perak recommends using the following statement to cite this report in our publication entitled “Health System Research (HSR) in Perak 2006-2009: Using Research to Make a Difference”: Shoba Pathmanathan, Lina Hashim, Affendi Yusuf, Vishanthri Kulasingam, Hooi-Meng Puah, Amar-Singh HSS, Sondi Sararaks, Ranjit Kaur Praim Singh, Asmah Zainal Abidin. ”Home Safety Practices for Prevention of Poisoning in Young Children” in Health System Research (HSR) in Perak 2006-2009: Using Research to Make a Difference. Clinical Research Centre (CRC) Perak, 2013, pp 1. (ISBN: 9789671063422)
1
ISBN 9789671063422
Contents of Report
page
Abstract
3
1. 0
Introduction
5
1.1
Problem statement
1.2
Problem analysis
2.0
Objective
2.1
General objective
2.2
Specific objectives
3.0
Methodology
3.1
Overview of research design
3.2
Intervention package
3.3
Study type
3.4
Ethical considerations
3.5
Variables
3.6
Sampling
3.7
Techniques for data collection & pre-testing
3.8
Plan for Data Analysis and Interpretation (Include Dummy Tables)
4.0
Results
4.1
Results of Evaluation of Safety Device
4.2
Socio-demographic data
5.0
Discussion
5.1
Statement of principal findings
5.2
Strengths and weaknesses of the study
5.3
Strengths and weaknesses in relation to other studies
5.4
Meaning of the Study (Possible Mechanism and Implication for Clinicians/Policymakers)
5.5
Unanswered questions and future research
6.0
Conclusion & Recommendations
27
References
28
Appendices
31
2
9
9
17
24
Home Safety Practices for Prevention of Poisoning in Young Children
ABSTRACT Home Safety Practices for Prevention of Poisoning in Young Children Shoba Pathmanathan¹, Lina Hashim², Affendi Yusuf³, Vishanthri Kulasingam4, Hooi-Meng Puah5, Amar-Singh HSS¹,², Sondi Sararaks6, Ranjit Kaur Praim Singh7, Asmah Zainal Abidin7 1 2 3 4 5 6 7
Paediatric Department, Hospital Raja Permaisuri Bainun Ipoh Clinical Research Centre Perak Manjung District Health Office Greentown Health Clinic Kinta District Health Office Institute for Health Systems Research Perak State Health Department
Introduction and Objectives Poisoning in young children is defined as unintentional ingestion of medication(s) and common household products or chemicals. Poisoning in young children is a preventable cause of mortality and morbidity. Poisoning accounts for 2% of the accidental deaths in developed countries and for 5% in developing countries. Most poisoning accidents occur in children aged between 1 to 4 years old. The objective of the study was to evaluate and improve home poison safety practices to prevent poisoning in homes with children aged 1-4 years in the Kinta and the Manjung Districts. Methodology The study was a non-controlled community trial conducted at urban and semi-urban areas in Perak state to assess home safety practices and effectiveness of an intervention programme in home setting. Initial validation of a safety device involved 100 children and 100 adults (parents/caregivers accompanying the child) who attended Ministry of Health (MOH) health clinics and were recruited to test two home safety devices. In both urban and semi-urban areas, 300 households with children aged 1-4 years were randomly selected. They were audited at baseline. Two post-intervention audits were conducted at 3 and 6 months post-baseline audit using the same tools as in the first audit. The households were divided into two intervention arms. Caregivers in the first arm received Intervention Package 1 which consists of an immediate post-audit feedback, an educational pamphlet and a home safety device while caregivers in the second arm received Intervention Package 2 which consists of an immediate post-audit feedback and an educational pamphlet. Results At baseline, 60-71% of urban and semi-urban households in Perak had unsafe home safety practices to prevent poisoning in young children. Only 30 (20.4%) households in the Kinta District compared to 79 (52.7%) households in the Manjung District had good Home Safety Practices for Prevention of Poisoning in Young Children
3
knowledge. Good knowledge does not ensure a safe household. At the end of the study there was a statistically significant increase in the percentage of safe households in both districts with Kinta District doing better. Kinta District had an incarese from 48.6% (CI 40.4-56.8) to 93.9% (CI 89.7-98.0) while in the Manjung District, the increase was from 21.3% (CI 14.7-28.0) to 67.7% (CI 59.7-75.6). Conclusion The intervention package notably the Home Safety Practices Audit checklist, which was developed by the researchers for the study, significantly improved home poisoning safety practices. 75.7-85.3% of urban and semi-urban households in Perak had a safe home to prevent poisoning in children at the end of the study. Addition of the safety device to the home safety practices audit further improves home poisoning safety practices. Knowledge and perception does not ensure a safe household in prevention of poisoning in young children. Keywords poisoning in children, home poisoning safety practices, safe households, home safety practices audit checklist, safety device
4
Home Safety Practices for Prevention of Poisoning in Young Children
1.0 INTRODUCTION Poisoning in young children is defined as unintentional ingestion of medication and common household products (J. Nixon et al. 2004). Poisoning in young children is a preventable cause of mortality and morbidity (Laffoy M., 1997). Poisonings account for 2% of the accidental deaths in developed countries and for 5% in developing countries (Nadarajah P., 2004). Most poisoning accidents occur in children aged between 1 to 4 years (48.5% in the study by Sibel E. and Sukran S. (2006) and 60.3% according to FDA’s Poisoning Surveillance and Epidemiology Branch 1981. Around 80-85% poisoning accidents occur in the home (B. Jacobson et al. 1989). Children under the age of 5 are in a stage of development where they constantly explore their home environment. This is a normal characteristic and should not be restricted. Unfortunately they usually put whatever they see or reach in their mouth (A. W. Craft, 1990). Most of the poisoning accidents (49.5%) stemmed from storing of drugs within the reach of children. Out of these accidents, 49.5% were due to drugs, 17.5% due to cleaning agents and 16.5% due to insecticides/pesticides (Sibel E. et al. 2006). In a study on home safety in the United States, although most families reported locked storage of medications, 77% had unlocked storage of medication documented during home observation (Kimberly E. et al. 2007). Medications involved in suspected poisoning were most frequently packed in containers without Child Resistant Containers (CRC) (63%) or transparent blisters (20%). However safe packaging cannot compensate for unsafe storage. Bathroom and kitchen cabinets and drawers are the safest place to store medication (H. M. Wiseman et al. 1987). The concept of CRC is widely supported by parents as an important mechanism for protecting children from toxic products. However the support for CRCs was often based on the notion that they were childproof rather than child resistant. As a result some parents were more likely to store products unsafely if they were in CRCs (L. Gibbs et al. 2005). CRC is defined by the Poison prevention Packaging Act to be packaging that is “difficult for children under age of 5 years to open” but “not difficult for normal adults to use properly”. US Consumer Product Safety Commission (CPSC) regulations require that certain drugs be packaged in special containers that would prevent at least 80% of those children younger than 5 years old from opening the container within 10 minutes (CPSC Federal Register 1983). Oral prescription drugs became subject to Child Resistant Packaging requirements since 1974 in the US. Introduction of CRC resulted in 47% reduction in the incidence of Home Safety Practices for Prevention of Poisoning in Young Children
5
paraffin poisoning in the study community compared to the control community (Krug et al. 1994). Safe storage of toxic products should be in a locked cabinet or cupboard out of reach if possible in the kitchen or bathroom (L. Gibbs et al. 2005). Safe disposal according to the National Drug Control Policy Federal Guidelines Washington DC for unneeded or expired prescription drug should be taken out of their original container and thrown into the trash, returned to a community pharmaceutical take back program or flush down the toilet if the label instructs so. Other implementation measure, besides safe storage and disposal practices and CRC, is parental education and improved supervision by parents. In rendering the child’s environment safe, the family’s education especially that of the mother is vital (Stewart J., 2001). 67% of the children involved in a poisoning accident were under the supervision of their mothers at the time of the accident (Sibel E. et al. 2006). 69% of mothers claimed to have taken measures to prevent future poisoning accidents in their homes however there was no mention at all of basic precautions such as storage in locked cupboards which are out of reach of children. This proves the necessity for educational measures in the families (Sibel E. et al. 2006). In summary, a combination and not a single home poison safety strategy is needed to reduce accidental poisoning in young children. The strategies are: 1. 2. 3. 4. 5.
Safe storage practices. Efficacious CRC and Child Safety Devices. Safe disposal practices. Parent education. Responsible supervision of children by caregiver at all times.
1.1 Problem Statement
The number of cases of accidental poisoning admitted to government hospital is static with no reduction over the years. There are no available local studies assessing the knowledge of caregivers or home poison safety practices. There is also no CRC or Child Safety Device in regular use in our local setting.
Based on international data, only 20% of homes are safe in terms of preventing an accidental poisoning and we assume this is the case in our setting as well.
Here is a table showing the number of admissions to government hospitals in Malaysia due to poisoning by drugs, medicaments and biological substances in the 1-4 years age group. (Data was obtained from Admissions and Deaths in Government Hospitals due to Injury in Malaysia 1999-2002.)
6
Home Safety Practices for Prevention of Poisoning in Young Children
Table 1. Number of deaths in government hospital due to poisoning by drugs, medicaments and biological substances. Age (years)
1999
2000
2001
2002
80 %
161
25.4
126
30.1
0.10
60-80 %
242
38.2
179
42.8
0.15
1 OHA
n
1.2
4.4
%
4.8
4.4
52.4
51.5
16.7
52.9
41.7
61.8
1.2
4.4
88.1
91.5
Baseline
38
32
38
32
38
32
38
32
38
32
38
32
30
32
n
55.3
28.1
47.4
40.6
55.3
78.1
50.0
84.4
13.2
18.8
84.2
90.6
18.4
31.3
%