The page number in the footer is not for bibliographic referencingwww.tandfonline.com/ojfp 55 RESEARCH ARTICLE ABSTRACTS South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Cogent, Taylor & Francis Group S Afr Fam Pract ISSN 2078-6190 EISSN 2078-6204 © 2016 The Author(s) RESEARCH South African Family Practice 2016; 1(1):1–6 http://dx.doi.org/10.1080/20786190.2015.1125167 Open Access article distributed under the terms of the Creative Commons License [CC BY-NC-ND 4.0] http://creativecommons.org/licenses/by-nc-nd/4.0 Profile and management of the firework-injured hand T Pillinga and P Govender (née Naidoo)b* a Department of Occupational Therapy, Edendale Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa b Discipline of Occupational Therapy, School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa *Corresponding author, email: naidoopg@ukzn.ac.za Background: Numerous studies internationally highlight the devastating effects of firework-related injuries and the costs involved in treating these injuries, in addition to the calls to alter legislation to prevent these injuries from occurring. There has, however, been a paucity of research studies in the South African context that describes the complexity of the injuries sustained. The aim of this study was thus to profile the firework-injured hand and to review the management from a surgical and rehabilitation perspective. Methods: A retrospective file audit was conducted on patients who had sustained firework injuries between 2009 and 2014 (n = 65) in two hospitals in KwaZulu-Natal (KZN), South Africa. Results: The firework-injured hand has a varied profile, which appears to be dependent on the blast capacity. The thumb, index and middle fingers were predominantly affected at the level of the distal phalanges and distal interphalangeal joints resulting in amputation due to severe soft tissue injury and resultant fractures. Hand Injury Severity Scores indicated a large percentage of cases within the severe category. Medical and surgical interventions occurred within the first three to six hours post-injury and involved washout, cleaning, debridement and suturing. Formalisation of amputation was the predominant course of action. Rehabilitation was focused on assessment and hand therapy to ensure functional outcomes. Conclusions: From this study, the authors conclude that the firework-injured hand should be managed according to the resultant diagnosis, be it an amputation, fracture, or soft tissue injury, whilst managing the symptoms of oedema, pain and stiffness, which will all impact on hand function outcomes. Keywords: hand function, hand rehabilitation, hand therapy, soft tissue injuries, traumatic amputation Introduction Fireworks are a sight to behold when displayed safely and correctly, but, as the name suggests, are dangerous. When used by untrained persons and children, fireworks are especially dangerous, having the capacity to explode unexpectedly. The injury caused by a firework exploding while being held can have a devastating effect on the functional status of the hand. The human hand is described as the most developed prehensile organ among all living creatures.1 Preservation of hand function is thus of utmost importance following a firework injury. Function is defined as the manner in which the human hand is able to perform (assume, use, maintain and release) the necessary grips and grasps in a range of activities for task completion against a sensory background.1 Types of firework injuries to the hand The injuries that occur in a firework-injured hand include soft tissue injuries, fractures, burns and traumatic amputations in addition to disruption of the neurovascular supply.2,3 Ground- spinners, sparklers and flares have wicks that are lit, and are the primary culprits of burns and soft tissue injuries. String-bombs and rockets cause blast injuries that result in fracture(s), amputation(s) and disruption of the hand’s neurovascular supply.4–6 Soft tissue injuries are injuries that cause abrasion and lacerations that affect the skin and underlying fascia. These tissues are essential in covering the underlying blood supply, nerves, muscles and tendon, ligaments, bones and joints. The skin as an organ in its own right is essential for successful hand function as pliable skin allows for tendons to glide under the skin, it stretches over joints to allow for movement and is essential for tactile functions of the hand. Any soft tissue injury with resulting scar tissue, if left untreated, can have a significant negative impact on hand function by limiting the amount of pliability and elasticity, and reducing the range of movement. Fractures occur when the vibration of the blast component causes the phalanges to break while the distal volar plates of the interphalangeal joints (IPJs) give way, which results in dislocations and avulsion fractures of the IPJs.7,8 In most cases, these joints undergo amputation. In cases where the joint undergoes repair or reconstruction, the complications include infection, stiffness from long-term immobilisation and pain. The stiff and fixed joint has a direct implication on the ability of the patient to assume a specific grip or pinch. Traumatic amputation occurs when the soft tissues, bones, tendons and ligaments are unable to withstand the explosive force of the firecracker, resulting in a shattering of bone, disruption of the joint, and irreparable damage to the blood vessels and digital nerves as well as insufficient skin coverage. It is common that the patient presents with denuding and de-gloving injuries of the fingers with exposed bone. In these cases, the patient undergoes formalisation of amputation to ensure that there is sufficient skin and soft tissue coverage and the exposed bone is trimmed. It is imperative for the surgeon to ensure adequate soft tissue coverage so as to prevent neuromas, which cause hypersensitivity in the stump and render the stump useless. Medical and surgical interventions for firework injuries to the hand Wilson9 highlighted a number of risk factors related to the use of fireworks that resulted in injuries to the hand. These included the relighting of an unexploded firework, holding the firework in the hand that explodes and the firework being thrown at a passer-by.9 South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Cogent, Taylor & Francis Group S Afr Fam Pract ISSN 2078-6190 EISSN 2078-6204 © 2015 The Author(s) RESEARCH South African Family Practice 2015; 1(1):1–6 http://dx.doi.org/10.1080/20786190.2015.1120933 Open Access article distributed under the terms of the Creative Commons License [CC BY-NC-ND 4.0] http://creativecommons.org/licenses/by-nc-nd/4.0 Evaluation of the use of oral rehydration therapy in the management of diarrhoea among children under 5: knowledge attitudes and practices of mothers/caregivers Sergius Onwukwea, Claire van Deventera* and Olu Omolea a Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa *Corresponding author, email: cvandeventer@nwpg.gov.za Introduction: Dehydration from diarrhoea and vomiting has remained a threat to the lives of children under 5 years old especially in developing countries. Oral rehydration therapy (ORT) administered by caregivers is lifesaving but evidence shows unsatisfactory implementation of this. Methods: A descriptive cross-sectional study involving 377 systematically recruited caregivers was conducted. A face to face questionnaire was used to measure the level of ORT knowledge, attitudes, practices, and responses to diarrhoea and vomiting in children. The data collected were analysed by the use of descriptive statistics, the chi-square test, and Fisher’s exact test. The main outcome measures were the level of ORT knowledge of mothers/caregivers, attitudes, practices, and responses to diarrhoea. Results: In total, 88.3% of caregivers were biological mothers. Only 53.3% were aware of the importance of initiating ORT at home with the onset of diarrhoea, and 4% administered traditional remedies. Some 66% of the caregivers had used ORT, 18.3% knew that it prevents dehydration, and 33.7% were able to prepare a correct recipe. Knowledge and attitudes correlated with the ability to initiate ORT at home (p = 0.0000). Conclusion: Unsatisfactory uptake of ORT appears to be due to caregivers’ lack of knowledge concerning the perfect mixture, function, and appropriate quantity of ORT administration. Mothers have heard of ORT, but some still believe that traditional remedies are better in treating diarrhoea. Keywords: attitudes, caregivers, knowledge, ORT, practices Introduction Dehydration from diarrhoea and vomiting has remained a threat to the lives of children under 5 years old, especially in developing countries. Over the years, diarrhoea, the second global leading cause of deaths among this age group, has declined from about 2.4 million in 20001 to about 1.7 million 10 years later.2 In South Africa, according to a burden of disease report, diarrhoea is estimated to be the cause of death of over 10 000 children under 5 annually,3 and this is worrisome especially as the Millennium Development Goals (MDGs) 2015 target date for the reduction of overall under-5 mortality is a decrease of at least two-thirds.4 Most of these deaths would have been avoided by the simple administration of ORT, which was introduced in 1979 to reverse the dehydration that predisposed these children to death,5,6 but emerging evidence still points to unsatisfactory implementation of ORT globally with childhood diarrhoea especially common in developing countries.2,7 Some studies have shown clearly that caregivers’ responses and the use of ORT is aligned to their knowledge and attitudes towards this therapy,7,8 and that is why some resort to traditional remedies or prescriptions instead of giving rehydrating ORT to their children during episodes of diarrhoea. For example, despite concerns regarding their safety,9,10 there is strong evidence that unconventional remedies are still being used to treat diarrhoea in some parts of South Africa,11,12 and this is consistent with reports from other similar contexts across countries.7,13–19 These misconceptions in the ORT attitudes of caregivers is compounded by their apparent poor knowledge and awareness.20−26 Despite attempts that have been made to increase ORT awareness especially in South Africa,21,27 since it was introduced over 25 years ago,28 there appears not to have been a high success rate. In terms of practices, preparing ORT correctly is the key to effective treatment of diarrhoea. However, according to several studies, most caregivers still give dangerous hypo/hyper- osmolar ORT mixtures to their children,29–31 simply because they do not know how to prepare it correctly.15,20,23,24,27,32 The current teaching therefore for the preparation of adequate and life- saving rehydration solution is to mix eight level teaspoonfuls of sugar, and half a teaspoonful of salt in a litre of boiled/clean water.27 Vomiting is a recognisable barrier to the effective use of ORT, and this is because some caregivers are unaware of the need to continue giving ORT and other feeds to their child after the vomiting has subsided.33 In some cases, this practice is attributable to the caregivers’ level of education, and the quality of diarrhoea-related health messages that they receive.34,35 Several studies have been conducted on this subject in our context. However, most of these studies have some critical methodological issues that may limit the generalisation of their findings.21,27 In light of the above, the aim of this study was to evaluate the use of oral rehydration therapy in the management of diarrhoea at the study site, and with special emphasis on the ORT knowledge, attitudes and practices of mothers/caregivers. Methods Study design and setting This was a descriptive cross-sectional study conducted in the busy Integrated Management of Childhood Illness (IMCI) clinic of a large community health centre that is accredited as a training site for primary health care nurses, interns, medical students, and registrars attached to the University of the Witwatersrand. This clinic attends to about 1646 children under 5 every month. S Afr Fam Pract 2015; DOI:10.1080/20786190.2015.1120933 S Afr Fam Pract 2015; DOI:10.1080/20786190.2015.1125167 Abstract (Full text available online at www.tandfonline.com/ojfp) Abstract (Full text available online at www.tandfonline.com/ojfp)