Food poisoning an SA epidemic, community service doctor says

A total of 22 pupils at Makahlule Primary School in Ntlhaveni Block H, Malamulele, in Limpopo were rushed to hospital on Wednesday, due to suspected food poisoning.

The Limpopo department of education was investigating the incident.

MEC Mavhungu Lerule-Ramakhanya has called for calm. “We call on the parents and education community not to panic as the situation is under control and will be investigated thoroughly to ensure that learners are safe at all times,” Lerule-Ramakhanya said.

The department said the pupils were rushed to a nearby clinic in the afternoon when they started vomiting, and were later transferred to Malamulele Hospital. The MEC's spokesperson Matome Taueatsoala said the pupils were treated and discharged.

“A second group comprising 13 learners was rushed to the hospital complaining of headaches and stomach cramps. They were also released after screening by the health professionals,” he said. He said the department would submit samples of the food the pupils ate on Wednesday for testing to ascertain if the school nutrition rations could have been the cause.

“The department will also check the food, mainly snacks, sold by vendors outside the school premises with the assistance of health inspectors.”

Pesticide poisoning

The surge in poisoning cases and the ease with which toxins can be bought or accessed by children were a major cause for concern, said Dr Simon Fraser, a medical professional completing his community service at Tshepong Hospital in Klerksdorp.

“I think it needs to be stressed that this is literally a pandemic in SA. I can guarantee that there is a child or young person right now as you read this who is in a public or private hospital in SA with organophosphate [pesticide] poisoning,” he said.

Fraser spoke about poisoning cases after the deaths of five children who consumed snacks that they allegedly bought from a local tuck shop in Naledi, Soweto. The case followed that of three children aged between one and four years who died of suspected food poisoning in Mdantsane NU2, Eastern Cape. Fraser said while poisoning is a leading cause of toxin-induced deaths in SA, it is mostly accidental in small children and often intentional among teenagers.

“Organophosphates are a leading cause of toxin-induced deaths in SA. Exposure in small children is most commonly accidental. In older age groups — adolescents and into young adults — it is unfortunately increasingly common as a form of intentional poisoning such as suicide or intentional poisoning of another person,” said Fraser. Between April 26 and May 5, four pupils from Eqinisweni Secondary School in Ivory Park took their own lives by consuming poison.

Fraser says examples of organophosphates include insecticides like malathion and halipirimi, which is a black, granular, pepper-like powder commonly found in townships as a pesticide.

“The first symptoms are typically gastrointestinal, such as nausea, vomiting and stomach cramping,” he said.

“In the emergency department we often see patients presenting with late signs, usually with every imaginable body fluid pouring from the various orifices in the body. Though revolting to think about, this is a helpful memory aid for the recognition of organophosphate poisoning: if the patient is ‘wet and slimy’ in every imaginable fluid, you have to consider organophosphates, or their sister group, the carbamates.”

Fraser says the treatment is complex and requires immediate medical attention.“The initial management of a suspected organophosphate poisoning is related to symptomatic treatment and relief of immediately life-threatening symptoms ... I need to stress that treatment of organophosphate poisoning is time-consuming, difficult and unpleasant — more especially for the patient than the healthcare provider.”

He emphasises the importance of prompt action and outlines the treatment process. “Children can change condition very quickly, and due to their much smaller body size are more likely to have rapid onset of more severe symptoms. Treatment comprises protecting the patient’s airway from excessive bronchial secretions and bronchospasm... Atropine has the general effect of ‘drying up’ the body’s secretions, so we give it in incrementally increasing doses until we have reached a dose where the effect is the cessation of signs and symptoms related to the poison,” he said.

Prevention strategies are crucial. Fraser advises: “If keeping poisons around is necessary, ensure they are stored far out of reach in clearly labelled and closed containers.”

He stresses the importance of educating older children about the dangers of hazardous substances: “In older children, education is important: not to explore or fiddle with possible sources such as rat traps or poisons.”

SA Depression and Anxiety Group (Sadag) project manager Roshni Parbhoo-Seetha said their research indicates that rat poison is among the most accessible and frequently used methods for self-harm.

“One of the concerns flagged were the number of suicide attempts happening at or before school starts. Rat poison is one of our biggest ones and what we are finding is that schools themselves don't know what to do in a crisis. Three weeks ago, we had two pupils who had taken rat poison in the morning and their friends had taken them to the sick room, but the school didn't know how to deal with it,” Parbhoo-Seetha said.

“In terms of rat poison, we found that it’s cheap. For R10 you can walk to the corner shop and just buy it. You don’t have to be a certain age, you can be anyone and it’s sitting there and easily accessible.”

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