Injury Control Centre – Uganda,
WHO Collaborating Center for Violence &
Injury Prevention & Control
Paraffin Poisoning in Kampala, Uganda
-A qualitative baseline study for WHO’s future paraffin project
Authours: Emelie Haig & Terese Isakson
Email: emelie.juel-haig.575@student.ki.se &
terese.isakson.073@student.ki.se
Supervisor: Executive Director Mable N. Tomusange
Email: iccu@infocom.co.ug
Date: September to December 2010
Research Location: Kampala, Uganda
Abstract
Background: Poisoning is a widespread global public health issue. Paraffin poisoning
among children has been largely eliminated in high income countries but is still widely
spread in low income countries.
Objective: To contribute with present base line information, disseminate knowledge and
elevate the consciousness regarding paraffin poisoning and its preventative measures.
Method: This qualitative study was performed with an interview guide in Kampala,
Uganda, during September, October and November 2010 by individual interviews on ten
healthcare personnel from six hospitals. Microsoft Excel was used to perform a
randomized hospital selection (governmental, NGO and private hospitals). The targets
interviewed where found available during one visiting hour opportunity. Literature
review was collected through Pub Med. Data collected included: age, gender, risk factors,
symptoms, number of cases (increased or decreased) and seasonal variations.
Results: The perceptions and experiences of the people interviewed were divided into
three major topics; The Development of Paraffin Poisoning through Time, Risk Factors
and Preventative Measures. The experiences varied among the healthcare personnel
depending on the hospital.
Conclusions: The results indicated that there were four major contributors regarding
paraffin poisoning; 1) socioeconomic position; the number of cases seemed to be
positively correlated to poverty as well as the social gradient; 2) age; paraffin poisoning
cases were more common among children under the age of five; 3) gender; the majority
of the casualties tended to be boys; 4) lack of adult supervision; the absence of the adults
was a clear risk factor in relation to the number of paraffin cases.
2
Index
Abstract ............................................................................................................................... 2
Abbreviations ...................................................................................................................... 4
1. Background ..................................................................................................................... 5
1.1 WHO ......................................................................................................................... 5
1.2 ICCU ......................................................................................................................... 5
1.3 Safe Kids ................................................................................................................... 5
1.4 Poison........................................................................................................................ 5
1.5 Paraffin ...................................................................................................................... 6
1.5.1 Symptoms and treatment.................................................................................... 6
1.5.2 Risk factors ........................................................................................................ 6
2. Objective ......................................................................................................................... 7
3. Main questions of the project .......................................................................................... 7
4. Method ............................................................................................................................ 7
4.1 Ethical aspects ........................................................................................................... 8
4.2 Challenges ................................................................................................................. 8
5. Results ............................................................................................................................. 9
5.1 The development of Paraffin Poisoning through time .............................................. 9
5.2 Risk factors ............................................................................................................... 9
5.2.1 Socioeconomic Position ..................................................................................... 9
5.2.2 Age ..................................................................................................................... 9
5.2.3 Gender .............................................................................................................. 10
5.2.3 Adult supervision ............................................................................................. 10
5.3 Preventative measures ............................................................................................. 10
5.3.1 Education ......................................................................................................... 10
5.3.2 Accessibility..................................................................................................... 11
5.3.3 Family planning ............................................................................................... 11
6. Discussion ..................................................................................................................... 11
7. Conclusion .................................................................................................................... 13
Acknowledgement ............................................................................................................ 13
Reference .......................................................................................................................... 14
Appendix 1 ........................................................................................................................ 16
Interview Guide .............................................................Error! Bookmark not defined.
3
Abbreviations
CNS
Central Nerve System
ICCU
Injury Control Centre
NGO
Non Governmental Organization
UN
United Nations
UNICEF
The United Nations Children's Fund
WHO
World Health Organization
4
1. Background
1.1 WHO
The World Health Organisation (WHO) has together with the Injury Control Centre
Uganda (ICCU) decided to administer a Paraffin Poisoning Prevention Programme for
children. The topic had been up for discussion for a long period of time when the
representatives from the WHO came to meet stakeholders from all over Africa in
September 2010. During the conference, where the interns Emelie Haig and Terese
Isaksson from the Karolinska Institute were the sole representatives from the ICCU, it
became clear that the WHO needed more data regarding paraffin poisoning among
children.
WHO has created specific Millennium Goals in order to combat the eight major global
public health issues. It is vital to bear these goals in mind when conducting a study
regarding public health related issues such as paraffin poisoning (WHO, 2010).
1.2 ICCU
ICCU is a national non governmental organization (NGO) which was funded in 1996 in
Kampala, Uganda. The objective of the organization was to confront the increasing cases
of child related injuries. ICCU has since then expanded its field of responsibility, both
nationally and internationally, and is currently cooperating with the World Health
Organization (WHO) and the United Nations Children’s fund (UNICEF). The ICCU is a
part of Injury Prevention Initiative for Africa, of which merely another African country is
a member, South Africa.
1.3 Safe Kids
The ICCU became a member of Safe Kids Worldwide in 2003. This cooperation led to
the establishment of a local Safe Kids in Kampala. The aim of Safe Kids Uganda is to
promote the general knowledge of child injuries, to inform about the risk factors and to
induce preventative measures, both rural and urban.
Upon arrival at the ICCU Kampala it became clear that the Safe Kids project no longer
was active due to lack of personnel. It was thereby decided, together with the ICCU’s
Executive Director, that the Safe Kids project was to be re-established as a part of the
interns’ main project.
1.4 Poison
Poison is classed as an injury and is a chemically active substance which is capable of
causing harm. The poison may enter the body in various ways e.g. airways, direct skin
contact and indigestion. Children ingest two types of substances: there is one type that is
ingested more frequently but is less harmful and the other type is less frequently ingested
but more harmful (Craft A.W, Lawson G R, Williams H and Sibert J R, 1984). According
to a study by Lang T, Thuo N & Akech S (2008), the main cause of poisoning is
5
negligence. Acute poisoning is common in low socioeconomic groups in Africa (Shotar,
A.M, 2005 & ICCU, Home Safety For Children).
1.5 Paraffin
Paraffin (also known as kerosene) is a hydrocarbon which comes from products made of
petrol (Stones DK, van Nierkerk & Cilliers C, 1987). Paraffin is widely used in low
income countries as fuel for cooking, lanterns and heating, particularly among poor
people in the rural areas. Paraffin poisoning has been largely eliminated in high income
countries but is still a widely spread issue in low income countries. Paraffin poisoning
among children is more common in low socioeconomic groups. The cases result in high
incidence of paediatric poisonings and can lead to health problems, complications and
with some cases of mortality (Tshiamo W, 2009). The paraffin should be stored in blue
containers in order to be distinguished from other liquids. However, paraffin is rarely
ingested directly from the original container as it is often sold in mineral bottles (Craft
A.W, Lawson G R, Williams H & Sibert J R, 1984 & Stones DK, van Nierkerk & Cilliers
C, 1987).
Many children have been victims of paraffin poison either through direct indigestion or
through vapour inhalation, as it is mistaken for water (Shotar, A.M, 2005 & ICCU, n.d &
Lang et al, 2008 & Cachia EA & Fenech FF, 1964). There are data that indicate that there
is a higher risk of paraffin poisoning during the summer season than the winter season as
the child is more likely to be thirsty during the warm summer (Shotar, A.M, 2005). A
study suggests that the amount taken frequently is overestimated, however, a quantity of
two tablespoons or less is most commonly indigested (Cachia EA & Fenech FF, 1964 &
Stones DK, van Nierkerk CH & Cilliers C, 1987).
1.5.1 Symptoms and treatment
Paraffin affects mainly the respiratory system, whereby the earliest signs are respiratory
symptoms such as choking, coughing and gasping. The most serious complication is
pulmonary pathology, such as pulmonary oedema and pneumonia which in most cases
are bilateral. Other symptoms are fever, symptoms of CNS (central nerve system)
impairment (e.g. headache, drowsiness, restlessness, convulsions and coma) and
gastrointestinal involvement (e.g. vomiting, diarrhoea and nausea) (Shotar, A.M, 2005).
Treatments may consist of supplementary oxygen, intravenous fluids and antibiotics
(Stones DK, van Nierkerk CH & Cilliers C, 1987).
1.5.2 Risk factors
Several studies confirm that boys are more likely to suffer from paraffin poisoning than
girls. A study conducted by Shotar (2005) reports that the patients predominately were 3
years or younger. Low socioeconomic position is also a risk factor, as findings of a study
confirm that there was a positive correlation between safe habits and income (Schwebel
DC, Swart D, Hui SK, Simpson J & Hobe P, 2009).
6
2. Objective
To contribute with present base line information, disseminate knowledge and elevate the
consciousness regarding paraffin poisoning and its preventative measures.
3. Main questions of the project


What are the risk factors regarding paraffin poisoning among children?
What are the healthcare personnel’s thoughts and experiences concerning
paraffin poisoning among children?
4. Method
The WHO meeting was followed up by several discussions with representatives from the
WHO team. After the discussions a background investigation was instigated by using
several scientifical data bases in search of scientific articles and general information
regarding paraffin poisoning. The data base used was Pub Med and search words
included: kerosene; paraffin; poisoning; paraffin poisoning among children; paraffin
poisoning Africa and paraffin poisoning Uganda.
A randomized selection of healthcare centers were selected using the Ministry of Health
in Kampala’s healthcare list combined with Kampala’s Tourist Information’s healthcare
list. The healthcare information included hospitals and clinics that were governmental,
non-governmental (NGO) and private. Microsoft Excel was used in performing the
randomized selection. The lists contained two governmental-, two NGO- and two private
healthcare centers and among these two of each were randomly selected.
The study had a qualitative approach due to the study’s time limitation as well as the
rarity of the paraffin poisoning cases. The qualitative method consisted of individual
interviews in order to give a deeper insight in the healthcare personnel’s perceptions and
feelings regarding paraffin poisoning among children.
The targets for the interviews were the healthcare personnel that were available during
one complete visit during the hospitals visiting hours. The number of interviews was
negatively correlated to the number of patients in the waiting area as the healthcare
personnel at these hospitals were overloaded with work. There may thereby have been a
loss of healthcare personnel particularly among the hospitals that were free of charge.
The number of interviews individuals consisted of a total of 10 healthcare personnel
whereby this included four physicians, four nurses, one midwife and one medical
assistant. The interviews varied between 7 to10 minutes and consistently held in the
personnel’s communal break and lunch area. The setting of the interviews may have had
an impact on the results.
The instrument that was used was a pilot-tested interview guide with open questions. As
a presence of a recorder could interfere with the results a method of note writing was
selected. The notes were taken during the interviews and the results where clarified
directly after each interview. The students took turns in observing and conducting the
interviews. The data collected was analyzed and transcribed by using the scientifical
7
methods recommended by Patel & Davidson (2007). The findings were divided into
various themes in order to facilitate the analyzing process. The themes included the
development of paraffin poisoning through time, risk factors and preventative measures.
The interviewed persons were coded with the following cipher; I1-I10 in order to protect
and respect their anonymity in the study.
4.1 Ethical aspects
Ethical issues have consisted of unavoidable differences between the healthcare
personnel and the field workers. The variations consisted of various factors, such as
disparate levels of education, socioeconomic position, cultural backgrounds, economical
possibilities, age differences as well as dissimilar paradigms (Kvale, 2008). Ethical
permission and informed consent was sought for at each hospital before the interviews
were given. The target groups were informed that the participation was voluntary and
discretionary and that their results would remain anonymous.
Particular considerations were taken to respect the circumstances related to some of the
hospitals poor conditions. These considerations included adaptation towards the
magnitude of the patients and their urgent needs as well as the healthcare personnel’s
hectic work situation. As a result of this the waiting periods could be prolonged and the
time-intervals for the interviews where not able to be as elongated and extensive, as
initially hoped for. Another consideration was the fact that the interviews where held
discreetly during the visiting hours when opportunities where given.
4.2 Challenges
The furthermost challenge was the project’s deadline as the internship was time limited.
The evaluation thereby became somewhat more difficult to execute as the results most
probably will be shown in a few years rather than in the near future.
A lack of funding contributed to the main challenges as Safe Kids had a slim financial
plan, which constricted the possibilities for the projects various activities as well as the
follow up and the evaluation.
As the project was conducted in Kampala, Uganda, several practical difficulties rose. The
deficiency of internet access at the ICCU office limited the possibility to investigate
relevant scientific data as well as restricting certain mail communication.
The infrastructural deficits, such as dire roads and traffic jams, have had an impact on the
project as it makes it more difficult to commute and be on time.
Certain cultural differences, such as distinctions between the European and African
perceptions of time, have had a clear impact on the project.
8
5. Results
5.1 The development of Paraffin Poisoning through time
The results were differentiated among the private-, the governmental- and the NGO
hospitals regarding the number of casualties suffering from paraffin poisoning. This study
indicates that private hospitals had fewer cases than the two other types of hospitals.
However, the entire group of healthcare personnel agreed upon the fact that paraffin
poisoning has increased slightly during the years. I10 declares that: it has increased…we
have had four cases this year…five last year and this year has not yet ended…more
cases…now I see them before I didn’t. Regarding the number of cases through time, I7
comments:…it is same or increased.
The lack of data appears to make it difficult for the healthcare personnel to estimate the
number of cases and their development through time: It’s difficult to say as there are no
records…it might have increased…I don’t know…there are so few cases a year…but I
think it has mostly increased (I9).
5.2 Risk factors
5.2.1 Socioeconomic Position
The socioeconomic situation seems to have a positive correlation to the cases of paraffin
poisoning. I5 explains that a majority of the causalities are children from rural villages
and from poor families. The majority of the healthcare personnel thought that poverty
was clearly linked to the cases of paraffin poisoning among children. A comment from I6
indicates that: families with low income…they need paraffin all year round…so I think it
is mainly children from the slum areas…and I6 continues to discuss the problems
regarding paraffin poisoning and socioeconomic position:…chances of them [high
income earners] using paraffin is rare.
One of the persons interviewed explains why low income earners and individuals living
below the poverty line are more prone to use paraffin:…the type of poisoning is
proportional to what is available in the home […] I think whatever is available the child
will take it…I would expect this type of poison is from houses where they don’t have
electricity…in the slum…they [the illegal night vendors] have a small lantern and they
put the paraffin inside…maybe you don’t want the candle so you buy the lantern…maybe
they fill the lantern in a hurry and they don’t close it properly and then the child drinks it
(I4).
Poverty sets aside primary needs (e.g. thirst and hunger) as there are no economical
resources to support the needs. I2 clarifies:…it’s in the slum areas…they [the children]
are hungry and thirsty…they [the families] have no income and don’t get the basic things
they need…the children become thirsty and drink what they find in the house.
5.2.2 Age
Age seems to be a key variable when it comes to paraffin poisoning. All of the
participants agreed that children under five were more prone to drink paraffin. I7 declares
9
that:…infants less than five are at risk. The matter is described further by I1:…it’s mostly
young ones under five…they see it in the bottle and drink it and they come here with
breathing problems. Although most of the participants indicated that of the category of
zero to five year olds, it seemed that it was mostly the younger infants (i.e. one to two
year olds) who succumbed to paraffin poisoning.
5.2.3 Gender
The majority of the healthcare personnel thought that most of the paraffin poisoning
cases concerned principally boys independently of age, as I5 comments:…it is definitely
boys…Reasons included that boys have somewhat more bold and exploratory
characteristics. I8 explains that:…boys are very playful and the matter is furtherly
discussed by I6:…boys are more inquisitive and adventurous.
Two exceptions of the previous remarks were however made. One of the persons
interviewed claimed that causalities below five years of age were most probably not
gender significant; more than six years…they are boys…but less than six years…same
(I7). Another comment illustrated that the girls were most likely more susceptible to
paraffin poisoning risks due to their presence in the cooking area:…the risk factors are
girls… mainly girls…because they go to cooking because the mothers are cooking…the
boys want to drive the vehicle…and girls are cooking with the maids and sees the maids
pour paraffin on the charcoal stove (I10).
5.2.3 Adult supervision
The lack of adult supervision is a major contributor for paraffin poisoning and as I4
explained:…the parents always come in with the child and tells us that the child drank it
at the neighbours house…they always drank it at the neighbours. Although I7 made a
dissimilar statement regarding the adult supervision:…they [the children] get poisoned at
home.
Statements point out that a large number of the paraffin poisoning cases, which are due to
a lack of adult supervision, are catalyzed during the holidays when the children are at
home during the week days. It is mostly common during the holidays when the child is at
home with nothing to do, when they are in school they are kept in school (I6).
5.3 Preventative measures
5.3.1 Education
The entire healthcare personnel agreed that education was the primary solution for
prevention of paraffin poisoning. The matter was further discussed by I6:…good
education…means good job…and better understanding…a better standard of living…
and better home to live in.
I7 also pointed out the various types of education that are imperative in the struggle
towards combating paraffin poisoning:…there are three types of education…school
education…family education…social education…knowledge of toxicity and keep in a safe
10
place. I7 continues to explain the issue regarding the lack of education:…it’s adult
problem…especially mama…teach mama education and then mama teach the children.
5.3.2 Accessibility
Several of the participations mentioned that the paraffin is stored in other containers than
the original designated container and is also stored within easy reach for small children.
The paraffin could be stored in common areas such as in the kitchen, under staircases and
in the bathroom. The content could be stored in glass bottles, water bottles and glasses, as
I6 explains: …they [low income earners] need to use paraffin…they keep it in a container
and use it for cooking…they keep in a soda bottle or whatever container they can find. A
preventative measure suggested by I6 was the pivotal matter of proper storage of the
paraffin:…most of all the key is to keep it out of reach…in well-labeled containers…not
soda bottles…and talking to people…educating the people.
Another intervention that arose during the interviews was the challenges regarding the
lack of supervision. A number of the interviewed mentioned that when an immense
family unit is residing in a crowded common living area, children surveillance must be a
primary and constant task. I7 suggests that a supervision of the children must be
implemented in everyday life:…it’s very important to look at the children.
5.3.3 Family planning
Family planning seems to be a vital issue when it comes to paraffin poisoning
interventions. I3 claims that the lack of adult supervision is made inferior by the number
of children per household:…it is hard to watch one child…and many children is even
harder.
Another phenomenon related to paraffin poisoning cases is polygamy, as it is correlated
to poverty, according to I10:…It [the cases of paraffin poisoning] is connected to low
education…to low income…and to polygamy […] it’s mainly the Muslims…some of them
have four wives and these women have to work very hard to survive selling charcoal and
tomatoes along the roadside…I10 claims that when several co-wives share the savings
from the same income earner, the scarcity of money may lead to increased risk of paraffin
poisoning among the co-wives children. I10 continues:…many [of the co-wives] are
under the poverty line…they can’t get basic needs in life…they are not salary
earners…they survive by chance…they live with very minimum and they have low income
and education.
6. Discussion
The fact that the governmental hospitals experienced additional work load restricted the
amounts of interviews given in comparison to the private and NGO-hospitals. The
governmental hospitals where more prone to receiving paraffin cases and this lack of
interviews may therefore have effected the result. Vital information regarding paraffin
poisoning may thereby be lacking. Another pivotal matter raised was the fact that the
interviews where conducted by two English speaking interviewers, which thereby
restricted any interviews with non-English speaking healthcare personnel. This may have
11
had a significant impact on the results of the study. The result correlated with previous
studies and thereby corresponded with what was expected. The mere exception concerned
polygamy, which was not mentioned in any previous studies. Three distinct types of
hospitals, private, NGO and governmental, where targeted in the study, which has
enabled information from all healthcare arenas in Kampala, Uganda. This broad approach
has augmented the credibility of the study.
Living in the slum areas leads to an increased risk of paraffin poisoning. This is due to
the habitants’ low socioeconomic positions which lead to the residents living within an
exceptionally close range of each other, whereby the self tending infants have a broader
scale of household to stir in. As the children loiter in their own domicile as well as in the
neighbours’ shacks, which due to poverty are likely to use paraffin on a daily bases, they
are more prone to come across paraffin which has not been stored in a safe place. The
socioeconomic position has a clear impact on the risk the child is exposed to in several
ways. The poverty leads to residing in a congested area which is lit by paraffin, as the
usage of electricity is too costly. This results in a constant presence of unsafely stored
paraffin in the household which is within easy access of children, due to the lack of safe
storing areas. The poverty also induces a famine and thirst which may increase the risk of
poisoning, as it is often mistaken for a beverage which is safe to drink. The reason for
this is the fact that it has not only been stored but also bought directly in a soda bottle. A
container that would be child resistant would most likely not prevent many cases of
paraffin poisoning, as it rarely is indigested from the original container, which Crafts
study indicates.
Other reason for paraffin poisoning is the lack of adult supervision, both as a direct cause
of poverty and also partly as a cultural component. One explanation to the shortage of
parental supervision is their requirement to many hours of household tasks and income
generating work. Many of the adults residing in the slum areas are obligated to work
during the nights as they thereby escape the compulsory vendor fee. This night labour
requires the usage of paraffin lanterns which increases the paraffin supply kept in the
house. Another component which is related to the matter is the burden of fatigue due to
the double work load, both daily and nocturnally, as it restricts the adults in their child
supervision. Another reason might be that the Ugandan culture enhances a behaviour
where the adults are less prone to supervise their children and the latter is expected to
take care of themselves. Childcare centres do not seem to be an affordability or a part of
the custom for most part of Ugandans. The most common is instead to place the children
with the neighbours or merely let them tend to themselves. This, combined with the fact
that the slum areas are immensely crammed and thereby enabling the children to run
freely between numerous households containing paraffin, increases the risk of poisoning.
Family planning could be a solution to paraffin poisoning, as a combination of many cowives and children seems to induce the risk of paraffin poisoning among children.
One study drew the conclusion that a train-the-trainers model might be particularly useful
when it comes to reducing paraffin poisoning in low income countries. This model could
be used to train and educate the parents, who thereafter will pass on the knowledge to
12
other adults and thereby diffusing the information. By advocating the specific
Millennium Goals and thereby focusing on educating and empowering women in
addition to eradicating poverty and hunger, the Millennium Goals would serve as a key
component in combating paraffin poisoning among children.
Even though the result is saturated it is not possible to generalize from this baseline study
as the foundation for the project merely consists of a few interviews as well as a
diminutive selection of six hospitals, due the time limitations. It would take a superior
number of interviews to apply these findings on an entire population.
7. Conclusion
Certain conclusions can be drawn by the findings of the study. The result indicate that
there are four major contributors when it comes to paraffin poisoning according to the
healthcare personnels’ experiences and thoughts; 1) socioeconomic position; the number
of cases seem to be positively correlated to poverty as well as the social gradient; 2) age;
paraffin poisoning cases are more common among children under the age of five; 3)
gender; the majority of the casualties tend to be boys; 4) lack of adult supervision; the
absence of the adults is positively correlated to the number of paraffin cases.
In order to disseminate and develop successful paraffin poisoning preventions it is pivotal
to have baseline data regarding knowledge and habits. It is hoped that this study can
increase awareness of the widespread phenomenon of paraffin poisoning and its hazards
in low income countries. There is still a lack of knowledge and more field studies are
thereby required in order to eliminate the problem. The WHO may find this study
beneficial for their upcoming project regarding paraffin poisoning in Uganda.
Acknowledgement
We are grateful for the support we have received from the Executive Director of ICCU;
Mable T. Nakitto, as well as the ICCU team.
13
Reference
Cachia EA & Fenech FF. (1964). Kerosene poisoning in children. ADC.Vol: 39, pp: 502504.
Craft A.W, Lawson G R, Williams H and Sibert J R. (1984). Accidental childhood
poisoning with household products. British Medical Journal. Vol: 288, pp: 682.
Five Year Strategic Plan. (n.d). ICCU.
ICCU (n.d). Home Safety for Children. Graphic Concepts Ltd, Kampala
ICCU & Safe Kids. (n.d). Common Injuries among Uganda Children and their
Prevention.Kampala.
Kvale S., Brinkmann S. (2008). InterViews-Learning the Craft of Qualitative Research
Interviewing. Sage Pubns, London.
Lang T, Thuo N & Akech S. (2008). Accidental paraffin poisoning in Kenyan children.
Trop Med Int Health. Vol: 13(6), pp:845-847.
Mulenga, D. UNICEF. (2007). Uganda Annual Report 2007.
Spry- Leverton, J. UNICEF. (2008). Getting it Right for Children- UNICEF Uganda
Annual Report 2008.
Nakitto, M., Mutto, M. & Lett, R. (2003). Environmental Hazards and Access to Injury
Care at 20 Primary Schools in Kampala, Uganda. African Safety Promotion- A Journal
of Injury and Violence Prevention. UNISA, South Africa. Vol: 4(3), pp: 59-68.
Patel, R & Davidson, B. (2007).Forskningsmetodikens grunder- Att planera, genomfora
och rapportera en undersokning. (3rd ed) Studentlitteratur, Lund.
Safekids Worldwide. (2010). Member Country Reports.
Shotar, A.M. (2005). Kerosene Poisoning in Childhood: A 6-year propective study at the
Princess Rahmat Teaching Hospital. Neuroendocrinol Lett 2005; 26(6), pp:835-838.
Schwebel DC,Swart D, Hui SK, Simpson J & Hobe P. (2009). Paraffin-related injury in
low-income South African communities: knowledge, practice and perceived risk. Bull
World Health Organ. Vol: 87(9), pp:700-706.
Stones DK, van Nierkerk CH & Cilliers C. (1987). Pneumatoceles as a complication of
paraffin pneumonia. SAMT.Vol: 72, pp:535-537.
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The National Children’s Study. (u.a) Growing up Healthy. NHI Publications.
Tshiamo, W. (2009). Paraffin (kerosene) poisoning in under-five children: a problem of
developing countries. Int J Nurs Pract. Vol: 15(3):140-144.
UNICEF. (2008). Uganda at a crossroad- Uniting for Child Survival and Development.
Kampala.
UNICEF & WHO. (2008). World Report on Child Injury Prevention. WHO Press,
Switzerland, Geneva.
UNICEF. (2010). Country Program 2010-2014. Kampala.
WHO. (2010). Retrieved 25 November, 2010, WHO:
www.who.int/topics/millennium_development_goals/en/
15
Appendix 1
Interview Guide
Do we have Your permission to perform the interview?
1. What is Your position at the hospital?
2. Describe the symptoms of Paraffin Poisoning?

From the first day till death.
3. In which ways have You encountered Paraffin Poisoning?





Patient (personal or other medical personnel’s patients)?
Neighbourgs?
Family?
Friends?
Other?
4. What would You consider are the risk factors regarding Paraffin Poisoning?





Gender?
Age?
Social position?
Rural or urban setting?
Season during the year?
5. Can You estimate how many cases of Paraffin Poisoning among children that
have come to Your hospital?





That you can recall?
During the last ten years?
During this year?
During the last six months?
During the last month?
6. Would You estimate that the cases have increased or decreased?

In what way?
7. What are Your suggestions for preventing Paraffin Poisoning among children?
8. Is there anything You would like to add?
16