Although some hospital-based data are available, there are no large scale or nationwidedata available on the problem of pesticide poisoning in Nepal. This study wasdone to fill up this gap to some extent and was carried out at five major hospitals ofNepal - Bir Hospital, Patan Hospital and Tribhuvan University Teaching Hospital(TUTH) in Kathmandu, Western Regional Hospital (WRH) in Pokhara, and B. P.Koirala Institute of Health Sciences (BPKIHS) in Dharan. A harmonized PesticideExposure Record (PER), which was finalized during the "WHO Regional Workshopon Pesticide Poisoning Database in SEAR Countries" held in 1999 in Delhi,1 was usedin the study. Data collection was done for a period of six months in each of the fivehospitals.Altogether there were 256 patients in the present study. There were 98 patients fromBir hospital, 48 from Patan hospital, 45 from TUTH, 36 from BPKIHS, and 29 fromWRH. Of the 256 patients, 112 were males and 144 females. The most common agegroup involved in pesticide poisoning was 15-24 years. In most of the cases patient'sarrival to hospital was within three hours after pesticide exposure. In the majority ofcases the nature of exposure was intentional and the route of exposure oral. Mostpoisonings occurred in urban set-up and at home.Organophosphorous compounds were found to be the most common pesticides involved(in >50% cases), followed by zinc phosphide and aluminium phosphide. All caseswere given first aid treatment in the Emergency Room of the study hospitals, followingwhich most of the cases (n=197) were admitted; the rest were discharged or referredto other hospitals. Systemic effects of poisoning were recorded to have been present in95% of cases. For nearly two-third (65.6%) of the cases the poisoning severity scorewas recorded in the PER as "moderate" or "severe." More than 16% of patients hadfatal outcome.Improved regulation on availability of pesticides, strict registration of vendors,modification in packaging of pesticides, adequate provision of information to thepublic, further research on pesticide poisoning (including community-based studies),creation and regular revision of national/local standard treatment guidelines (STGs),regular training of health care providers based on such STGs, better availability ofdrugs/antidotes, establishment of poison information centers, and enhanced regionallinkages are some of the measures that will help reduce the problem of pesticidepoisoning in Nepal.Key Words: Pesticide poisoning, Organophosphates, Zinc phosphide, Aluminiumphosphide, Pesticide exposure record, Hospital, Nepal.
PESTICIDE POISONING CASES ATTENDING FIVE MAJOR HOSPITALS OF NEPAL
