Childhood poisoning causes and prevention; eight years of our rural hospital experience from South India

Poisoning is a significant public health problem, globally as well as in India.1 Poisoning among adults are mostly suicidal whereas among children are accidental in nature.2 In India, childhood poisoning is usually under reported as there is no proper surveillance system is available India and only hospital based data are available.2,3We report our experience from a remote rural hospital from South India after getting institute ethical committee clearance for dissemination of data (Ref no. RC 18/55). We extracted the data of under-five children poisoning cases from poisoning register maintained in the hospital for the period of past eight years from 1st January 2012 to 31st December 2019. Total of 21 childhood poisoning were reported among them 12 (57%) were male and 9 (43%) were female. Most common poisoning was due to kerosene (8(38%)) followed by laundry bleaching detergent locally known as ‘Ala’ 5 (23%), pesticide poison 2 (10%), eucalyptus oil poisoning 2 (10%) and others like ant killer poisoning tablets overdose were 4 (19%).In children, poisoning are accidental nature and the amount consumed may also be less as the child has tendency for aversion due to smell and taste whereas in suicidal (deliberate poisoning) the dose will be higher to cause permanent damage and death.2 But unlike other poisoning a peculiar finding on reported eucalyptus oil poisoning was, in both cases eucalyptus oil was given to the children to consume as a medicine to cure respiratory tract infection and both of them presented with seizure and unconsciousness. Eucalyptus oil is advice as a topical medicine in the indigenous system of medicine but not as a parenteral medicine.4 In a place like India where there are prevailing false cultural beliefs, there is a need to educate and guide the people on misuse of medicines without proper advice, especially among children. A higher dose of eucalyptus oil poisoning may even result in death.5,6 Another important observation was bleaching detergent poisoning which is not properly reported other major studies from India, but this poisoning is the second most commonest among under-five children.2,3 This poison is an oxidizer and a corrosive in nature and on accidental ingestion may result in minor to transient adverse event with no sequelae in majority of cases.7

AN OBSERVATIONAL STUDY ON ACUTE POISONING IN PAEDIATRIC POPULATION IN A RURAL MEDICAL COLLEGE.

Backgound: In paediatric emergencies acute poisoning is frequently encountered and is the leading cause of morbidity and mortality in developing countries. There is natural division of acute poisoning in paediatric population in to two groups i.e. young children and adolescents. The first group comprises of young children who innocently ingest small amount of single substances. Second group comprises of adolescents who purposefully ingest substantial quantity of multiple substances secondary to emotional outburst or psychiatric illness. This study aimed to study the clinical, toxicological profile and outcome of Acute poisoning in paediatric population in Adichunchanagiri institute of medical sciences, Mandya, Karnataka, India. Subjects and methods: This is a retrospective observational study done from January 2018- December 2019, in Adichunchanagiri institute of medical sciences, Mandya, Karnataka, India, involving childhood poisoning. Data was noted on a predesigned proforma, it was compiled and entered in MS Excel spread sheet; descriptive statistics was applied. Results: Out of 50 cases 24 cases (48%) were males and 26 cases (52%) were females. Majority of cases were distributed in the age group of 1-4 years 24 cases (48%), followed by 15-18 years 19 cases (38%). Suicidal poisoning was more seen in adolescent females 15 cases (30%). Pesticide and insecticide remains the most common toxic agent i.e. 21 cases (42%), followed by hydrocarbons 16 cases (32%). 42 cases (84%) got improved, 5 cases (10%) got referred and there was 1 (2%) death. Majority of the cases (52%) got discharged between 1-3 days. Conclusions: Pesticides and hydrocarbons remains most easily accessible toxins in rural area hence, are most commonly implicated toxins in childhood poisoning. Though poisoning remains worrisome problem, it is preventable.

Endocrine Consequences of Childhood Poisoning

Poisoning is reported as a major problem in the childhood period especially under five years. Acute or chronic exposure to toxic material occurs as a different clinical picture. Some cases have different endocrinological findings. Early diagnosis and management are required for careful clinical evaluation. In this article, endocrinological problems of childhood poisoning are reviewed.

Accidental childhood poisoning in Paediatrics department of a tertiary care facility: A retrospective review

Background: Accidental childhood poisoning is a recognized preventable cause of morbidity and mortality among children worldwide. This studywas aimed at determining the prevalence, pattern, and outcome of childhood poisoning among children in Abakaliki, Ebonyi State. Material and Methods: Medical records of all cases of accidental childhood poisoning admitted into Children’s emergency room (CHER) of the health facility of study between January 2014 and December 2018 were retrospectively identified and relevant data extracted and analyzed usingSPSS version 22. Results: Out of the 7,700 children that presented to CHER over a 5- year period, 42 were cases of poisoning, giving prevalence rate of 0.5%. Of the 42 cases, only 20 case notes were retrieved. The male to female ratio was 2.3:1 while the ages ranged between 6months and 14 years with the mean age of 3.06±2.88. Kerosene poisoning had the highest proportion of 50.0% (10/20) with the overall mortality rate of 5.0% (1/20).The relationship between age, place of residence and outcome in poisoned children was statistically significant (p = 0.038, 0.045 respectively). Conclusion: Accidental childhood poisoning is common in Abakaliki. Kerosene still remained the major agent while male toddlers were most vulnerable. There is need to intensify enlightenment campaigns and education of the public about the hazard of improper storage of kerosene and other implicated substances at home. Keywords: Accidental poisoning, Childhood, Kerosene

Childhood accidental poisoning among hospitalised children in a tertiary health care in North Central Nigeria - A two year prospective report

Background: The young child can be at risk of accidental poisoning because of its being very inquisitive to mouth objects. The prevalence and typesof poisoning vary within Nigeria and different parts of the world. Aim: To describe the sociodemographics, clinical features and outcome in childhood poisoning seen at the National hospital Abuja (NHA) Nigeria. Subjects and Methods: A descriptive prospective study on children admitted for acute poisoning from September 2014 -August 2016. Consecutive children with a history of poisoning were recruited during the study period. The children were examined, and poison severity scores were recorded into a proforma, and followed up till discharge or demise. Results: Twenty-two children were admitted for acute poisoning, out of the 2336 children seen during the study period, with a prevalence rate of 0.94%. Fourteen (63.6%) were of upper social class, with 12 (54. 5%) mothers having tertiary level education. The mean time (±SD) of presentation was 11.9 ± 23.9 hours, while the mean (SD) duration of hospital stay was 4.8 ± 6.2 days; hospital stay was significant with types of poisoning (Fisher exact test 22.062, p<0.0001). The common poisoning agents were kerosene and organophosphate, 8(36.4%) each, while main clinical features were cough in 8 (36.4%), tachypnoea in 7(31.8%), fever in 6 (27.3%) and 8(36.4%) had home intervention. Two (9.1%) and 4(18.2%) had poison severity scores (PSS) of 3 and 4 respectively, which was significant for time interval of presentation and use of harmful home intervention (Fisher exact test3.697, p=0.024) and (Fisher exact test10.04, p=0.018) respectively. Fatality was 18.2%. Conclusion: kerosene and organophosphate were most common poison agents, while PSS was related to time of presentation, home intervention and types of poisoning agents. Key words: childhood, poisoning, hospitalized, outcome.

Sociodemographic profile of pediatric poisoning cases

Background: Poisoning is one of the commonest cause of emergency hospital admission in children. The accidental poisoning is seen more commonly in toddlers and intentional poisoning is seen in adolescents. Rapid globalization and increased stress has increased the risk of suicidal poisoning. The accidental poisoning can be reduced by proper education to parents and by keeping poisonous substances out of reach of the child.Methods: The study was carried out over 18 months. Sociodemographic profile of pediatric cases was studied in department of pediatrics at Rajarajeswari medical college and hospital. Descriptive study analysis was done.Results: During 18 month study period, 34 cases were analysed. The incidence was found to be 1.64%. Male:female ratio was found to be 1:1.6. Majority belonged to upper lower class and majority were from urban class.Conclusions: The importance childhood poisoning with its association with socio-demographic factors were studied and intervention were done.