IJCRR - Vol 06 Issue 16, August, 2014
Date of Publication: 20-Aug-2014
Download XML Download PDF
SCENARIO OF ACUTE POISONING IN A SUB DIVISION HOSPITAL OF WEST BENGAL, INDIA
Author: Md. Hamid Ali, Arijit Sinha, Kapildev Mondal, Subhra Jyoti Mitra, Anupam Mandal, Pranab Kumar Maity
Abstract:Background: Acute poisoning is one of the leading causes of morbidity and mortality throughout the world. Review of the sociodemographic profile of poisoning is of much important for recognizing this public health concern and to find the way out. Objective: Few literatures are available regarding the poisoning in eastern India. . In India incidence of accidental and selfpoisoning are increasing day by day .Our objective is to study the sociodemographic profile of acute poisoning and its outcome. Materials and Methods: This retrospective study was done among patients admitted with acute poisoning in a subdivision hospital of West Bengal,India,during the year 2011 and 2012. Our study included 1237 patients admitted with acute poisoning admitted through emergency in one year period. The demographic pattern, type of poisoning, route of exposure,seasonal variation, patient survival and referral were collected in a pre-structured proforma. Data collection was performed according to hospital regulations after approval by the hospital authorities.Then the data were analyzed by descriptive statistical method by using software. Results: Acute poisoning cases are burden of 2.72% of total admission and 5.08% of medical ward admission. Highest number of admission are seen in September (n=147) and October(n=149) months. Male to female ratio of poisoning is 1.22:1. Organo phosphorus (n=594) poisoning is the commonest and next is snakebite (n=451). Overall death rate is 4.36% (n=54). Commonly affected age groups are 11 to 20 years (n=435), 21 to 30 years(n=414). Death is also common in age group of 11 to 20 (n=18) and 21 to 30 years(n=16).Rate of referral to higher center is 2.10%. Average hospital stay is 2 days. Among self- poisoning cases
(n=746), 1.73% (n=13) were already under treatment for psychiatric illness. Conclusion: As the affected patients are mostly in adolescent and young age group and as they are the future of a nation, it is important to take measure to prevent poisoning. Psychological assessment, social and economic security is important in this regard.
Keywords: Acute poisoning; organophosphorus; snakebite.
A poison is any substance that is harmful to our body by means of inhalation, ingestion, injection or absorption through skin. Acute poisoning is an important cause of morbidity and mortality. In India incidence of accidental and self-poisoning are increasing day by day. Over the last few decades, agricultural pesticides have become common household items in the developing world, which are commonly used for self poisoning. Acute poisoning is an important cause of body injury IJCRR which may be accidental or self-inflicted. During the year 2008 about 24.26% death occurred due to poisoning in India . Acute poisoning is responsible for 10% hospital admission in U.K. and in-hospital mortality is less than 1%. . Commonest cause of acute poisoning in India is pesticides (organophosphorus compounds) due to their low cost, easy availability, particularly in rural areas. Snake bite is the most common accidental poisoning and accounts for 0.47% of total deaths in India with male preponderance (59%) . Anxiety, depression, isolation, unemployment, failure in examination, marital disharmonies are the common precipitating factors for self poisoning .Rural populations of low socioeconomic groups are commonest sufferer. It is important to know the patterns and outcome of acute poisoning.
MATERIAL AND METHOD
The present study is a retrospective, observational, epidemiological study conducted over a period of one year (1.1.2011 to 31.12.2011) at Jangipur subdivision hospital, Murshidabad district of West Bengal (India). Ethical clearance was obtained before the study data were collected. Patients admitted with history of acute poisoning were included in this study but those who absconded were excluded. All patients in the study were examined clinically with details history taken from patients and their relatives. Previous psychiatric illnesses of poisoning cases were assessed from history and past medical records. After discharge patients were advised for psychiatric consultation. Patients economic condition, race, sex, educational qualification, residential area, age group, type of poison, hospital stay, death rate, referral rate were assessed. Total 1237 number of patients was included in this study. Socio economic status was judged by APL, BPL (above or below poverty line) card issued by government authority. Patients of non-municipality areas were designated as rural and of municipal areas were urban. Then the data were analyzed by descriptive statistical method by using computer based software.
Our present study consists of 1237 patients, of which 682 were male and 555 were female (M: F=1.2:1).Total number of acute poisoning cases were 2.72% of total hospital admission (n=45375) and 5.08% of medical ward admission (n=24337) during that year. Among them self- poisoning cases were 746(60.30%) and accidental cases were 491(39.70%). Accidental cases included snake bite, wasp, bee or scorpion sting, ingestion of kerosene oil in children, exposure to organophosphorus compounds during spraying. 1008 cases (81.48%) were BPL category and 229 cases (18.51%) were APL category. 864 (69.84%) were Hindu and 373(30.75%) were Muslim. Age wise incidences were 0-10 years (n=36,2.91%),11-20 years(n=435,36.16%), 21-30 years (n=414,33.46%),31-40 years (n=184,14.87%), 41-50 years (n=96,7.76%), 51-60 years 9n=46,3.63%), 61 years+ (n=26,2.10%). Month wise incidences were January (n=56,4.52%), February (n=32,2.58%), March (n=81,6.54%), April (n=109,8.81%), May (n=117,9.45%), June (n=142,11.47%), July (n=144,11.64%), August (n=129, 10.42%), September (n=147,11.88%) October (n=149,12.04%), November (n=93, 7.51%), December (n=38,3.07%). Types of poison were organophosphorus (n=594,48.01%), Snakebite (n=451,36.45%), sedatives (n=39,3.15%), rat killer(n=38,3.07%) bee and wasp(n=25,2.02%), acid ingestion (n=23,1.85%), kerosene ingestion(n=21 ,1.69%),dhatura(n=9,0.72%), lice killer(n=8,0.64%), unknown(n=8,0.64%), organocarbamate (n=4,0.32%), paracetamol(n=4,0.32%), phenyl(n=2,0.16%), Gamoxene (n=2,0.18%) and contraceptive pills (n=2,0.18%), scorpion sting(n=2,0.18%). Snake bite was the major accidental poisoning (n=451) and month wise incidence were-January (n=5,1.1%), February (n=6,1.33%), March (n=12,2.66%), April (n=20,4.43%), May (n=35,7.76%), June (n=64,14.19%), July (n=72,15.96%), August (n=77,17.07%), September (n=73,16.18%), October (n=53,1.75%), November (n=29,6.43%), December (n=5,1.10%). Organophosphorus poisoning was the major self-poisoning and month wise incidences were-January (n=37,6.22%), February (n=21,3.53%), March (n=56,9.42%), April (n=69,11.61%), May (n=60,10.10%), June (n=58,9.70%), July (n=54,9.09%), August (n=35,5,89%), September (n=58,9.76%), October (n=72,12.12%), November (n=48,8.08%), December (n=26,4.37%).13 patients (1.74% of self-poisoning cases) were under treatment for psychiatric illness (depression 69.23%, schizophrenia 23.07%,anxiety 7.69%). Other precipitating factors for self-poisoning were impulsion, unemployment, poverty, marital disharmony, stressful life events, alcohol abuse, divorce, isolation, failure in examination.26 patients (2.10%) were referred to higher medical centre. Average hospital stay was 2 days. Among 1237 patients, 54 (4.36%) were expired in hospital. Among dead patients male were 33 and female were 21 (M: F=1.57:1) and age group wise incidence were 11-20 years (n=18,33.3%) 21-30 years (n=16,29.62%) 31-40years(n=8,14.81%), 41-50 years (n=7,12.96%), 51-60 (n=5,9.29%). Month wise death (n=54) were – January (n=3,5.55%), February (n=2,3.70%), March (n=4,7.40%), April (n=6,11.11%), May (n=8,14.81%), June (n=7,12.96%), July (n=8,14.8%), August(n=4,7.40%), September (n=1,1.85%), October (n=4,7.40%), November (n=5,9.25%), December (n=2,3.70%). Among death cases 2 died from snake bite (0.44% of snake bite cases), 2 from acid poisoning (8.69% of acid poisoning cases) and 50 for organophosphorus poisoning (8.41% of organophosphorus poisoning cases).
Acute poisoning may be self-inflicted or accidental. With increasing of population and socio-psychological hazards the burden of acute poisoning is increasing day by day. Poisoning ranked in the 5th position in India according to priority . Acute poisoning accounts for about 10% hospital admission in United Kingdom in-hospital mortality is less than 1%.Types of poisoning varies from country to country and state to state. Paracetamol is the drug most commonly used in U.K while an insecticide (organophosphorus and carbamates) is more common in India. On the other hand aluminium phosphide is more common in Haryana followed by organophosphoruscompounds . In our study total 1237 acute poisoning cases are 2.72% of total hospital admission and 5.08% of medical ward admission patients.Of them 81.48% was BPL category and 74.2% was of rural origin.It is 1% of medical ward admission in a study in Nepal .In our study self-poisoning was 60.30% and accidental poisoning was 39.70%, whereas in a study conducted in Haryana,91.4% was self-poisoning, 8.1% was accidental poisoning and 0.5% was homicidal poisoning, 75% patients were of lower socio-economic status . In a study by Srivastava etal male to female ratio was 53:43,suicidal cases was 53% and accidental 45% . Murad Zaffar Mari etalfound male to female ratio 1.5:1 with 34.30% at the age group of 20-30years.In our study male to female ratio is 1.2:1 and commonly affected age groups are 11-20years (35.16% ) 21-30years(33.46%). Acute poisoning are more common in the month of June (11.47%), July (11.64%), August (10.42%), September (11.85%),October (12.04%). Among them snake bite are more common in the month of June (14.69%),July (15.96%), August (17.07%), September (16.18%), October (11.75%). Mahapatra B,Warrel DA etal found maximum cases of snake bite during June to September. Organophosphorus poisoning are more common in the month of April(11.61%),May(10.10%) and October(12.12%).1.05% of all acute poisoning cases and 1.74% of self-poisoning cases had history of treated psychiatric illness. Among them 69.23%(9/13) were suffering from depression, 23.07%(3/13) from schizophrenia, 7.69%(1/13) from anxiety disorder, which are correlating to previous studies.  Commonest type of accidental poisoning is snake bite(36.45%) and self- poisoning is organ phosphorus poisoning (48.01%) but kerosene is more common in children. Ramesh KN et al  found that organophosphorus was the commonest suicidal poison and Thomas M. et al. found kerosene as the commonest poison in children.  In present study mortality is 4.36% among total acute poisoning cases and mostly in the age group of 11-20 years,(33.33%) and 21-30 years (29.62%). Individually mortality are 0.40% in snake bite cases, 8.69% in acid poisoning cases and 8.4% in organophosphorus poisoning cases.The overall mortality in acute poisoning varies in different studies – 4%, 3.3%,6.9% and it is in organophosphorus poisoning varies from 5 to 20 % in Asian countries.
As the affected patients are mostly in adolescent and young age group and as they are the future of a nation, it is important to take measure to prevent poisoning. Psychological assessment, social and economic security is important in this regard.
To Dr.Sawasata Mondal, Superintendent and staffs of record section, Jangipur SD Hospital,West Bengal,India.
1. Government of India(2010). National health profile 2009,Central Bureau of Health Intelligence, Ministry of Health and Family welfare, New Delhi. Chapter 199, page118-119.
2. Thomas S.H.L White J Poisoning Davidson’s Principles and Practice of Medicine, 21st Edition 2010,chapter 9, page203-208.
3. Mahapatra B Warrel DA Suraweera W Bhatia PDhingra N etal(2011), Snake bite mortality in India, A nationally representative mortality survey, 12Apr 2011PLOS Neglected Trop Dis 10.1371/journal .pntd.0001018.
4. Shaffer D Suicide: risk factors and public health, Am J Public Health, 1993, February, 83(2),171-172.
5. WHO (2002) Health situation in the South-East Asia Region, Priorities for Policy and Action, SEA/Injuries/ AI,www.searo.who/int/entity/health_situation_trends/ documents/health_situation_sear_99-2000.pdfS_2560k
6. Thomas SH Watson 1D on behalf of the National Poisons Information Service and Association of Clinical Biochemists. Laboratory analysis for poisoned patients.Ann.Clin. Biochem2002; 39:328-339.
7. Siwach SB Gupta A .The profile of acute poisoning in Haryana, JAPI, 1995, 43(11), 756-9.
8. Maskey A Parajuli M Kohli SC Baral SBasnet S and Poudal N. Scenario of poisoning in adults admitted in Manipal teaching hospital, Pokharan, Nepal. Nepal Journal of Medical Sciences, 2012,1(1), 23--26.
9. Srivastava A Peshin SS Kalec Kal T Gupta SK An epidemiological study of poisoning cases reported to the National Poisons Information center. All India Institute of Medical Sciences, New Delhi, Hum. Exp. Toxicol. 2005, June 24(6) 279-85.
10. MuradZafar Marry Farhat Hussein Mirza Qudsia HassanPattern incidence and mortality rate of acute poisoning at Karachi—one year study. Hum. Exp. Toxicol.1996, www. medforum.pk/index.php
11. Ramesh KN Krishna Murthy BH Ganesh SK etal.Pattern and outcome of acute poisoning cases in tertiary care hospital in Karnataka, India. Indian Journal of Critical care Medicine 2009,13,152-5.
12. Thomas M Anandan S Kuruvilla PJ et al. Profile of hospital admission following acute poisoning—experience from a major teaching hospital in South India. Adverse Drug Toxicol Rev. 2009, 19, 313-317.
13. www.toxonet.nim.nih.gov, National Library of Medicines Toxonet:a hazardous substances data bank, including Toxins for references to literature on drugs and other chemicals 67-56-1.