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BRIEF RESEARCH ARTICLE
Year : 2021  |  Volume : 65  |  Issue : 4  |  Page : 400-402  

Changing epidemiology of poisoning in children: A retrospective study from a tertiary care center in New Delhi, India


1 Senior Resident, Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
2 Assistant Professor, Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
3 Director Professor, Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

Date of Submission04-Jun-2021
Date of Decision13-Jul-2021
Date of Acceptance21-Oct-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Vikram Bhaskar
Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_234_21

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   Abstract 


Poisoning is the fourth leading cause of unintentional injuries in children. With continuously changing environment, the epidemiology of poisoning keeps on changing. The present study was undertaken to describe the clinical and epidemiological profile of childhood poisoning in a tertiary care center of New Delhi, India. All children <12 years of age admitted to pediatric ward with a history of ingestion of poison or envenomation between January 2019 and June 2020 were identified, and their medical records were obtained from medical records department. A total of 203 patients were enrolled in the study. Drugs and medications were the most common agents (19.2% cases), followed by prallethrin (13.7% cases). Majority of the cases were asymptomatic. Vomiting (25%) was the most common symptom. Drugs and medications were the leading cause of poisoning, followed by liquid mosquito repellant. This study highlights the change in characteristics of acute poisoning in Indian children.

Keywords: Changing trends, children, epidemiology, poisoning, prallethrin


How to cite this article:
Suting E, Bhaskar V, Batra P. Changing epidemiology of poisoning in children: A retrospective study from a tertiary care center in New Delhi, India. Indian J Public Health 2021;65:400-2

How to cite this URL:
Suting E, Bhaskar V, Batra P. Changing epidemiology of poisoning in children: A retrospective study from a tertiary care center in New Delhi, India. Indian J Public Health [serial online] 2021 [cited 2022 Jan 22];65:400-2. Available from: https://www.ijph.in/text.asp?2021/65/4/400/333980



Poisoning is a common pediatric emergency resulting in significant morbidity and mortality in children. The causative agents and associated mortality vary from place to place. Young children, due to their curious and explorative nature, are prone for unintentional poisoning, whereas adolescents are also at increased risk because of their risk-taking behavior. Understanding the circumstances and etiology of poisoning is important, as most cases of pediatric poisoning are preventable.

According to the World Health Organization (WHO) report on child injury prevention, each year 45,000 deaths occur in <20-year-old population due to poisoning.[1] While the developed world has accurate information on incidence of poisoning in children,[2],[3],[4] there is a lack of data on childhood poisoning in developing countries like India, and the real burden of problem may be far more than being reported.

Household products are a common cause of poisoning, and kerosene oil has been reported as one of the most common causes of poisoning in children in metro cities of India,[5],[6],[7] while insecticides poisoning is more commonly seen in rural areas.[8] However, with decreasing use of kerosene as a fuel, and ever increasing use of chemical-based mosquito repellant, hand sanitizers, and over-the-counter medicines, the epidemiology of childhood poisoning is changing rapidly and needs to be reviewed frequently.

There have been several descriptive studies from India on profile of poisoning in pediatric population, but very few have focused on changing trends and urban–rural population comparison. The present study was undertaken to study the clinical and epidemiological profile of poisoning in children, presenting in a tertiary care center over a period of 18 months.

This retrospective, observational study was conducted in a tertiary care center of New Delhi, India. All children <12 years of age brought to pediatrics emergency and admitted to pediatric ward or pediatric intensive care unit with definite history of ingestion of poison or envenomation between January 2019 and June 2020 were identified, and their medical records were obtained from medical record department. The information obtained from medical records included the age, gender, poison consumed, initial presenting symptoms and timing of presentation, treatment given, course during hospital stay, and outcome in terms of recovery or mortality. Cases with incomplete data or missing information were excluded from the study. Cases with allergic reaction to drugs were also excluded from the study.

Ethical clearance for the study was obtained from the institutional ethics committee. All information was noted on a predesigned case record form, and collected data were transferred to Microsoft Excel spreadsheet for analysis. Descriptive statistics, frequencies, median, or mean were used for data presentation.

During the study period, a total of 203 patients (123 males and 80 females) were admitted to the hospital with acute poisoning or envenomation. Median age of these children was 3 years ranging from 7 months to 12 years. The majority of children were in the 1–3-year age group (n = 111, 54.6%), followed by 3–5-year age group (n = 34, 16.74%). A male preponderance (59.5%) was observed in admitted children [Table 1]. Median timing for presentation to hospital was 3 h, which ranges from 10 min to 24 h (137 cases within 2 h, 48 cases in 2–6 h, and 18 cases after 6 h).
Table 1: Age and sex distribution of the poisoning cases (n=203)

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Drugs and medications were the most common agents responsible for poisoning in 19.2% (n = 39) of cases with antiepileptics being most common (11 cases), followed by thyroxin tablets (6 cases). It was also observed that drugs and medications poisoning was more common in urban population (n = 28) as compared to rural population (n = 11).

Liquid mosquito repellant (prallethrin) was found to be the most common household agent (13.7%) implicated in poisoning and was seen more commonly in urban population. Other agents included paint thinner, kerosene, turpentine oil, and rat poison [Table 2].
Table 2: Distribution of childhood poisoning cases according to type of poison

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Majority of the cases were asymptomatic at presentation. Among the symptomatic, vomiting (25%) was the most common clinical feature followed by altered sensorium (14%). Few patients presented with serious manifestations such as breathlessness (7%) and seizures (4%).

Of the 28 patients who had liquid mosquito repellent poisoning, 13 cases were asymptomatic at presentation, while others presented with vomiting (six cases), respiratory complaints (four cases), unconsciousness (two cases), altered sensorium (two cases), and seizures (one case). There was one death following liquid mosquito repellent ingestion A 2-year-old female child had seizure followed by loss of consciousness and was brought to the pediatric emergency 5 h following the incident and expired within 24 h of hospital admission.

Twenty patients (9.85%) received preadmission interventions such as induced vomiting at home and eight patients were referred from other hospitals. Gastric lavage was done in 36 (17.7%) cases. Respiratory support in the form of mechanical ventilation was required in seven cases (3.4%). Most common indications for the use of mechanical ventilation were snake bite (n = 2) and hydrocarbon poisoning (n = 2). There were 7 (3.4%) deaths and two cases left the hospital against medical advice. Poisoning by unknown substance was implicated in three deaths, hydrocarbon ingestion in two cases, while prallethrin and organophosphorus in one case each. All deaths occurred within 48 h of admission.

Acute poisoning in children is an important cause of hospital admission and morbidity in developing countries. Most common range of age of patients in our study was 1–3 years, which is similar to other Indian studies.[5],[6],[8] Male-to-female ratio found in our study was 1.5:1, which is also observed in other Indian studies showing male predominance.[5],[6],[8] This higher occurrence of unintentional poisoning in this age group can be attributed to the exploratory behavior of the toddlers and preschool children.

We found in our study that prescription drugs are the most common cause of hospital admission due to poisoning. This could be due to an easy availability of over-the-counter medications and lack of strict laws. Study done by Roy et al. and Devaranavadagi et al. demonstrated prescription drugs as the most common cause of poisoning in urban population.[6],[9]

We observed that liquid mosquito repellent is the most common household substance responsible for childhood poisoning. In the past, several studies from Indian subcontinent have shown kerosene to be the most common agent responsible for childhood poisoning.[7],[10],[11],[12],[13],[14] This change in trend could be due to shift in the use of cooking fuel from kerosene to natural gas. Furthermore, urbanization and shift in mosquito ecosystems could have contributed to the increased use of liquid mosquito repellents. This coupled within adequate seal of containers, improper storage, and easy accessibility increases the risk of accidental poisoning. Several studies done in the recent past have shown that mosquito repellant is an emerging poison in pediatric patients.[15],[16],[17],[18] The liquid formulations currently available in India contain synthetic pyrethroids such as transfluthrin or prallethrin as the active insecticide component (~1%) and deodorized kerosene as a solvent. Clinical manifestations can happen due to the hydrocarbon component or due to the pyrethroid component.[18] Systemic effects of pyrethroids range from headache, vertigo, impaired consciousness, and vomiting to life-threatening convulsions and coma, while local side effects include mouth ulceration, sore throat, and skin irritation. In the absence of a specific antidote, the management of these children is predominantly supportive and skin decontamination.[15] In our study, one patient died due to prallethrin poisoning.

Although organophosphorus compounds are still found to be the most common poisonous substance in rural areas as shown in a recent study by Mandal et al.,[14] the trend is changing in urban areas. In our study, organophosphorus poisoning was seen more commonly (n = 5) in rural population, as compared to urban population (n = 2).

In our study, the most presenting symptom was vomiting followed by altered sensorium and loss of consciousness. This is comparable to the previous studies where vomiting, pain abdomen, and altered sensorium have been documented as the most common presenting complaints.[6],[8],[10] Our study observed an overall mortality of 3.44%, which is comparable to the case fatality rates reported in recent studies.[9],[14] There is an overall significant decrease in the poisoning-related mortality possibly due to improved intensive and supportive care.

With continuous changes in children's surroundings and environment, it is important for parents, physicians, and lawmakers to keep pace with these changes to prevent the unwanted and unintentional poisoning in children.

Our study has limitation due to small sample size and retrospective nature of data collection. Furthermore, since it is a single-center study, it is difficult to predict the true epidemiology of poisoning in children.

This study highlights the change in trend of acute poisoning in Indian children. Drugs and medications are the leading cause of poisoning followed by liquid mosquito repellent and both are seen more commonly in urban population as compared to rural population. There is a need to educate the parents regarding the safe storage of medicines and toxic household substances beyond the reach of children. There is also a need to create awareness among health-care workers in the management of poisoning due to common household items.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Rahman AK, et al. Poisoning. World Report on Child Injury Prevention. Geneva: World Health Organization; 2008. p. 123-42.  Back to cited text no. 1
    
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Bhat NK, Dhar M, Ahmad S, Chandar V. Profile of poisoning in children and adolescents at a North Indian tertiary care centre. J Indian Acad Clin Med 2012;13:37-42.  Back to cited text no. 8
    
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Devaranavadagi RA, Patel S, Shankar P. A study on profile of poisoning in pediatric population. Int J ContempPediatr 2017;4:810.  Back to cited text no. 9
    
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Basu M, Kundu TK, Dasgupta MK, Das DK, Saha I. Poisoning, stings and bites in children – What is new? An experience from a tertiary care hospital in Kolkata. Indian J Public Health 2009;53:229-31.  Back to cited text no. 10
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Hamid MH, Butt T, Baloch GR, Maqbool S. Acute poisoning in children. J Coll Physicians Surg Pak 2005;15:805-8.  Back to cited text no. 11
    
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Paudyal BP. Poisoning: Pattern and profile of admitted cases in a hospital in central Nepal. JNMA J Nepal Med Assoc 2005;44:92-6.  Back to cited text no. 12
    
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Jadhav S, Rathi S, Biakthansangi KS, Kondekar S. Clinical profile of poisoning in children: A hospital based study. Inter J Contempor Pediatr 2016;3:709-12.  Back to cited text no. 13
    
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Mandal A, Kumar DP, Asok D. Clinico-epidemiological profile of poisoning in children under 8 years of age, at rural medical college in West Bengal. J Pediatr Assoc India 2016;5:71.  Back to cited text no. 14
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Ray DE, Forshaw PJ. Pyrethroid insecticides: Poisoning syndromes, synergies, and therapy. J Toxicol Clin Toxicol 2000;38:95-101.  Back to cited text no. 15
    
16.
Jayashree M, Singhi S. Changing trends and predictors of outcome in patients with acute poisoning admitted to the intensive care. J Trop Pediatr 2011;57:340-6.  Back to cited text no. 16
    
17.
Reddy MV, Ganesan SL, Narayanan K, Jayashree M, Singhi SC, Nallasamy K, et al. Liquid mosquito repellent ingestion in children. Indian J Pediatr 2020;87:12-6.  Back to cited text no. 17
    
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Chandelia S, Dubey NK. Mosquito repellent vaporizer poisoning – Is the culprit transfluthrin or kerosene? Indian Pediatr 2014;51:319.  Back to cited text no. 18
    



 
 
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