Accidental and Deliberate Self-Poisoning with Medications and Medication Errors among Children in Rural Sri Lanka

Abstract

Context. Pharmaceutical products are the leading cause accidental poisoning in middle- and high-income countries. Patterns of poisoning with medicinal drugs change across different geographic regions and over decades owing to variability in prescription practice, sociocultural factors, safe storage of medicines, and free availability of over the counter medications. Methods. This multicentre descriptive study was conducted over a seven-year period (February 2007 to January 2014) to assess patterns and trends of medicinal drug-related poisoning among children less than 12 years of age in thirty-six hospitals across rural Sri Lanka. Children with both accidental and deliberate medication poisonings and medication errors were recruited to the study. Data on poisoning events and medication errors were gathered via patient/parent interviews using multistructured questionnaires that assessed demographic factors, first aid measures, location and circumstances of poisoning, clinical management, and complications. In addition, focus group discussions were performed on all children and their families who had deliberate poisoning events and medication errors. Results and Conclusions. Among 1621 children presented with acute poisoning over seven years of age, 410 children had acute poisoning with medications. Male children (225, 54.9%) outnumbered female children. Paracetomol (137, 35.6%), salbutamol (55, 14.3%), and chlorpheniramine (35, 9.1%) were the most commonly poisoned medications. Prospective data at Anuradhapura teaching hospital (n = 112) revealed that unsafe first aid measures were practiced on 22 (19.6%) children. Although the majority of children remained asymptomatic (61, 54.5%), neurological symptoms (34, 67%) were predominantly seen in symptomatic children. The majority of poisonings took place within home premises (76, 67.9%). There were 16 reports of medication errors (14.2% of acute poisoning events) either due to erroneous administration by caregivers or erroneous issue of medicines by health workers. The current study did not observe mortality following medication poisonings. This study brings to light the burden of medicinal drug-related poisoning morbidity among children in rural Sri Lanka. Potentially, interventions such as community educational initiatives, written safety warnings, increased use of child resistant containers, and enforcement of laws to bring down accidental medication poisonings need to be implemented, and their effectiveness should be evaluated.

Frequency and Management of Acute Poisoning Among Children Attending an Emergency Department in Saudi Arabia

“…In the literature, most incidences of poisoning occurred at home supporting our study’s finding of 92.8% [ 1 , 3 , 13 , 15 , 17 , 21 , 24 , 29 ]. Unintentional poisoning accounted for most incidents in this study (56.5%) while intentional self-poisoning was reported in five incidents.…”

“…Most incidents were in boys which is consistent with other recent studies [ 27 , 28 ]. Although there have been no comprehensive epidemiological studies of the incidence of poisoning in the Kingdom of Saudi Arabia to date, studies published for different Gulf regions and time periods also indicate that children 4 or 5 years and younger are most often affected; similar results were reported in studies worldwide [ 1 , 7 , 9 , 11 , 14 , 21 , 22 , 23 , 24 ]. The literature notes that the balance switches in adolescents when girls were more likely to attend hospital emergency departments with intentional poisoning [ 1 , 15 ].…”

“…Analgesics—specifically non-steroidal anti-inflammatory drugs—as well as household cleaning substances are the most common poisons in children in recent studies [ 9 , 10 , 11 , 12 , 19 , 21 , 23 , 30 ]. In these studies, analgesics like paracetamol were the most documented cause of poisoning in children (39.1%) in addition to pharmaceutical products such as syrups that attract children due to colors and flavors followed by anticonvulsants (18.8%) and antipsychotics (13%) [ 1 , 28 ] Other studies have reported that neurological medicines were the most common drugs causing poisoning in children followed by analgesics [ 10 , 21 ].…”

“…Studies by Berta et al (2020) in Northern Italy [ 7 ], Patel et al (2017) in the United States [ 8 ], Ahmed et al (2015) in Qatar, [ 9 ], Mintegi et al (2006) in Spain [ 10 ], Hoy et al (1999), Reith et al (2001), Schmertmann (2013) and Lee et al (2019) in Australia [ 11 , 12 , 13 , 14 ], Mutlu et al (2010) in Turkey [ 15 ], Azab et al (2016) in Egypt [ 16 ], Sharif et al (2003) in Ireland [ 17 ], Tobaiqy et al (2010) in Scotland [ 18 ], Christophersen (2002) in Denmark [ 19 ], Dayasiri (2017 and 2020) in Sri Lanka [ 20 , 21 ], Mohammadi et al (2020) in Iran [ 22 ], Yehya et al (2020) and Albals et al (2020) in Jordan [ 23 , 24 ] and Ham et al (2020) in Korea [ 25 ] demonstrate the global nature and breadth of research of the problem of acute poisoning. The most frequent source of poisoning varies from country to country depending on social, economic, cultural, and educational background [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. In developed countries, the most toxic substances are medicines and household cleaning products; developing countries more frequently see kerosene and pesticides causing acute p...…”

“…The most frequent source of poisoning varies from country to country depending on social, economic, cultural, and educational background [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. In developed countries, the most toxic substances are medicines and household cleaning products; developing countries more frequently see kerosene and pesticides causing acute poisoning in children [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”