Child and adolescent mortality associated with pesticide toxicity in Cape Town, South Africa, 2010–2019: a retrospective case review

Abstract

Background Poisoning of children after exposure to pesticides is a major public health concern, particularly in countries with poorer urban populations, such as South Africa. This may stem from the illegal distribution and domestic use of street pesticides, which are highly hazardous agricultural pesticides. The aim of this study was to profile paediatric deaths due to acute pesticide poisoning in the west-metropole of Cape Town, South Africa; to identify whether the active ingredients were highly hazardous pesticides according to the FAO and WHO; and to inform policy and public health interventions to prevent future exposures and mortality. Methods A retrospective and descriptive analysis of forensic post-mortem records (2010 to 2019) was conducted to identify cases of paediatric deaths (< 18 years old) in the west metropole of Cape Town, involving pesticide poisoning admitted to the Salt River mortuary (one out of 16 mortuaries in the Western Cape province). Demographic, circumstantial, autopsy, and toxicological information was captured. Descriptive statistics, together with chi-square tests, Fisher’s probability tests, and Mann–Whitney U tests were used to analyse the data. Results In total, 54 paediatric pesticide deaths were identified, including 22 (40.7%) males and 32 (59.3%) females, out of 5,181 paediatric unnatural deaths admitted over the 10-year period. The median age of the decedents was 8.3 years (range: 1 day to 17.9 years), with the majority under five years (42.6%) or between 15 and 18 years old (40.7%). All incidents occurred in peri-urban areas of Cape Town, with most individuals being admitted to hospital (88.9%) for a median survival time of 4.8 h. Toxicological analysis was requested in 50 cases (92.6%) with the organophosphate pesticides terbufos (n = 29), methamidophos (n = 2) and diazinon (n = 2) detected most frequently. Adolescent (15–18 years) suicides (29.6%) and accidental child deaths (< 4 years) (18.5%) were common. Conclusions Terbufos and methamidophos are highly hazardous pesticide (HHP) active ingredients registered in South Africa for agricultural uses, yet commonly sold as street pesticides for domestic use in lower socioeconomic areas. Reducing access and availability of toxic pesticides, especially through the illegal selling of street pesticides, and providing low toxic alternatives to poorer communities, may support mortality reduction initiatives. Mortality and toxicology data provide important, often overlooked, surveillance tools for informing policy and public health interventions to reduce toxic pesticide harm in local communities.

An approach to the management of acute poisoning in emergency settings

“…The WHO considered poisoning a significant public health issue in middle-and low-income countries. 3,4 The reported cases of poisoning and self-harm in South Africa mirror the international trends. 5 The exact number of poisoning incidents is complex to ascertain because of the exclusion of fatalities resulting from drowning or trauma caused by intoxicated persons in reported data.…”

“…On the other hand, pinpoint pupils (miosis) can suggest an overdose of various drugs, such as opiates, organophosphate, and chloral hydrate. 1 , 4 …”

“…In some cases, a central nervous system depressant used by a patient can trigger a respiratory arrest. 1 , 4 …”

“…One of the main reasons this method is commonly used is when poisonous substances such as lithium and iron or enteric-coated drugs that are poorly absorbed by activated charcoal, and in case of heroin, cocaine, and opioids packet ingestion (body packing or stuffing). 1 , 4 The nasogastric or mouth tube delivers the polyethylene glycol solution at 25 mL/kg/hr – 40 mL/kg/hr until the effluent from the rectal tract is clear. Individuals with gastrointestinal bleeding or mechanical or functional bowel obstructions are excluded from whole bowel irrigation.…”

“…The WHO considered poisoning a significant public health issue in middle- and low-income countries. 3 , 4 …”