Drug poisoning in the community among children: a nine years’ experience from a tertiary care center in south India

A, Blessed Winston; Adhikari, Debasis Das; Das, Saibal; Vazhudhi, Kaysina; Kumar, Ajay; Fx, Margaret Shanthi; Agarwal, Indira

doi:10.1080/21548331.2017.1273734

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…A similar recent study from Nepal observed equal contribution of medications to overall poisoning although mortality rates were higher [ 22 ]. Medications were the cause of poisoning in over 50% of children in one study from Pakistan [ 23 ] and 36% of children in a study from South India [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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

Dayasiri¹,

Jayamanne

Jayasinghe

2020

Emergency Medicine International

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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.

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Section: Discussionmentioning

confidence: 99%

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

Dayasiri¹,

Jayamanne

Jayasinghe

2020

Emergency Medicine International

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“…The studies included in this review described variable data and evidence regarding epidemiology, risk factors, and prevention or management strategies of pharmaceutical poisoning among children in LICs/LMICs. Of the eighteen epidemiologic studies, twelve reported that more than 30% of poisonings in children were due to pharmaceuticals [ 29 - 31 , 33 - 35 , 37 - 39 , 41 , 43 , 44 ]. The most common pharmaceuticals responsible for poisonings varied between studies and settings, but often included analgesics/antipyretics, antipsychotics, antiepileptics, sedatives and nutritional supplements.…”

Section: Discussionmentioning

confidence: 99%

“…There are limitations in care due to the inability to accurately diagnose poisonings and monitor the progression of therapies [ 67 , 69 ]. Epidemiology articles characterised several medications such as acetaminophen, iron, and salicylates, for which the identification and management of overdoses are optimised by reliable laboratory testing [ 36 , 39 - 42 , 44 ]. There are significant barriers to the development of quality laboratory systems in many LICs/LMICs including limited workforce, fragmented health care systems and infrastructure, insufficient training programs, and the need for robust quality control systems [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, risk factors, and strategies to prevent and manage poisonings due to pharmaceuticals in children in low income and low-middle income countries: A systematic review

Mottla,

Bowler,

Asgary

2023

J Glob Health

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Background There are significant disparities in the burden of disease due to poisoning between children in low- and high-income countries (HICs). However, there is limited data on the impact of increasing pharmaceutical access in low income countries (LICs) and low-middle income countries (LMICs) on the epidemiology of and risk factors associated with poisoning in children in these settings. Furthermore, while strategies in HICs have effectively reduced the burden of disease due to poisonings in children, there is limited information regarding the efficacy of these interventions in LICs/LMICs. Methods We conducted a systematic review in eight databases for literature published between January 2000 to April 2022 to evaluate the epidemiology and risk factors associated with poisonings due to pharmaceuticals and effective strategies to prevent and manage them in children in LICs/LMICs. From 16 061 retrieved articles, 41 were included in the final analysis. Results Pharmaceuticals were a common cause of poisoning in children in LICs/LMICs, occurring in between 12.4% and 72.36% of cases. Major risk factors were unsafe medication storage and inadequate caregiver knowledge. Delayed access to care and younger age were associated with increased mortality. Prevention strategies that included education demonstrated improvements in knowledge; however, their impact on incidence and mortality was unclear. Management strategies detailed individual patient care interventions, most commonly gastric lavage and activated charcoal. Meanwhile, delayed presentation, limited provider knowledge, and inadequate laboratory resources to support therapeutic monitoring hindered optimal management. Conclusions The combination of educational interventions for prevention, along with regulatory processes to maximise medication storage and formulation safety, could be effective in reducing the burden of poisoning in LICs/LMICs. The development of national or regional protocols for the management of common medication poisonings, augmented by the development of poison control centers and expansion of laboratory access in facilities may help reduce the morbidity and mortality associated with pharmaceutical poisonings in children in LICs/LMICs. Further evidence regarding contextual factors, risk and benefit profiles, the pattern of poisoning, and the impact of preventive and treatment interventions specific to LICs/LMICs is needed to better refine recommendations in these settings. Registration PROSPERO: CRD42022315686

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“…1 The type of poisoning is different in developed and developing countries, and it depends upon various factors. 2 Though poisoning in children is largely accidental, it is an important public health issue which has significant costs, both financial and emotional. 1 There are many studies available regarding poisoning in developed countries but in developing countries, data is lacking and due attention has not been given to determine the extent of problem it is creating in the community.…”

Section: Introductionmentioning

confidence: 99%

Accidental household poisoning in children: shedding light on the common agents and risk factors

Rameshkumar

Tamilarasan

Arunagirinathan

2021

Int J Contemp Pediatr

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Background: Household poisoning is one of the leading causes of accidental injuries in children. The cause may vary between different countries. The aim of the study was to identify the causative agents as well as risk factors pertaining to our country such as social, demographic, cultural factors and local customs.Methods: This was a descriptive cross-sectional study. All children in the age group of 6 months to 12 years with established diagnosis of acute accidental known household poisoning were included in the study group.Results: Most of the children with accidental poisoning were in the age group of less than 2 years (56.8%), with male preponderance (66.7%). The commonest poisoning agent was kerosene in 45% of the children followed by detergents (9%), drugs (8.1%), paint thinner (7.1%) and ant chalk (4.5%). In 62.2% of cases poisons were not in original container. Socio-demographic factors such as parents’ education status, mother’s employment or type of family did not show significant correlation.Conclusions: Accidental poisoning is a preventable cause of morbidity and rarely even mortality in children. Awareness needs to be generated amongst parents about simple but effective measures in the household to prevent such incidents. Given the pandemic, the presence of children at home constantly increases the importance of vigilance regarding this public health issue.

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Drug poisoning in the community among children: a nine years’ experience from a tertiary care center in south India

Abstract: This study for the first time gives an elaborative insight into pediatric drug poisoning over a nine-year period from a Pediatric Emergency Department tertiary care center in south India.

Cited by 7 publications

References 7 publications

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

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

Epidemiology, risk factors, and strategies to prevent and manage poisonings due to pharmaceuticals in children in low income and low-middle income countries: A systematic review

Accidental household poisoning in children: shedding light on the common agents and risk factors

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