Factor affecting poisoning

Submitted to:
Dr. Muhammad Fawad Rasool
Submitted by:
Ayesha Kalsoom 08-E-14
Komal Nawaz 21-E-14
Maria Tahir 11-E-14
Munaza Rana 31-E-14
Savina Nadab 03-E-14

Department of Pharmacy
Bahauddin Zakariya University, Multan.

1
 CONTENTS PAGE NO.
1. Abstract 4

2. Introduction 5

3. Material and methods 6

3.1 Study design 6

3.2 Data collection 9

3.3 Data documentation 9

3.4 Data analysis 9

4. Result 10

4.1 Tables 10, 11

4.1 Charts 12,13

5. Discussion 13

6. Conclusion 14

7. Reference 15

2
 Acknowledgement
With the name of Allah, the most beneficient and merciful, who has all the powers to enable
His creatures to observe and distinguish, it is He, who has bestowed us all the facilities and
abilities to excecute our research work. We would owe an exclusive debt of gratitude to the Holy
Prophet Muhammad (PBUH) and His Al who is Beacon House in the darkness whose life is a
symbol of veracity and true source of guidance and inspiration for all mankind in all the ages. It
is the blessings of Allah Almighty and His Prophet (PBUH), that have enabled us to make our
efforts a success.
With a deep sense of acknowledgement, we pay our gratitude to our research supervisor Dr.
Muhammad Fawad Rasool for his guidance, keen interest and kind attitude in the completion of
our research work.

3
 1. Abstract
Objective: To identify the factors that affect intentional poison intake in the Pakistan people. To

explore the reason that why the people are taking the poison and what products are used for

poisoning. Method: The study was conducted in Nishtar hospital Multan. A questionnaire was

designed. 44 cases of poisoned patients were interviewed by the final year students using the

questionnaire that covered demographic, socioeconomic, behavioral, literacy and past injury

characteristics. Information was also obtained concerning type and conditions of poisoning for

cases. Statistical analysis was undertaken by modeling the data using conditional logistic

regression. Results: illiteracy and financial status of the patient were important risk factors as 70-

75% of the patients were illiterate and belonged to lower class. 90% of the poison intake patients

were from the rural areas. Age of the patient and type of house do not seem to affect intentional

poisoning in adults. While gender seems to be a major risk factor as 75% of the poisoned patients

were females. Conclusion: poor people and people from the rural areas seem more likely to take

poison. The patients do not state their financial condition as the reason for poisoning,

nevertheless it is seen that mostly lower class people take poison. Females are seen to be more

4
 prone to taking poison after domestic instability and it seems as they have nowhere else to go

they turn to suicide.

2. Introduction

2.1. Poisoning:
Poisoning happens when you take into your body a substance that damages your cells and organs
and injures your health.[1]

2.2. Explanation:
Death due to poisoning has been known since time immemorial. Athough its type and the
associated morbidity and mortality vary from country to country, Poisoning is a major problem

5
all over the world. According to the legal system of our country, all poisoning death cases are
recorded as unnatural death and a medico-legal autopsy is routine. Toxicology is defined as the
study of the effects of chemical agents on biological materials. Modern toxicology is a
multidisciplinary science and forensic toxicology is required to determine any exogenous
chemical agent present in biological specimens made available in connection with medico-legal
investigations.[2]
A study carried out in National Institute of Child Health, Pakistan in 1988 noted that 2.98%
patients coming to casualty were with some forms of poisoning[3].

Accidental poisoning is a major problem of large population.[4] and a persistent cause of injury
related morbidity and mortality worldwide. In 1940. primarily some household products in
childhood poisoning was responsible for an estimated 500 deaths per year [5]. This is the
21st century and with the establishment of first poison control centre in 1953 in Chicago, USA
we have a come a long way in combating accidental poisoning. However, in developing
countries like Pakistan accidental household poisoning continues tenacious due to lack of
functional poison control centers and the lack of awareness among the population. New
research indicates that various social and demographic factors like family size, socioeconomic
status, attention to child as well as storage place of poison are important risk factors which
significantly effect the acute household poisoning cases in children[6,7].

In developed countries, there is lot of data is collected and research is done about accidental
children household poisoning.[8,9,10] however, there is alack of data from Pakistan because
there is neither a national database nor any relevant authority but only individual studies have
been carried out in local cities [11,12] in the past. The magnitude of the problem as well as
significant morbidity and mortality, parent's anguish and cost of admission and treatment
incurred to the state compelled us to carry out our research. Factors such as patient's age,
poisoning agent, demographic distribution, parents' education level especially of mothers,
number of siblings, presenting symptoms and their outcome in terms of hospital stay and
mortality were taken into consideration. The main objective of our study was to determine the
agents of poisoning and demographic distribution of children brought to CHK with a history of
accidental poison intake and to examine the various risk factors associated with it.

Pesticide poisoning is a well-known public health problem in many developing countries. World
Health Organization (WHO) estimates that more than 300 000 people die out of several million
people that are getting poisoned each year a majority of these poisonings happen in developing
countries. [13,14]
Out of the total number of suicides globally, Pesticide self-poisoning accounts for about one
third summing up to 258 000 completed suicides yearly as estimated in a study. [15]
Individual access to methods of suicide often determines the method chosen, and in developing
countries, where pesticides are more easily available, they are the predominant method of
suicide. Also the organophosphates of them are more common [16,17].

6
1.3. Types of poison
There are lots of different poisonous substances, including medications, household products
(such as cleaning products) and some plants and berries.
Substances that are not usually considered as a poisons, such as alcohol and tobacco, can also
be very dangerous and cause harmful effects.

1.4. Common cases

Most cases of poisoning are accidental and occur in the home. Although these cases are rarely
fatal, Children under five years of age have the highest risk of accidental poisoning,. Medicines
are the most common cause of poisoning in children of this age.
Occasionally, poisoning may be intentional. For example, a person may attempt to poison
themselves by taking an overdose of prescription medication or pesticides available.

1.5. Symptoms of poisoning:

General symptoms includes:
 Nausea
 Vomiting
 Diarrhea
 Stomach pain
 Fever
 Chills
 Loss of appetite
 Skin rash
 Burn around the nose or mouth
 Seizeures
 coma

7
2. Material and Method

3.1 Study Design

From this date to this date, 44 cases of intentional and unintentional poisoning involving
children and adults were brought Nishtar emergency. The hospital treats the patients in
emergency and sends them back or admits them to general ward as needed. The patients we
interviewed were admitted in the general ward or if they were children in the paediatric ward.
After informed consent from the patient or the guardian, in case of children the patient was
interviewed using a standard questionnaire that covered demographic, socioeconomic, and
behavioral, literacy and past injury characteristics. Information was also obtained concerning
type and conditions of poisoning for cases.

8
 Risk Assessment of Poisoning in Children
Social Aspects
City:

Nature of Job
Income Working hours
House surrounding environment
1. What is the age group of the patient?
a) 1-6 years
b) 6-12 years
c) 12-20 years
d) Above 20
2. What is the education of the patient?
a) Uneducated
b) Educated
c) Well educated
3. What are the house conditions?
a) Brick house
b) Mud house
c) Slums
d) Other
4. What is the socio-economic status of the patient?
a) Lower class
b) Middle class
c) Upper class
5. Has there been a previous poisoning incident?
a) Yes
b) No
6. How did the patient procure the poison?
a) Poison was at home
b) Bought from the market
c) Other
7. Where did the incident take place?
a) At home
b) At work

9
 c) At a relative’s home
d) Other

8. What was the poison?

a)medication
b)cleaning agents
c)pesticides
d)other
9. What was the route of intake?
a)oral
b)nasal
c)Skin
d)Other
10. How was the poison taken by the patient?
a)Intentionally
b)unintentionally
c)given by someone else
11. What were the actions taken before coming to the hospital?
a)induction of vomiting
b)administration of an antidote
c)administration of a neutralising agent
d)nothing
12. How is the environment at home?
a)peaceful
b)unstable
13. What was the procedure carried out at the hospital?

14. How severe is the patient’s condition?

a)Conscious
b)Partially conscious
c)unconscious
d)Comatose
15. How soon was the patient brought to the hospital?
a)at once
b)3-4hours
c)12 -24hours
d)More than one day
16. No of days the patient was hospitalised
a)for a few hours

10
 b)For 1-5 days
c)5-10 days
d)More than 10days

2.4. Data collection:

A total data of 44 patients was collected within a period of one month from Nishter
Hospital Multan by 5 five students. The data was collected from the patients of different age
groups.

2.5. Data documentation:

The data was extracted from the questionare consist of 16 questions and responses
were recorded.

2.6. Data analysis:

The data analysis shows that incident of poisoning occurs most commonly in the
uneducated, lower class female patients and in the house where the person lives. The financial
status is an important risk factor. After collecting the data, it was put into software Microsoft
Word 2010 and then tranferred to and analyzed by software IBM SPSS 24.

11
3. Results:
Gender
It was surprising to find out that females are more likely to take poison intentionally with 75%
females poisoning cases and only 25% males. Also it was observed that most of the intentional
poisoning cases belonged to rural areas and were illiterate. Most poisoning occurs in the house
when the person lives. This is especially true for children and women. Men might tend to take
the poison at work where they spend more time.

Cumulative
Frequency Percent Valid Percent Percent
Valid female 33 75.0 75.0 75.0
Male 11 25.0 25.0 100.0
Total 44 100.0 100.0

Table 4.1: percentage of poisoning incidece according to gender

Age

Unintentional poisoning occurred within ages of 1-12. In Intentional poisoning on the other
hand it was observed that there were 45% teenage people while 50% were above 20 and that
included the middle aged people.

Cumulative
Frequency Percent Valid Percent Percent
Valid 1-12 2 4.5 4.5 4.5
12-20 20 45.5 45.5 50.0
>20 22 50.0 50.0 100.0
Total 44 100.0 100.0

Table 4.2: poisoning incidence in different age groups

12
 literacy rate
it was observed from the data that most of the patient who take poison
was uneducated while only 25% patients were educated. So the cases of
poisoning are more common in illiterate persons.
Cumulative
Frequency Percent Valid Percent Percent
Valid educated 11 25.0 25.0 25.0
uneducated 33 75.0 75.0 100.0
Total 44 100.0 100.0

Table 4.3: effect of literacy on poisoning incident

financial status
Financial status of the patient is an important risk factor as 70% of the
patients belonged to lower class while only 2% belonged to the upper
class The type of house they lived in does not tend to make difference.
The ratio of intentional poisoning was highest in housewives
Cumulative
Frequency Percent Valid Percent Percent
Valid lower class 31 70.5 70.5 70.5
middle class 12 27.3 27.3 97.7
upper class 1 2.3 2.3 100.0
Total 44 100.0 100.0

Table 4.4: poisoning incident in different class groups

house environment
The reason for taking poison was stated to be a domestic fight mostly but when asked how the
home environment was generally,it was claimed that it was calm and peaceful. On the other
hand depression was the cause of suicide attempt in 2% people

Cumulative
Frequency Percent Valid Percent Percent
Valid Peaceful 27 61.4 61.4 61.4
aggressive 17 38.6 38.6 100.0
Total 44 100.0 100.0

Table 4.5: effect of environment on poisoning incidence

13
 Area
Out of the 44 patients, 40 patients lived in the rural area that take
the poison while the remaining 4 belong to the urban area. So it
means that incident of poisoning is more likely to occur in rural
areas.
Cumulative
Frequency Percent Valid Percent Percent
Valid Rural 40 90.9 90.9 90.9
urban 4 9.1 9.1 100.0
Total 44 100.0 100.0

Table 4.6: poisoning incidence in different areas

Figure 1: poisoning incidence in different age groups

14
Figure 2: poisoning incident in different class groups

15
Figure 3: percentage of poisoning incident in people of different occupations

4. Discussion:
The present study was conducted in Nishtar hospital. There was no selection bias because we
interviewed all the poisoning cases in the hospital. Moreover people from all classes have to come to
Nishtar in case of poisoning as private hospitals do not cater suicide cases. Also the hospital covers
urban and rural area patients so there is no bias in that regard either. Moreover the clinical setting
builds participants confidence hence preventing information bias.
However there was one thing that was contradictory; when we asked the patients the reason of taking
poison, they said it was because of a domestic fight but when asked whether the home environment
was peaceful or unstable they said that it was peaceful.
Also the fact that females are more prone to intentional poisoning was surprising. These women were
mostly illiterate and belonged to rural areas. It seems that they are more affected by domestic fights
because they feel they have nowhere else to go and no particular skill so they think that this is the only
way out. Also they are not aware of their rights.

5. Conclusion:

16
Poor people and people from the rural areas seem more likely to take poison. The patients do
not state their financial condition as the reason for poisoning, nevertheless it is seen that
mostly lower class people take poison. Females are seen to be more prone to taking poison
after domestic instability and it seems as they have nowhere else to go they turn to suicide.

6. Reference:
1. https://www.hse.ie/eng/health/az/p/poisoning/causes-of-poisoning.html
2. Muhammad NI, Nasimul I. Retrospective study of 273 deaths due to poisoning at Sir
Salimullah Medical College from 1988 to 1997. Leg Med. 2003;5:S129–
31. [PubMed] [Google Scholar]

3. Rehman GN, Khan AM: Experience of a paediatric emergency/casualty service. PPJ. 1984,
8 (3): 134-Google Scholar
4. Rodgers , Matyunas NC: Poisonings: drug, chemicals and plants. Nelson text book of
paediatrics. Edited by: Behrman RE, Kleigman RM, Jenson HB. 2000, Philadelphia, W B
Saunders, 2160-71. 16Google Scholar
5. Leibelt EL, Angelis CD: Evolving trends and treatment advances in paediatric poisoning.
JAMA. 1999, 282 (12): 113-5.Google Scholar
6. Nhachi Charles, Kasilo Ossy: The pattern of poisoning in urban Zimbabwe. Journal of
Applied Toxicology. 2006, 12 (6): 435-438. 10.1002/jat.2550120612.View ArticleGoogle
Scholar
7. Mahdi AH, Taha SA, Al Rifai MR: Epidemiology of accidental home poisoning in Riyadh
(Saudi Arabia). Journal of Epidemiology and Community Health. 37: 291-295.
10.1136/jech.37.4.291.Google Scholar
8. Izoura GI, Adeoye A: A seven year review of accidental poisoning in children at a military
hospital in Hafr Al Batin, Saudi Arabia. Ann Saudi med. 2001, 21: 13-15.Google Scholar
9. Obafunwa JO, Busutlil A: Deaths from substance overdose in the Lothian and border
region of Scotland(1983-91). Hum Toxicol. 1994, 13: 401-6.
10.1177/096032719401300606.View ArticleGoogle Scholar
10. Yates Kim: Accidental poisoning in New Zealand. Emergency Medicine. 2003, 15 (3): 244-
249. 10.1046/j.1442-2026.2003.00443.x.View ArticlePubMedGoogle Scholar
11. Babar MI, Bhait RA, Cheema ME: Kerosene oil poisoning in children. JCPSP. 2002, 12 (8):
472-6.Google Scholar
12. Aslam M, Boluch GR, Hussain W, Malik A, Haider A: Accidental poisoning in children. PPJ.
2002, 26 (2): 67-70.Google Scholar

17
13. WHO Global Health Estimates. [Accessed January 1,
2016].http://www.who.int/healthinfo/global_burden_disease/en/
14. Konradsen F. Acute pesticide poisoning—a global public health problem. Dan Med
Bull. 2007;54:58–59. [PubMed] [Google Scholar]
15. Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal
pesticide self-poisoning: systematic review. BMC Public Health. 2007;7:357. [PMC free
article] [PubMed] [Google Scholar]
16. Hirsch JK. A review of the literature on rural suicide: risk and protective factors,
incidence, and prevention. Crisis. 2006;27:189–199. [PubMed] [Google Scholar]
17. Hawton K, van Heeringen K. Suicide. Lancet. 2009;373:1372–1381. [PubMed] [Google
Scholar]

18