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Indian Pediatr 2019;56:
329-330 |
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Unintentional Poisoning and Bites during Childhood in Ujjain,
Madhya Pradesh
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Ashish Pathak 1,2,
Aditya Mathur1
and Love Mehra1
From
1,2Department of Pediatrics, RD Gardi Medical College, Ujjain,
India; and 2Department of Women and Children’s Health,
International Maternal and Child Health Unit, Uppsala University,
Uppsala SE-751 85, Sweden.
Email:
[email protected]
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The prevalence of poisoning and bites
was 0.76% (48/6308) and 1.24% (78/6308), respectively in a
community-based survey in Ujjain district, Madhya Pradesh. Household
cleansing agents and medicines, and-dog bite and bee-sting were the most
common poisons and bites, respectively. Most parents (59%) reported lack
of appropriate first-aid knowledge. Educational interventions and
implementing the medicine take-back program are suggested.
Keywords: Community-based injury survey,
Rural, Slum, Prevalence.
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U
nintentional poisoning in children is a crucial
public health concern and has resulted in a loss of 10.7 million years
of disability-adjusted life years [1]. As most studies on poisoning have
been conducted in hospitals, their results are affected by the
health-seeking pattern of a community and access to health care
services. In view of the paucity of community-based preventive programs
[2], this cross-sectional, community-based study was conducted from
January 2017 to October 2017 in 10 slums and 7 villages in Ujjain city
and district, respectively. This study determined the prevalence and
patterns of acute unintentional poisoning, animal and insect bites in
children and adolescents aged upto 18 years to develop a community-based
program for poisoning prevention.
Data for this study were obtained using World Health
Organization TEACH-VIP 2 guidelines for surveys on injuries [3]. A
house-to-house survey was conducted, covering a total of 2846 households
of which 2518 had 6308 children aged upto 18 years. The survey
identified 1049 different injuries [4]. After obtaining informed written
consent, the household heads were interviewed on questions related to
unintentional poisoning, animal and insect bites that occurred in the
past one year. The Institutional Ethics committee of our college
approved the study.
A total of 126 children experienced poisoning and
bites (Table I). The prevalence of poisoning and bites was
0.76% (48/6308) and 1.24% (78/6308), respectively. The mean (SD) age of
children when poisoning occurred was 3.9 (3.69) years, with 44% children
being aged below 2 years. The mean (SD) age of children that experienced
bites was 9.5 (4.4) years, with 47% children being above 8 years of age.
Overall, boys were affected more often than girls (P<0.001), and
most cases were reported from rural areas (P<0.001). A total of
31 hospital admissions were reported with no deaths. Poisoning was by
soap detergent (24,50%), kerosene (11, 23%), leftover medicines (7,
15%), pesticides (5, 10%) and phenyl or toilet cleaner (1, 2%). Similar
poisonings have been reported in other community-based studies [2,5-7]
and are unlike a hospital-based study that reported kerosene as the most
commonly ingested poison in India [8]. Stings were by bees (24, 37%) and
scorpions (7, 9%), whereas bites were by dogs (26, 33%) and snakes (16,
21%). Approximately half (n=65) of the children with poisoning
and 63% (n=49) of the children with bites received first-aid at
home (Table I). Children in rural areas were taken to
informal health care providers for treatment. Most of the family heads (n=73;
59%) reported lack of first-aid knowledge.
TABLE I Details of Poisoning and Bites in Children Below 18 Years in Ujjain
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Poisoning
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Bites
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No. (%), n =48 |
No. (%), n =78
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Age
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1 mo-5 y (n=56) |
41 (85) |
15 (19) |
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>5 to 18 y (n=70) |
7 (15) |
63 (81) |
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Gender |
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*Boys (n=79) |
29 (60) |
50 (64) |
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Locality |
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*Rural (n=85) |
29 (60) |
56 (72) |
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Multiple poisoning/bites |
26 (54) |
44 (56) |
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Symptomatic (n=116) |
43 (90) |
73 (94) |
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Common signs/symptoms |
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Wound at bite site |
– |
26 (33) |
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Swelling |
– |
24 (31) |
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Skin discoloration |
– |
7 (9) |
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Pain |
– |
6 (8) |
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Vomiting
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32 (67) |
4 (5) |
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Increased salivation |
4 (8) |
– |
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Foul smelling breath |
2 (4) |
– |
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Spasmodic pain |
1 (2) |
– |
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Loose motion
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1 (2) |
– |
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Vertigo |
1 (2) |
4 (5) |
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Unconsciousness |
1 (2) |
2 (3) |
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Uneasiness |
1 (2) |
– |
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Treatment status |
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Home treatment (n=24) |
8 (7) |
16 (21) |
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Hospitalized (n=31) |
14 (29) |
17 (22) |
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By HCP (n=71) |
26 (54) |
45 (58) |
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* P<0.001 for male-female and Rural-urban comparison; HCP:
health care provider. |
In conclusion, an educational intervention program
providing anticipatory guidelines to parents can improve poisoning
management [1,5,9]. Other proven interventions, such as providing
child-resistant caps for storing kerosene and medicines [9],
implementing the ‘kerosene-free city’ program [8] and medicine take-back
program, can be used in our settings [9]. Cognitive/behavioral
interventions to educate children about dog safety can prevent dog bites
[10].
Funding: Indian Council of Medical Research, New
Delhi; Grant No. 2013-1253.
References
1. World Health Organization 2012. International
Programme on Chemical Safty-Poisoning Prevention and Management.
Available from: https://www.who.int/ipcs/ poisons/en/. Accessed
January 28, 2019.
2. Nixon J, Spinks A, Turner C, McClure R. Community
based programs to prevent poisoning in children 0-15 years. Inj Prev.
2004;10:43-6.
3. World Health Organization TEACH-VIP 2 2012.
Training Educating and Advancing Collaboration in Health on Violence and
Injury Prevention Users’ manual. Available from:
whqlibdoc.who.int/publications/2012/ 9789241503 464_eng.pdf?ua=1.
Accessed January 28, 2019.
4. Mathur A, Mehra L, Diwan V, Pathak A.
Unintentional childhood injuries in urban and rural Ujjain, india: A
community-based survey. Children (Basel). 2018;5.E23 [abstract].
5. International Labour Organization, United Nations
Environment Programme and World Health Organization 2004: Guidelines on
the Prevention of Toxic Exposures Education and Public Awareness
Activities. Available from
https://www.who.int/ipcs/features/prevention_guide lines.pdf.
Accessed January 28, 2019.
6. Franklin RL, Rodgers GB. Unintentional child
poisonings treated in United States hospital emergency departments:
national estimates of incident cases, population-based poisoning rates,
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7. Hung HT, Hojer J, Du NT. Potentially hazardous
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survey. Southeast Asian J Trop Med Public Health. 2010;41:1021-7.
8. Sachdeva S, Gupta P. Kerosene-free Delhi: Safer
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pharmaceutical poisonings. Am J Lifestyle Med. 2018;12:117-9.
10. Shen J, Rouse J, Godbole M, Wells HL, Boppana S,
Schwebel DC. Systematic review: Interventions to educate children about
dog safety and prevent pediatric dog-bite injuries: A meta-analytic
review. J Pediatr Psychol. 2017;42:779-91.
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