Meta-analysis of mortality burden due to Aluminum phosphide poisoning in India: A call for strong policy and decision...

Aluminum phosphide(AlP) insecticide is India's leading cause of poisoning-related mortality. Limited information is available about its mortality burden, common presentation type, and exposure(suicidal/accidental) characteristics. There exists no definite antidote for AlP poisoning management. The study was planned to systematically review the exact mortality burden, type of exposure- accidental/suicidal, commonest presentation in emergency department(ED), and gender difference in poison exposure, if any.

We conducted comprehensive search in Scopus, PubMed, Web of Science, and Embase, and cross-referencing relevant articles from 1982 to 31 January 2025. Prospective, retrospective, and cross-sectional Indian studies that provided information on mortality data, common clinical presentation, and exposure type-accidental/suicidal were included. Study details- time to reach ED, duration of hospital-stay, average dose consumed, gender distribution in poison exposure, and other relevant information, were also assessed. Random-effects meta-analysis with DerSimonian & Laird estimator, meta-regression, and subgroup analyses were conducted using R.

Forty-two studies involving 3449 Indian patients were included in the analysis. Pooled mortality prevalence was 54 %(95 % CI- 48-61 %) in the primary endpoint evaluation. In secondary endpoints analysis, it was observed that 94 %(95 % CI- 88-97) of the AlP poisonings were intentional(suicide), while accidental exposure accounted for 5 %(95 % CI- 2-12) of cases presenting to ED. Hypotension, with odds of 78 %(95 % CI- 64-88)(p < 0.01) was observed as common presentation type. Odds ratio for male-to-female gender among patients exposed to AlP was not significant, at 89 %(95 % CI- 61-129)(p = 0.86).

Death of every second patient with AlP poisoning in ED room underscores the urgent need for stringent regulatory measures to control its access in India.