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Trends in poisoning in children: experience at a large referral teaching hospital
Insights
Childhood poisoning in India remains a significant concern, with kerosene consistently being the leading cause over five decades. While mortality rates are high, trends show an increase in insecticide poisonings and a decrease in plant-based poisonings.
Area of Science:
- Pediatrics
- Toxicology
- Public Health
Background:
- Poisoning is a major pediatric health issue in India, with limited data on evolving trends.
- Clinicians observe shifts in commonly used poisonous substances over time.
Purpose of the Study:
- To determine the pattern of childhood poisoning in India.
- To analyze nationwide poisoning trends over the past 50 years.
Main Methods:
- Retrospective analysis of pediatric admissions from 1989, 1991, and 1993.
- Categorization of poisons into bites/stings, medicinal, and non-medicinal compounds.
- Review of Indian literature and decade-wise data from 22 studies.
Main Results:
- Non-medicinal compounds, primarily kerosene (47%), were the leading cause of poisoning.
- Insecticide and pesticide poisonings increased significantly, while plant poisonings decreased.
- Childhood poisoning accounted for 2.1% of pediatric admissions and 1.2% of deaths, with a 9.2% case-fatality rate.
Conclusions:
- Childhood poisoning mortality in India has remained high over five decades (2.9%-4.7%).
- Kerosene continues to be the predominant cause of childhood poisoning, with consistent prevalence over the decades.
Background:
Poisoning is a major problem in the paediatric population. The offending substances used vary from place to place. Information on poisoning trends in India is meagre and there is an impression among clinicians that there has been a change in the commonly used poisons over the years. This retrospective study aimed to determine the pattern of poisoning in children and to study the nationwide trend over the past five decades.
Methods:
Case records of children (age group: 1 month and above) admitted to the Department of Paediatrics, King George's Medical College, Lucknow, Uttar Pradesh in three alternate calendar years, i.e. 1989, 1991 and 1993 were screened. All children were grouped into three categories based on the poison: (i) bites and stings, (ii) medicinal compounds, and (iii) non-medicinal compounds. The Indian literature on poisoning in children was reviewed and decade-wise data from a total of 22 studies (including the present study) were used to determine the changing trend.
Results:
Childhood poisoning constituted 2.1% of the total paediatric admissions and 1.2% of total deaths. Non-medicinal compounds were the largest contributors (69.2%), of which kerosene alone was responsible for 47% of cases. Medicinal compounds, and bites and stings accounted for 21.6% and 9.2% of these cases, respectively. The case-fatality rate was 9.2%. Comparison of our data, after excluding bites and stings, with a previous study (1977-79) from our institution showed that kerosene poisoning continues to be responsible for a substantial part of the morbidity (51.8% v. 31.5%). Also, poisoning due to insecticides and pesticides has increased (13.7% v. 2.1%) while that due to plant poisons (primarily dhatura) has reduced markedly (4.8% v. 19.2%).
Conclusion:
Mortality due to poisoning in children has remained high over the last five decades (2.9%-4.7%). Kerosene has remained the single largest contributor to childhood poisoning (51.5% in the 1960s v. 52.8% in the 1990s).