Epidemiology of Accidental Poisoning of Children in Riyadh, Saudi Arabia

Abstract

Original ArticlesEpidemiology of Accidental Poisoning of Children in Riyadh, Saudi Arabia Mohammed Abdulaziz Al-SekaitMPH, DSc Mohammed Abdulaziz Al-Sekait Address reprint requests and correspondence to Dr. Al-Sekait: Department of Community and Family Medicine, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia. From the Department of Community and Family Medicine, College of Medicine, King Saud University, Riyadh Search for more papers by this author Published Online:1 May 1990https://doi.org/10.5144/0256-4947.1990.276SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutAbstractA study was carried out to determine the incidence of accidental poisoning in children admitted to Riyadh Governmental Hospitals during 1988. Drugs were the most common poisoning agent and accounted for 52% of all cases. Kerosene poisoning and ingestion of household cleansers accounted for 46% of the cases, and ingestion of plants represented 2% of cases. Most of the poisoning incidents occurred in children who were 1 to 2 years of age. Our findings indicate that improved living conditions, proper storage of drugs and chemicals, and health education of parents will help to reduce the incidence of poisoning.IntroductionAccidental poisoning represents a serious source of childhood morbidity and mortality throughout the world.1–3 Various studies have shown a clear distinction in the pattern and extent of poisoning among children between developed and developing countries, and this reflects attitudinal and behavioral differences.2–4There are few reports on the epidemiology of accidental poisoning in the Kingdom of Saudi Arabia.4–6 Therefore, we conducted a prospective study to define the local pattern of childhood poisoning and to provide a basis for its prevention.MATERIAL AND METHODSThe study was conducted from January through December 1988 on three days of a week in all children up to 12 years of age who were admitted to the following Riyadh hospitals: Children's Hospital, Armed Forces Hospital, King Khalid University Hospital, Security Forces Hospital, and National Guard Hospital. A special form was prepared to record the age and sex of the patient, type of poisoning, time of poisoning, source of poison, time before presentation at hospital, treatment, complication, final outcome, and duration of hospital stay.RESULTSDuring the study period, there were 794 cases of poisoning in children and this constituted 4.9% of the total medical pediatric admissions. There was no seasonal variation in the incidence.Table 1 shows the age and sex distribution of the children. Ages ranged between 3 months and 12 years, with a peak at one year. Most cases (92%) occurred in children younger than five years. There were 422 males and 372 females (ratio, 1.1:1.0), which did not achieve statistical significance (P > 0.05) when analyzed with respect to age.Table 1. Age and sex distribution of accidental poisoning.Table 1. Age and sex distribution of accidental poisoning.Most affected children belonged to the family equivalent of social classes IV (semiskilled) and V (unskilled). In 78% of the cases the child's father had an elementary school education and the mother no formal education. Only 5% of the children lived in a villa: 42% lived in flats and 35% in small detached houses in the poor quarters of Riyadh. The remaining 18% lived in mud houses or tents.Table 2 breaks down the cases according to the type of poisoning. Drugs were the most common source and accounted for 52% of all cases. This was followed by products (46%) and plants (2%).The most common drugs ingested included analgesics and antipyretics (19.4%), contraceptives (7.3%), iron supplement syrup (6.5%), barbiturates (4.2%), cough syrup (3.1%), antiemetics (2.8%), and unidentified drugs (6.3%). Kerosene was the most common household agent ingested and accounted for 24.4% of all cases. Household chemicals (bleach and detergent) accounted for 16.7% of all cases, insecticide and rodenticide, 1.4%; and unidentified agents, 3.5%.Table 2. Summary of cases according to type of poisoning.Table 2. Summary of cases according to type of poisoning.Clinical FeaturesKerosene: It was impossible to quantify the amount of kerosene ingested and thus symptoms could not be related to the quantity consumed. Forty-one percent of the children affected exhibited no symptoms. In the remainder the most common clinical features were vomiting (41%), followed by fever (29%), diarrhea (22%), cough (17%), abdominal pain (15%), and unconsciousness (1%). Clinical signs of pneumonitis consisting of dyspnea, intercostal and subcostal recession, and crepitations existed in 71 (13%) cases. Radiological examination confirmed pneumonia in 34 (48%) cases.Drugs: Of the children admitted with drug poisoning, 23% were asymptomatic, 64% presented with vomiting, and 33% were in varying degrees of unconsciousness. Metabolic acidosis was verified by laboratory studies in 13% of the cases.Other poisons: In the remaining children who were poisoned by other agents, the presenting features included womiting, diarrhea with dehydration, abdominal pain, and restlessness.ManagementFirst aid was administered at home in 32% of the children and this was done mainly in children who had ingested kerosene. No treatment was given in the remaining 68%.The majority of the patients (61%) were seen four hours after the poisoning episode; only 6% were seen within 2 hours. Gastric lavage was car ried out in 33% of the patients (all cases of non-kerosene poisoning). In the cases of kerosene poisoning, patients with clinical evidence of pneumonitis were treated with antibiotics.Forty-two percent of the patients were discharged within 24 hours of admission and only 12% stayed beyond 96 hours. Mean hospitalization time was 48 hours.DISCUSSIONThis study shows that accidental poisoning is a major health problem in Saudi Arabia. Of the total annual medical admissions to the main pediatric department, 4.9% were cases of poisoning. This rate is higher than those reported for other developing countries,8–10 but lower than those for Britain and the United States.11–14As with other published studies,5–8,10,11 we found no significant difference in the distribution of cases by sex. We found a high incidence of accidental poisoning in children between 1 and 5 years of age and this agrees with the rates cited in other reports.4–6,8,10,11 This age is characterized by impulsive behavior, curiosity, thoughtlessness, and lack of experience. Few cases occurred in children younger than one year, probably because infants are more limited in their mobility, or after age five when children are more discriminating about what they swallow.Unlike other developing countries where household products represent the most frequent cause of accidental poisoning, in Riyadh drugs constitute a greater problem.8–10 One reason for this is that medications are dispensed in loose plastic envelopes rather than in child-resistant containers. In some hospitals, drugs are dispensed without appropriate labels giving the drug name, dosage, and date. Careless storage of drugs at home is another contributing factor. In the present study, 19% of the cases of drug poisoning were caused by analgesic or antipyretic consumption. These drugs are used commonly at home for the treatment of fever and pain.Kerosene, which is used for cooking and heating in some parts of Riyadh, is the most common household agent causing poisoning and accounts for 54% of the accidents due to household products and 24% of the total number of cases. This percentage is less than those reported for developing countries,9,10 but is still higher than those reported for developed countries.11,12 Careless storage is responsible for most cases. The situation observed in Riyadh is similar to that seen elsewhere in Saudi Arabia.4–7An in depth, prospective epidemiological study is needed that will identify the factors associated with accidental poisoning in Saudi Arabia. In this way effective preventive measures can be implemented. In the meantime, various effective preventive measures adopted in other countries can be used.1,2,15,16Education of parents and other caregivers of young children will help reduce the morbidity and mortality associated with accidental poisoning. Educational pamphlets describing the hazards and safe storage of all potentially toxic substances at home are helpful aids. The widespread use of child-resistant containers is necessary to combat the number of drug-related poisonings. If it is not practical for all medications to be issued in such containers, then this should be done for a selected number of dangerous compounds. This has proved effective in developed countries.12–15 A committee is needed to regulate the number of registered brands of medicines.Regional poisoning control centers are an important step toward the rapid identification and treatment of poisoning accidents and are also important in their prevention through planning, research, and education.ARTICLE REFERENCES:1. 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"Poisoning in children: a statistical study of 1057 cases" . J Pediatr. 1978; 2: 299–305. Google Scholar15. Sibert JR, Minchon PE, Craft AW, Jackson RH. "Child resistant containers really are effective" . Lancet. 1978; 2: 522–3. Google Scholar16. Mclntire MS, Angle CR. "Regional poison control centres improve patient care" . N Engl J Med. 1983; 308: 219–21. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byIzuora G and Adeoye A (2001) A Seven-Year Review of Accidental Poisoning in Children at a Military Hospital in Hafr Al Batin, Saudi Arabia, Annals of Saudi Medicine , 21:1-2, (13-15), Online publication date: 1-Jan-2001. Volume 10, Issue 3May 1990 Metrics History Accepted6 August 1989Published online1 May 1990 InformationCopyright © 1990, Annals of Saudi MedicinePDF download