PMH9 - A Systematic Review and Meta-Analysis of the Prevalence and Complications of Paraphenylene Diamine (PPD) Containing Hair Dye Poisoning in Developing Countries

Abstract

A systematic review and meta-analysis to estimate the prevalence and complications associated with hair dye poisoning in developing countries We conducted a systematic review of epidemiological studies using MeSH terms and text keywords to identify studies from the inception to March 2016 about hair dye poisoning with suicidal intentions in developing countries. A meta-analysis was used to calculate the pooled prevalence proportion of hair dye poisoning and its major complications. Data extraction, data analysis and risk of bias assessment were performed. Thirty-two studies were included in the systematic review and twenty-nine of these studies containing 5,559 subjects covering six countries were included in the meta-analysis. The pooled prevalence proportion of hair dye poisoning with suicidal intentions was 4.9% (95% CI= 4.54-5.33) with a mortality rate of 12% (95% CI=11.0-13.3). 93.5% ingested PPD containing hair dye as a suicidal solution (95% CI=91.65-95.42). Of these, 73% were females and 26.8% were males (sex ratio 2.7:1). The occurrence of angioneurotic edema in hair poisoning patients was 67.1% (95% CI=56.6-77.6) and tracheostomy intervention was considered in 47.9% (95% CI=22.7-73.2) patients with respiratory distress. Acute renal failure was noticed in 54.7% (95% CI=34.4-74.9) of the pooled sample and with mortality rates were 14.4% (95% CI= 11.1-17.8). The pooled rate of the population studied from Asia and Africa showed 94.6% (95% CI=92.5-96.7) and 82.9% (95%CI=70.6-95-3) ingested hair dye with suicidal intentions. Further, studies carried out in Africa showed slight higher mortality 15.1% (95%CI=6.56-23.7) than the Asians 14.3% (95%CI=10.5=18.1). This meta-analysis provided a clear evidence of the prevalence of hair dye poisoning among individuals with suicidal intentions and provided robust evidence for policy making to curtail emerging PPD containing hair dye poisoning in developing countries.