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Asrie AB, Atnafie SA, Getahun KA, Birru EM, Mekonnen GB, Alemayehu GA, Endehabtu BF, Badi MB, Adinew GM. Poisoning cases and their management in Amhara National Regional State, Ethiopia: Hospital-based prospective study. PLoS One 2024; 19:e0303438. [PMID: 38820326 PMCID: PMC11142576 DOI: 10.1371/journal.pone.0303438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/23/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Poisoning is a significant public health problem globally. Ethiopia is a low-income country undergoing technological and social change that may increase access to drugs and chemicals, potentially increasing the incidence of poisoning. This study describes the epidemiology of hospital admissions due to poisoning in a region of Ethiopia. METHODS An institution based prospective observational study was employed, as a study design, in selected hospitals of the region from January to December 2018. RESULTS Of 442 poisoning cases, 78 (17.6%) died. Almost all poisoning cases were intentional self-poisonings. The most frequent poisonings were organophosphate compounds, 145 (32.8%), and metal phosphides (majorly aluminum phosphide), 115 (26.0%). The ingested poison was most frequently accessed from the patients' homes, 243 (55.0%), followed by purchases from local shops, 159 (36%). The median duration of admission was 24 hours. Of all the cases, 23 (5.2%) were admitted to intensive care units (ICU) requiring mechanical ventilation. Most of the cases admitted to the ICU were aluminum phosphide-poisoned patients. The majority of deaths (43 of 78) were due to metal phosphides. From the multivariate logistic regression analysis, altered level of consciousness on hospital arrival, metal phosphide poisoning, and no laboratory result as a part of the diagnosis process or investigation of the extent of toxicity were found to be significantly associated with the likelihood of poor treatment outcome. CONCLUSION The majority of the poisoning cases were females. The most common reasons for the intent of self-poisoning were dispute-related, mainly family disharmonies, followed by psychiatric conditions. The poisoning agents were mostly obtained from households. Organophosphate compounds and metal phosphides were the first and the second most frequently encountered poisoning agents, respectively, and it was noted that the later ones were responsible for most of the fatal cases. Of the pharmacologic interventions, atropine was the only agent regarded as an antidote. The most commonly employed agent for supportive treatment was cimetidine followed by maintenance fluids, while gastric lavage was the only GI decontamination method used among others. The fatality rate of poisoning in this study was found to be much higher than in other similar studies. Impaired consciousness upon hospital arrival, metal phosphide poisoning, and no involvement of laboratory investigation were found to significantly associate with the likelihood of death. Generally, the results dictate the need for the design and implementation of strategies to create awareness, prevent, and manage poisoning incidences in the community.
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Affiliation(s)
- Assefa Belay Asrie
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Seyfe Asrade Atnafie
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kefyalew Ayalew Getahun
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eshetie Melese Birru
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Binega Mekonnen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Geta Asrade Alemayehu
- Department of Health Service Management and Health Economics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhanu Fikadie Endehabtu
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Marta Berta Badi
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getinet Mequanint Adinew
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Salem W, Abdulrouf P, Thomas B, Elkassem W, Abushanab D, Rahman Khan H, Hanssens Y, Singh R, Zaki HA, Azad AM, Al Hail M, Mohammed S. Epidemiology, clinical characteristics, and associated cost of acute poisoning: a retrospective study. J Pharm Policy Pract 2024; 17:2325513. [PMID: 38741897 PMCID: PMC11089918 DOI: 10.1080/20523211.2024.2325513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Introduction Poisoning is a major public health issue and a leading cause of admission to the emergency department (ED). There is a paucity of data describing the epidemiology and cost of acute poisoning. Therefore, this study investigated the epidemiology, patterns, and associated costs of acute poisoning in emergency department of the largest tertiary care healthcare centre in Qatar. Method This study was a retrospective review of the health records of patients admitted to the ED due to poisoning between January 2015 and December 2019. Incidence, clinical characteristics, and costs associated with acute poisoning were assessed. Frequency and percentages were calculated for categorical variables and mean and SD for continuous variables. The relationship between sociodemographic characteristics and poisoning profile was assessed using the chi-square test. A micro-costing approach using the cost of each resource was applied for cost calculations. Result The incidence of acute poisoning was 178 cases per 100,000 patients. Females (56%) and children below 14 years (44.3%) accounted for the largest proportion. Most of the exposures were accidental involving therapeutic agents (64.2%). The mean length of hospital stay was found to be 1.84 ± 0.81 days, and most patients (76.6%) were discharged within the first 8 h. A statistically significant difference was found between age groups and type of toxin (χ2 = 23.3, p < 0.001), cause and route of exposure (χ2 = 42.2, p < 0.001), and length of hospital stay (χ2 = 113.16, p < 0.001). Admission to intensive care units had the highest cost expenditure (USD 326,008), while general wards accounted for the least (USD 57,709). Conclusion Unintentional poisoning by pharmacological agents is common in infants and children. This study will assist in the development of educational and preventive programmes to minimise exposure to toxic agents. Further studies are required to explore the impact of medical toxicology services, and post discharge monitoring of poisoning.
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Affiliation(s)
- Waleed Salem
- Medical Toxicology, Trauma & Emergency Center, Hamad Medical Corporation, Doha, Qatar
| | - Pallivalappila Abdulrouf
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Binny Thomas
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Wessam Elkassem
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Dina Abushanab
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Haseebur Rahman Khan
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Yolande Hanssens
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Department of Biostatistics, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hany A. Zaki
- Medical Toxicology, Trauma & Emergency Center, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Mohammed Azad
- Medical Toxicology, Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Moza Al Hail
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Shaban Mohammed
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
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Telayneh AT, Habtegiorgis SD, Birhanu MY, Sume BW, Ayenew T, Gedif G, Endalew B, Tsegaye D, Yirdaw G, Mitiku KW, Molla F, Moges NA, Kassa GM. Mortality of acute poisoning and its predictors in Ethiopia: A systematic review and meta-analysis. Heliyon 2024; 10:e29741. [PMID: 38681614 PMCID: PMC11046229 DOI: 10.1016/j.heliyon.2024.e29741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Poison is defined as any chemical that has the potential to affect or harm human physiology due to its chemical activity. Poisoning is becoming a major preventable public health issue in many countries, including Ethiopia. There is a variation in acute poisoning mortality among the existing evidence in Ethiopia. This study aims to determine the pooled mortality rate from acute poisoning and its predictors in Ethiopia. Methods We searched available evidence of acute poisoning mortality in databases such as PubMed, Hinari, Cochrane, ScienceDirect, and other search engines. Using the Microsoft Excel data extraction form, three authors independently extracted all relevant data. The Higgins I2 test statistics were used to examine heterogeneity among included studies A random-effects model was used to analyze the pooled estimates and predictors in Stata MP version 17. Results We retrieved 2685 relevant records from different database sources, and after screening, 21 studies (17 published and 4 unpublished) were included. The pooled mortality rate for acute poisoning was 4.69(95 % CI: 3.69, 5.69 I2 = 94.7 %). The most common poisoning agents are organophosphate (29.9 %), household cleansing agents (17.5 %), and pharmaceuticals/medications (9.3 %). The majority of poisoning cases were intentional poisoning committed suicide. Poisoning cases in rural areas [RR: 3.98(95 % CI: 1.41, 11.25)] and delayed arrival times [RR: 2.90(95 % CI: 1.45, 5.84)] were identified predictors of mortality. Conclusions In this study, the pooled mortality from acute poisoning was 4.69 %. Poisoned cases from rural areas and delayed arrival times to the hospital were predictors of mortality. To prevent mortality, healthcare professionals should give special attention to rural residents and delayed arrival of poison cases. To control this avoidable death, poison control centers should be strengthened, and other preventive measures implemented at the national level.
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Affiliation(s)
- Animut Takele Telayneh
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Samuel Derbie Habtegiorgis
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Molla Yigzaw Birhanu
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bickes Wube Sume
- Department of Anatomy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Temesgen Ayenew
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getnet Gedif
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Endalew
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Dejenu Tsegaye
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getasew Yirdaw
- Department of Environmental Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Kalkidan Worku Mitiku
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Frehiwot Molla
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nurilign Abebe Moges
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Teym A, Melese M, Fenta E, Ayenew T, Fentahun F, Tegegne E, Alamneh AA. Patterns, Clinical Outcome, and Factors Associated with Poisoning Outcomes among Poisoned Patients in Northwest Ethiopia. SAGE Open Nurs 2024; 10:23779608231226081. [PMID: 38222268 PMCID: PMC10785725 DOI: 10.1177/23779608231226081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/19/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Poison is a substance that can hurt or cause dysfunction in the body due to its chemical action. Poisoning related to pesticides used in agriculture is a major public health issue in developing countries. However, there is a limited epidemiological data on poisoning in Ethiopia. Objective The aim of this study was to determine poisoning patterns, clinical outcome, and factors associated with poisoned patients in Northwest Ethiopia. Methods A cross-sectional study was conducted in July 2021 to include data of 1 year period. Data of all poisoned patients were collected using a standardized checklist from the registration book and patient medical records. The association between variables and outcomes was analyzed using a multivariable logistic regression model. A p-value of < 0.05 was considered to declare a statistically significant association. Result Over one-third of the poisoning cases (35.9%) were seen in the spring, according to a survey of 315 patient medical data. The majority of patients were in the age group of 21-30 years (44.1%). The most common form of poison consumed was organophosphate (OP), which accounts for 61.3% of all visits, and the least common was food poisoning, which accounts for 1.9%. About 82.5% of poisoning cases survived, while the remaining 17.5% were died. Time of arrival to the hospital ≥1 h (adjusted odds ratio (AOR) = 7.02; 95% confidence interval (CI): 1.16, 11.40), lack of oxygen support (AOR = 6.64; 95% CI: 3.56-6.78), and lack of adrenaline/dopamine medication (AOR = 3.57; 95% CI: 1.17-5.78) were all substantially linked with death of poisoned cases. Conclusions Three-fourth of poisoning cases survived, while the remaining one-fourth died. Ingestion of OPs is the most prevalent type of poisoning, and most cases are intentional. Delayed arrival ≥1 h, lack of oxygen support, and adrenaline/dopamine treatment were all linked to death. On-time arrival, oxygen assistance, and adrenaline/dopamine treatment in a healthcare setting are all recommended.
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Affiliation(s)
- Abraham Teym
- Department of Environmental Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mebrat Melese
- School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Enyew Fenta
- School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Temesgen Ayenew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Firehiwot Fentahun
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Eniyew Tegegne
- Department of Environmental Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Alehegn Aderaw Alamneh
- Department of Human Nutrition, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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George AV, Sharma A, Rodha MS, Choudhary B, Bohra GK, Rohila AK, Goel AD. Clinico-Epidemiological Profile and Short-Term Outcomes of Patients with Acute Poisoning Presenting to an Emergency of a Tertiary Care Center in Western Rajasthan. Indian J Community Med 2023; 48:734-740. [PMID: 37970173 PMCID: PMC10637612 DOI: 10.4103/ijcm.ijcm_92_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/02/2023] [Indexed: 11/17/2023] Open
Abstract
Background This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital. Materials and Methods This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes. Results Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning. Conclusions This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate.
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Affiliation(s)
- Akhil V. George
- Department of Trauma and Emergency, AIIMS, Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Trauma and Emergency (Anesthesiology and Critical Care), AIIMS, Jodhpur, Rajasthan, India
| | - Mahaveer S. Rodha
- Department of Trauma and Emergency (General Surgery), AIIMS, Jodhpur, Rajasthan, India
| | - Bharat Choudhary
- Department of Trauma and Emergency (Pediatrics), AIIMS, Jodhpur, Rajasthan, India
| | - Gopal K. Bohra
- Department of General Medicine, AIIMS, Jodhpur, Rajasthan, India
| | - Amit K. Rohila
- Department of Trauma and Emergency (General Medicine), AIIMS, Jodhpur, Rajasthan, India
| | - Akhil D. Goel
- Department of Community and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
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Waktola LG, Melese EB, Mesfin N, Altaye KD, Legese GL. Prevalence of unfavorable outcome in acute poisoning and associated factors at the University of Gondar comprehensive specialized hospital, Gondar, Northwest Ethiopia: a hospital-based cross-sectional study. Front Public Health 2023; 11:1160182. [PMID: 37361165 PMCID: PMC10285079 DOI: 10.3389/fpubh.2023.1160182] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023] Open
Abstract
Background Acute poisoning is a medical emergency in which the toxic effects occur almost immediately, usually within hours from the time of exposure, and can result from exposure to excessive doses of any chemical. It is the common cause of emergency admission, which may result in morbidity and mortality. There are a lot of factors that are associated with an increased magnitude of mortality and complication. Therefore, this study was carried out to assess the clinical characteristics of patients, unfavorable outcomes of acute poisoning, and associated factors to improve the quality of care, resource utilization, and decrease mortality. Objective This study aimed to assess the outcome and associated factors among acute poisoning patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia (2021). Methods A prospective follow-up study was conducted from January 2021 to September 2021 at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia. Data were collected using a comprehensively organized and pretested interviewer-administered questionnaire. The data were entered using EPI data version 4.6.0 statistical software and then exported to Stata 14 for analysis. The data were analyzed for descriptive statistics. Statistical analysis was performed using bivariate and multivariate logistic regression models to identify factors associated with the unfavorable outcome of acute poisoning. The result is presented in the form of tables, figures, and text using frequencies and summary statistics such as mean, SD, median, IQR, and percentage. Result A total of 233 patients were included in the study. The prevalence of unfavorable poisoning outcomes in acute poisoning was 17.6% (95% CI: 13.2, 23.1). In the multivariate logistic regression analysis, known chronic medical comorbidities [AOR: 3.846 (1.619, 9.574); value of p: 0.014] and hospital stay of less than 48 h [AOR: 6.57 (2.03, 21.273); value of p: 0.002] were found to be independent factors associated with unfavorable outcomes in acute poisoning. Conclusion The magnitude of unfavorable poisoning outcomes was high in patients with acute poisoning. Having known medical comorbid illness and short hospital stay of less than 48 h were found to be associated with unfavorable outcomes.
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Acute poisoning in children in Ethiopia: a cross-sectional study. Sci Rep 2022; 12:18750. [PMID: 36335242 PMCID: PMC9637174 DOI: 10.1038/s41598-022-23193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022] Open
Abstract
Acute poisoning is a global pediatric emergency problem. However, a wide variation in patterns of acute poisoning and associated factors across different geographical regions was stated. As a result, our research focused on the investigation of acute poisoning in children. An Institutional-based Retrospective study design was conducted at the University of Gondar comprehensive specialized hospital from October 2016 to October 2020. The analysis of the data was performed via SPSS Version 25. Furthermore, multiple logistic regression analysis was recruited. A P-value ≤ 0.05 was declared as statistically significant. Our study's prevalence of acute poisoning was 82/5489 (1.5%). 53 (64.6%) of patients were males. Of the total patients who had the diagnosis of poisoning, 54 (65.9%) came from rural areas. Venom was the most frequent offending agent (26.8%) and oral ingestion was the most common route of exposure (70.7%). Of the total patients who had the diagnosis of poisoning, 54 (65.9%) came from rural areas. Venom was the most frequent offending agent (26.8%), followed by insecticides (organophosphates) (21.5%). Accidental poisoning was the most common mode of poisoning more often than intentional (75.6-24.4%). The digestive tract (oral ingestion) (69.5%) was the commonest route of poisoning, followed by the cutaneous (skin bite) (24.4%). Death was three times more likely in the rural population than in urban residents [AOR 2.9 (1.21-13.7); P value 0.046]. Appropriate emergency care is the mainstay of the supportive management protocol for childhood poisoning.
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Abdelhamid WG, Wahdan MM, Zaafar D. Acute toxic exposures in Egypt population: analysis of a five-year registry from 2015 to 2019. TOXICOLOGY AND ENVIRONMENTAL HEALTH SCIENCES 2022; 14:235-244. [DOI: 10.1007/s13530-022-00134-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 10/16/2023]
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Nigussie S, Demeke F, Getachew M, Amare F. Treatment outcome and associated factors among patients admitted with acute poisoning in a tertiary hospital in Eastern Ethiopia: A cross-sectional study. SAGE Open Med 2022; 10:20503121221078155. [PMID: 35198211 PMCID: PMC8859693 DOI: 10.1177/20503121221078155] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/18/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Acute poisoning causes morbidity and mortality worldwide. There is scarce of information on acute poisoning in the study area. OBJECTIVE To assess treatment outcome and the associated factors among patients admitted with acute poisoning at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia. METHODS A cross-sectional study was conducted. All acutely poisoned patients who had been admitted at the emergency department of Hiwot Fana Comprehensive Specialized Hospital from 1 January 2016 to 31 December 2020 who fulfilled the inclusion criteria of the study were included. Data were collected by review of medical records. Poor treatment outcome of acute poisoning was defined as the acutely poisoned patient was died, or survived with disability. Multivariate logistic regression analysis was used to determine factors associated with the outcome of acute poisoning. RESULT A total of 175 patient's medical records were reviewed. Of these, 150 patient's medical records had complete information and were included in the final analysis. The majority of participants 89 (59.3%) were in the age group of 19-37 years. More than half of the participants 86 (57.3%) were females. Organophosphate was the most poisoning agent encountered in 62 cases. Acetaminophen was the predominant drug poisoning agent encountered in 10 participants. Among 30 patients managed with antidote, 18 patients were treated with atropine for organophosphate poisoning. Of all the poisoning cases admitted during the study period, 16.7% died. Participants who were poisoned by themselves were 2.4 times more likely to have poor treatment outcomes than those who were poisoned accidentally: 2.44 (95% confidence interval: 1.10-5.42). The odd of having poor treatment outcome in participants who were poisoned by drugs was 2.13 more likely: 2.13 (95% confidence interval: 1.21-3.32). CONCLUSION Organophosphate was the predominant cause of acute poisoning encountered in 62 cases. The modes of poisoning and drug poisoning were significant risk factors associated with poor treatment outcomes of acute poisoning.
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Affiliation(s)
- Shambel Nigussie
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekade Demeke
- Department of Epidemiology, College of Medicine and Health Science, Jigjiga University, Somali, Ethiopia
| | - Melaku Getachew
- Department of Emergency and Critical Care Medicine, School of Medicine, College of Health and Medical Sciences, Haramay University, Harar, Ethiopia
| | - Firehiwot Amare
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Kifle ZD, Yimenu DK, Demeke CA, Kasahun AE, Siraj EA, Wendalem AY, Bazezew ZA, Mekuria AB. Availability of Essential Antidotes and the Role of Community Pharmacists in the Management of Acute Poisoning: A Cross-Sectional Study in Ethiopia. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580211062449. [PMID: 35114845 PMCID: PMC8819777 DOI: 10.1177/00469580211062449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Morbidity and mortality related to acute poisoning is a major public health
issue in both developing and developed countries. Community pharmacists have
a crucial role in ensuring drug availability, increasing drug safety,
counseling patients, overdose risk reduction and management, and provision
of appropriate drug information. This study aimed to assess the availability
of necessary antidotes in community pharmacies in Gondar and Bahir-Dar
cities, Ethiopia, and the role of community pharmacists in the management of
acute poisoning. Methods A cross-sectional survey was conducted in Gondar and Bahir-Dar cities. A
self-administered, structured questionnaire was used for data collection and
Statistical Package for Social Sciences (SPSS) version 24.0 was used for
data analysis. Chi-square analysis was computed to identify the associated
factors with a confidence interval of 95% and a P value
less than .05 was used as a cut-point for statistical significance. Results Out of 101 community pharmacies invited to participate in the study, 80 of
them completed the survey with a response rate of 79.2%. The overall mean
antidote availability score was .59 (SD = .837), which falls within the
definition of Poor availability. None of the pharmacies had kept all of the
antidotes, and the maximum number of an antidote kept by a single pharmacy
was 7 out of nineteen essential antidotes surveyed. The most commonly
reported reason for the unavailability of essential antidotes was stock was
not ordered (56.3%) followed by stock ordered but not delivered from
suppliers (wholesalers) (20.0%). More than 3 fourth of the respondents
(83.8%) had poor knowledge about the antidotes for the common
poisonings. Conclusion There was a significantly very low availability of essential antidotes in the
community pharmacies. Strategies should be implemented to improve
pharmacist’s knowledge about antidotes, and management of poisoning
emergencies through on-job training and provision of reference
materials.
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Affiliation(s)
- Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Kumilachew Yimenu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Abiyu Demeke
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Emagn Kasahun
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ebrahim Abdela Siraj
- Department of Pharmacognosy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Adane Yehualaw Wendalem
- Department of Pharmaceutics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zegaye Agmassie Bazezew
- Department of Medicinal Chemistry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebe Basazn Mekuria
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Acute Poisoning Cases Presented to the Addis Ababa Burn, Emergency, and Trauma Hospital Emergency Department, Addis Ababa, Ethiopia: A Cross-Sectional Study. Emerg Med Int 2021; 2021:6028123. [PMID: 34925919 PMCID: PMC8674071 DOI: 10.1155/2021/6028123] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/20/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background Acute poisoning is a common reason for visits to the emergency room and hospitalization across the world, as well as a possible cause of morbidity and death. This study aimed to assess acute poisonings at Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital. Methodology. A one-year cross-sectional study was conducted at AaBET Hospital from February 1, 2018, to January 31, 2019. Data were collected using a structured and pretested questionnaire by the Emergency Medicine and Critical Care residents from acutely poisoned patients' interviews and patient charts. Results Data were collected from 98 acute poisoning cases, and 52% were males and 48% were females. 85 (86.7%) were less than 45 years. 52 (55.1%) were unemployed, and 33 (33.7%) were farmers. 96 (98%) cases were due to intentional poisoning, and 96 (98%) had oral ingestion. Organophosphates poisoning (27.5%) was the commonest cause, followed by 26.5% of unknown poisons and 16.3% prescribed drugs. Sixty-six percent of the patients presented to the hospital after 2 hours of ingestion. The case fatalities were 10.2% of which 40% of the cases were due to 2,4-dichlorophenoxyacetic (2, 4-D) poisoning, followed by aluminum phosphide (20%). Conclusion This study showed farmers and the unemployed were more affected. The most common mode of poisoning was intentional poisoning, oral ingestion being the primary route. The common poisons used by the victims were organophosphates. 2, 4-D poisoning was the major cause of death.
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12
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Bogale DE, Ejigu BD, Muche TA. Clinical Profile and Treatment Outcome of Aluminum Phosphide Poisoning in Felege Hiwot Referral Hospital, Northwest Ethiopia: A Retrospective Study. Open Access Emerg Med 2021; 13:239-248. [PMID: 34163261 PMCID: PMC8216064 DOI: 10.2147/oaem.s313181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Aluminum phosphide (AlP) is an effective fumigant and rodenticide which is a commonly used agent for self-poisoning in parts of Ethiopia. AlP poisoning results in serious manifestations involving many vital organs and it has high mortality. Despite its high incidence and mortality, studies on AlP poisoning in Ethiopia are lacking. Our objective was to study the clinical profile and treatment outcome of AlP poisoning in Felege Hiwot Referral Hospital (FHRH), a major referral hospital in Ethiopia. Methods It is a retrospective study conducted over all consecutive AlP poisoning cases who presented to the emergency department (ED) of the hospital from March 2018 to August 2020. A questionnaire was used to collect data from patient medical records. All data were analyzed using SPSS 25. Results A total of 125 patients were studied. Females were 57.6% and males were 42.4%. Age of patients ranged from 12 to 60 with mean age 28.5 years. The average number of AlP tablets taken was 1.2 (3.6 gm) and the average time of arrival to hospital after AlP ingestion was 4.8 hours. Nausea and vomiting were the commonest presenting features seen in 74.4% of the cases followed by hypotension which was seen in half of the cases. A wide range of laboratory findings and complications were also observed. Cases of AlP poisoning with hypotension were managed in the ICU with dopamine infusion, magnesium sulphate, hydrocortisone, and calcium gluconate in addition to gastric lavage and fluid administration. Those cases without hypotension were managed with gastric lavage and maintenance fluid only. Overall mortality from AlP poisoning was 31.2%. Conclusion With a treatment protocol used in FHRH, mortality from AlP poisoning was 31.2%. Using this protocol in resource limited settings might give opportunities to reduce mortality from AlP poisoning.
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Tefera GM, Teferi LG. Prevalence, Predictors and Treatment Outcome of Acute Poisoning in Western Ethiopia. Open Access Emerg Med 2020; 12:365-375. [PMID: 33209064 PMCID: PMC7669523 DOI: 10.2147/oaem.s277269] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/24/2020] [Indexed: 12/05/2022] Open
Abstract
Background Acute poisoning is a common reason for visiting the emergency department (ED) worldwide. However, little is known about this issue in the western part of Ethiopia. This study was carried out to determine the prevalence, predictors, and treatment outcome of acute poisoning at the ED of western Ethiopia. Patients and Methods A hospital record-based retrospective study design was conducted on all patients admitted to the ED of the two hospitals between 01 January 2018 to 17 March 2019. Socio-demographic, clinical presentation, medication history, poisoning characteristics, time to hospital arrival, treatment given, and outcome of treatment were collected. All collected data were analyzed using SPSS Version 20. Backward multiple logistic regression analysis at p-value ≤0.05 tested the predictor for treatment outcome. Results The prevalence of acute poisoning was 134/7883 (1.7%) per ED admissions. The mean ±SD age of the study participants was 23.90±10.606 with female to male ratio of 1:1.06. The most vulnerable patients to poisoning were individuals in the age range of 18 to 29 years 68/134 (50.7%) for both genders. Moreover, the most common poisoning agent was organophosphate 72/134 (53.7%). Besides, intentional poisoning was the most common 103/134 (76.9%) manner of poisoning with family disharmony 37/103 (35.9%) as the common reason. The case fatality rate of acute poisoning in the two hospitals was 2/134 (1.5%). The mean ±SD length of hospital stay was 1.86 ±0.943. The independent predictors of poor treatment outcome of acute poisoning were age ≥35 years [p-value= 0.049], female gender [p-value= 0.027], and hospital stay of >48 hours [p-value= 0.035]. Conclusion The prevalence of acute poisoning in western Ethiopia is higher than the ever-reported data in Ethiopia. Thus, stakeholders should have to pay more attention to prevention and control strategies and appropriate handling of agrochemical substances to minimize their negative effects on this productive age group.
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The Scenario of Acute Poisoning in Jashore, Bangladesh. J Toxicol 2020; 2020:2109673. [PMID: 32508916 PMCID: PMC7254068 DOI: 10.1155/2020/2109673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/30/2020] [Indexed: 11/28/2022] Open
Abstract
Background Acute poisoning is a common scenario in the emergency department of any general hospital globally, but its pattern may vary in different parts of the world and even may be a different regional variation in the same country. Objective Our recent study aims to assess the demographic characteristics, psychological aspect, pattern, and treatment outcome in different acute poisoning. Method The present cross-sectional study was conducted in the medicine department of Jashore Medical College and Hospital from 1st January to 30th June 2018, which recruited 487 eligible cases of admitted acute poisoning patients. Results The study reveals that the total incidence of acute poisoning in Jashore, Bangladesh, is 17.1 per 100,000 populations over a 6-month period. The mean age of our study population was 27 ± 11 (SD) years with having significant female preponderance in acute poisoning (female: 253/52% and male: 234/48%; p = 0.002). Female subjects were significantly younger than male (p <0.001). Moreover, the total suicidal intension of acute poisoning in our study was 97.3%, whereas the female subjects were more committed to suicidal attempts (p = 0.027). Organophosphorus compounds (OPCs) were the significant leading agents (66.1%, p = 0.029) of acute poisoning, and even, it had been significantly used as suicidal intention of poisoning substance (65.1%, p <0.001) in our observation. Muslim (97.5%, p = 0.005), 10–29 year age group (68.0%, p = 0.002), rural (99.2%), unmarried (51.3%), middle class (50.1%), students (48.9%), and secondary educational background population (76.4%) were more victimized of acute poisoning. Among different factors, familial disharmony constituted of 56.1% cases of suicidal attempt in acute poisoning. Finally, we had observed that the death incidence by acute poisoning in Jashore, Bangladesh, was 1.9 per 100,000 population over a 6-month period. Conclusion The recent study reveals that there is high incidence of acute poisoning in Jashore, Bangladesh, with a significant amount of death toll. Organophosphorus compound is the most common agent of deliberating self-poisoning in our study due to its easy availability in our agriculture-based community.
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Getie A, Belayneh YM. A Retrospective Study of Acute Poisoning Cases and Their Management at Emergency Department of Dessie Referral Hospital, Northeast Ethiopia. Drug Healthc Patient Saf 2020; 12:41-48. [PMID: 32184673 PMCID: PMC7062390 DOI: 10.2147/dhps.s241413] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background Poisoning causes significant patient morbidity and mortality worldwide. It is a common reason for emergency department visits and hospitalizations. Acute poisoning needs immediate effective management to prevent patient mortality or sequela. This study was carried out to determine the pattern of acute poisoning cases and their management at the emergency department of Dessie referral hospital, northeast Ethiopia. Methods A retrospective cross-sectional study of all registered poisoning cases managed at the emergency department of Dessie referral hospital was conducted from March 10 to May 2, 2018. Results There were a total of 147 registered poisoning cases listed in the registry during the study period, of which 120 cases (81.6%) had complete data and were included in the study. Among the total of 120 studied poisoning cases, 66 (55%) were females, and 53 (44.2%) were in the age group of 21–30 years. The causative poison was documented for 118 cases. Organophosphates were the most common poisoning agents involved in 54 (45%) of the cases followed by sodium hypochlorite, 27 (22.5%), and food poisoning, 19 (15.8%). Among the total patients, 77 (64.2%) were self-poisoned intentionally, 31 (25.8%) were poisoned in an unintentional manner and the rest, 12 (10%), had an unknown manner of poisoning. Mental disorder, 25 (20.8%); family disharmony, 23 (19.2%); and marital disharmony, 19 (15.8%) were the three most common causes of intentional poisoning. In all cases of acute poisoning, both pharmacological and non-pharmacological treatment approaches were used. Cimetidine was the most commonly used pharmacologic treatment, 118 (98.3%), followed by antiemetic, 107 (89.2%); proton pump inhibitor, 87 (72.5%), and atropine, 67 (55.8%). ANOVA did not show a statistically significant difference (P>0.05) in the frequency of poisoning cases across seasons. Conclusion Among 120 acute poisoning cases, 77 (64.2%) were intentional poisoning cases. Organophosphate poisoning accounts for 45% of the total poisoning cases. The three major reasons for intentional poisoning were mental disorders (20.8%), family disharmony (19.2%) and marital disharmony (15.8%). Cimetidine (98.3%) was the most commonly used pharmacologic treatment of the poisoning cases.
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Affiliation(s)
- Abebe Getie
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yaschilal Muche Belayneh
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Chelkeba L, Mulatu A, Feyissa D, Bekele F, Tesfaye BT. Patterns and epidemiology of acute poisoning in Ethiopia: systematic review of observational studies. Arch Public Health 2018; 76:34. [PMID: 29988616 PMCID: PMC6027736 DOI: 10.1186/s13690-018-0275-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute poisoning is a common reason for emergency department visit and hospitalization worldwide with major morbidity and mortality. The burden of poisoning exposures in Africa is a significant public health concern, but only 10 of 58 countries have poisons information centers (PICs). OBJECTIVE The primary intention of our current review is to explore and summarize the published evidence on the patterns and epidemiology of poisoning in Ethiopia. METHOD PubMed and Scopus were searched for primary, case series and human studies for publications from inception to July 2017. A manual search for additional relevant studies using references from retrieved articles was also performed. Only studies that reported acute poisoning in both pediatric and adult patients were included. From the screened articles, data were extracted for baseline characteristics and relevant end points such as case fatality rate, time for health institution presentation and length of hospital stay. RESULT Initial entry and search resulted in the retrieval of 332 articles. Finally, 9 studies comprised of 4763 participants were included in this current review. In 78% of the studies included in this review, acute poisoning is reported to be more prevalent in females. Acute poisoning was revealed to be prevalent in less than 30 years old. Organophosphates and household cleaning agents were the predominant agents of acute poisoning. Intentional poisoning was identified responsible for the majority of acute poisoning cases and factors such as psychiatric problems, and quarrel were identified as the underlying reasons for poisoning. Time of presentation to health institution after poisoning, length of hospital stay and case fatality rate were reported and lies in the ranges between 0.2 h-24 h, 0.5 days-17.7 days and 0-14.8%, respectively. CONCLUSION The occurrence of acute poisoning was higher in females and common in less than 30 years of age, making this a real public health burden in Ethiopia. Psychiatric problems, quarrel and substance abuse were identified as the most common reasons for acute poisoning. Awareness creation how to handle chemicals and prescribed drugs and psychiatric consultations should be in place for the community.
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Affiliation(s)
- Legese Chelkeba
- School of pharmacy, Department of Clinical pharmacy, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Abera Mulatu
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Dessalegn Feyissa
- Mizan Tepi University School of pharmacy, Clinical Pharmacy Unit, Mizan, Ethiopia
| | - Firomsa Bekele
- Metu UniversitySchool of pharmacy, Clinical Pharmacy Unit, Metu, Ethiopia
| | - Behailu Terefe Tesfaye
- School of pharmacy, Department of Clinical pharmacy, College of Health Sciences, Jimma University, Jimma, Ethiopia
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Eyasu M, Dida T, Worku Y, Worku S, Shafie M. Acute poisonings during pregnancy and in other non-pregnant women in emergency departments of four government hospitals, Addis Ababa, Ethiopia: 2010-2015. Trop Med Int Health 2017; 22:1350-1360. [PMID: 28901626 DOI: 10.1111/tmi.12940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To characterise acute poisonings in pregnant and non-pregnant women treated at emergency departments of government hospitals in Addis Ababa, Ethiopia, between 2010 and 2015. METHODS All data for acutely poisoned women were retrospectively collected from patient medical charts at the emergency departments of Saint Paul's Hospital Millennium Medical College, Ras Desta Memorial Hospital, Yekatit 12 Hospital Medical College and Zewditu Memorial Hospital. Data were collected by extraction questionnaire and analysed using SPSSv. 20 statistical software. RESULTS During the study period, 998 cases of acutely poisoned women were listed in the hospital registries. Of these, complete data for inclusion in the study were available for 592. 36.3% of the study participants were in the age group of 20-24, with a mean (±SD) age of 23.03 (±6.3) years. 80.9% were from Addis Ababa; 4.6% were pregnant. The mean arrival time of all cases was 4.14 h. 85.5% of all study cases were due to intentional self-poisoning, of whom 42.1% were discharged without complications. The most common poisons were bleach and organophosphates; 25.9% of pregnant cases and 32.6% of non-pregnant cases were poisoned by bleach; and 18.5% of pregnant cases and 18.9% of non-pregnant cases had organophosphate poisoning. 0.7% had a history of poisoning; all were non-pregnant women. The common route of poison exposure was oral, and the case fatality rate of organophosphate poisoning in pregnant and non-pregnant women was 20 and 1.87%, respectively. The pre-hospital intervention for the majority of the women was milk, in 12.0% of cases. CONCLUSION Acute poisoning remains a public health problem in our community. Bleach is the most common poisons. Our present findings indicate the necessity of educational programmes on preventable reasons of acute poisonings and their outcomes on pregnant and non-pregnant women.
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Affiliation(s)
- Mebrahtu Eyasu
- Department of Pharmacology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tolesa Dida
- Department of Nursing, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yoseph Worku
- Department of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Solomon Worku
- Center for International Reproductive Health Training, University of Michigan, Addis Ababa, Ethiopia
| | - Mensur Shafie
- Department of Pharmacology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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