Study of acute organophosphates insecticide poisoning cases in a medical college hospital

 

S Mohan Singh¹, Shaik Khaja Moinuddin^2*

 

 

Abstract               Acute pesticide poisoning occur in low-and middle-income families, over 3 million cases of OP poisoning per year were recorded worldwide with approximately 300,000 deaths. Majority of these occur in agricultural countries. The present study was aimed to assess the demographic patterns of OP poisoning and mortality rate at the general hospital located at south india. The present study comprised 74 cases of acute OP compound poisoning and those who came with history and clinical features of OP poisoning. The result of the present study shows that the distribution of age of the patients varied from <20 to >40 years and maximum number of cases was observed in 21-30 years of age and moreover married and male patients were higher in number when compared to unmarried and female cases of poisoning respectively. In the present study, maximum number of poison cases was organophosphorus and other compounds like aluminium phosphide, zinc phosphide and Pyrethrin were also associated. The present study observation also shows that mortality rate was very low when compared with many other studies. To conclude, poison prevention strategies should be implemented at various levels to reduce the use of pesticides and to minimize the overall exposure to pesticides.

Key Words: Organ phosphorus; Aluminium and zinc phosphates; Suicidal; Homicidal.

 

 

INTRODUCTION

Recent WHO estimates suggest that more than 3.1million cases of acute pesticide poisoning occur worldwide annually; the majority of them were being caused by organophosphorus compounds used for agricultural purposes in developing countries. Acute pesticide poisoning occurs in low-and middle-income families, mainly in areas where there are low education levels and poor frameworks for pesticide regulation, which could be associated with the inappropriate management of pesticides¹. Acute pesticide poisoning is an injury in which the toxic effects occur almost immediately, usually within hours from the time of exposure. Acute poisoning results from exposures to toxic agents that may lead to harmful effects based on the reaction of the body to these agents². Exposures may be through ingestion, transdermal, injection, or inhalation. Moreover, the exposures may be deliberate or accidental. The resulting effects of the exposure may be localized or generalized; they may also be topical or systemic. At the core, the adverse functional or morphological changes observed upon clinical, gross or histopathological examinations are almost invariably a consequence of biochemical lesions³. The mortality rate of acute poisoning varies across settings. According to data available from National Poison Information Centre India, the incidence of poisoning cases in India is highest in the world, and it is estimated that more than 50,000 people die every year from toxic exposure⁴, and is determined by many factor such as the poisonous substance’s inherent toxicity and the amounts consumed, the treatment instituted, and various patients and health systems’ factors. With regard to the relationship between the fatal outcomes and specific groups of toxic agents, agrichemicals particularly organophosphates (OP), carbamates, pyrethroids and aluminium/zinc phosphide pesticides continue to be responsible for the majority of deaths in most deliberate self-poisoning cases in many developing countries⁵. Pesticide poisoning is significant problem in India. causes most self-poisoning deaths in southern and central India. In India, OP compounds are easily accessible; therefore, it is the most common mode of poisoning fatalities as a source of both intentional and unintentional poisoning⁶ which may leads to life-threatening complications and may result in mortality. So, in a light of increased use of OP compounds poisoning the present study was aimed to assess the demographic patterns of OP poisoning and mortality rate in medical college associated hospital.

MATERIAL AND METHODS

This study comprised 74 cases of acute OP compound poisoning to the emergency ward and medical wards in Osmania Medical College and Hospital, Hyderabad a large teaching hospital in south India during January-December 2014 period. Present study included all patients with history of acute organophosphorus poisoning of either sex and above 12 years of age, and those who came with history and clinical features of OP poisoning, irrespective of their vital status during our study period. Patients brought dead cases were excluded in the study. By inform consent, information was collected from the relatives, attenders and eyewitnesses (in some cases), about the type of poison consumed, mode of poisoning, occupation of the patient and other demographic profile. Data were documented and statistically analyzed by using SPSS software and P< 0.05 was considered significant.

 

RESULTS

Table 1: Distribution of patients according to Age

In the present study, the distribution of age varied from <20 to >40 years. Maximum number (55.4%) of cases was observed in 21-30 years of age. Whereas, the age group 31-40 years (32.4%) and >40 (18.9%) (Table 1).

 

Table 2: Distribution of patients according to Sex and Mode of poisoning

There were 46 (62.1%) male OP poisoning which include 42 suicidal cases, 3 accidental cases and 1 homicidal attempt. Whereas, 28 (37.8%) female OP poisoning in which 26 cases were of suicidal and 2 were accidental cases and there is none homicidal attempts seen. Irrespective of sex, suicide was the most common mode of poisoning. Moreover, male patients were more when compared to female cases of poisoning (Table 2).

 

Table 3: Distribution of cases according to Marital status of victims

The present study found that the number of married subjects were 67.5% (n = 50) while only 27% (n = 20) patients were unmarried and 5.4% of cases marital status was not known (Table 3).

 

Table 4: Distribution of cases showing type of poisoning

In the present study, maximum number (49) of poison cases were organo phosphorus compound, 14 cases were aluminium phosphide and zinc phosphide, 8 cases were Pyrethrin compounds and in remaining 3 cases of poison was unknown (Table 4).

Table 5: Distribution of cases according to Outcome of Poisoning Cases

In the present study, mortality rate was very low 17.5% (Table 5); this may be due to reaching of the patients to the hospital within very short time after getting poisoned.

 

DISCUSSION

India is predominantly an agriculture-based economy. Acute organophosphorus compound poisoning is one of the commonest causes of acute poisoning with high mortality, particularly among the agricultural workers in India. The probable cause of high mortality is depending on the variety of factors such as affordable price and easy availability of the poison. Maximum number of the victims was from age group of 21 -30 years (55.4%), our observations are in accordance with earlier studies^7-9. The distribution pattern among particular age group illustrates the psychological vulnerability in this age group. In the present study, suicide was the most common mode of poisoning observed (68 cases) when compared to other modes of exposure to poison. Some studies suggests that suicide by using poisons may be due to easy availability and also general belief that poison terminates life with minimal suffering¹⁰. In a recent study from India it was revealed that suicidal poisoning was the common cause with almost 80% incidence and majority of these cases were belonging to rural setup with low socio economic condition and low educational status¹¹. The present study found that the number of married subjects was 67.5%, irrespective of the sex. Our observations were in agreement with earlier studies, which shows that married persons number are higher towards the suicidal poisoning due to greater stress, family, financial and job related problems and other matters¹². In Indian scenario OP Poisoning is common in rural community as these compounds are like Over the Counter (OTC) Drugs which are easily available to people on affordable price. In the present study, maximum numbers (49) of poison cases were organophosphorus compound when compared with other compounds. Studies from other parts of India have reported organophosphates and other pesticides as common causes of poisoning¹³. Acute poisoning occurs when toxic reactions follow shortly after exposure, however, chronic poisoning takes its time and reacts gradually after prolonged exposure¹⁴. In the present study, mortality rate was very low and observed in only 17% cases. Similar mortality rates were also observed by Goel and co-workers¹⁵. Higher mortality rate was observed by Padmanaba et al (25%)¹⁶ and Dayanand et al (21.25%)¹³. To conclude, poison prevention strategies should be implemented at various levels. Illiteracy, poverty, cheap and easy availability of the OP compounds, lack of employment and stressful life-style were the common reasons behind suicidal poisoning. The overall aim of agricultural policies must be to reduce the use of pesticides to the lowest feasible level. This will reduce number of agricultural pesticide poisoning and minimize the overall exposure to pesticides at the community level.

 

REFERENCES

• Wesseling C, McConnell R, Partanen T, Hogstedt C. Agricultural pesticide use in developing countries: health effects and research needs. International journal of health services. 1997 Apr; 27(2):273-308.
• Rosenstock L, Keifer M, Daniell WE, McConnell R, Claypoole K, Pesticide Health Effects Study Group. Chronic central nervous system effects of acute organophosphate pesticide intoxication. The Lancet. 1991 Jul 27; 338(8761):223-7.
• Zampagni M, Cascella R, Casamenti F, Grossi C, Evangelisti E, Wright D, Becatti M, Liguri G, Mannini B, Campioni S, Chiti F. A comparison of the biochemical modifications caused by toxic and non‐toxic protein oligomers in cells. Journal of cellular and molecular medicine. 2011 Oct; 15(10):2106-16.
• Pillay VV. The utility of poison control centres in diagnosing and managing cases of poisoning and overdose. Journal of the Indian Medical Association. 2010 Mar; 108(3):162-4.
• Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal pesticide self-poisoning: systematic review. BMC public health. 2007 Dec; 7(1):357.
• Corriols M, Marin J, Berroteran J, Lozano LM, Lundberg I, Thörn Å. The Nicaraguan pesticide poisoning register: constant underreporting. International journal of health services. 2008 Oct; 38(4):773-87.
• Kiran N, Rani RH, Prakash VJ. Pattern of poisoning reported at south Indian tertiary care hospital. Indian Journal of Forensic Medicine andToxicology. 2008; 2(2):17-9.
• Shetty VB, Pawar GS, Inamadar PI. Profile of poisoning cases in district and medical college hospitals of north Karnataka. Indian Journal of Forensic Medicine andToxicology. 2008; 2(2):26-8.
• Sahin HA, Sahin I, Arabaci F. Sociodemographic factors in organophosphate poisonings: a prospective study. Human and experimental toxicology. 2003 Jul; 22(7):349-53.
• Unnikrishnan B, Singh B, Rajeev A. Trends of acute poisoning in south Karnataka. Kathmandu University medical journal (KUMJ). 2005; 3(2):149-54.
• Sangalad PN, Huddar MG. Pesticide poisoning among agriculturists of Dharwad district: a study. Recent Research in Science and Technology. 2010 Oct 20; 2(4).
• Sharma BR, Harish D, Sharma V, Vij K. The epidemiology of poisoning: An Indian view point. Journal of forensic Medicine and Toxicology. 2002; 19(2):5-11.
• Raddi D, Anikethana GV. Clinical profile of organophosphorus poisoning in a tertiary care hospital. Indian Journal of Basic and Applied Medical Research. 2014 Dec;4(1):14-22.
• The World Bank. World development report 1980. New York, Oxford University Press; 1980
• Goel A, Joseph S, Dutta TK. Organophosphate poisoning: predicting the need for ventilatory support. The Journal of the Association of Physicians of India. 1998 Sep; 46(9):786-90.
• Padmanabha T S, Kashinath Guumma, Gajanan P Kulkarni. Study of Profile of Organophosphorus Poisoning cases in a Tertiary care Hospital, North Karnataka, Bidar, India. Int J Pharm Bio Sci 2014 Jan; 5(1):(P)332–339.