Sociodemographic study of poisoning at a tertiary care teaching hospital in Puducherry

 

N Naveen^1*, A Edwin Joe², R N Kagne³

 

¹Assistant Professor, Chengalpattu Government Medical College and Hospital, Chengalpattu, Tamil Nadu.

²Professor, Department of Forensic Medicine and Dean, Thoothukudi Government Medical College and Hospital, Thoothukudi, Tamil Nadu.

 

Abstract               Background: Deaths due to poisoning are not uncommon and it carries high mortality and morbidity. There is a widespread increase in use of insecticides, pesticides and toxic chemicals in domestic and industrial fields which also contributes to the increase abuse of these drugs and poisonous substances. Aim: To study the socio-demographic profile of poisoning cases in and around Puducherry and to find out the factors affecting age, gender, and education and occupation. Material and Methods: All 615 cases who had consumed poison or victims of bites and stings, reported to casualty, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, were studied with respect to their socio-demographic characteristics. Results: Out of 615 cases, most common manner of poisoning was suicidal in nature i.e. 253 cases (41.1%) followed by accidental i.e. 69 cases (11.2%). Whereas all the cases of bites and stings i.e. 293 cases (47.7%) were accidental in nature. Maximum cases i.e. 434 cases (70.6%), were from lower economic class followed by 148 cases (24.1%) from middle class and the least number of cases 33 (5.4%) were from upper class. Maximum incidence of poisoning was found in unemployed (412 cases). Conclusion: Awareness regarding poisons handling and poisonous substances to the general public through various means can reduce the incidence of poisoning. Proper psychiatric guidance to vulnerable group of people such as people with psychosocial, financial and social problems is needed.

Key Word: Poisoning, bites and stinges, lower economic class, unemployed

 

 

INTRODUCTION

Deaths due to poisoning are not uncommon and it carries high mortality and morbidity. There is a widespread increase in use of insecticides, pesticides and toxic chemicals in domestic and industrial fields which also contributes to the increase abuse of these drugs and poisonous substances. Annually around three million poisoning cases were reported worldwide among them 90% of the cases were from developing countries.¹ Poisoning deaths are very high in developing countries like India when compared to developed countries.^2,3 In India intentional, occupational and accidental poisoning is a major public health problem.⁴ Manner of poisoning is mainly suicidal and accidental, whereas even few cases of homicide are reported.⁵ In Puducherry region, during 2013, the suicidal rate was 35.6 per one lakh populations and suicidal poisoning deaths were 12.3%, whereas the accidental poisoning deaths were 2%.⁶ As majority of the population is from rural area they largely depend on agriculture for their living. The pesticides used for agricultural purposes are easily available in market and hence it becomes the most common type of suicidal poison. Organophosphorous is the most common insecticide used for suicidal poisoning in southern parts of India. Accidental case of poisoning is due to various stings and bites. In India about 10,000 snake bite deaths⁷ and 1.2 million cases of scorpion stings were reported annually every year.⁸ This increased in incidence of bites and stings is due to climatic factors, predominance of rural population and their agricultural dependence.⁹ Accidental ingestion is common in children less than 5 years old.^10,11 This study was aimed to study the socio-demographic profile of poisoning cases in and around Puducherry and to find out the factors affecting age, gender, and education and occupation.

 

MATERIAL AND METHODS

This hospital based descriptive study was conducted in the Department of Casualty and Forensic Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry.

Sample and sample size: The number of poisoning cases reported to casualty during study period were 760, which comprises 30% of all the medico legal cases. So, with this 30% as P, with the precision of 5% and design effect of 2, the sample size will be approximately 470. So, all poisoning cases were taken up for study during the study period. Data was collected by interview questionnaire after obtaining approval from Institutional Ethical Committee.

Inclusion criteria: All the cases who had consumed poison or victims of bites and stings, reported to casualty, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, during the study period were included.

Exclusion criteria: Poisoning cases treated elsewhere before reporting to Casualty, Sri Manakula Vinayagar Medical College and Hospital, Puducherry.

METHODOLOGY

When the person arrived to the casualty with the history of poisoning initial management was done. Once the poisoned person was stabilized, the patient information sheet both in Tamil and English were issued to the patient or relative’s which contained all the information regarding the study. Consent was then obtained from the patient himself or relatives. The victims profile like name, age, sex, marital status, education and occupational status were obtained and two identification marks were recorded. History about the poisoning regarding, time, date, type of poison, manner of poison, route of administration, time elapsed in hospital admission and prognosis of poisoning were recorded in the proforma.

Statistical analysis: Data collected was entered in the computer database, analysis done using EpiInfo software version 3.4.3.

 

 

 RESULTS

In this present study of total 615 poisoning cases, 300 cases (48.78%) were males and 315 cases (51.22%) were females and the male female ratio is 0.95:1. Maximum number of cases were in age group of 21-30 years i.e. 178 cases (28.94%), followed by 11-20 years i.e. 126 cases (20.49%) and least incidence was found in age group > 70 years i.e. 6 cases (0.98%). Maximum number of male and female victims were observed between 21-30 years i.e. 80 cases (13.2%) and 98 cases (15.9%) respectively. In poisoning consumption cases as well as bites and stings cases maximum number of male female distribution was observed in the same age group.

                Table 1: Age and Gender wise distribution of total poisoning cases

Maximum cases i.e. 434 cases (70.6%), were from lower economic class followed by 148 cases (24.1%) from middle class and the least number of cases 33 (5.4%) were from upper class. The incidence of poisoning in this study is more in Hindus i.e. 597 cases (97.1%), followed by Christians 11 cases (1.8%) and low in Muslims 7 cases (1.1%). Most of the victims are married 322 cases (52.4%) when compared to unmarried 293 cases (47.6%). Among male victims unmarried 176 cases (58.7%) outnumbered married 124 cases (41.3%). Among females married 198 cases (62.9%) outnumbered unmarried 117 cases (37.1%). Incidence of poisoning cases is more in nuclear family 529 cases (86%) when compared to joint family 86 cases (14%). In this study maximum incidence of poisoning was found in unemployed (students, house wives, unemployed) 412 cases (67.1%), followed by unskilled (clerk, farmer, fisherman, watchman, labourer) 111 cases (18.1%) and least observed in professionals 8 cases (1.3%).

 

Table 2: Distribution of cases according to sociodemographic characteristics

Out of total 615 cases maximum person were Illiterate 140 cases (22.8%), followed by Graduate 128 cases (20.8%) and the lowest number are Diploma candidates 15 cases (2.4%). Consumption of poison cases were more among Graduates followed by Illiterate whereas in cases of sting and bites maximum cases were of Illiterate followed by High school and Graduates.

Table 3: Manner of poisoning

Out of 615 cases, accidental poisoning was reported in 362 cases (58.9%) and suicidal poisoning was reported in 253 cases (41.1%), but not a single case of homicidal poisoning was reported. In poison consumption cases most common manner of poisoning was suicidal in nature i.e. 253 cases (41.1%) followed by accidental i.e. 69 cases (11.2%). Whereas all the cases of bites and stings i.e. 293 cases (47.7%) were accidental in nature.
DISCUSSION

In this hospital based descriptive study a total of 615 cases with history of poisoning were analysed. The present study when compared with previous studies is useful in understanding the epidemiology of poisoning in this area. In the present study, females outnumbered males with male female ratio 0.95:1. Female gender predominance of this study correlates with the studies conducted by Padmakumar K et al¹² and Pokhrel D et al¹³ but in contrast male predominance was noted in most of the other studies.^14-16 The most commonly affected age group was 21-30 years (28.94%). It was observed that this age group was affected in most of the studies.^1,2,4,17,18 The second commonest age group affected was 11-20 years (20.49%). The least affected were of age more than 70 years (0.98%). This finding correlates with study conducted by Santhosh CS et al,⁴ Kumar NH et al⁴², Padmakumar K et al.¹² This may be due to stress, failure in love or examinations, family problems, modified life style and peer pressure at this age group. The higher incidence of poisoning was found in Hindu people 597 cases (97.1%), followed by Christians (1.8%) and Muslims (1.1%). Similar results were found in studies conducted by Bharath K et al,² Navinkumar M et al,¹⁸ and Tapse SP et al.²⁰ Hindu are in majority as compared to Christians and Muslims in India hence this trend is seen. Majority of victims were married which is similar to other studies.^1,4,15,18,20 Among male victims majority were married which correlates most studies. ^1,4,15,18,20 Among female victims majority are unmarried which is similar to the study conducted by Pawan T et al²¹ which in contrast to other studies where majority female victims were married.^4,18,20 The high incidence of poisoning in married people may be due to quarrel because of cultural differences, low income, frustration, unemployment etc. The incidence of poisoning was more in nuclear family 86% than joint family 14%. This study correlates with similar studies conducted by Navinkumar M et al¹⁸ which is contradictory to the study conducted by Bharath K et al² and Tapse S et al.²⁰ This may be due to in current period joint family is reduced. Lack of guidance by elderly person in stressful conditions leads to suicidal tendencies in nuclear family whereas in joint family guidance from elders, sharing of sorrows, failure and moral support avoids one from taking extreme steps in stressful conditions. The incidence of poisoning was more common among unemployed 67.1%, followed by unskilled 18.1% which is contradictory and reverse in most studies in which unskilled are more common followed by unemployed.^16,18,22 This may be due to reduced opportunities of jobs due to population explosion. The incidence of poisoning was more among illiterate 140 cases (22.8%), followed by graduates (20.8%). This study correlates with study conducted by Joshi SC et al,²² Tapse SP et al²⁰ and Navinkumar M et al¹⁸ in which illiterate is most common. Haloi M et al,²³ Siddapur KR et al¹⁷ observed that incidence of poisoning is common among high school education and low in graduates.This may be the illiterate people have poor knowledge towards poison and inability to succeed in life than less educated people. Maximum victims were from lower economic class 70.6%, followed by middle (24.1%), and upper class (5.4%). This study correlates with most studies.^17,18,20,21 and it contradictory to the study carried by Kumar S et al in which middle class victims are common followed by lower class.¹⁹ This may be due to financial stress because of low income.

 

CONCLUSION

Awareness regarding poisons handling and poisonous substances to the general public through various means can reduce the incidence of poisoning. Education about poisonous substances to all sectors of population and proper psychiatric guidance to vulnerable group of people such as people with psychosocial, financial and social problems is needed.

 

REFERENCES

1. Sanjeev K, Mangal HM, Akhilesh P. Trends of fatal poisoning in Saurastra region of Gujarat a prospective study. JIAFM 2011Jul-Sep; 33(3):197-9.
2. Bharath KG, Pal US. The pattern of poisoning in Khammam. JIAFM 2011Oct-Dec; 33(4):296-300.
3. Dhaval P, Tekade J, Pawan R. Profile of Organophosphorous poisoning at Maharani hospital, Jagdalpur, Chattisgarh: a three year study. JIAFM 2011Apr-Jun; 33(2):102-5.
4. Santhosh CS, Kumar S, Nawaz B. Profile of poisoning cases autopsied at district government hospital, Davangere. IJFMT 2012Jan-June; 6(1):104-6.
5. Kumar A, Vij K. Trends of poisoning in Chandigarh-A six year autopsy study. JFMT 2001Jan-June; 18(1):8-10.
6. Accidents and accidental deaths in Tamil Nadu. www.tnpolice.gov.in/pdfs/cit2012/writeup14_12.pdf. Accessed on 11 March 2014.
7. Chippaux JP. Snake bites: apprasail of the global situation. Bull World Health Organ 1998; 76(5):515-24.
8. Kumar L, Naik SK, Agarwal SS, Bastia BK. Autopsy diagnosis of a death due to scorpion stinging- a case report. J Forensic LEG MED 2012; 19: 494-6.
9. Viramani SK, Dutt OP. A profile of snakebite poisoning in Jammu region. J Indian Medical Association 1987; 185: 132-4.
10. Zine KU. Pattern of acute poisoning at INdira Gandhi medical college and hospital, Nagpur. JIAFM1998; 20(2):37-9.
11. Reddy KSN. Essentials of forensic medicine and toxicology. General toxicology 2003; 22: 473-93.
12. Padmakumar K, Maheshkrishna BG, Jaghadheeswararaj J, Natarajan A. Incidence of poisoning reported at a tertiary care hospital. J-SIMLA 2013 Sep; 5(2):58-62.
13. Pokhrel D, Pant S, Pradhan A, Mansoor S. “A comparative retrospective study of poisoning cases in central, zonal and district hospitals”. Kathmandu university journal of science, engineering and technology 2008Sep; 1(5):40-48.
14. Dhattarwal SK, Singh H. Profile of deaths due to poisoning in Rohtak,Haryana. JFMT2001; 18(2):28-9.
15. Harish D, Sharma BR, ChavaliKH, Sharma.A. Poisoning mortality in Chandigarh:Anoverview. JIAFM 2006; 28(3):110-3.
16. Udaykumar C, Rajan K, Reddy KSN. A study of snake bite poisoning in Gulbarga region. IJFMT 2009Jul-Dec; 3(2):29-33.
17. Siddapur KR, Pawar GS, Mestri SC. Trends of poisoning and gross stomach mucosal appearance in fatal poisoning cases: An autopsy study. JIAFM 2011Apr-Jun; 33(2):106-11.
18. Navinkumar M, Kalele. Study of profile of deaths due to poisoning in Bhavnagar. JIAFM 2011Oct-Dec; 33(4):311-6.
19. Kumar NH, Reddy PS. A study of poisoning cases at Harsha hospital Nelamangala, Bangalore Rural. Medicolegal update 2013Jan-Jun; 13(1):168-70.
20. Tapse SP, Shetty VB, Jinturkar AD. Profile of fatal poisoning in and around Bidar, Karnataka. IJFMT 2012Jan-Jun; 6(1):127-9.
21. Pawan T, Mohan RS, Kalita R, Nitin D. Study of suicidal poisoning cases in tertiary care hospital in Central India. Medicolegal update 2012Jan-Jun; 12(1):96-8.
22. Joshi Sc, Prakash C, Joshi A, Joshi G. Profile of organophorous poisoning at tertiary care hospital in Uttarakhand. JIAFM 2013Oct-Dec; 35(4):346-8.
23. Haloi M, Haloi MD, Patowary A. Death due to poisoning in district of Kamrup, Assam a Medicolegal study. IJAFM 2013Jan-Mar; 35(1):17-20.