Pattern of chemical poisoning in baghdad 2012

Pattern of Chemical Poisoning among Consultation Requests to Poisoning

Consultation Center, Iraq during the year 2012: A record based study

Submitted byDr. Munir Talib SalmanIraq FETP- 2nd.cohort

Supervised byDr. Ahmed Sameer Al-nuaimi M.B.Ch.B. PhD

Introduction: Large numbers of people are injured or die

each year as a result of exposure to chemicals.An estimated 346,000 people died worldwide

from unintentional chemical poisoning. WHO 2004 91% of those deaths occurred in low- and

middle income countries. Nearly a million people die each year as a

result of suicide chemicals account for a significant number of these deaths.

Objectives: To identify the positive predictive value of referred samples

to the Iraq Poisoning Consultation Center (IPCC). Assess the association of age, gender, type of laboratory

sample, chief complaint and type of communication with the positive predictive value of referred samples to the IPCC. To list types of External Chemical Poisoning (ECP)

and order them by frequency. Describe the epidemiology of cases by person time and place

model.

Patients and Methods: Study design:

A cross-sectional record based study design.Study sample:

All Chemical Poisoning consultations referred to the IPCC during the year 2012. Data collection:

The data will be obtained from: IPCC report form , laboratory results files and Request papers.

Results: Socio-demographic variables of

total registered cases:

Male composed 58% of the total

sample.

Mean age of the total sample was 24.3

year m 18 (SD).

IPCC registered cases, age distribution, total 1705 case, 2012.

67%

IPCC registered cases, age distribution, total 1705 case, 2012.

>1_1011_20

21_3031_40

41_5051_60

61_7071_80

80_900%

10%20%30%40%50%60%70%80%90%

100%

MaleFemale

IPCC cases by age group crosstab gender total 1705 cases, 2102.

>1_1011_20

21_3031_40

41_5051_60

61_7071_80

80_900%

10%20%30%40%50%60%70%80%90%

100%

MaleFemale

Female=52%/out of age group11-20

=58%

IPCC cases by age group crosstab gender total 1705 cases, 2102.

Province N %Misan 41 2.4Babylon 40 2.3Thee qar 38 2.2Diwaniya 30 1.8Basrah 22 1.3Karbala 21 1.2Mousel 14 0.8Muthanna 11 0.6

Province N %Baghdad 126

274.1

Anbar 86 5.0Diala 62 3.6Kut 54 3.2Najaf 9 0.5Saladin 9 0.5Kirkuk 3 0.2Sulaimaniya 1 0.1

IPCC registered cases by province 2012.

Province N %Misan 41 2.4Babylon 40 2.3Thee qar 38 2.2Diwaniya 30 1.8Basrah 22 1.3Karbala 21 1.2Mousel 14 0.8Muthanna 11 0.6

Province N %Baghdad 126

274.1

Anbar 86 5.0Diala 62 3.6Kut 54 3.2Najaf 9 0.5Saladin 9 0.5Kirkuk 3 0.2Sulaimaniya 1 0.1

IPCC registered cases by province 2012.

IPCC Total registered cases1705

Evidence compatible with significant

poisoning575 33.7%

Not significant poisoning results including the not

done samples1130 66.3%

External chemical poisoning(ECP)180 31.3%

Internal chemical poisoning (ICP) 395 68.7%

.

Hierarchy of IPCC registered cases 2012. workload characterization.

1. Type of communication involved

N %

direct contact 22 1.7phone call 1 0.1written request 130

7 98.3Total 133

0100.

0

2. Status of patientER 243 19.0Non ER 103

5 81.0Total 127

8100.

0

Frequency Distribution of IPCC Database by variables describing workload 2012.


N %


7 98.3Total 133

0100.

0


5 81.0Total 127

8100.

0



N %


7 98.3Total 133

0100.

0


5 81.0Total 127

8100.

0


Negative Positive Totalp valueN % N % N %

Gender 0.6[NS]Male 577 63.8 327 36.2 904 100.0Female 414 62.5 248 37.5 662 100.0 ..

Age group (years) <0.001< 5 child 220 82.1 48 17.9 268 100.05-9 years 92 69.2 41 30.8 133 100.0Teenagers (10-17) 136 59.1 94 40.9 230 100.0Young adults (18-49) 446 59.0 310 41.0 756 100.0Middle age/elderly (50+) 97 54.2 82 45.8 179 100.0

IPCC Laboratory significant results among total cases in relation to selected explanatory (independent) variables :









<0.04 Gastric lavage

Negative 990 63.4 571 36.6 1561 100 Positive 1 20 4 80 5 100

Urine sample <0.001 Negative 580 86.3 92 13.7 672 100 Positive 411 46 483 54 894 100

Blood/serum sample <0.001 Negative 421 51.9 390 48.1 811 100 Positive 570 75.5 185 24.5 755 100

Laboratory samples


Cont. IPCC Laboratory significant results among total cases in relation to selected explanatory (independent) variables :

<0.04 Gastric lavage

Negative 990 63.4 571 36.6 1561 100 Positive 1 20 4 80 5 100

Urine sample <0.001 Negative 580 86.3 92 13.7 672 100 Positive 411 46 483 54 894 100

Blood/serum sample <0.001 Negative 421 51.9 390 48.1 811 100 Positive 570 75.5 185 24.5 755 100

Laboratory samples



<0.001Hepatic Related 159 40.8 231 59.2 390 100.0Gastrointestinal 64 68.1 30 31.9 94 100.0Neuropsychological 375 73.4 136 26.6 511 100.0Others 15 78.9 4 21.1 19 100.0Musculoskeletal and Dermatological 19 79.2 5 20.8 24 100.0

For check 97 80.2 24 19.8 121 100.0Renal / respiratory related 16 84.2 3 15.8 19 100.0


Chief complaint


<0.001Hepatic Related 159 40.8 231 59.2 390 100.0Gastrointestinal 64 68.1 30 31.9 94 100.0Neuropsychological 375 73.4 136 26.6 511 100.0Others 15 78.9 4 21.1 19 100.0Musculoskeletal and Dermatological 19 79.2 5 20.8 24 100.0

For check 97 80.2 24 19.8 121 100.0Renal / respiratory related 16 84.2 3 15.8 19 100.0


Chief complaint


IPCC; ECP (significant) cases characterization:

Gender N %Male 100 55.6Female 80 44.4Total 180 55.6..Age group (years) N %< 5 child 31 17.25-9 years 9 5Teenagers (10-17) 22 12.2Young adults (18-49) 105 58.3Middle age /elderly 13 7.2Total 180 100

Frequency distribution of cases with significant poisoning of ECP by age and gender 2012.






= 22.2


Male Female

Total

N % N % N %Age group (years)< 5 child 17 54.

8 14 45.2 31 100.05-9 years 6 66.

7 3 33.3 9 100.0Teenagers (10-17) 5 22.

7 17 77.3 22 100.0Young adults (18-49) 63 60.

0 42 40.0 105 100.0

Middle age /elderly 9 69.

2 4 30.8 13 100.0

Gender composition by age group among cases with significant poisoning of ECP, 2012.

P (chi-square) = 0.02

Male Female

Total

N % N % N %Age group (years)< 5 child 17 54.

8 14 45.2 31 100.05-9 years 6 66.

7 3 33.3 9 100.0Teenagers (10-17) 5 22.

7 17 77.3 22 100.0Young adults (18-49) 63 60.

0 42 40.0 105 100.0

Middle age /elderly 9 69.

2 4 30.8 13 100.0

P (chi-square) = 0.02

Gender composition by age group among cases with significant poisoning of ECP, 2012.

Category of chemical involved N %Sedatives 57 31.

7Analgesics 43 23.

9Insecticide 25 13.

9Rodenticide 11 6.1Other Drugs 11 6.1Heavy Metals-external 33 18.

3Total 18

0100

Frequency distribution of cases with significant poisoningdue to external causes (n=180) by type poisoning events 2012.


7Analgesics 43 23.

9Insecticide 25 13.


3Total 18

0100


61.7%


7Analgesics 43 23.

9Insecticide 25 13.


3Total 18

0100


20%


7Analgesics 43 23.

9Insecticide 25 13.


3Total 18

0100


Type of intention N %Suicide 51 33.3Unknown 21 13.7Abuse 20 13.1Accidental 20 13.1Environmental 15 9.8Misuse 12 7.8Occupational 9 5.9Criminal 2 1.3Other 2 1.3Therapeutic Error 1 .7Total 153 100.0Missing= 27 15.0


Cont.

The association between gender and selected characteristics of cases with significant poisoning of external origin 2012...

Male Female PN % N %

Category of chemical involved

<0.001

Analgesics / other drugs

19 19 35 43.8

Sedatives 43 43 14 17.5

Insecticide / rodenticide

14 14 22 27.5

Heavy metals-ECP 24 24 9 11.3

Total 100 100 80 100Intentional Vs Non-intentional

0.19[N]

intentional 38 45 38 56unintentional 46 55 30 44Total 84 100 68 100




<0.001


19 19 35 43.8

Sedatives 43 43 14 17.5


14 14 22 27.5



0.19[N]





<0.001


19 19 35 43.8

Sedatives 43 43 14 17.5


14 14 22 27.5



0.19[N]


January

Fabruary

March

AprilMay June

JulyAuge

st

Septem

ber

October

November

December

0

5

10

15

20

25

30

Months

No.

of E

CP c

ases

IPCC Significant(positive) ECP cases by date 2012

January

Fabruary

March

AprilMay June

JulyAuge

st

Septem

ber

October

November

December

0

5

10

15

20

25

30

Months

No.

of E

CP c

ases

Spring 8% Summer 51% Autumn 23%W

inte

r 9%

Win

ter 9

%

IPCC Significant(positive) ECP cases by date 2012

1. Teenager and older has higher

probability to have significant poisoning than other age groups.

2. Gastric lavage and urine samples provide a higher yield for significant poisoning results compared to blood/serum samples.

3. A very low phone call usage was observed within the IPCC services.

5. Overall ECP, drugs were the predominant agents implicated, the commonest offender drugs found to be sedative group.

Conclusions:

1. Revitalise the phone call within the IPCC

2. Collaboration between IPCC with other health facilities and other stakeholders to establishing a poisoning surveillance center.

3. Reactivation of legislations that limit the prescriptions and supply of drugs especially sedatives.

4. Implantation of educational program within the educational institutions about the ECP risks and safe storage play vital role in controlling and limitation of drugs poisoning.

Recommendations:

Thank you

Date post:	15-Apr-2017
Category:	Health & Medicine
Upload:	munir-salman
View:	143 times
Download:	1 times

Pattern of chemical poisoning in baghdad 2012

Health & Medicine