Poisoning in children is still an important public health problem and represents a frequent cause of admission in      pediatric wards and leading cause of injury-related deaths in children and adolescents. Majority of poisoning cases in children are unintentional and most often occurs at home through ingestion of any poisonous substance. The incidence of childhood poisoning in various studies across the globe ranges from 0.33% to 7.6%. Poisoning account for 1- 6% of bed occupancy in pediatric hospitals and 3.9% in pediatric intensive care unit in India.^1-5

The most frequent implicated sources of poisoning are adult medicines(like analgesics such as paracetamol), Alcohol and its related substances (like coolants, paints, detergents ,solvents, paint removers, fuel etc.) , Personal care products (like cosmetic products such as bleach),Household Products(like baking powder, metal polish, vinegar, sulfuric acid etc.), Pesticides(likeorgano-phosphates ,carbamates etc.),Hydrocarbons(like gasoline, kerosene, paint removers etc.), Household Plantsand cleaning products. Poisoning in children commonly occurs through direct ingestion, inhalation, absorption through the skin and contact with eyes.⁶

The pattern of childhood poisoning changes with time according to age group and they differ from country to country. Relatively little research has been published with respect to types of Poisoning in children in Himachal Pradesh. Epidemiological surveillance specific for each country and state is necessary to determine the extent & characteristics of this problem, according to which related preventive measures can be taken. Therefore, this study aimed to evaluate the pattern of Poisoning in children admitted in Pediatric wards of a Indira Gandhi Medical College, Shimla.

Objectives of the Study

To evaluate the pattern of Poisoning in children admitted in Pediatric wards of a Indira Gandhi Medical College, Shimla

• Research Approach -Descriptive

• Research Design- A retrospective review

• Study area: Pediatric wards of Indira Gandhi Medical College, Shimla

• Study duration- between January to December 2021

• Study population-  Children  admitted in the Pediatric wards of Indira Gandhi Medical College, Shimla due to poisoning

• Sample size-  All the children  admitted in the Pediatric wards of Indira Gandhi Medical College, Shimla due to poisoning between January to December 2021

• Data collection: A Pre tested semi structured questionnaire containing questions regarding socio-demography and pattern of poisoning was created and used for data collection. Data regarding age, gender & type of poisoning was retrieved. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc. 

• Permission- obtained from the concerned authorities of Kamla Nehru Hospital ,Shimla

• Ethical Considerations- Participants confidentiality and anonymity was maintained.

Retrospective review of records of all the children admitted in the Pediatric wards of Indira Gandhi Medical College, Shimla due to poisoning from January to December 2021was conducted. 

A total of 168 children were admitted in pediatric wards of Indira Gandhi Medical College, Shimla due to poisoning. Among them 67(39.9%) were males while 101(60.1%) were females. Among the total, 33(19.6%) were ≤ 5 years of age , 27(16.1%) were between 6 to 10 years, 33(19.6%) were between 11 to 15 years while 75(44.6%) were between 16-18 years of age. Mean age of them was 11.95±5.532 years.(Figure-1)

Figure-1: Age and gender distribution of study participants

In the present study, maximum poisoning cases 55 (32.7%)  were of Organophosphates poisoning, followed by 14(8.3%) of Phosphide poisoning, 13(7.7%) of Herbicide poisoning, 7(4.2%) of Mushroom poisoning,  6 (3.6%)  of Hydrocarbon/kerosene poisoning, 4( 2.4%) cases each  of Berries , Corrosive ,Pyrethroid & Rat poison, 3(1.8%) cases each of   Paraquat & Opiod poisoning, 2(1.2%) cases of  Carbamate poisoning and 1(0.6%) case each of Camphor, Mixed, Acetone, Paracetamol, Sanitizer, Phenytoin, Calcium, Melamine, Cocaine &Napthalene poisoning. Beside these,  39(23.2%) cases were of poisoning with Unknown substances.(Table-1)

Table-1: Pattern of poisoning among study participants

Childhood Poisoning has been identified as a frequent cause of admission in Pediatrics Emergency Departments worldwide. Nevertheless, information on this public health problem remains scare. Epidemiological studies in each country and state might help in defining the problem situation and to understand how this issue can be prevented and dealt with.

Based on these considerations, we have conducted this retrospective study- including all the children admitted in the Pediatric wards of Indira Gandhi Medical College, Shimla due to poisoning between January to December 2021. A total of 168 children were admitted due to poisoning. Among them 67(39.9%) were males while 101(60.1%) were females.Similar to our findings, in the study done by Sabiha Sahin et al², among the total children who were reffered to the emergency department due to acute poisoning, 48.4% of patients were boys and 51.6% were girls. But many studies from India and other countries across the globe there were relatively higher proportion of boys in childhood poisoning cases.^7-11

In the present study,among the total, 33(19.6%) were ≤ 5 years of age , 27 were between 6 to 10 years, 33(19.6%)  were between 11 to 15 years while 75(44.6%) were between 16-18 years of age. Contrary to our findings, in the study done by Sabiha Sahin et al² approximately half of the patients were less than four years old which was opposite to our study.Various other studies also showed that <5 year age group  is vulnerable to household accidental poisoning due to inquisitive nature, oral exploratory nature, and recently acquired mobility and hand skills.^3,4,5,12

In the present study, maximum poisoning cases 55 (32.7%)  were of Organophosphates poisoning, followed by 14(8.3%) of Phosphide poisoning, 13(7.7%) of Herbicide poisoning, 7(4.2%) of Mushroom poisoning,  6 (3.6%)  of Hydrocarbon/kerosene poisoning, 4( 2.4%) cases each  of Berries , Corrosive , Pyrethroid & Rat poison, 3(1.8%) cases each of   Paraquat & Opiod poisoning, 2(1.2%) cases of  Carbamate poisoning and 1(0.6%) case each of Camphor, Mixed, Acetone, Paracetamol, Sanitizer, Phenytoin, Calcium, Melamine, Cocaine & Napthalene poisoning. Beside these,  39(23.2%) cases were of poisoning with Unknown substances.In the present study the probable reason for higher incidence of poisoning by insecticides & pesticides could be the involvement of higher age group , more involvement of rural children where these substances are used for agricultural purposes for being the main occupation of people in Himachal Pradesh,  easily availability, lack of legislation for sale, and lack of identifiable storage practices.

Similar to our results, study by Bindu Aggarwal¹described that the most commonly ingested poisoning agent was kerosene (28.6%) in <12 age group and organo-phosphorus compound (21.6%) in adolescents.Contrary to our results, in the study done by Sabiha Sahin et al², Drugs were the most common agent causing the poisoning (48.3%), followed by ingestion of corrosive substance (23.1%) and carbon monoxide (CO) intoxication (12.5%).

Nowneet Kumar Bhat et al¹³, reported that Insecticides (37.61%), drugs (25.64%) and kerosene oil (18.8%) were the substances most frequently implicated in their patients. Another study by Diganta Saikia et al¹⁴ described that household chemicals were ingested in 54.25% cases  followed by the pesticides and insecticides in 18.3% cases followed by medicines and drugs, i.e. by 11% followed by unknown substances, i.e. 8.5%, followed by workplace products, i.e. 6.5%.Similar to our finding, in the study done by Zhu Liet al¹⁵, the three most common poisonous substances were pesticides, drugs, and rat poisons.

Indian researchers like S Rathore et al¹⁶., Brata Ghosh et al¹⁷ and U Kohli et al¹⁸ have reported kerosene to be the most commonly encountered  poisonous agent in urban areas and overall incidence too while studies from the rural part of India done by NK Bhat et al¹⁹ reported insecticides to be the most common agent causing acute childhood poisonings.

The easy-access packaging and colorful appearance of pesticides and herbicides increases their danger to young children. Public health authorities should impose stricter regulations on the packaging of pesticides to prevent ingestion.

Caregivers should be responsible and cautious while selecting, storing, and informing children about the dangers of household supplies. It is recommended that while bringing the child to the hospital or any healthcare facility; make sure to bring the suspected source of poisoning, including all its packaging details. Make sure that it is carefully and securely packaged for the protection of everyone.^20-22

As the child is being examined, the concerened healthcare providers’ must explore every minute to  minute detail regarding the type of poison to determine the best medical management for the child. Important details that are mainly required include the suspected substance involved, its dose or amount ingested (an estimated amount), type of preparation (liquid, capsule or tablet) and type of route (ingested, inhaled, eaten or in contact with the eyes or skin).^20-22

The best way to manage childhood poisoning is to prevent them from happening in the first place. Other ways are usage of proper storage options for dangerous& poisonous objects and place them in areas where children cannot reach & cannot easily open these. Always use the original packaging or bottles for household items and do not transfer contents of any container to another one that is labelled for a different substance or material. One must throw away expired medicines, Keep them in their original packaging, away from young children and while giving medications to a child, always double check the bottle or container before administering the medicine.^20-22

Limitations 

Our research has some limitations. It was done retrospectively. So, it is possible that not all medical data regarding pattern of poisoning have been recorded into the files of children in pediatric wards of IGMC, Shimla.

Preventable childhood poisonings are still a significant cause of morbidity in Himachal Pradesh. Pesticides and herbicides are the most frequent agents causing poisoning. We need to take measures to prevent poisoning in both preadolescents and adolescents age groups. Various preventive measures such as better child resistant storage practices, strengthening of Pesticide Act and health education including adolescent counseling are necessary to prevent childhood poisonings.

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