Profile of poisoning cases in district and medical college hospitals of north Karnataka
Author(s): Vinay. B. Shetty, Gurudatta S. Pawar, P. I. Inamadar
Vol. 2, No. 2 (2008-07 - 2008-12)
Vinay. B. Shetty٭, Gurudatta S. Pawar٭٭, P. I. Inamadar٭٭٭
٭Assistant Professor, ٭٭Professor and Director Post Graduate Studies, ٭٭٭Associate Professor, Department of Forensic Medicine,
J J M Medical College, Davangere, Karnataka
Abstract
Morbidity and mortality due to poisoning is a world wide
problem. The pattern poisoning varies from Country to
country, place to place and changes over a period of time
due to various reasons.
The present study is a prospective study conducted in
District and Al – Ameen Medical college hospitals of Bijapur (North Karnataka) during 2004-2005. Total 229 poisoning
cases were studied from OPD to IPD, followed from admission
to recovery or death in a systematic manner. All these cases
were analyzed with an objective of knowing age and sex
distribution of victims, commonest type of poison, the manner
of poisoning, occupation, and also the rural and urban trends.
Among 229 cases, male (51.15%) predominated females
(42.85%) with majority (42.25%) belonging to 21-30 yrs age
group. The commonest poison encountered was the
Organophosphorous compounds (73.14%). Suicide (77.33%)
was the commonest manner than accidental poisoning.
Agricultural farmers with rural background, belonging
to lower socioeconomic strata were the commonest victims
(78.29%) compared to others.
Key words: Poisoning cases, Organophosphorous compounds, Suicide, Accident
Introduction
Pattern of poisoning in a region depends upon variety
of factors, ranging from availability and access of poison to
the socio-economic status of the individual; also not to forget
of the cultural and religious influences. Poisoning forms a
major problem all over the world, though the type of poison,
the associated morbidity and mortality varies from place to
place and changes over a period of time 1.
Poisonings claim substantial numbers of lives throughout
the world, in the form of Suicide, Accident or Homicide.
Suicides by poisoning are increasing recently, possibly due to
the stress and strain of modern life style. This is in turn could
be from the changes occurring due to globalization and
urbanization. Extensive usage of chemicals in industries,
agricultural sector and domestic front is causing increased
accidental poisoning.
The traditional methods of suicide by drowning, hanging
etc. are being replaced by poisoning. The poisons and their
compounds are cheap and easily available with out any
questions or documentation, especially in developing
countries like India.
In our area of study the irrigation projects have definitely
contributed for the greenery of the region, but also given
way for indiscriminate usage of pesticides and weed killers
by the farmers who are looking for big yields. Thus these
poisonous substances are available in their backyards round
the clock. With this back drop of factors prompted us to study
the profile or trend of poisoning cases which were admitted
or autopsied at District and Al-Ameen Medical college hospital
Bijapur [North Karnataka]. The aim was to collect
authenticated data of the poisoning cases and analyze them
in all respects. These kinds of data are in turn helpful for the
concerned authorities to look for solutions to the problem
and evolve necessary policies to reduce or prevent them.
Materials and methods
Study design- Descriptive
Study period- 01-11-2004 to 31-10-2005
Study Method- A total of 229 poisoning cases admitted
and autopsied at District hospital and Al-Ameen medical College
Hospital, Bijapur (North Karnataka) were analyzed during
2004-2005 ( out of these 54 cases were that of Snake bite ,
which were excluded in this present study).
The victims were studied from the time of OPD admission
to wards and followed up till recovery or death. Data were
collected in a Performa, from the history given by the patient,
hospital records, police inquest reports, post mortem reports,
FSL reports and also personal interview with the concerned
relatives. The emphasis was on the age, sex, rural / urban,
type of poison and manner of poisoning. All data was
documented and statistically analyzed.
Results
Among 229 cases of poisoning studied during 2004 -
2005, majority of the victims were males (57.15%) (Table No.1)
and male and female ratio was 1.3:1. 21-30 yrs (42.29%)
(Table No.2) was the commonest age group involved and were
residents of (in and around) Bijapur.
Table 1: Sex wise Distribution of victims.
Age
Males
Females
No
%
No
%
0-10
1
1.00
3
4.00
11-20
11
11.00
28
37.33
21-30
44
44.00
30
40.00
31-40
28
28.00
9
12.00
41-50
10
10.00
5
6.67
51-60
4
4.00
0
0.00
61 and Above
2
2.00
0
0.00
Total
100
100.00
75
100.00
Table 2: Age wise distribution of victims.
Age
No of patients
Percentage
0-10
4
2.29
11-20
40
22.86
21-30
74
42.29
31-40
37
21.14
41-50
14
8.00
51-60
4
2.29
61 and Above
2
1.14
Total
175
100
Table 3: Commonest type of poison.
Poison
No of Cases
Percentage
Organophosphorus compounds
128
73.14
Diazepam
16
9.14
Rat poison
12
6.86
Barbiturates
6
3.43
Kerosene
2
1.14
Alcohol
2
1.14
Datura
5
2.86
Endrin
2
1.14
Bhang
1
0.57
Phenol
1
0.57
Total
175
100.00
Table 4: Manner of poisoning.
Manner
Males
Females
No
%
No
%
Accidental
21
21.00
17
22.67
Suicidal
78
78.00
58
77.33
Unknown
1
1.00
0
0.00
Homicidal
0
0.00
0
0.00
Total
100
100.00
75
100.00
Table 5: Occupation of Victims.
Occupation
No of patients
Percentage
Farmer
63
36.00
House wife/ Labourer
33
18.86
Labourer
41
23.43
Student
19
10.86
Driver
7
4.00
Clerk
5
2.86
Others
7
4.00
Total
175
100
Table 6: Rural/Urban distribution of victims.
Areas
No of patients
Percentage
Rural
133
76.00
Urban
42
24.00
Total
175
100.00
Table 7: Socio- economic status of victims.
Status
No of Cases
Percentage
Lower class
127
72.57
Middle class
45
25.71
Upper class
2
1.14
Unknown
1
0.57
Total
175
100
The commonest type of poison encountered was the
compounds of Organophosphorus (73.14%) (Table No.3) and
last was the Phenol with single case (0.57%).
The commonest manner (Table No.4) of poisoning was
suicide both in male (78%) and female (77.33%) followed by
accidental poisoning accounting for 21% and 22.67% in male
and female respectively. Not a single case of homicidal
poisoning was observed in our study. Occupation wise (Table
No 5) agricultural farmers topped the list (36%) followed by
laborers (23.43%). Most of the victims belonged to rural area
i.e. 133 (76%) compared to urban area (Table No.6).
Persons of low socio-economic strata are the commonest
victims (72.57%) followed by middle class (25.71%) and least
involved were the upper class (1.14%) (Table No.7).
Discussion
The present scenario of globalization, urbanization and
industrialization is creating lot of stress on individuals in
particular as well as on the society in common. Persons who
are not able to sustain these stressful situations are the major
victims of either suicidal or accidental poisonings.
Males out numbered the females and majority were in
the age group of 21-30 yrs (42.25%). This particular age group
is the most active phase of life for men who are involved
mentally, physically and socially. They are exposed to day to
day stresses of life than females. This observation is consistent
with previous studies2,3,4.
The commonest poison observed was the
Organophosphorus compounds and least encountered was
the Phenol. This is consistent with the observations made by
earlier studies5,6,7. Suicide being the commonest manner
of poisoning (77.33%) with agricultural farmers being the
major victims (78.29%) residing in rural setup (76%) belonging
to lower socio economic strata (72.5%).These observations
are similar to the other earlier workers4,5,8. This is possibly
due to illiteracy and poverty of the agricultural farmers
residing in rural parts. They solely depend on the agricultural
income for their living. Due to some reason (i.e. either lack of
water or flood) if they are not able to generate the required
income for their day to day living and commitments, they
may get frustrated and resort to suicide by these agricultural
insecticides, pesticides or weed killers which are available in
their backyard.
Even though the government and other agencies are
trying their best to prevent these unfortunate events by
various projects and programmes, but still the trend
continues. Knowing the pattern of poisoning in an area, not
only helps in early management of poisoning cases but also
suggests taking earliest preventive measures9.
Conclusion
The study clearly highlights the profile of poisoning in
North Karnataka area, showing that the males of 21-30 yrs
age group are the major victims. It also point towards the
commonest poison used i.e. Organophosphorous compounds
to commit suicide by agricultural farmers of rural area
belonging to lower socio-economic strata.
The incidence, trends of poisoning, the morbidity and
mortality due to poisoning can be possibly curtailed by
following means:
- Strict vigilance over the sale and distribution of
insecticides.
- Educating the users regarding the safety measures.
- Good treatment facilities (i.e. antidotes etc) at rural areas
like P H C’s and P H U’s.
- Establishing Poison Information Centers.
- Proper and correct implementation of social and economic
projects aimed for upliftment of the Rural poor and
downtrodden.
References
- Sharma B R, Harish Dasari, Sharma, Vivek Vij Krishnan.
Poisoning in Northern India ,changing trends, causes and
prevention there of. Med.Sci.Law. 2002 ; 42(3), 251-255.
- Escoffery T Carlos, Shirley E Suzane. Fatal poisoning in
Jamaica. A Coroner’s autopsy study from the University
hospital of West Indies ; 2004; 44(2),116 – 120.
- Peterson H , Brosstad F. Pattern of acute drug poisoning
in Oslo. Acta-Med-Scand. 1977 ; 201 (3).233-37.
- Dalal, Poisoning trends–a post mortem study. J.Ind.Acad.
Forensic Med. 1998; 20(2) ; 27 -31.
- Karlliedde Lakshman, Senanayake Nimal. Acute Organo
phosphorous insecticide poisoning in Sri Lanka.
For.Sci.Int.1988; 36, 97-100.
- Jamil H. Organo phosphorous insecticide poisoning. J.-
Pak- Med. Asso.1989 ; 39(2), 27 – 31.
#
- Dogra. Trends of pesticides consumption and poisoning
in District of Faridabad. (Haryana) Med. Legal Update,
1996 ; 1(2), 32 -34.
- Otto K R ,Spate H F. Suicidal trends in Urban and Rural
districts of Brandenburg, Psychiatr – Neurol –Med –
Psychol , 1975; 27 (4) ; 239 – 46.
- Kumar A, Vij K. Trends of poisoning in Chandigarh – A
six year autopsy study. Journal of Forensic Medicine and
Toxicology 2001; 18(1):8-11.
Vinay. B. Shetty٭, Gurudatta S. Pawar٭٭, P. I. Inamadar٭٭٭
٭Assistant Professor, ٭٭Professor and Director Post Graduate Studies, ٭٭٭Associate Professor, Department of Forensic Medicine, J J M Medical College, Davangere, Karnataka
Abstract
Morbidity and mortality due to poisoning is a world wide problem. The pattern poisoning varies from Country to country, place to place and changes over a period of time due to various reasons.
The present study is a prospective study conducted in District and Al – Ameen Medical college hospitals of Bijapur (North Karnataka) during 2004-2005. Total 229 poisoning cases were studied from OPD to IPD, followed from admission to recovery or death in a systematic manner. All these cases were analyzed with an objective of knowing age and sex distribution of victims, commonest type of poison, the manner of poisoning, occupation, and also the rural and urban trends. Among 229 cases, male (51.15%) predominated females (42.85%) with majority (42.25%) belonging to 21-30 yrs age group. The commonest poison encountered was the Organophosphorous compounds (73.14%). Suicide (77.33%) was the commonest manner than accidental poisoning. Agricultural farmers with rural background, belonging to lower socioeconomic strata were the commonest victims (78.29%) compared to others.
Key words: Poisoning cases, Organophosphorous compounds, Suicide, Accident
Introduction
Pattern of poisoning in a region depends upon variety of factors, ranging from availability and access of poison to the socio-economic status of the individual; also not to forget of the cultural and religious influences. Poisoning forms a major problem all over the world, though the type of poison, the associated morbidity and mortality varies from place to place and changes over a period of time 1.
Poisonings claim substantial numbers of lives throughout the world, in the form of Suicide, Accident or Homicide. Suicides by poisoning are increasing recently, possibly due to the stress and strain of modern life style. This is in turn could be from the changes occurring due to globalization and urbanization. Extensive usage of chemicals in industries, agricultural sector and domestic front is causing increased accidental poisoning.
The traditional methods of suicide by drowning, hanging etc. are being replaced by poisoning. The poisons and their compounds are cheap and easily available with out any questions or documentation, especially in developing countries like India.
In our area of study the irrigation projects have definitely contributed for the greenery of the region, but also given way for indiscriminate usage of pesticides and weed killers by the farmers who are looking for big yields. Thus these poisonous substances are available in their backyards round the clock. With this back drop of factors prompted us to study the profile or trend of poisoning cases which were admitted or autopsied at District and Al-Ameen Medical college hospital Bijapur [North Karnataka]. The aim was to collect authenticated data of the poisoning cases and analyze them in all respects. These kinds of data are in turn helpful for the concerned authorities to look for solutions to the problem and evolve necessary policies to reduce or prevent them.
Materials and methods
Study design- Descriptive
Study period- 01-11-2004 to 31-10-2005
Study Method- A total of 229 poisoning cases admitted
and autopsied at District hospital and Al-Ameen medical College
Hospital, Bijapur (North Karnataka) were analyzed during
2004-2005 ( out of these 54 cases were that of Snake bite ,
which were excluded in this present study).
The victims were studied from the time of OPD admission to wards and followed up till recovery or death. Data were collected in a Performa, from the history given by the patient, hospital records, police inquest reports, post mortem reports, FSL reports and also personal interview with the concerned relatives. The emphasis was on the age, sex, rural / urban, type of poison and manner of poisoning. All data was documented and statistically analyzed.
Results
Among 229 cases of poisoning studied during 2004 - 2005, majority of the victims were males (57.15%) (Table No.1) and male and female ratio was 1.3:1. 21-30 yrs (42.29%) (Table No.2) was the commonest age group involved and were residents of (in and around) Bijapur.
Table 1: Sex wise Distribution of victims.
| Age | Males | Females | ||
|---|---|---|---|---|
| No | % | No | % | |
| 0-10 | 1 | 1.00 | 3 | 4.00 |
| 11-20 | 11 | 11.00 | 28 | 37.33 |
| 21-30 | 44 | 44.00 | 30 | 40.00 |
| 31-40 | 28 | 28.00 | 9 | 12.00 |
| 41-50 | 10 | 10.00 | 5 | 6.67 |
| 51-60 | 4 | 4.00 | 0 | 0.00 |
| 61 and Above | 2 | 2.00 | 0 | 0.00 |
| Total | 100 | 100.00 | 75 | 100.00 |
Table 2: Age wise distribution of victims.
| Age | No of patients | Percentage |
|---|---|---|
| 0-10 | 4 | 2.29 |
| 11-20 | 40 | 22.86 |
| 21-30 | 74 | 42.29 |
| 31-40 | 37 | 21.14 |
| 41-50 | 14 | 8.00 |
| 51-60 | 4 | 2.29 |
| 61 and Above | 2 | 1.14 |
| Total | 175 | 100 |
Table 3: Commonest type of poison.
| Poison | No of Cases | Percentage |
|---|---|---|
| Organophosphorus compounds | 128 | 73.14 |
| Diazepam | 16 | 9.14 |
| Rat poison | 12 | 6.86 |
| Barbiturates | 6 | 3.43 |
| Kerosene | 2 | 1.14 |
| Alcohol | 2 | 1.14 |
| Datura | 5 | 2.86 |
| Endrin | 2 | 1.14 |
| Bhang | 1 | 0.57 |
| Phenol | 1 | 0.57 |
| Total | 175 | 100.00 |
Table 4: Manner of poisoning.
| Manner | Males | Females | ||
|---|---|---|---|---|
| No | % | No | % | |
| Accidental | 21 | 21.00 | 17 | 22.67 |
| Suicidal | 78 | 78.00 | 58 | 77.33 |
| Unknown | 1 | 1.00 | 0 | 0.00 |
| Homicidal | 0 | 0.00 | 0 | 0.00 |
| Total | 100 | 100.00 | 75 | 100.00 |
Table 5: Occupation of Victims.
| Occupation | No of patients | Percentage |
|---|---|---|
| Farmer | 63 | 36.00 |
| House wife/ Labourer | 33 | 18.86 |
| Labourer | 41 | 23.43 |
| Student | 19 | 10.86 |
| Driver | 7 | 4.00 |
| Clerk | 5 | 2.86 |
| Others | 7 | 4.00 |
| Total | 175 | 100 |
Table 6: Rural/Urban distribution of victims.
| Areas | No of patients | Percentage |
|---|---|---|
| Rural | 133 | 76.00 |
| Urban | 42 | 24.00 |
| Total | 175 | 100.00 |
Table 7: Socio- economic status of victims.
| Status | No of Cases | Percentage |
|---|---|---|
| Lower class | 127 | 72.57 |
| Middle class | 45 | 25.71 |
| Upper class | 2 | 1.14 |
| Unknown | 1 | 0.57 |
| Total | 175 | 100 |
The commonest type of poison encountered was the compounds of Organophosphorus (73.14%) (Table No.3) and last was the Phenol with single case (0.57%).
The commonest manner (Table No.4) of poisoning was suicide both in male (78%) and female (77.33%) followed by accidental poisoning accounting for 21% and 22.67% in male and female respectively. Not a single case of homicidal poisoning was observed in our study. Occupation wise (Table No 5) agricultural farmers topped the list (36%) followed by laborers (23.43%). Most of the victims belonged to rural area i.e. 133 (76%) compared to urban area (Table No.6). Persons of low socio-economic strata are the commonest victims (72.57%) followed by middle class (25.71%) and least involved were the upper class (1.14%) (Table No.7).
Discussion
The present scenario of globalization, urbanization and industrialization is creating lot of stress on individuals in particular as well as on the society in common. Persons who are not able to sustain these stressful situations are the major victims of either suicidal or accidental poisonings.
Males out numbered the females and majority were in the age group of 21-30 yrs (42.25%). This particular age group is the most active phase of life for men who are involved mentally, physically and socially. They are exposed to day to day stresses of life than females. This observation is consistent with previous studies2,3,4.
The commonest poison observed was the Organophosphorus compounds and least encountered was the Phenol. This is consistent with the observations made by earlier studies5,6,7. Suicide being the commonest manner of poisoning (77.33%) with agricultural farmers being the major victims (78.29%) residing in rural setup (76%) belonging to lower socio economic strata (72.5%).These observations are similar to the other earlier workers4,5,8. This is possibly due to illiteracy and poverty of the agricultural farmers residing in rural parts. They solely depend on the agricultural income for their living. Due to some reason (i.e. either lack of water or flood) if they are not able to generate the required income for their day to day living and commitments, they may get frustrated and resort to suicide by these agricultural insecticides, pesticides or weed killers which are available in their backyard.
Even though the government and other agencies are trying their best to prevent these unfortunate events by various projects and programmes, but still the trend continues. Knowing the pattern of poisoning in an area, not only helps in early management of poisoning cases but also suggests taking earliest preventive measures9.
Conclusion
The study clearly highlights the profile of poisoning in North Karnataka area, showing that the males of 21-30 yrs age group are the major victims. It also point towards the commonest poison used i.e. Organophosphorous compounds to commit suicide by agricultural farmers of rural area belonging to lower socio-economic strata.
The incidence, trends of poisoning, the morbidity and mortality due to poisoning can be possibly curtailed by following means:
- Strict vigilance over the sale and distribution of insecticides.
- Educating the users regarding the safety measures.
- Good treatment facilities (i.e. antidotes etc) at rural areas like P H C’s and P H U’s.
- Establishing Poison Information Centers.
- Proper and correct implementation of social and economic projects aimed for upliftment of the Rural poor and downtrodden.
References
- Sharma B R, Harish Dasari, Sharma, Vivek Vij Krishnan. Poisoning in Northern India ,changing trends, causes and prevention there of. Med.Sci.Law. 2002 ; 42(3), 251-255.
- Escoffery T Carlos, Shirley E Suzane. Fatal poisoning in Jamaica. A Coroner’s autopsy study from the University hospital of West Indies ; 2004; 44(2),116 – 120.
- Peterson H , Brosstad F. Pattern of acute drug poisoning in Oslo. Acta-Med-Scand. 1977 ; 201 (3).233-37.
- Dalal, Poisoning trends–a post mortem study. J.Ind.Acad. Forensic Med. 1998; 20(2) ; 27 -31.
- Karlliedde Lakshman, Senanayake Nimal. Acute Organo phosphorous insecticide poisoning in Sri Lanka. For.Sci.Int.1988; 36, 97-100.
- Jamil H. Organo phosphorous insecticide poisoning. J.- Pak- Med. Asso.1989 ; 39(2), 27 – 31. #
- Dogra. Trends of pesticides consumption and poisoning in District of Faridabad. (Haryana) Med. Legal Update, 1996 ; 1(2), 32 -34.
- Otto K R ,Spate H F. Suicidal trends in Urban and Rural districts of Brandenburg, Psychiatr – Neurol –Med – Psychol , 1975; 27 (4) ; 239 – 46.
- Kumar A, Vij K. Trends of poisoning in Chandigarh – A six year autopsy study. Journal of Forensic Medicine and Toxicology 2001; 18(1):8-11.
