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Indian Journal of Forensic Medicine & Toxicology

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

  1. 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.
  2. 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.
  3. Peterson H , Brosstad F. Pattern of acute drug poisoning in Oslo. Acta-Med-Scand. 1977 ; 201 (3).233-37.
  4. Dalal, Poisoning trends–a post mortem study. J.Ind.Acad. Forensic Med. 1998; 20(2) ; 27 -31.
  5. Karlliedde Lakshman, Senanayake Nimal. Acute Organo phosphorous insecticide poisoning in Sri Lanka. For.Sci.Int.1988; 36, 97-100.
  6. Jamil H. Organo phosphorous insecticide poisoning. J.- Pak- Med. Asso.1989 ; 39(2), 27 – 31. #
  7. Dogra. Trends of pesticides consumption and poisoning in District of Faridabad. (Haryana) Med. Legal Update, 1996 ; 1(2), 32 -34.
  8. Otto K R ,Spate H F. Suicidal trends in Urban and Rural districts of Brandenburg, Psychiatr – Neurol –Med – Psychol , 1975; 27 (4) ; 239 – 46.
  9. 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.
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