Epidemiology of accidental home poisoning in Riyadh (Saudi Arabia)

Sociodemographic Characteristics and Risk Factors for Childhood Poisoning Reported by Parents at a Tertiary Care Teaching Hospital

Background Childhood poisoning is a major health problem. Mostly, it is accidental and associated with low morbidity and mortality. The association between sociodemographic factors and childhood injury rates could be used for improvement to prevent and reduce such injuries. Childhood poisoning is preventable through appropriate education and judicious storage of drugs and household chemicals that might help in reducing and eliminating the accidental ingestion of toxic materials at home. Objectives To recognize the potential risk factors that might be associated with childhood home poisoning in Riyadh City, Kingdom of Saudi Arabia. Design A survey-based questionnaire study. Setting A tertiary care teaching hospital in Riyadh City. Patients and methods A structured questionnaire was created, which included questions on the poisoning incidence, home medication history, and possible risk factors for poisoning and the sociodemographic characteristics, and was disseminated to individuals who visited the King Khalid University Hospital. Main outcome measures Demographic characteristics of participants and risk factors related to childhood poisoning. Results The study included 152 randomly selected participants, 62 men (40.79%) and 90 women (59.21%). Self-ingestion was reported to be the most common mode of poisoning 28/44 (63.6%). The appearance of clinical manifestations suggesting poisoning was reported to be the most frequent method of discovery of children poisoning 20/44 (45.5%). Thirty-six out of the 44 respondents (81.8%) with a positive history of childhood poisoning in their family transferred their children to a hospital immediately. Drugs were the most common causative agent reported for poisoning among the respondents 21/44 (47.7%). Conclusion Accidental and non-intentional self-ingestion still presents as a major mode of childhood home poisoning. Despite the significant advancement in the lifestyle among the majority of Saudi Arabian regions, especially the capital city Riyadh, childhood poisoning remains a significant cause of morbidity and possible mortality. Creating health education and prevention programs might help to prevent such serious preventable problems. Limitations The limited number of participants may not reflect the whole population living in Riyadh City, hence, interpretation of the study results might be taken cautiously. Conflict of interest There was no conflict of interest.

Evaluation of poisoning cases admitted to pediatric emergency department

Background

Every year, more than one million children lose their lives due to preventable accidents. Poisoning is the most common among these accidents.

Objective

In this study, we investigated the demographic and clinical characteristics of poisoning cases referred to the pediatric emergency department.

Methods

The cases (0–18 years old) related to complaints of intoxication in the pediatric emergency department between January 1, 2017, and December 31, 2017, were examined retrospectively.

Results

The study included 453 patients, with 202 (46.4%) female and 233 (53.6%) male patients. The mean age of the patients was 51.12 months. The most frequent poisoning agents were 211 (46.6%) household cleaning products and 172 (38%) drugs. When the mechanism of poisoning was examined, it was determined that 377 (83.2%) cases were accidental and 47 (10.4%) cases were suicide attempts. It was observed that 286 (45.8%) items were not in original packaging and 95% of those in original packaging were not locked.

Conclusion

To avoid childhood poisoning that may have widespread and serious consequences, the poisonous products should be sold with locked covers and kept in places where children cannot reach them.

An epidemiological snapshot of toxicological exposure in children 12 years of age and younger in Riyadh

BACKGROUND

Poisoning among the pediatric population is an important public health concern that is responsible for frequent pediatric emergency department visits and hospital admissions. Surveillance of poisoning cases is essential for designing and implementing effective preventive strategies.

OBJECTIVE

Describe the characteristics of acute poison exposure and related therapeutic interventions in children aged 12 years and younger.

DESIGN

Prospective, descriptive cross-sectional study.

SETTING

Two pediatric emergency departments in Riyadh.

PATIENTS AND METHODS

We prospectively reviewed pediatric poisonings that presented to emergency departments over a period of two years.

MAIN OUTCOME MEASURES

Epidemiological aspects of pediatric poisoning Riyadh.

SAMPLE SIZE

1035 patients.

RESULTS

The median (IQR) age at the time of exposure was 27 (23-42) months. The most frequently involved substance class was toxic household products in children younger than 6 years and pesticides in children 6 years or older. A frequently involved single agent was paracetamol in younger and older children. The majority of patients (78.7%) were completely asymptomatic at the time of presentation and during the observation period. Almost half of the exposure incidents (47.8%) needed no intervention. Most exposure incidents (95%) did not require any pharmacological support and most (87%) did not require nonpharmacological intervention. Eight (0.7%) patients required intubation and mechanical ventilation. Activated charcoal was administered for 27% of cases. Gastric lavage, whole bowel irrigation, and ipecac were used in a few cases (1%, 0.3%, and 0.1%, respectively). Enhanced elimination interventions were performed for only 0.5% of exposure cases. Only two patients died.

CONCLUSIONS

Household products were the commonest reason for pediatric poisonings in Saudi Arabia and most of them were asymptomatic. Our results suggest a need for strategic plans for prevention and care.

LIMITATIONS

May not be representative of the experiences and practices of smaller hospitals in remote regions of the country.

CONFLICT OF INTEREST

None.

Social determinants of health associated with childhood accidents at home: An integrative review

OBJECTIVE

to analyze the factors associated with childhood accidents at home according to the levels of the social determinants of health.

METHOD

integrative review of the literature, with research in databases CINAHL, LILACS and PubMed, with the following main descriptors: child; social determinants of health; accidentes, home. We included 31 studies that related the social determinants of health and childhood accidents, in English, Portuguese and Spanish.

RESULTS

the proximal determinants identified were: age and sex of children, and ethnicity. Among the intermediate determinants of health, parental behavior, related to the supervision of an adult, prevailed. Parental employment and socioeconomic status were identified as distal determinants.

CONCLUSION

the age and sex of the child, besides direct supervision, were the determinants most associated with accidents. The distal determinants should be better studied because their relation with the occurrence of domestic accidents has not been sufficiently clarified.

The patterns of children poisoning cases in community teaching hospital in Riyadh, Saudi Arabia

Introduction

Although the majority of poisoning-related cases can be managed in home settings, reduction of hospital visits and admissions are still important challenge. Thousands of interventions are involved and the appropriate management of poisoning is therefore a major task and burden to any institution. Therefore, the present study was aimed to identify the most common classes of toxic substances and route of poisoning in children and to investigate the pattern of drug and chemical poisoning in suspected case fatalities, the subsequent need for hospital admission and arrival time to hospital.

Methods

A retrospective cross-sectional descriptive study of all registered poisoning cases of children reported to drug and poison information center at King Khaled University Hospital Riyadh, Saudi Arabia during the period of January 2010–December 2016.

Results

A total of 735 children presented to Pediatric Emergency Medicine with poisoning. Most of the cases were asymptomatic, and majority of children were arrived to the hospital in less than 3 h. The drugs were the most common cause of poisoning (70%) followed by chemical materials (29%), which is more common in children under 2 years comparing to other groups (p < 0.001). The route of poisoning was oral in the majority of cases (98.8%). The drugs most frequently ingested were analgesic (18.8%). Among the chemicals, pesticide products involved in (39.6%) of the cases, followed by cleaning products (25.9%) and cosmetic (22.8%).

Conclusion

The results found that the majority of poisoning cases occurred in children under the age of six and required only observation without treatment. These results necessitate the need for close cooperation between different governmental health-sectors to establish national epidemiological surveillance of poisoning events in Saudi Arabia to help to develop national plans to decrease the financial burden of emergency department congestion and hospital crowding.

Pattern of drug overdose and chemical poisoning among patients attending an emergency department, western Saudi Arabia

Poisoning is a medical emergency that represent a major health problem all over the world. Studies on drug overdose and chemical poisoning are very limited in Saudi Arabia (SA). We aimed to describe the current pattern and assess risk factors of drug overdose and chemical poisoning in King Khalid National Guard hospital, Jeddah, SA. Medical records of patients attended emergency department in King Khalid National Guard hospital during the period from January 2008 to December 2012 due to drug overdose and chemical poisoning were reviewed. A total of 129 cases were included in the study. The majority of the population was Saudi (97.7 %), and almost half of them were females (54.3 %). Children under 12 years were the most affected age group (44.2 %). Drug overdose was the most common cause of poisoning (92.2 %). Analgesics and non-steroidal anti-inflammatory drugs represented the highest percentage of used medications (20.4 %). The most commonly reported symptoms were symptoms of the central nervous system (57.4 %) followed by GIT symptoms (41.9 %). Intentional poisoning was reported in 34 cases (26.4 %). Female patients were significantly more likely to attempt suicide than male patients (OR = 7.22, 95 % CI = 1.70, 30.62). Children continue to be at high risk for medication and chemical poisoning. Accessibility to medications at homes encountered for most of poisoning cases among children. Implementing methods to raise public awareness and minimize children access to medications would significantly contribute to reducing burden of this problem on the community.

Epidemiology of Pediatric Acute Poisoning in Southern Iran: A Hospital-Based Study

OBJECTIVE

To determine the epidemiology of acute childhood poisoning in Shiraz, southern Iran.

METHODS

This was a prospective cross-sectional descriptive study, being performed in Nemazee and Dastgheib Hospitals affiliated with Shiraz University of Medical Sciences. The study included pediatric patients (<18 years) referred to our centers due to acute poisoning. Demographic and etiological factors were prospectively recorded and analyzed.

RESULTS

A total of 773 patients with mean age of 3.86 ± 1.5 years were recruited in the study. The most common group which included 352 (45.5%) patients, aged between 8 months and 5 years followed by 330 (42.6%) cases aged from 12-18 years. In majority of cases, poisoning was due to opium in 222 (23.5%) followed by analgesics in 181 (19.1%), which mostly included acetaminophen in 75(7.9%), anti-depressants in 170 (17.9%), anti-hypertensive drugs in 65 (6.8%) and hydrocarbons in 60 (6.3%). There were 260 (33.7%) boys and 513 (66.3%) girls. The poisoning occurred inadvertently in 387 (50.1%) cases while 298 (38.5%) patients committed suicide. Most cases (255 patients; 32.9%) were asymptomatic at presentation.

CONCLUSION

Our study substantiated the following findings: A) Alarmingly, opium is the most common cause of acute childhood poisoning in our area. B) Easy access to toxic material is the most common risk factor for acute childhood poisoning. C) Female predominance of acute childhood poisoning accompanied by high rate of suicidal attempts shows that psychiatric problems, especially depression is most common among young girls.

Pioneers of paediatrics: Professor Salah Abdelrahman Ali Taha, MD (U of K), DCH, PRCP (London), FRCP (Edin)

This article highlights the contributions of Professor Salah Abdelrahman Ali Taha (1927-1988), one of the pioneers in paediatrics in Sudan and Saudi Arabia. He graduated from Kitchener School of Medicine (renamed, Faculty of Medicine, University of Khartoum[U of K]) in 1952 and was awarded an MD from the U of K in 1973, having accomplished a survey on the prevalence and underlying causes of childhood malnutrition in 14 villages. His impact was remarkable in establishing child health services in Sudan and Saudi Arabia, and in laying the foundation of the Department of Pediatrics, College of Medicine, King Saud University. He was also an active researcher in various fields in child health, and was pioneering in those related to nutrition. Following his return to Sudan, Dr Salah A Taha was elected Member of Parliament from his rural district in Gezira State and was the Speaker of the House of Parliament in 1986.

Poison exposure and outcome of children admitted to a pediatric emergency department

BACKGROUND

This paper reports the characteristics, outcomes and clinical features of children with poisoning treated at an emergency department (ED).

METHODS

This retrospective study at an emergency department consisted of 140 children with poison exposure who were aged under 18 years. Their characteristics were analyzed in order to understand the differences between accidental and non-accidental poisoning. The poisonous materials were divided into two major categories (pharmaceuticals and non-pharmaceuticals) and their associations with patient outcomes were analyzed. Furthermore, the association was analyzed between the incidence of poison exposure and the season in which the poison exposure occurred.

RESULTS

The incidence of poison exposure was highest among adolescents and pre-school age children. Nonaccidental poisoning was more common in older girls and accidental poisoning was more common in younger boys (P<0.001). Neurological system agents were the most common cause of poisoning in the pharmaceutical group and cleansing products were the most common cause of poisoning in the non-pharmaceutical group. Neurological and gastrointestinal symptoms were the most common clinical presentations for the pharmaceutical and non-pharmaceutical groups, respectively. Furthermore, poisoning due to cleansing products and analgesics were associated with the longest duration of hospitalization. March was the highest risk month for pediatric poisoning (P=0.018).

CONCLUSIONS

Cleansing products and analgesics were associated with the longest duration of hospitalization and intentional poison was more common in girls.

Pattern and determinants of poisoning in a teaching hospital in Riyadh, Saudi Arabia

BACKGROUND

The Drug and Poison Information Center (DPIC) at King Khalid University Hospital, Riyadh, Saudi Arabia, was founded in 1983. Since then it has responded adequately to queries from medical and non-medical callers from all over the Kingdom. Queries ranged from simple material identification to poisoning cases.

OBJECTIVES

To assess the pattern and circumstances of poisoning in the Kingdom of Saudi Arabia through reviewing data from DPIC in King Khalid University hospitals.

METHODS

This is a retrospective study of referred cases and calls received by DPIC. All records and documentation forms during the study period were investigated.

RESULTS

This study included 1161 cases. There were 7.9% infants, 52.9% under 5 years old, 7.2% between 6-12 years old and 32.0% more than 12 years old. Number of males with toxic exposure was almost equal to that of females. More than 92% of cases were toxic exposure through oral route. Causes of poisoning include drugs among 76.7% of cases followed by household chemicals (6.8%). Suicidal intention was reported among 25.6% of cases. Using multivariate regression analysis, significant predictors of suicidal attempts are more than 12 years old, patients who were exposed to more than one toxin and patient who came to the hospital within 1-3 h since poisoning.

RECOMMENDATIONS

Establishing and operating DPIC centers throughout the kingdom, in addition to implementing of legislations to ban over the counter selling of medications and to sell potentially dangerous chemicals in childproof containers.

The epidemiology of childhood poisonings in Cyprus

Information on childhood poisonings in Cyprus is limited. Our objective was to examine the epidemiology of poisonings among children in Cyprus. All children up to 15 years of age admitted for poisoning to the Archbishop Makarios Hospital in Nicosia, Cyprus between 2005 and 2008 were included in our study. All hospital poisoning records were reviewed. A total of 257 children were admitted for poisoning. The mean age of children was 3.1 years, of which 83.7% were below the age of 5 years old, while 53% were boys. The poisoning hospitalizations accounted for about 3% of all admissions to the pediatric department during the study period (4 years). The annual cumulative incidence of childhood poisoning hospitalizations was 116 per 100,000 children. Medications accounted for 46.1% of all poisonings, the most frequent cause being paracetamol (9.8%), cardiovascular medications (5.3%), antitussive medications (4.5%), and other painkillers (4.1%). Another 37.6% of hospitalizations involved household products such as household cleaning products (11.8%), petroleum products (11.0%), and rodenticides (5.7%). Among children who ingested petroleum distillates, 55.6% developed clinical symptomatology. The vast majority of cases were accidental (93.8%). Suicidal cases involved children 8-14 years old, mainly girls, and the most frequent poisoning ingested was paracetamol (46.7%). Poisoning hospitalizations represent an important cause of morbidity among children in Cyprus. Preventive strategies should include the education of caregivers on the handling of medications and household products as well as legislation requiring child-resistant packaging for all medications and household products including petroleum distillates.

The study of etiological and demographic characteristics of acute household accidental poisoning in children--a consecutive case series study from Pakistan

BACKGROUND

To determine the agents of poisoning and demographic distribution of children brought to Civil Hospital Karachi (CHK) with a history of accidental poison intake and to examine the factors associated with it.

METHODS

This hospital based descriptive study of first 100 patients from both sexes who presented to Pediatric department, CHK from 1st January 2006 till 31st December 2008 with exposure to a known poisonous agent and fulfilling other inclusion criteria were included in the study. Data regarding their demographic profile and potential risk factors was collected on a well structured proforma, cases were followed until discharge or expiry. Data was analyzed using frequencies, proportions, group means, median and standard deviations.

RESULTS

The male to female ratio in our study was 1.2:1, with kerosene (50%) being the most common household agent followed by medicines (38%), insecticides (7%) and bathroom cleaners (5%). Factors such as mother's education level, number of siblings and storage place of poison correlated significantly with the cases of accidental poisoning. Most of the children (70%) presented within 3 hours of ingestion. Dyspnea was the most common symptom observed. The mortality rate in our study was 3%.

CONCLUSIONS

Children belonging to age group 2-3 years are the most susceptible both in terms of morbidity and mortality. Preventive strategies need to be adopted at a national level to spread awareness among parents.

Pharmaceutical and chemical pediatric poisoning in Kuwait: a retrospective survey

Past studies of pediatric poisoning in Kuwait have suggested differences at hospital level which could impact on the implementation of public health interventions. The objective was to compare pediatric poisoning admissions at general hospitals in Kuwait.

Pattern of childhood poisoning in abha city - southwestern saudi arabia

OBJECTIVE

To describe the pattern of childhood poisoning in the Emergency Room (ER) of the Pediatrics Department in Aseer Central Hospital (ACH), in order to suggest possible causes and preventive measures.

METHODS

This is a retrospective study of cases of childhood poisoning or ingestions attending the pediatric emergency room of Aseer Central Hospital or those admitted to the Pediatric Department of same hospital in Abha, Kingdom of Saudi Arabia, during the period of January 2000 to December 2003. Children aged 12 years and below were included. Review of records was done to collect data on clinical information such as age, sex, type of poison, clinical condition on admission as well as the time, place and date of exposure to the offending agent.

RESULTS

In this study, 114 poisoned children aged 12 years and below were studied. It was found that children from 2-4 years were more liable to poisoning (81%, p<0.001). Males were (68%) while females were (32%), with a sex ratio of 2.2:1. Medical drugs offended the most (72%, p<0.001). As regards clinical condition on admission, drowsiness, nausea and vomiting as well as abdominal pain represented (82%) of the cases. Daytime was when 80% of poisoned cases were admitted (p<0.001). The peak months were from June to August (71%, p<0.01). As regard the place of exposure to offending agent, living rooms and bedrooms accounted for 58% of the cases(p<001).

CONCLUSION

The peak age for poisonings in children is before the age of four with significantly high diurnal frequency, significant seasonal variation in favor of summer. Medical drugs were the most common agents of poisoning, and living rooms and bedrooms the places where most poisoning occurred. Good and continuous supervision by parents is essential, especially from the age 1-5 years. There should also be legislation for the use of child resistant containers for home medicines and household agents.

A seven-year review of accidental poisoning in children at a Military Hospital in Hafr Al Batin, Saudi Arabia

BACKGROUND

Accidental ingestion of poisons and household products is a potential source of morbidity and mortality in children all over the world. The relative paucity of publications on this subject in Saudi Arabia necessitated our study, to delineate the pattern of acute poisoning in children at the King Khalid Military City Hospital, Hafr Al Batin.

PATIENTS AND METHODS

Case notes of children 12 years and below who were admitted to the pediatric medical ward were retrospectively reviewed for relevant data. Included in the study were children of military and non-military personnel who were seen over a seven-year period (January 1992 to 1998).

RESULTS

Of the 9951 single pediatric admissions, 168 (1.7%) were identified as cases of accidental poisoning. There was a male preponderance, even though this was not statistically significant. The age group mostly affected was 1 to 3 years (63%). More than 60% of children were asymptomatic, with 4% presenting with severe symptoms. Unlike in other parts of Saudi Arabia, poisoning due to petroleum products was relatively uncommon.

CONCLUSION

Although no deaths were recorded in this study, continuous education of parents and caregivers of young children is recommended, as this would help to reduce the chances and complications of accidental poisoning. The role of local and regional Drug Information Centers cannot be overemphasized.

Hospitalisation due to Acute Poisoning in Children - Tabuk Experience

BACKGROUND #ENTITYSTARTX00026;

METHOD

Acute poisoning in children is still a major problem in our community, taking up a lot of resources from the health care system. We report here the result of' a three year study (1991-1994) carried out in the Northwest Armed Forces Hospital, Tabuk, Saudi Arabia regarding hospitalisation of children as a result of poisoning.

RESULTS

Sixty eight children below twelve years of age were admitted, accounting for a total of approximately 175 inpatient days. The majority of them (n=60, 88.2%) were below the age of five years. house hold products (16.2%), kerosene (10.3%) and antihistamines (19.1%) were the commonest ingested substances. An analysis of various aspects of this problem and the review of relevant literature is included.

CONCLUSIONS

Health education about safe storage of medicine at home and a knowledge of first aid is very necessary. This may prevent the occurence of such accidents and reduce morbidity.

Epidemiology of drug overdose in children

Childhood drug overdoses are a continuing important public health problem. Although drug overdoses are no longer the important cause of childhood mortality they once were, such poisonings account for highly frequent and unacceptable instances of childhood injuries. These poisonings exact a high cost from society. They result in many emergency department visits and hospitalisations, with the attendant indirect costs of suffering, parental anxiety, and lost days of work or school. Childhood drug overdoses are preventable; those children and families at highest risk show identifiable characteristics, and the medications which pose the greatest hazard to children have already been identified. These injuries divert expensive and scarce medical resources from society's other health problems. Thus, clinicians must do more to prevent childhood drug overdoses whenever possible.

Behavioral antecedents of pediatric poisonings

To determine how the behavior of 3- to 7-year-olds might contribute to pediatric poisoning, a taxonomy of pediatric ingestions was conceptualized and tested. Thirty-nine of 50 caretakers who called the Middle Tennessee Poison Center about poison ingestions by a child in this age group provided details of the poisoning history and family characteristics. Histories were coded by a psychologist according to the 14 antecedent conditions of the poisoning taxonomy. Improper storage, noncompliant behavior, curiosity, misinterpretation of the substance, improper child monitoring, and imitative behavior were judged the most common antecedent conditions of these ingestions. Lack of knowledge of poison prevention methods was infrequently coded. Noncompliant behavior as a condition of the poisoning was associated with parental reports of general child behavioral problems. Ingestions involving imitative behavior were associated with parental report of poor social supports. The findings highlight the need to address behavior in designing poison prevention programs.

Risk factors for accidental poisoning in urban Malaysian children

In a case control study, 70 children consecutively hospitalized for acute ingestion of poisons were compared with 140 other hospitalized children matched for age. Children aged less than 3 years and boys were most often the victims. Univariate analysis identified Indian race, having a parent younger than 21 years, residing at present address for less than 1 year and living in a household with more than five occupants as significant risk factors. Experience of a recent stressful event in the family barely failed to reach the level of significance. Logistic regression analysis confirmed that Indian race, having a parent younger than 21 years and residing less than 1 year at the present address were independent predictors of acute poisoning. Positive interactions were noted between Indian race and duration of residence and between parental age and duration of residence. Knowledge of risk factors and their interactions may be useful in planning preventive measures against childhood poisoning.

Home accidents in Al-Khobar city, eastern province, Saudi Arabia: a case-control socioeconomic study

A one-month prospective case-control study was conducted in two sectors of Al-Khobar City (Saudi population of 65,070) with the objective of identifying the socioeconomic factors that are related to home accidents among Saudis. All accidents reported to 20 health facilities during the period were recorded and for the home accidents a questionnaire was completed at the Emergency Rooms (ERs) and the subjects were subsequently interviewed at their homes. Of the 1,104 Saudis who reported to the ERs of these health facilities 209 (18.9 percent) had home accidents. 206 were interviewed at home together with 448 families (controls) randomly drawn from the family folders at the primary health care centers in the two sectors. In the event 25 more home accidents were identified and the number of control families was accordingly reduced to 423 while the accidents increased to 231. The overall incidence rate was 355/100,000 Saudis per month, being lower (327.6/100,000) for the first sector (Al-Thougba) with a population of a relatively lower socioeconomic status than the second (Al-Khobar) sector (399.5/100,000). The number of home accidents was related to family size and was also larger in families living in villas and flats compared to single story and portable buildings. Families with home accidents had significantly more members than the controls. It is recommended that extensive community-oriented research be conducted to identify, evaluate, and subsequently control the environmental and human factors that contribute to the incidence and outcome of home accidents in Saudi Arabia.

Pulmonary radiological changes in kerosene poisoning in the Asir region of Saudi Arabia

A prospective study of pulmonary radiological changes following accidental kerosene poisoning in 67 children is presented. Abnormalities were seen in 41 patients (61.2%), and these were categorized according to nine patterns. These included varying degrees of perihilar and lung infiltration, pulmonary cystic changes, pleural effusion, empyema, pneumomediastinum and surgical emphysema. The two most common were bilateral perihilar infiltrates with clear lung bases and bilateral perihilar with basal infiltrates. In the majority of cases, these radiological changes resolved completely within 10-12 days with only two needing surgical intervention.

Accidental poisoning of children in Riyadh, Saudi Arabia

There were 7142 cases of accidental poisoning in children admitted to all Riyadh Governmental Hospitals during the five years period (1983-87). Household products were the most common poisoning agent, accounting for 59% of all cases. This was followed by drugs (39%), and plants (2%). Children aged one to two years were the most affected. The fatality rate was 0.1%. This study indicates that improved living conditions, proper storage of the drugs and chemicals as well as health education of parents will help in reducing the incidence of poisoning.

The ecological context of child health in Saudi Arabia

The general background to child health in Saudi Arabia is reviewed. Information is provided on the social and demographic characteristics of the population, on common health indicators, on the health care system and its utilization, and on the general pattern of childhood morbidity and mortality. The unprecendented socioeconomic development has transformed the health care system. In 15 years the number of nurses have increased from 3261 to 29896, physicians from 1172 to 14335, primary health care centers from 591 to 1821, and hospital beds from 9036 to 30707. In spite of this progress, the disease pattern seems to resemble that of some developing countries with more limited resources. Parasitic diseases are still widespread, and sample surveys have indicated suboptimal nutrition of rural preschool children. Recent estimates on the infant mortality rate have ranged from 65 to 120 per 1000 live births. The preferred marriage partner is a close relative, and genetic diseases, such as hemoglobin disorders, are common in certain areas. Thus, the prevalence of alpha thalassemia is reported at 50 percent, and the sickle cell trait at 4.4-20 percent in sample surveys from the Eastern Province. The modest educational attainment of the mother, the heavy reliance on foreign manpower in all sectors, including the health sector, and the further development of the primary health care system are key issues today. It is emphasized that demographic and epidemiological information from Saudi Arabia is scarce and frequently uncertain, and that further studies are needed to identify the health needs of Saudi children.

Accidental poisoning in childhood: a multicentre survey. 1. General epidemiology

As background to a study of the effectiveness of packaging in preventing childhood poisoning, the National Poisons Information Service coordinated a prospective survey, in which 9 Accident and Emergency (A & E) departments and 5 paediatric departments, between July 1982 and February 1984, recorded 2043 cases of suspected accidental poisoning in children aged 0-60 months. The products implicated were drugs (59%), household products (37%) and plants (3%). The drugs most frequently implicated were analgesics, anxiolytics, cough medicines, oral contraceptives and drugs to supplement diet or treat dietary disorders. The most frequently implicated household products were cleaners such as bleach, detergent and disinfectant, and petroleum distillate. Seventy-five per cent of the children were 2 and 3-year-olds. Fifty-six per cent were male. Only 22% of the children had signs or symptoms on admission. In only 2 cases were these serious. Treatment other than ipecacuanha and/or oral fluids was seldom required. Of the cases where outcome was recorded, 56% were discharged from A & E. The rest were admitted to a ward; only 7 children were admitted to intensive care units. No child died. Comparison with HASS and other epidemiological surveys shows that these results are representative of national trends.