Childhood Drug and Non-Drug Poisoning in Nigeria: An Economic Appraisal

Streamlining referral decisions for childhood poisoning: a cross-sectional study from a tertiary children's hospital in Cape Town, South Africa

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Poisoning is one of the top five causes of childhood injury-related disease globally, but data in Africa are limited.

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Low socioeconomic status plays a role in the types of toxins to which children are exposed, some of which may cause significant morbidity and mortality.

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The far-reaching primary health care system relies on early assessment of all patients, to refer those requiring advanced medical care timeously.

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Detailed knowledge of age-groups, toxin groups and clinical outcomes of paediatric poisoned patients may allow streamlining of triage and referral systems, in order to optimise the use of limited resources and improve patient outcomes.

Introduction

The study objectives were to report on current paediatric poisoning figures from South Africa, and to better understand this patient population to contribute suggestions for streamlining local triage and referral criteria.

Methods

A retrospective review of children presenting to Red Cross War Memorial Children's Hospital (RCWMCH) with poisoning between January 2009 and December 2019 was performed. Data were extracted from the Poisons Information Centre's Clinical Poisonings Database.

Results

There were 3699 incidents, involving 3662 patients; 3011 (81%) patients were under 5 years (median 29 months, IQR 19 to 49 months). There was a slight decline in numbers over the 11-year period.

Most patients were referred (n = 2542, 69%), which included a greater proportion that were symptomatic (p < 0.001). There were 8 deaths (case fatality rate 0.2%).

Medications were the most common single toxin group (n = 1270, 38%), followed by handyman and industrial (HI) products (n = 889, 27%), household products (n = 451, 14%), and pesticides (n = 445, 13%). There was a significant relationship between toxin type and referral patterns (p < 0.001) as well as clinical severity (p < 0.001): pesticides and HI products (paraffin, n = 486/568, 86%) had a greater proportion of referrals, and pesticides more moderate to fatal poisonings (n = 132/445, 30%), all due to cholinergic (organophosphates and carbamates) and formamidine pesticides.

The medication subgroups anticonvulsants (n = 21/78, 27%), anti-infectives (n = 4/34, 12%), multi-vitamin/mineral (MVM) supplements (n = 17/84, 20%), neuropsychiatric medications (n = 50/350, 14%) and substances of abuse (n = 13/47, 28%) had larger proportions of moderate to severe poisonings (p < 0.001), as did the small group of biological toxins (n = 17/55, 31%; p < 0.001).

Conclusion

Certain medication, pesticide, and biological toxin subgroups, should be flagged for early referral. The goal is to improve patient outcomes as well as optimize the use of limited resources.

Accidental poisoning with aluminum phosphide presenting with excessive cholinergic symptoms with response to atropine: A case report

Accidental poisoning in children, though underreported in our environment, is common and could prove fatal. It is important to identify the primary chemical agent that is responsible for the poisoning. We present a case of accidental ingestion of fish poisoned with aluminum phosphide (AlP) used as rat poisoning by a 14-month-old girl. At presentation, the actual chemical content of the poison was not available and clinical features were suggestive of organophosphate poisoning. She was commenced on atropine together with other treatment, on which she made remarkable improvement. The atropine was continued with complete resolution of symptoms on the third day of admission. We, therefore, report a serendipitous use of atropine in the management of AlP poisoning with successful outcome.

Economic evaluation of the direct cost resulting from childhood poisoning in Morocco: micro-costing analysis

Background

The analysis of the economic burden for childhood poisoning has great value in Morocco where there still exists a paucity of information on the subject. The objective of this study was to explore the economic costs of unintentional and intentional poisoning in children in the region of Rabat-Salé-Kénitra, Morocco.

Methods

A prospective study of children younger than 15 years with a poisoning diagnosis conducted between March and July 2016 in the Children’s University Hospital of Rabat, Morocco. The source of data for this study was questionnaire that collected information on the costs, the epidemiological and the socio-economic characteristics of childhood poisoning.

Results

Eighty-seven patients were interviewed during the study period (39 females and 48 males). The majority of poisoning cases (98.85%) were accidental and 1.15% were intentional. Drugs, snake bites and scorpion stings, carbon monoxide, food, plants, household products, illegal drugs, pesticides, petroleum and industrial chemicals products were caused the poisoning. Of all the hospitalized patients, 77 (88.5%) were admitted to the emergency department and 5 (5.7%) were admitted to the intensive care unit. The average direct medical costs and the average direct non-medical costs of providing poison treatment were USD 127 and USD 30 per child, respectively. Total average direct cost of USD 157 (127 + 30) represented 60% of the national minimum wage per month in Morocco. Total direct medical costs accounted for 80%, as against 20% direct non-medical costs. The mean ± SD length of stay (LOS) for children with poisoning was 2.15 ± 1.87 days with a range variated between 0 day and 10 days.

Conclusions

Overall, this study confirms that the costs of childhood poisoning are not negligible costs in Morocco. Therefore, the prevalence and the costs of childhood poisoning can be reduced by monitoring an open communication between parents, the Poison Control Centre of Morocco (MPCC) and physicians in order to increase the vigilance of parents against the risks related to unintentional poisoning that can be prevented with more awareness.