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Original Article
ARTICLE IN PRESS
doi:
10.25259/KPJ_19_2025

Clinical and environmental determinants of paediatric poisoning

Department of Paediatrics, Karnataka Medical College and Research Institute, Bengaluru, Karnataka, India
Department of Paediatrics, Karnataka Medical College and Research Institute, Hubballi, Karnataka, India.

*Corresponding author: B. Priyanka, Department of Paediatrics, Karnataka Medical College and Research Institute, Bengaluru, Karnataka, India. 1806priyanka@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Priyanka B, Namadhari RG, Ratageri VH. Clinical and environmental determinants of paediatric poisoning. Karnataka Paediatr J. doi: 10.25259/KPJ_19_2025

Abstract

Objectives:

The objectives of the study are to evaluate the environmental risk factors and clinical profile of paediatric poisoning cases admitted to a tertiary care centre in North Karnataka.

Material and Methods:

A retrospective study was conducted at a tertiary care hospital in North Karnataka, including children aged 1 month to 12 years who presented with poisoning between September 1, 2022, and August 31, 2023. Relevant demographic, environmental and clinical data were collected and analysed.

Results:

A total of 60 children were admitted during the study period, with a mean age of 3.78 ± 2.49 years. There was a male predominance. The average time from ingestion to hospital presentation was 5.3 ± 12.01 h, and the average duration of hospital stay was 2.6 ± 1.96 days. Accidental ingestion accounted for the majority of cases (93.33%). Most patients (63.33%) were from urban areas, primarily urban slums, with a high prevalence of overcrowding (80%). A large proportion of children belonged to lower socioeconomic strata (86.66%), had an agricultural family background (41%) and parents with limited formal education (78%). Hydrocarbons were the most ingested substances (43.33%), followed by miscellaneous household compounds (21.66%), tablets (15%), pyrethroids (10%), organophosphates (8.3%) and organochlorines (1.6%).

Conclusion:

Paediatric poisoning was most prevalent amongst toddlers, with hydrocarbons being the most frequently involved agents. Environmental and socioeconomic factors such as urban slum residence, overcrowding, poverty, low parental education and agricultural backgrounds significantly contributed to the risk of poisoning.

Keywords

Clinicoetiological profile
Environmental factors
Paediatric poisoning
Prevention
Toxicology

INTRODUCTION

Childhood poisoning remains a significant global health concern, particularly in developing countries where children are more vulnerable to environmental hazards. In India, unintentional poisoning is amongst the leading causes of morbidity and mortality amongst children, with cases often concentrated in rural and underdeveloped areas due to a combination of socioeconomic and environmental factors.[1] Poisoning in children often occurs due to accidental ingestion of toxic substances such as household chemicals, pesticides and pharmaceuticals, as well as exposure to harmful environmental pollutants.[2]

In rural regions of North Karnataka, unique factors contribute to the prevalence of paediatric poisoning. Inadequate knowledge of poison prevention and the easy availability of hazardous substances are key contributors to the high rates of poisoning incidents.[3] The cultural practice of storing chemicals in non-original containers and a lack of awareness amongst parents secondary to poor educational status and lower socioeconomic status further exacerbate the risk, particularly in households with limited safety measures.[4]

This study aims to examine the clinical characteristics of children admitted with poisoning at a tertiary care centre in North Karnataka. It focuses on identifying the types of poisons involved, demographic trends and contributing environmental factors. The goal is to highlight effective preventive strategies and enhance management approaches, particularly in comparable socioeconomic settings. The insights gained are expected to support targeted interventions that can reduce the incidence of paediatric poisoning and promote child safety in at-risk communities.

MATERIAL AND METHODS

Study design

This study was a retrospective observational study conducted at Department of pediatrics, Karnataka Medical College and Research Institute, Hubballi. Data were collected from September 1, 2022, to August 31, 2023.

Study population

All children aged between 1 month and 12 years with an alleged history of poisoning were admitted during the study period.

Inclusion criteria

All children aged between 1 month and 12 years with an alleged history of unknown compound consumption who were admitted during the study period.

Data collection

Medical records were reviewed using a pre-designed pro forma, documenting demographic details, type of compound consumed, socioeconomic status and environmental factors.

Statistical analysis

Categorical data were summarised by frequency and percentages. Quantitative normal data were summarised by mean, standard deviation and confidence interval. Quantitative non-normal data were summarised by median and interquartile range and univariate analysis was used.

Graphical representation of data

MS Excel and MS word were used to obtain the various tables.

Statistical software

The Statistical Package for the Social Sciences 23 software was used to analyse the data. Level of significance was 5%

RESULTS

Sixty children fulfilled inclusion criteria [Flow Chart 1]. The mean age at presentation was 3.78 ± 2.49 years. There was a male predominance (68%) with male: female ratio of 2.125 [Table 1].

Study design.
Flow Chart 1:
Study design.
Table 1: Age distribution among cases
Age(years) No of children (n=60)
<1 4 (6.67%)
1-3 31( 51.67%)
3-5 12 (20%)
5-10 10 (16.66%)
>12 2 ( 3.33%)

Table 2 shows location and socioeconomic factors: Most cases were from urban areas (63%) (Coefficient of Variation [CV] = 0.266) with a high prevalence of overcrowding (80%) (CV = 0.6) and most of them belonged to lower socioeconomic status (82%) (CV = 0.63). In addition, many had parents with limited educational backgrounds (78%) (CV = 0.56) and had an agricultural background (41.66%) (CV = 0.16).

Table 2: Social and Environmental parameters (N=60)
Location Urban 38 (63.33%)
Rural 22 (36.66%)
Socioeconomic Class Upper 11 (18.33%)
Lower 49 (81.66%)
Agricultural Background Present 25 (41.66%)
Parents education Status Poor 47 (78.33%)
Overcrowding Present 48 (80%)

Poisoning circumstances

Most cases (93%) were accidental (CV =1.27). A small fraction (3%) was due to suicidal or homicidal intent. The average time taken to arrive at hospital post-consumption was 5.3 ± 12.01 h (CV = 2.23). Moreover, 75% of cases were referred from other hospitals. (CV = 0.5).

Substances involved

Hydrocarbons were the most common (43%), followed by various other substances including camphor, tick poisons, alcohol, etc., (22%) followed tablets (15%), pyrethroid compounds (10%) and pesticides such as organophosphorus (8%) and organochlorine (2%) (CV = 0.84) [Table 3].

Table 3: Common causes of poisoning N=60
Substance Consumed No of cases (n=60)
Hydrocarbon 26 (43%)
Organophosphorus 5 (8%)
Organochlorine 1 (2%)
Others 13 (22%)
Pyrethroid 6 (10%)
Tablets 9 (15%)

Clinical features: The average hospital stay was 2.63 ± 1.96 days (CV = 0.746). About 23.33% (CV = 0.533) of the cases had systemic side effects. While most cases were managed symptomatically (95%), a few required antidotal treatment (5%) (CV = 0.9). Discharge rates were high (97%) (CV = 0.933), with two fatalities reported (3%) [Table 4]. Both fatalities were hydrocarbon poisoning, and the death was attributed to complications secondary to late presentation.

Table 4: Treatment history and Outcomes (n=60)
Etiology Accidental 56 (93.33%)
Suicidal 2 (3.33%)
Homicidal 2 (3.33%)
Severity Wards 49 (82%)
PICU 11 ( 18%)
Clinical features Systemic Manifestations 14 (23.33%)
Asymptomatic 46 (76.66%)
Intervention Symptomatic 57 (95%)
Specific Antidote 3 (5%)
Outcome Discharged 58 (97.2%)
Death 2 (2.8%)

DISCUSSION

In our study involving 60 cases of childhood poisoning amongst children aged 1 month to 12 years, the mean age at presentation was 3.78 ± 2.49 years. This finding is consistent with a study conducted by Suting et al. in New Delhi, which reported that the most commonly affected age group was 1–3 years, followed by 3–5 years.[5] The higher vulnerability of younger children may be attributed to their exploratory behaviour and lack of awareness about potential hazards.

A male predominance was observed, with 68% of the cases involving boys. This pattern has been similarly reported by Aggarwal et al., who also noted a higher incidence amongst male children.[6] The gender disparity may be linked to increased outdoor activity and risk-taking behaviour typically observed in boys.

The majority of cases (63%) originated from urban areas, with overcrowding present in 80% of the households. These findings align with those of Naseem et al., who reported that 68.2% of poisoning cases in their Hyderabad-based study were from urban settings.[7] Urbanisation coupled with overcrowding may contribute to increased exposure to hazardous substances in the domestic environment.

Socioeconomic factors played a significant role, with 82% of the affected children belonging to lower socioeconomic strata. This is comparable to the study by Shah et al., which documented that 89.98% of cases were from low-income families.[8] Limited parental education (noted in 78% of cases) and agricultural backgrounds (41.66%) further highlight the influence of sociodemographic determinants. Factors such as illiteracy, lack of supervision, poor awareness regarding toxic substances and inadequate health education may collectively contribute to the high incidence of poisoning in these populations.[9]

The mean duration from substance ingestion to hospital presentation was 5.3 ± 12.01 h. This is in accordance with findings from a study in Ahmedabad, where most patients presented within 6 h post-exposure.[8] Delays in presentation can significantly impact prognosis, particularly in cases involving toxic agents like hydrocarbons.

Accidental ingestion was the predominant mode of poisoning, accounting for 93% of cases. This aligns with the study by Reddy et al., which also identified accidental consumption as the leading cause of paediatric poisoning.[10] Preventive strategies focusing on safe storage and parental awareness are essential in reducing such incidents.

In terms of substances involved, hydrocarbons were the most frequently implicated agents (43%), followed by camphor, tick repellents, alcohol and other household products (22%). Tablets accounted for 15%, pyrethroid compounds for 10%, and pesticides – including organophosphates (8%) and organochlorines (2%) – were also noted. Similar patterns were reported by Naseem et al. and Shah et al.[7,8] The easy accessibility of these substances in households underscores the need for targeted public health interventions.

The average hospital stay was 2.6 days, comparable to a study conducted in Bangalore, where most children required <3 days of hospitalisation.[10] A high recovery rate (97%) was observed, with only two fatalities (3%), both due to hydrocarbon poisoning. Delayed presentation was a significant factor contributing to mortality. This fatality rate is consistent with that reported by Shah et al., who found a case fatality rate of 2.54%.[8]

Strengths of the study

This study gives us insight about the incidence of childhood poisoning and the risk factors associated with it. Analysing these and the installation of appropriate preventive practices can help in the reduction of the incidence and severity of childhood poisoning.

Limitations

  • There was no control group taken for comparison.

  • Study period was short - 1 year only.

  • It was a single-centre study, and all findings cannot be generalised to the rest of the population.

  • Other factors such as unsafe storage practices, working parents were not analysed.

CONCLUSION

We conclude that poisoning in children was most common in the toddler age group with the most common compound consumed being hydrocarbons and it can be attributed to a number of environmental factors such as overcrowding in urban slums, poverty, poor parental education and agricultural background. These results suggest that preventative efforts should focus on raising awareness amongst parents, particularly regarding safe storage practices and the dangers associated with common household substances. Improved education and living standards, along with targeted community education, could potentially reduce the incidence of such poisoning events.

Ethical approval:

The institutional review board approval is obtained by Karnataka Medical College and Research Institute approval no KMCRI:ETHICS:COMM:108:2024-25, dated 10th December 2024.

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship: Nil.

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