Clinical and environmental determinants of paediatric poisoning

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

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].

Close

Flow Chart 1:

Study design.

Export to PPT

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).

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]

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.