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Abstract
Introduction Background: Childhood poisoning, characterised by exposure to toxic substances, poses a global health concern with variations across regions. Despite the importance of having current information about childhood acute poisoning in our region, there is a noticeable gap in such research in our local context. Regularly reviewing the agents responsible for poisoning in our locale is essential for devising prevention strategies and treatment approaches. This study aimed to examine the patterns and outcomes of childhood poisoning at the Children’s Emergency Department of the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
Methods A retrospective cross-sectional study was conducted, analysing cases of childhood poisoning in the Children’s Emergency Ward, presenting from January 2013 to December 2022. Sociodemographic data, types of poisoning agents, home interventions, clinical features and outcomes were extracted from medical records.
Results Of 9389 admissions, 81 (0.8%) cases were admitted for childhood poisoning, but only 69 cases were analysed (total n=69). Children aged under 5 years (52.2%) and who were males (59.4%) were mostly involved. Organophosphates (21.7%) and kerosene (20.3%) were common poisoning agents, often accidental (72.5%) and occurring at home (94.2%). Delayed hospital presentation (>2 hours) was common (68.1%). Vomiting (72.5%) and drooling saliva (56.5%) were prevalent symptoms. Hydration (60.9%) was the main hospital intervention, while antidotes were infrequently used (15.9%). Mortality was 8.7%, predominantly due to kerosene ingestion in young children.
Conclusion Organophosphate and kerosene poisoning are the most common in this facility. Enforcement challenges persist, emphasising the importance of safe storage practices and improved poison control measures. Addressing resource constraints for antidote availability and increasing awareness are vital for effective management and prevention.
- Mortality
- Toxicology
- Infant
- Adolescent Health
- Epidemiology
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
Childhood poisoning, a global health concern, varies in prevalence and agents worldwide. In Nigeria, previous studies noted kerosene and organophosphates as common poisoning agents with varying mortality rates.
WHAT THIS STUDY ADDS
This study adds detailed insights into childhood poisoning patterns and outcomes in a tertiary facility in Yenagoa, Nigeria, highlighting organophosphates and kerosene as prevalent agents affecting children under 5 years. Kerosene ingestion, especially among young children, significantly contributes to fatalities, emphasising the urgency of addressing enforcement challenges and advocating safe storage practices.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
The findings underscore the urgent need for improved poison control measures, enhanced access to antidotes and increased awareness among healthcare providers and caregivers. Policymakers can use this information to strengthen regulations, advocate for safe storage practices and allocate resources to address enforcement challenges.
Introduction
Background
Poisoning is characterised by the exposure of an individual to substances that can lead to symptoms and signs of organ dysfunction, potentially resulting in injury or fatality.1–4 While this can be either accidental or non-accidental in younger children, it tends to be more intentional, particularly in older children, especially in high-income countries.5–14 Childhood poisoning represents a significant cause of hospitalisation, disability and mortality on a global scale.4 The epidemiology of childhood poisoning exhibits variations across different geographical, socioeconomic, cultural and human development contexts.4 Both medicinal and non-medicinal substances have been identified as common agents responsible for childhood poisoning, encompassing a wide array of substances that affect both children and adolescents.5 13–18
Frequently, medicinal substances ingested by children include analgesics, anti-inflammatory agents, psychotropic drugs like antidepressants and benzodiazepines and related compounds.4 14 On the other hand, non-medicinal chemicals such as organophosphates, pesticides, insecticides, organic solvents and household agents like bleach and caustic soda are recognised as prevalent causes of poisoning among children.4 10 18 More than 90% of toxic exposures affecting children occur within the home environment, with the majority of cases involving a single toxic substance.4 19 Ingestion is the most common route of exposure, with a smaller number of cases resulting from dermal contact, inhalation or ocular contact.15 19 20 In developing countries, paediatric poisoning is increasing due to the ready availability of household chemicals, medications and pesticides, which heightens the risk of poisoning.4 19 20 Notably, in Nigeria, the incidence of childhood poisoning ranges from 0.22% to 1.54%, with kerosene and organophosphates being the primary agents responsible for childhood poisoning.7 9 11 20 Mortality rates associated with childhood poisoning in Nigeria vary, ranging from 0.72% to 13.3%, with variations primarily linked to the dominant poisoning agent.3 5 6 8 13 14 21
Despite the importance of having current information about childhood acute poisoning in our region, there is a noticeable gap in such research in our local context. Regularly reviewing the agents responsible for poisoning in our locale is essential for devising prevention strategies and treatment approaches. This study is expected to offer paediatric clinicians an overview of childhood poisoning specific to our area, thus contributing to the body of knowledge regarding poisoning in Nigeria. The information derived from this study can serve as a foundation for preventing accidental poisonings, early detection and treatment of cases and community health education. As a result, this study aimed to investigate the patterns and outcomes of childhood poisoning at the Children’s Emergency Department of the Federal Medical Centre, Yenagoa (FMCY), Bayelsa State, Nigeria.
Materials and methods
Study design and area
This was a retrospective cross-sectional hospital-based study conducted in the Children’s Emergency Ward (CHEW) of FMCY. The FMCY is presently a 425-bed hospital, which provides primary, secondary and tertiary healthcare services to meet the needs of the people of Yenagoa with a projected population of 559 746 in 2023.22 However, it is not the only centre treating poisoning cases in Yenagoa, and the majority of poisoning cases present directly or get referred to this facility. The CHEW consists of a 10-bed open ward, procedure room, intensive care room, triaging room, and a side laboratory. It also consists of nursing staff (some specialised in paediatrics nursing) running three shifts and physicians comprising supervising consultants, resident doctors and house officers. The Children’s Emergency Room runs a 24-hour service.
Study population
All cases of childhood poisoning that presented to CHEW of FMCY from January 2013 to December 2022. The following cases were excluded: Cases of food poisoning, poisoning from snake envenomation, cases of allergic reactions and cases of adverse drug reactions.
Data collection
The admission/discharge record book of CHEW was looked at, and cases of childhood poisoning between January 2013 and December 2022 were identified. The folders of cases were retrieved from medical records. The following data were then extracted: demographics, types of poisoning agents, home interventions, clinical features and outcomes.
Data analysis
Data was analysed using the Statistical Package for Social Science software for Windows version 26. Quantitative variables were summarised using mean or median as appropriate, while categorical variables were summarised using frequency and proportion.
Results
During the 10-year review, a total of 9389 children were admitted into the CHEW. Among them, 81 (0.8%) were admitted for childhood poisoning. However, 69 cases were analysed due to 12 missing case notes.
Demographic characteristics
More than half (52.2%) of the children were under 5 years with a median age of 3 years. There was a slightly higher percentage (59.4%) of males with a male-to-female ratio of 1.1:1 (table 1) .
Demographic characteristics of the study population
Types of poison involved
Organophosphates (brand name sniper) were the most common type, accounting for 21.7% of cases. Kerosene poisoning was the second most frequent at 20.3%, followed by carbon monoxide poisoning (14.5.3%). Other types of poisoning were less common, including paracetamol, antipsychotics, hypochlorite, alcohol, caustic soda, cyanide, pesticides and rodenticide (rat poison) (table 2).
Type and sources of poison in the study population
Modes, routes, places, containers and attractiveness of poisoning
As shown in table 3, the majority of poison cases were accidental (72.5%). Ingestion was the most common route (85.5%), with a smaller percentage involving inhalation (14.5%). The place where poisoning incidents occurred was predominantly at home (94.2%), with a smaller number of cases occurring at the workplace, shop or other locations.
Modes, routes, places, containers and attractiveness of poisoning
Regarding where the poison was kept, the highest proportion was found in the kitchen (39.1%), followed by the bedroom (36.2%), while the living room, drug box and other places had fewer cases. For the container status, a significant number of poison containers were unsealed (50.7%).
Time before presentation and clinical presentation
The majority of cases (68.1%) presented more than 2 hours after the poisoning incident, with smaller percentages presenting within 1–2 hours (23.2%) or an hour (8.7%). Regarding common presentations and severity, vomiting was the most frequent symptom (72.5%), followed by drooling saliva (56.5%), respiratory distress (42.0%), cough (36.2%), fever (27.5%) and loss of consciousness (26.1%) (table 4). The most common presenting symptoms for organophosphates, kerosene and carbon monoxide poisoning included vomiting and drooling of saliva, respiratory distress and loss of consciousness, respectively (table 5). Two children had an intellectual disability. One was a female with Down syndrome aged 5 years, while the other was a male aged 15 years with poorly controlled seizures (table 4).
Clinical presentation
Clinical presentation and type of poison
Home and hospital interventions
Only a small portion of caregivers (11; 26.1%) did not take any home interventions when faced with childhood poisoning cases. Among caregivers who did take action at home, the most common approach was administration of palm oil (31.9%), followed by mixed interventions (combination of two or more) (27.5%) (table 5).
Most of the children received various interventions while on admission, except in 23.2% of cases who were only observed and discharged. Hydration in the form of intravenous fluid (60.9%), intranasal oxygen (53.6%) and antibiotics (23.2%) were the common hospital intervention given. Antidotes were only given to 11 (15.9%) cases of poisoning (table 6). For those that were given antidotes, the majority (81.8%) were cases of organophosphate poisoning, while the remaining was a case of paracetamol poisoning (table 7). Atropine for organophosphate poisoning and N-acetylcysteine for the only case of paracetamol poisoning. Oxygen was mostly administered to those with carbon monoxide (27%) and kerosene poisoning who developed chemical pneumonitis (29.7%) (table 7).
Home and hospital interventions
Hospital intervention and type of poison
Outcomes of childhood poisoning
A significant majority of patients were discharged post-treatment, constituting 82.6% of cases. A smaller proportion of patients accounting for 8.7% of cases were discharged against medical advice or withdrew from treatment. Mortalities were relatively low, with six (8.7%) patients succumbing to poisoning. Four of the deaths were children aged 1–3 years following severe aspiration pneumonia secondary to kerosene ingestion and harmful emesis induction measures given by caregivers, whereas the remaining two deaths were intentional for 17- and 8-year-olds with organophosphate (sniper) and cyanide poisoning, respectively.
In terms of the duration of hospital stay, 59.4% of patients required hospitalisation for more than 48 hours, while 40.6% had a shorter stay of less than 48 hours.
Discussion
In this study, childhood poisoning accounted for 0.8% of all admissions to CHEW during the study period. However, it is important to note that this study is limited by its retrospective, single-centre design, which may not fully capture the true burden of childhood poisoning in the study area. This is consistent with findings in Jos (0.74%), Umuahia (0.6%), Azare (0.64%) and Kenya (0.8%).6 10 12 16 Interestingly, our study’s prevalence is lower than the reported rates of 1.54%, 1.4%, 4.4% and 8.5% in Ekiti, Sagamu, South Africa and the USA, respectively.5 8 14 17 Conversely, a notably lower rate 0.23% was reported in Gombe, Nigeria.20 These regional variations can be attributed to differences in access to medical care, the availability of toxic agents, and differences in poison reporting systems.
A substantial proportion of the affected children in our study were under 5 years of age, which aligns with findings from other studies conducted in Sagamu, Umuahia, Warri, Ekiti, Enugu, Ghana and South Africa.5–9 15 17 This trend may be attributed to the exploratory behaviours typical of preschool-aged children. However, it is worth noting that Shreekrishna et al in India and Lovegrove et al in the USA reported a higher number of poisoning cases in children older than 5 years.14 18
The gender distribution in our study indicated a higher percentage of male children, suggesting potential gender-related variations in exposure to poisoning agents. This observation is in line with the more inquisitive and adventurous nature often attributed to boys. Similar gender patterns were reported in Umuahia, Warri, Ekiti, Azare, Kenya and South Africa.6–8 12 16 17 In contrast, Shwe et al in Jos reported a female preponderance, and Ansong et al in Ghana found an equal distribution between male and female cases.10 15
The types of poisoning agents were diverse. Organophosphates were the most common type of poison, followed by kerosene and carbon monoxide. The high incidence of organophosphate poisoning is not surprising. This is because, despite the ban on open markets and supermarket sales of this product, it remains a common household product for control of insects, pests, snakes and rodents in this region. The fact that organophosphates (sniper) remain the leading cause of poisoning underscores persistent challenges in enforcing these regulations. A similar finding was reported by some other studies in Nigeria and India.10 12 18 20 This consistency in results highlights the ongoing struggle to control and monitor the accessibility of organophosphates despite regulatory efforts. However, some other Nigerian studies reported kerosene as the most common poisoning agent.5–8 21 In developed countries like the USA and Turkey, for example, medications were the leading cause of childhood poisoning.13 14 17 These differences can be associated with the availability and usage of household products unique to each country.
Accidental poisoning incidents in our study predominantly occurred at home, specifically in the kitchen and bedroom. This pattern can be attributed to the storage of potential poisoning agents in unsealed and attractive containers, which can pique the curiosity of young children, especially when they are inadequately supervised. Similar findings were reported in Umuahia and Enugu, emphasising the importance of safe storage practices to prevent childhood poisoning.5 8 Ingestion as the most common route of poisoning in this study agrees with the reports of Ibeneme et al in Umuahia and Iragbogie et al in Azare.5 12
The most common home remedies administered to poisoned children before hospital presentation were palm oil and mixed interventions. These practices are based on the misconception that palm oil, with or without other interventions, acts as a general antidote to poisons. However, they can lead to adverse outcomes, including aspiration and respiratory diseases. This trend is consistent with findings in other Nigerian studies.5 6 8
Additionally, most patients in our study presented to the hospital more than 2 hours after the poisoning incident. Delayed presentation can significantly impact treatment outcomes, underscoring the importance of educating caregivers about the urgency of seeking medical attention and early intervention. Similar delays in hospital presentation were reported in Umuahia, Ekiti, Jos and Sri Lanka, often attributed to initial attempts at home remedies, lack of awareness and the distance to healthcare facilities.3 6 8 10
In terms of clinical presentation, vomiting was the most frequent symptom in our study, occurring in 72.5% of cases. This aligns with the findings of other studies, including those in Jos, Nigeria, Sri Lanka and the USA, where vomiting was a common presenting symptom in childhood poisoning cases.3 10 14 This consistency suggests that vomiting is a universal response to the ingestion of toxic substances in children. It serves as a protective mechanism to expel harmful substances from the stomach. Other common symptoms reported were drooling of saliva, respiratory distress and loss of consciousness, which was consistent with the common poisoning agents in this study (organophosphates, kerosene and carbon monoxide). Organophosphates cause pronounced irritation to the oral and pharyngeal mucosa leading to drooling, while kerosene and carbon monoxide cause respiratory distress following aspiration and loss of consciousness from hypoxia, respectively.1
In the current study, hydration, mainly in the form of intravenous fluids, was the most common hospital intervention, provided to 60.9% of cases. This approach aligns with the findings of several studies, including those conducted by Dayasiri et al in Sri Lanka and Mintegi et al in multiple countries.3 4 Hydration is a fundamental aspect of managing poisoned children, as it helps maintain vital organ function and supports the elimination of toxins. The consistency in the use of hydration as a primary intervention highlights its importance as a universal strategy in managing childhood poisoning cases. However, antidotes were administered in only 15.9% of poisoning cases in this study. The administration of antidotes, while crucial in managing specific poisonings, appears to be less common in this setting. A similar low use of antidotes was reported in Umuahia, Azare, Gombe and Sri Lanka.3 6 12 20 In resource-constrained settings, the availability of specific antidotes can be a significant challenge. Hospitals may not stock a wide range of antidotes, especially for rare or less common poisonings. The findings collectively highlight the need for improved access to antidotes and enhanced poison control measures in Nigeria and other African countries. Efforts to stock a wider range of antidotes, raise awareness among healthcare providers and establish clear guidelines for antidote administration can contribute to more effective management of poisoning cases.
Mortalities were relatively low (8.7%), which was similar to reports from Ekiti (8.6%) and Sri Lanka (8.9%),3 8 but higher than studies in Sagamu (3.8%), Turkey (0.72%) and USA (1.6%).5 13 14 Higher mortality rates have been reported in Ile Ife (11.9%), Umuahia (13.3%) and India (9.9%).6 18 21 Fatalities were predominantly observed among young children aged 1–3 years in the current study, emphasising the vulnerability of this age group to accidental poisonings. These tragic outcomes were primarily attributed to kerosene ingestion, exacerbated by harmful emesis induction measures by caregivers. Kerosene looks like water and is often stored in transparent plastic bottles, making ingestion possible for children.5 The highly volatile vapour of kerosene, when ingested, can lead to respiratory tract inflammation and, in some cases, aspiration.1 5 As such, it is not surprising that kerosene poisoning accounted for the highest number of deaths in our study.
The study has some limitations that warrant consideration. First, its retrospective nature may have led to missing data evidenced by the inability to retrieve 12 case notes. Second, as it was conducted at a single-centre hospital, it may not fully capture all cases of childhood poisoning because some cases may have been managed at home or presented to other facilities, thus potentially leading to underreporting.
Conclusion
This study revealed that organophosphate and kerosene poisoning are the most common in this facility, which underscores enforcement challenges. Poisonings mostly occur at home, emphasising the importance of safe storage and the need for supervision of children’s explorative activities, especially those aged less than 5 years, at home. The limited use of antidotes may be attributed to resource constraints. While mortality rates are relatively low, kerosene ingestion remains a significant contributor to fatalities, especially among young children.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Ethics statements
Patient consent for publication
Ethics approval
This study involved human participants and was approved by RESEARCH ETHICS COMMITTEE, FEDERAL MEDICAL CENTRE YENAGOAFMCY/REC/ECC/2023/MAY/574. It was a retrospective study involving extracting details from case notes of children that were admitted for childhood poisoning between January 2013 and December 2022.
Acknowledgments
We are grateful to the doctors, nurses and the other healthcare providers involved in the management and care of these patients.
Footnotes
Contributors This work was carried out in collaboration between all authors. T-EA conceptualised and designed the study, wrote the protocol, did the statistical analysis and wrote the draft of the manuscript. EJ-O supervised and corrected the protocol and manuscript. NOA and SUK collected the data. All authors read and approved the final manuscript. T-EA is responsible for the overall content and accepts full responsibility for the work and /or the conduct of the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.