Pattern of chemical poisoning in baghdad iraq 2012

1. Pattern of Chemical Poisoning
among Consultation Requests to Poisoning
Consultation Center, Iraq
during the year 2012: A record based study
Submitted by
Dr. Munir Talib Salman
Iraq FETP- 2nd.cohort
Supervised by
Dr. Ahmed Sameer Al-nuaimi
M.B.Ch.B. PhD

2. Introduction:
Large numbers of people are injured or die each year
as a result of exposure to chemicals.
An estimated 346,000 people died worldwide from unintentional
chemical poisoning. WHO 2004
91% of those deaths occurred in low- and middle income
countries.
Nearly a million people die each year as a result of suicide
chemicals account for a significant number of these deaths.

3. Objectives:
To identify the positive predictive value of referred samples
to the Iraq Poisoning Consultation Center (IPCC).
Assess the association of age, gender, type of laboratory
sample, chief complaint and type of communication with the
positive predictive value of referred samples to the IPCC.
To list types of External Chemical Poisoning (ECP)
and order them by frequency.
Describe the epidemiology of cases by person time and place
model.

4. Patients and Methods:
Study design:
A cross-sectional record based study design.
Study sample:
All Chemical Poisoning consultations referred to the IPCC
during the year 2012.
Data collection:
The data will be obtained from: IPCC report form , laboratory
results files and Request papers.

5. Results:
Socio-demographic variables of total registered cases:
Male composed 58% of the total sample.
Mean age of the total sample was 24.3 year m 18 (SD).

6. IPCC registered cases, age distribution, total 1705 case, 2012.

7. 67%
IPCC registered cases, age distribution, total 1705 case, 2012.

8. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Male
Female
IPCC cases by age group crosstab gender total 1705 cases, 2102.

9. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Male
Female
Female=52%/out of age group
11-20
=58%
IPCC cases by age group crosstab gender total 1705 cases, 2102.

10. Province N %
Misan 41 2.4
Babylon 40 2.3
Thee qar 38 2.2
Diwaniya 30 1.8
Basrah 22 1.3
Karbala 21 1.2
Mousel 14 0.8
Muthanna 11 0.6
Province N %
Baghdad 1262 74.1
Anbar 86 5.0
Diala 62 3.6
Kut 54 3.2
Najaf 9 0.5
Saladin 9 0.5
Kirkuk 3 0.2
Sulaimaniya 1 0.1
IPCC registered cases by province 2012.

11. Province N %
Misan 41 2.4
Babylon 40 2.3
Thee qar 38 2.2
Diwaniya 30 1.8
Basrah 22 1.3
Karbala 21 1.2
Mousel 14 0.8
Muthanna 11 0.6
Province N %
Baghdad 1262 74.1
Anbar 86 5.0
Diala 62 3.6
Kut 54 3.2
Najaf 9 0.5
Saladin 9 0.5
Kirkuk 3 0.2
Sulaimaniya 1 0.1
IPCC registered cases by province 2012.

12. IPCC Total registered cases
1705
Evidence compatible with
significant poisoning
575 33.7%
Not significant poisoning
results including the not
done samples
1130 66.3%
External chemical poisoning(ECP)
180 31.3%
Internal chemical poisoning (ICP)
395 68.7%
.
Hierarchy of IPCC registered cases 2012.
workload characterization.

13. 1. Type of communication involved N %
direct contact 22 1.7
phone call 1 0.1
written request 1307 98.3
Total 1330 100.0
2. Status of patient
ER 243 19.0
Non ER 1035 81.0
Total 1278 100.0
Frequency Distribution of IPCC Database by
variables describing workload 2012.

14. 1. Type of communication involved N %
direct contact 22 1.7
phone call 1 0.1
written request 1307 98.3
Total 1330 100.0
2. Status of patient
ER 243 19.0
Non ER 1035 81.0
Total 1278 100.0
Frequency Distribution of IPCC Database by
variables describing workload 2012.

15. 1. Type of communication involved N %
direct contact 22 1.7
phone call 1 0.1
written request 1307 98.3
Total 1330 100.0
2. Status of patient
ER 243 19.0
Non ER 1035 81.0
Total 1278 100.0
Frequency Distribution of IPCC Database by
variables describing workload 2012.

16. Negative Positive Total
p valueN % N % N %
Gender 0.6[NS]
Male 577 63.8 327 36.2 904 100.0
Female 414 62.5 248 37.5 662 100.0
..
Age group (years) <0.001
< 5 child 220 82.1 48 17.9 268 100.0
5-9 years 92 69.2 41 30.8 133 100.0
Teenagers (10-17) 136 59.1 94 40.9 230 100.0
Young adults (18-49) 446 59.0 310 41.0 756 100.0
Middle age/elderly (50+) 97 54.2 82 45.8 179 100.0
IPCC Laboratory significant results among total cases in
relation to selected explanatory (independent) variables :

17. Negative Positive Total
p valueN % N % N %
Gender 0.6[NS]
Male 577 63.8 327 36.2 904 100.0
Female 414 62.5 248 37.5 662 100.0
..
Age group (years) <0.001
< 5 child 220 82.1 48 17.9 268 100.0
5-9 years 92 69.2 41 30.8 133 100.0
Teenagers (10-17) 136 59.1 94 40.9 230 100.0
Young adults (18-49) 446 59.0 310 41.0 756 100.0
Middle age/elderly (50+) 97 54.2 82 45.8 179 100.0
IPCC Laboratory significant results among total cases in
relation to selected explanatory (independent) variables :

18. Negative Positive Total
p valueN % N % N %
Gender 0.6[NS]
Male 577 63.8 327 36.2 904 100.0
Female 414 62.5 248 37.5 662 100.0
..
Age group (years) <0.001
< 5 child 220 82.1 48 17.9 268 100.0
5-9 years 92 69.2 41 30.8 133 100.0
Teenagers (10-17) 136 59.1 94 40.9 230 100.0
Young adults (18-49) 446 59.0 310 41.0 756 100.0
Middle age/elderly (50+) 97 54.2 82 45.8 179 100.0
IPCC Laboratory significant results among total cases in
relation to selected explanatory (independent) variables :

19. <0.04
Gastric lavage
Negative 990 63.4 571 36.6 1561 100
Positive 1 20 4 80 5 100
Urine sample <0.001
Negative 580 86.3 92 13.7 672 100
Positive 411 46 483 54 894 100
Blood/serum sample <0.001
Negative 421 51.9 390 48.1 811 100
Positive 570 75.5 185 24.5 755 100
Laboratory samples
Negative Positive Total
p valueN % N % N %
Cont.
IPCC Laboratory significant results among total cases in
relation to selected explanatory (independent) variables :

20. <0.04
Gastric lavage
Negative 990 63.4 571 36.6 1561 100
Positive 1 20 4 80 5 100
Urine sample <0.001
Negative 580 86.3 92 13.7 672 100
Positive 411 46 483 54 894 100
Blood/serum sample <0.001
Negative 421 51.9 390 48.1 811 100
Positive 570 75.5 185 24.5 755 100
Laboratory samples
Negative Positive Total
p valueN % N % N %
Cont.
IPCC Laboratory significant results among total cases in
relation to selected explanatory (independent) variables :

21. <0.001
Hepatic Related 159 40.8 231 59.2 390 100.0
Gastrointestinal 64 68.1 30 31.9 94 100.0
Neuropsychological 375 73.4 136 26.6 511 100.0
Others 15 78.9 4 21.1 19 100.0
Musculoskeletal and
Dermatological
19 79.2 5 20.8 24 100.0
For check 97 80.2 24 19.8 121 100.0
Renal / respiratory related 16 84.2 3 15.8 19 100.0
Negative Positive Total
p valueN % N % N %
Chief complaint
Cont.
IPCC Laboratory significant results among total cases in
relation to selected explanatory (independent) variables :

22. <0.001
Hepatic Related 159 40.8 231 59.2 390 100.0
Gastrointestinal 64 68.1 30 31.9 94 100.0
Neuropsychological 375 73.4 136 26.6 511 100.0
Others 15 78.9 4 21.1 19 100.0
Musculoskeletal and
Dermatological
19 79.2 5 20.8 24 100.0
For check 97 80.2 24 19.8 121 100.0
Renal / respiratory related 16 84.2 3 15.8 19 100.0
Negative Positive Total
p valueN % N % N %
Chief complaint
Cont.
IPCC Laboratory significant results among total cases in
relation to selected explanatory (independent) variables :

23. IPCC; ECP (significant) cases characterization:
Gender N %
Male 100 55.6
Female 80 44.4
Total 180 55.6
..
Age group (years) N %
< 5 child 31 17.2
5-9 years 9 5
Teenagers (10-17) 22 12.2
Young adults (18-49) 105 58.3
Middle age /elderly 13 7.2
Total 180 100
Frequency distribution of cases with significant poisoning of ECP by age
and gender 2012.

24. IPCC; ECP (significant) cases characterization:
Gender N %
Male 100 55.6
Female 80 44.4
Total 180 55.6
..
Age group (years) N %
< 5 child 31 17.2
5-9 years 9 5
Teenagers (10-17) 22 12.2
Young adults (18-49) 105 58.3
Middle age /elderly 13 7.2
Total 180 100
Frequency distribution of cases with significant poisoning of ECP by age
and gender 2012.

25. IPCC; ECP (significant) cases characterization:
Gender N %
Male 100 55.6
Female 80 44.4
Total 180 55.6
..
Age group (years) N %
< 5 child 31 17.2
5-9 years 9 5
Teenagers (10-17) 22 12.2
Young adults (18-49) 105 58.3
Middle age /elderly 13 7.2
Total 180 100
= 22.2
Frequency distribution of cases with significant poisoning of ECP by age
and gender 2012.

26. Male Female Total
N % N % N %
Age group (years)
< 5 child 17 54.8 14 45.2 31 100.0
5-9 years 6 66.7 3 33.3 9 100.0
Teenagers (10-17) 5 22.7 17 77.3 22 100.0
Young adults (18-49) 63 60.0 42 40.0 105 100.0
Middle age /elderly 9 69.2 4 30.8 13 100.0
Gender composition by age group among cases with
significant poisoning of ECP, 2012.
P (chi-square) = 0.02

27. Male Female Total
N % N % N %
Age group (years)
< 5 child 17 54.8 14 45.2 31 100.0
5-9 years 6 66.7 3 33.3 9 100.0
Teenagers (10-17) 5 22.7 17 77.3 22 100.0
Young adults (18-49) 63 60.0 42 40.0 105 100.0
Middle age /elderly 9 69.2 4 30.8 13 100.0
P (chi-square) = 0.02
Gender composition by age group among cases with
significant poisoning of ECP, 2012.

28. Category of chemical involved N %
Sedatives 57 31.7
Analgesics 43 23.9
Insecticide 25 13.9
Rodenticide 11 6.1
Other Drugs 11 6.1
Heavy Metals-external 33 18.3
Total 180 100
Frequency distribution of cases with significant poisoning
due to external causes (n=180) by type poisoning events 2012.

29. Category of chemical involved N %
Sedatives 57 31.7
Analgesics 43 23.9
Insecticide 25 13.9
Rodenticide 11 6.1
Other Drugs 11 6.1
Heavy Metals-external 33 18.3
Total 180 100
Frequency distribution of cases with significant poisoning
due to external causes (n=180) by type poisoning events 2012.
61.7%

30. Category of chemical involved N %
Sedatives 57 31.7
Analgesics 43 23.9
Insecticide 25 13.9
Rodenticide 11 6.1
Other Drugs 11 6.1
Heavy Metals-external 33 18.3
Total 180 100
Frequency distribution of cases with significant poisoning
due to external causes (n=180) by type poisoning events 2012.
20%

31. Category of chemical involved N %
Sedatives 57 31.7
Analgesics 43 23.9
Insecticide 25 13.9
Rodenticide 11 6.1
Other Drugs 11 6.1
Heavy Metals-external 33 18.3
Total 180 100
Frequency distribution of cases with significant poisoning
due to external causes (n=180) by type poisoning events 2012.

32. Type of intention N %
Suicide 51 33.3
Unknown 21 13.7
Abuse 20 13.1
Accidental 20 13.1
Environmental 15 9.8
Misuse 12 7.8
Occupational 9 5.9
Criminal 2 1.3
Other 2 1.3
Therapeutic Error 1 .7
Total 153 100.0
Missing= 27 15.0
Frequency distribution of cases with significant poisoning
due to external causes (n=180) by type poisoning events 2012.
Cont.

33. The association between gender and selected characteristics
of cases with significant poisoning of external origin 2012...
Male Female P
N % N %
Category of chemical involved <0.001
Analgesics / other drugs 19 19 35 43.8
Sedatives 43 43 14 17.5
Insecticide / rodenticide 14 14 22 27.5
Heavy metals-ECP 24 24 9 11.3
Total 100 100 80 100
Intentional Vs Non-intentional 0.19[N]
intentional 38 45 38 56
unintentional 46 55 30 44
Total 84 100 68 100

34. The association between gender and selected characteristics
of cases with significant poisoning of external origin 2012...
Male Female P
N % N %
Category of chemical involved <0.001
Analgesics / other drugs 19 19 35 43.8
Sedatives 43 43 14 17.5
Insecticide / rodenticide 14 14 22 27.5
Heavy metals-ECP 24 24 9 11.3
Total 100 100 80 100
Intentional Vs Non-intentional 0.19[N]
intentional 38 45 38 56
unintentional 46 55 30 44
Total 84 100 68 100

35. The association between gender and selected characteristics
of cases with significant poisoning of external origin 2012...
Male Female P
N % N %
Category of chemical involved <0.001
Analgesics / other drugs 19 19 35 43.8
Sedatives 43 43 14 17.5
Insecticide / rodenticide 14 14 22 27.5
Heavy metals-ECP 24 24 9 11.3
Total 100 100 80 100
Intentional Vs Non-intentional 0.19[N]
intentional 38 45 38 56
unintentional 46 55 30 44
Total 84 100 68 100

36. 0
5
10
15
20
25
30
No.ofECPcases
Months
IPCC Significant(positive) ECP cases by date 2012

37. 0
5
10
15
20
25
30
No.ofECPcases
Months
Spring 8% Summer 51% Autumn 23%
Winter9%
Winter9%
IPCC Significant(positive) ECP cases by date 2012

38. 1. Teenager and older has higher probability to have significant
poisoning than other age groups.
2. Gastric lavage and urine samples provide a higher yield for
significant poisoning results compared to blood/serum samples.
3. A very low phone call usage was observed within the IPCC services.
5. Overall ECP, drugs were the predominant agents implicated, the
commonest offender drugs found to be sedative group.
Conclusions:

39. 1. Revitalise the phone call within the IPCC
2. Collaboration between IPCC with other health facilities and other
stakeholders to establishing a poisoning surveillance center.
3. Reactivation of legislations that limit the prescriptions and supply
of drugs especially sedatives.
4. Implantation of educational program within the educational
institutions about the ECP risks and safe storage play vital role in
controlling and limitation of drugs poisoning.
Recommendations:

40. Thank you