Imad Al-Sadoon, Yacoub AA, Najwa Abdull-Karim. Accidental poisoning among children in Basrah: an epidemiological perspective. J Fac Med (Baghdad) 1988;30(1):105-112.

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105
ACCIDENTAL POISONING AMONG CHILDREN IN BASRAH: AN
EPIDEMIOLOGICAL PERSPECTIVE
Imad Al-Sadoon1
, Alim Yacoub2
and Najwa Abdull-Karim1
Dept. of Paediatrics1
and Dept. of Community Med.2
, Coll. of Med. Basrah.
Key Words: Poisoning, Children, Hospital, Basrah-Iraq.
: ‫الخالصة‬
‫يتم‬ ‫التي‬ ‫الحاالت‬ ‫هذه‬ ‫كافة‬ ‫تسجيل‬ ‫طريق‬ ‫عن‬ ‫البصرة‬ ‫في‬ ‫االطفال‬ ‫عند‬ ‫التسمم‬ ‫حاالت‬ ‫ونمط‬ ‫حدوث‬ ‫نسب‬ ‫لمعرفة‬ ‫دراسة‬ ‫اجراء‬ ‫تم‬
‫االصابات‬ ‫هذه‬ ‫حدوث‬ ‫نسبة‬ ‫عن‬ ‫واقعية‬ ‫اكثر‬ ‫فكرة‬ ‫تعطي‬ ‫النوع‬ ‫هذا‬ ‫من‬ ‫دراسة‬ ‫ان‬ ‫وجد‬ . ‫سنة‬ ‫ولمدة‬ ‫األطفال‬ ‫مستشفى‬ ‫الى‬ ‫احالتها‬
‫مقارنة‬
‫وجد‬ ‫كما‬ .‫الحاالت‬ ‫بنفس‬ ‫والمصابين‬ ‫المستشفى‬ ‫يدخلون‬ ‫اللذين‬ ‫المرضى‬ ‫سجالت‬ ‫مراجعة‬ ‫على‬ ‫القائمة‬ ‫بالدراسات‬
‫أ‬
‫هناك‬ ‫ن‬
‫ومواسم‬ ‫السكن‬ ‫ومحل‬ ‫العمر‬ ‫ناحية‬ ‫من‬ ‫التسمم‬ ‫حاالت‬ ‫حدوث‬ ‫نسبة‬ ‫في‬ ً‫ا‬‫واضح‬ ً‫ا‬‫اختالف‬
. ‫حدوثها‬
SUMMARY:
A study was carried out to determine the incidence and pattern of reported cases of accidental
poisoning among children in Basrah. All cases reported to the Paediatric Hospital during a one-
year period were included. It was shown that the number of cases as obtained from such a study
gave a more realistic picture of the incidence of accidental poisoning among children than that
based on retrospective analysis of records. Kerosene poisoning and detergent "ingestion" were
the leading causes of such cases. A marked variation with respect to age, place of residence and
season was observed.
INTRODUCTION:
Accidental poisoning among children presents a challenging problem for the paediatrition,
epidemiologist and medical sociologist. For the paediatrician, the diagnosis of the type of
poisoning, the assessment of its severity and the provision of timely and adequate therapeutic
intervention are areas of prime concern. The clinical epidemiologist and the medical sociologist,
on the other hand, are interested in assessing the pattern and extent of the problem at a community
level and in studying the geographical and temporal variations. They are also concerned with the
study of the various factors which determine the availability, consumption and utilization of
various potentially poisonous house-hold and medicinal items. The ultimate aim of such endeavors
is to suggest effective preventive measures and explore the feasibility of their application.
Various studies carried out1-4
showed a clear distinction in the pattern and extent of poisoning
among children between developed and developing countries reflecting, on the whole, attitudinal
and behavioral (life style) differences. The need to examine the pattern and extent of this problem
among children in Basrah, southern Iraq, led us to carry out a study, the results of which, are
reported in this paper. This study also aims at examining the variation in such pattern with respect
to the place of residence, age and seasonal distribution of cases.
Since retrospective analysis of records related to the problem of poisoning among children
underestimates the true incidence5
(many reported cases are not admitted) and because of the lack

10. J. Fac. Med. Baghdad 1988 Vol. 30 No.1
106
of a reporting system of all cases, this study was based on perspective and consecutive recording
of all reported cases and as described below.
MATERIALS AND METHODS:
All cases of accidental poisoning among children were reported (not only admitted) to the
Paediatric Hospital in Basrah for period of one year (June 1985 to May 1986) were included in
this study. A special form was prepared to record information regarding date of admission, age,
sex, place of residence and type of poisoning.
In the analysis of the results, the place of residence was allocated to one of three zones:
Zone 1: Areas situated in the central part of the City of Basrah.
Zone 2: Areas situated in the suburbs of Basrah.
Zone 3: Areas which lie outside the City of Basrah (peripheral districts).
Such classification can be very useful since it could allow us to describe the variation in the
incidence of reported cases of poisoning among children in relation to two important factors,
namely:
1) Variation in the utilization of Paediatric Hospital services because of distance (and thus a
problem of accessibility).
2) Variation in the socioeconomic and culture characteristics of different areas of Basrah.
RESULTS:
The results showed that there were 1024 cases of accidental poisoning reported to the
Paediatric Hospital during the one-year study period. The types and frequencies are shown in
Table 1. They are arranged in the order of their causes. It can be seen that kerosene poisoning
accounted for almost two thirds (65%) of the reported cases. Ingestion of detergents came next
with a relative frequency of 6.7%. Sedatives and antispasmodics accounted for 4.59% and 3.8%
respectively.
Table 2 shows the age and sex distribution of those with kerosene poisoning. Almost 90% of
cases occurred among children 1-5 years old. Although the number of males who were reported
with this condition is higher than females, the difference between males and females when
analyzed with respect to age was not found to be significant.
The monthly distribution of the first five leading causes of poisoning among children are shown
in Table 3. A definite trend can be described for both kerosene and detergent poisonings. The
highest incidence of kerosene poisoning was recorded in April, May, June, July and August. This
was followed by a noticeable decline during September, October and November. A relatively
moderate increase can be observed in December and January. A more or less similar trend can be
described for detergent ingestion. Evidently the first peak can be ascribed to feeling of thirst in
summer and the second lower peak can be attributed to availability of kerosene in winter. No
consistent trend can be observed for the remaining types of poisoning.

11. J. Fac. Med. Baghdad 1988 Vol. 30 No.1
107
The proportional distribution of the first five leading types of poisonings with respect to place
of residence is shown in Table 4. The majority of reported cases. of all types came from zone II.
Such variation in the distribution of cases is more marked with kerosene and detergent poisonings.
Table 1: Types and annual incidence of cases of poisoning among children reported to
the Paediatric Hospital
Type Number (%)
Kerosene 674 (65.82)
Detergents 69 (6.74)
Sedatives & Hypnotics 47 (4.59)
Antispasmodics 39 (3.81)
Organophosphorous 28 (2.73)
Antiemetics 11 (1.07)
Aspirin 8 (0.78)
Paracetamol 8 (0.78)
Contraceptives 7 (0.68)
Alcohol 7 (0.68)
Iron 5 (0.49)
Antidepressants 4 (0.39)
antihistaminic 3 (0.29)
Miscellaneous 19 (1.86)
Unknown 95 (9.28)
Total 1024 (100.00)
Table 2: Age and sex distribution of cases of kerosene poisoning Number of cases (%)
Number of cases (%)
Age (years) Males Females Total
Below one 7 (1.69) 8 (3.23) 15 (2.26)
1-5 368 (88.67) 226 (91.13) 594 (89.59)
6-12 40 (9.64) 14 (5.65) 54 (8.14)
Total 415 (100.00) 248 (100.00) 663* (100.00)
X2
=4.78 P>0.05 * Information on the ages of 11 cases was not obtained.

12. J. Fac. Med. Baghdad 1988 Vol. 30 No.1
108
Table 4: The distribution of the first five leading causes of poisoning by place of
residence.
Type Number of cases (%) by zone
Zone 1 Zone 2 Zone 3 Total
Kerosene 58 (8.8) 486 (73.9) 113 (17.2) 657* (100)
Detergents 9 (13.0) 51 (73.9) 9 (13.0) 69 (100)
Sedatives 9 (19.6) 30 (65.2) 7 (15.20) 46** (100)
Antispasmodics 4 (10.8) 22 (59.5) 11 (29.7) 377*** (100)
Organophosphorous 6 (21.4) 19 (67.9) 3 (10.7) 28**** (100)
*Information on the place of residence of 17 cases was not obtained.
** Information on the place of residence of one case was not obtained.
*** Information on the place of residence of two cases was not obtained.
**** Information on the place of residence of three cases was not obtained.
DISCUSSION:
A recent Study5
based on retrospective analysis of records of cases of accidental poisoning of
children admitted to the Paediatric Hospital in Basrah showed that there were 126 and 127 such
cases in 1984 and 1985 respectively. These findings compared to the 1024 cases obtained in our
study suggests that a more realistic estimate of the incidence of poisoning among children can be
obtained by studying reported (and not only admitted) cases. We do not claim that the figure we
obtained in this study is the actual incidence since there must have been a fraction of cases which
were either not reported at all or possibly reported to a peripheral health centre. However, the
degree of underestimation of incidence could be greatly reduced by including reported cases as
compared to the incidence based on retrospective analysis of records. In addition, by such
inclusion, one would expect that the pattern of poisoning described in this study reflects to a
significant extent the community profile of poisoning among children. in Basrah. Such type of
study is a compromise between those studies based on retrospective analyses of records (cheap,
quick, but measures just the tip of iceberg) and studies based on household survey (provides a
better index about the incidence but expensive and time consuming).
The pattern of poisoning and its age distribution as shown in this study is similar to those
reported in other developing countries1-4
. Household items (kerosene and detergents) are the two
most common causes of accidental poisoning among children. This is in contrast to the pattern
reported from the developed countries whereby medicinal products are the most important causes
2,3
. The pattern which we described here is similar to that reported in the study carried out in Basrah
and to which we have already referred5
.
In this study it has been shown that children 1-5 years old coming from zone II are those who
are at a relatively greater risk of being afflicted with this condition. Since these areas are inhabited
by people who are generally less affluent than those inhabiting zone I, it might be hypothesized
that socioeconomic and cultural differences might be reflected on the extent and pattern of
poisoning among children. On the other hand, the lower proportion of afflicted children coming

13. J. Fac. Med. Baghdad 1988 Vol. 30 No.1
109
from peripheral areas might be attributed to a problem of access to paediatric Hospital or to
alternative use of care6
. The variation with respect to place of residence needs further exploration
through a community study which would allow indepth assessment of the various factors
responsible for such variation, for example, socioeconomic ones. Such a study will allow
comparison between the incidence rates through providing denominators of the population not
obtainable from studies which are hospital based.
Various measures have been suggested to prevent accidental poisoning among children7
. These
include parent education regarding proper storage and handling of products, proper drug selection
and use, use of child-resistant packaging and the preparation of parents for rapid effective response
should poisoning occurs. It is doubtful, however, that significant success could be achieved in any
given community without adequate understanding of the local situation conductive to the
occurrence of poisoning among children.
This study has highlighted the importance of accidental poisoning by the ingestion of kerosene
and detergents. There exists a pressing need in Basrah to carry out an indepth study to identify
factors which determine the storage, use and availability of these products. One of the authors, for
example, observed causally the high frequency with which people store kerosene in bottles used
originally for mineral water. It is only through the understanding of such factors that effective
preventive measures could be suggested and implemented. It does go without saying that
sociological work could contribute significantly in this direction.
REFERENCES:
1) El-Mouzan M., Elageb A. & Ali N. Accidental poisoning of children in the Eastern Province.
Saudi Medical Journal. 1986, 7, 231-236.
2) Fraser N.C. Accidental poisoning deaths in British children 1958-1977. British Medical Journal.
1980, 284, 1595-1598.
3) Lawson G.R., Craft AW. & Jackson R.H. Changing pattern of poisoning in children of
Newcastle 1974-1981. British Medical Journal. 1983, 287, 15- 17.
4) Khalil M.A. Accidental poisoning in Saudi Arabian children seen at Riyadh Al- Kharj Hospital.
Saudi Medical Journal. 1986, 7, 613-617.
5) Al-Sadoon I., Al- Hakiem M. & Ali. N. Acute poisoning in children: Two-year study of patents
admitted to Basrah Al-Jumhouri Hospital. (in press). The Medical Journal of Basrah University.
6) Habib O. & Vaughan P. The determinants of health services utilization in southern Iraq: A
household interview survey. International Journal of Epidemiology. 1986, 15, 395-403.
7) Temple A.R, Poison prevention education. Paediatrics. supplement, 1984, 964-969.