Assessment of trend of mortality due to poisoning in the northern zone of india and comparison with other international & national researches Authors:Naveen Sharma, Kunal Khanna, Kuldeep Kumar, Tarun Dagar, Sandeep Kumar Giri, Vijay Pal Khanagwal Int J Biol Med Res. 2024; 15(1): 7741-7745 https://www.biomedscidirect.com/2824/assessment-of-trend-of-mortality-due-to-poisoning-in-the-northern-zone-of-india-and-comparison-with-other-international-national-researches

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International Journal of Biological & Medical Research
Int J Biol Med Res. 2024; 15(1): 7741-7745
Assessment of Trend of Mortality due to Poisoning in the Northern Zone of India
and Comparison with other International & National Researches
a b c d e f
Naveen Sharma , Kunal Khanna , Kuldeep Kumar , Tarun Dagar , Sandeep Kumar Giri , Vijay Pal Khanagwal
a,d,e b,c f
Assistant Professor MD, Associate Professor MD, Professor & Head MD
Department of Forensic Medicine & Toxicology, Maharishi Markandeshwar College of Medical Sciences & Research, MM University, Sadopur, Ambala, Haryana, India-134007
Department of Forensic Medicine & Toxicology, Kalpana Chawla Government Medical College and Hospital, Karnal & University of Health Sciences, Rohtak, Haryana, India-132001
Department of Forensic Medicine & Toxicology, Pt. B.D Sharma Postgraduate Institute of Health Sciences & University of Health Sciences, Rohtak, Haryana, India-124001
Department of Forensic Medicine & Toxicology, Kalpana Chawla Government Medical College and Hospital, Karnal & University of Health Sciences, Rohtak, Haryana, India-132001
Department of Forensic Medicine & Toxicology, Kalpana Chawla Government Medical College and Hospital, Karnal & University of Health Sciences, Rohtak, Haryana, India-132001
Department of Forensic Medicine & Toxicology, Kalpana Chawla Government Medical College and Hospital, Karnal & University of Health Sciences, Rohtak, Haryana, India-132001
A R T I C L E I N F O A B S T R A C T
Keywords:
Deaths
Insecticide
Pesticide
Poison
Pattern of poisoning
Original Article
“All things are poison, and nothing is without poison; only the dose permits something not to be
poisonous.” - Paracelsus Poisoning is the well-known second most common cause of unnatural
deaths due to over usage of pesticides including fertilizers, especially in developing countries like
Indiawiththeintenttoincreasetheproductionofcrops.Reducingthedeathsbypoisoningisaglobal
challenge. The nature of death due to poisoning remains unnatural in these cases, therefore, these
cases fall under the jurisdiction of a forensic pathologist for medicolegal autopsy. Aims: This
researchwasdoneaboutupdatepresentinformationonthepatternsandanalyzethecharacteristics
of poisoning in relation to age, gender, area of living, type of poison used and manner of death in the
northernzone of India and also compare these characteristicswith other International and National
researches done on poisoning. Methods: This study comprised hospital deaths in the jurisdiction of
Karnal district alleged to have died due to poisoning in two years i.e. 2021 and 2022. The data
required was collected from the medical and medicolegal records including chemical analysis
reports of the deceased. Results: In total, 432 dead bodies were brought for medicolegal autopsy
during the study period. Out of them, poisoning constitutes 18.75 % of all unnatural deaths. The
incidences of deaths due to poison was found higher in male (64.2%) and male to female ratio was
1.8: 1. Mortality was seen higher in the individuals living in rural areas 65.43 % while urban areas
constituted34.57%.Thepoisoningdeathswerehigherintheagedbetween18to30years(48.17%).
In the pediatric age group, death due to poisoning was not seen. The five most common poisoning
agents in decreasing order, were pesticide (48.15%), insecticide (38.30%), unknown poison
including rodenticide (6.15%), therapeutic drug (3.70%) and snake bite (3.69%). The majority of
deceased consumed poison as suicide (44.44%) followed by accidental (32.11%) and homicidal
(3.70%) manner. The manner was not ascertained in 19.75% of cases. The results of the present
study were comparable to other International and National studies on poisoning. Conclusion: The
present study concludes that the maximum deaths occurred in male individuals of the productive
age group due to pesticides. This could be due to either excessive use of fertilizers or to take the
benefit of laws under which a claim is given by the state government to the farmers whose deaths
occurred due to poisoning while working in a field which creates an unnecessary burden on the
Nation. Results of this study suggest that such kind of research should be conducted at the world
level to assess the current scenario on the deaths by poison and effectivity of the already done
interventions. Furthermore, amendments in the already existing laws are a core demand for an
abruptreductionindeathsbypoisonacrosstheworld.
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1. Introduction
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Poisoning is a major public health problem for all Countries.
Poison is a substance (solid, liquid or gaseous), which if introduced in
the living body, or brought into contact with any part thereof, will
produce ill health or death.[1] Poisoning is a
pathophysiological condition resulting from the ingestion of toxic
substances (poisons) and can be broadly classified as either
chronic or acute.[2] Acute poisoning is caused by an excessive
single dose (usually equal to a fatal dose), but less than that used in
fulminantpoisoning.[3]
* Corresponding Author : Dr. Naveen Sharma
Assistant Professor
Department of Forensic Medicine & Toxicology
Maharishi Markandeshwar College of Medical Sciences & Research, MM University,
Sadopur, Ambala, Haryana, India-134007
Email: dr.naveendhananiya@gmail.com
Copyright 2023 BioMedSciDirect Publications. All rights reserved.
c

2. Naveen Sharma et al. Int J Biol Med Res. 2024; 15(1): 7741-7745
7742
According to the World Health Organization (WHO), 30 lakh
poisoning cases occur annually around the world and 2.2 lakh
deaths as a result of poisoning. Of these 90 % of fatal poisoning
occur in developing countries, particularly among agricultural
workers. [3] The toxicity of any poison depends upon its inherent
properties (physio-chemical as well as pharmacological), the
quantity or concentration involved, the route of absorption and the
factors specific to the individual who is exposed. [4] The main task
for forensic experts in alleged deaths due to poisoning is to exclude
or confirm the other non-toxic factors/pre-existing diseases
contributing to death. Before the autopsy, hospital death due to
poisoning, forensic pathologists should peruse the clinical record
because results of antemortem samples are likely to be of greater
use than fluids/samples drawn off at autopsy, because of sampling
defect, postmortem changes and because toxic levels are likely to
have been higher during life, representing more accurately the
maximumtoxicconcentrations.[5]
Itisevidentintheliteraturethat,morbidityandmortalitydueto
poisoning vary from place to place and changes in trend are
expected over some time due to advancement in the fields of
agriculture, industries and pharmacy.[6] The complete data-based
study on medicolegal autopsies in poisoning cases and other
clinical factors due to poisoning in India are rarely reported in the
literature and only very few authors compare the results with
international studies. The latest information on patterns of
poisoning and statistics of deaths due to poisoning is crucial for
earlydiagnosis,propermanagementandplanningnewpoliciesand
changes in already existing policies according to current scenario.
In light of the above, the present study was done to report or
compare the results of our study at the International and National
levels.
MATERIAL&METHODS:
This is a retrospective and descriptive study based on clinical
and medicolegal records, which was carried out in the Department
of Forensic Medicine and Toxicology, in Karnal (India) which is a
regional tertiary care level hospital. Hence many patients with
poisoning from other districts visit our hospital. Further, this
institute is also a referral center of other districts for medicolegal or
expert opinions. In the present study, the authors report only those
cases, whose autopsy was done by or under the supervision of the
authorsinthemortuaryofthisinstituteduringtheperiodof2years
i.e. January 2021 to December 2022. A total of 430 hospital deaths
were brought for post-mortem examination in the morgue. Out of
them, 81 cases, in which history of poisoning, autopsy findings
suggestive of poisoning and no pre-existing pathology contributing
to death were taken in the present study. Demographic data of
eligible patients, including age, gender, place of residence, clinical
diagnosis, type of toxic agent and final report from state chemical
analysis report brought by police for a final opinion regarding the
cause of death were collected and documented on a prepared
proforma and toxic agents were classified. No human or animal
interventionwasdoneduringthestudy.
RESULTS:
The present study was conducted on 81 cases of death due to
poisoning. For diagnosis of poisoning; history, type of poison,
clinical signs, symptoms and chemical analysis report positive for
poison; were taken into account from the medical record of the
deceased. An autopsy on such dead bodies constitutes 18.75 % of
total autopsies done during the study period i.e. January 2021 to
December 2022. The total of 81 cases included in the study, 52 were
males and 29 were females and male to female ratio was 1.8: 1.
which is summarized in table-1 that the incidence of poisoning was
foundhigherinmalesi.e.64.2%ascomparedtofemales35.8%.The
individuals brought with poisoning were predominantly from rural
areas 65.43 % (n=53) rather than urban areas 34.57% (n=28)
whichissummarizedintable-2.
Themaximumnumberofdeathsduetopoisoningwerefoundat
48.17% (n=39) in aged between 18-30 years old followed by
29.63% (n=24) aged between 31-40 years old, 14.81% (n=12) in
aged between 41-50 years old, 3.70% in aged between 51-60 years
old, 2.46% (n=2) in adolescence aged between 13-17 years old and
1.23% (n=1) in aged more than 61 years old individuals. In the
pediatric age group, no mortality was found and not brought for
autopsy. Further, in young adults i.e. aged between 18 to 40 years,
50.62% (n=41) cases were found male and 27.19 (n=22) were
female. Among middle aged i.e. aged between 41 to 60 years,
12.34%(n=10)werefoundmaleand6.16%(n=5)werefemale.Soit
is concluded from Table 3 that overall mortality due to poisoning
was found higher in male individuals as compared to female
individuals, which is summarized in Table 3. The
exposure/poisoning due to five common poison agents in
descending order were pesticides in 40.75% (n=39), insecticides in
38.30% (n=31), unknown poisons including rat killers in 6.16%
(n=5), snake bites in 3.69% (n=3) and medication/ drug overdose
in3.70%(n=3),thisisrepresentedintable-4.
The manner of poisoning is important and has to be decided by
forensic experts in all cases of unnatural deaths because sometimes
there is no direct eye-witness of the incidents and family members
can make a false charge on the innocent to take revenge on them. In
the present study, 44.44% (n=36) cases were found suicidal
followed by 32.11% (n=26) cases were accidental, 3.70% (n=3)
cases were homicidal and in 19.75% cases manner was
undetermined because no incident scene visit report made
available by the investigating officers and no direct eye witness was
found in those cases. Further, in suicidal cases, 28.36% were male
and 16.04% were female, hence it is clear that the incidence of
suicidal poisoning occurred higher in males as compared to
females. Among accidental poisoning deaths, 20.99% were male
and 11.13% were female. it is summarized in table-5. Males are
most vulnerable to poisoning across the world. Further, the results
ofthisstudyarecomparedwiththoseofothercountries(tableno6)
to understand the current global burden of deaths due to poisoning
and to plan different policies according to variations seen in trends
ofdevelopinganddevelopedcountries.

3. 7743
Table 1: Depicting gender wise distribution of deaths by
poison
Table 6: Depicting a comparison with other International
andNationalResearches
DISCUSSION:
The deaths that occur due to poisoning are a worldwide
problem. The last quarter of the 20th century saw tremendous
research in the fields of agriculture, industries and
pharmaceuticals. These advances have paralleled changes in the
trends of poisoning in developed as well as developing countries
like India. [6] The clinical picture of poisoning is referred to as
toxicosis and poisoning with more than one substance are called
mixed or polyintoxication. [2] Gosselin, Smith and Hodge scale
describes the toxicity class of poison from practically nontoxic to
super-toxic [3] which is useful for clinical management, possible
outcomeofpoisoningortheestablishmentofpoisonacenter.
In the present study, the incidence of acute poisoning in male
cases was higher (64.2%) than in female cases (35.8%) this is
consistent with the Indian studies conducted by Sharma et al. [7],
Dalal et al.[8] and International studies conducted by McDowell [9]
in New Zealand & Vougiouklakis et al.[10] in Poland. The gender-
wise incidence of the present study is not consistent with
international studies conducted by Below et al. [11] in Germany &
Nesime et al. [12] in Turkey. In the present study, higher deaths
(65.43%) were seen in the persons who were living in rural areas
and 34.57% of cases were living in urban areas. This is consistent
withthenationalstudydonebyChatterjeeetal.[13]howeverthisis
not consistent with the international study done by Getie and
Table 2: Depicting distribution of poison cases by place of
residence
Table 4: Depicting distribution of poisonous agents
consumedbythedeceased
Naveen Sharma et al. Int J Biol Med Res. 2024; 15(1): 7741-7745

4. 7744
Most of the poisoning cases in this study were from the age
group 18 to 30 years followed by 31 to 40 years old. This is
consistent with international studies conducted by McDowell [9] &
Nesime et al. [12] and national studies conducted by Raju et al. [15]
andGuptaetal[16].
Our study showed that deaths in descending order occurred,
48.15% due to pesticides (aluminum phosphide) followed by
38.30% insecticides (organophosphate compounds), 6.15%
unknown poisons including rodenticides and 3.70% snake bites
and drug overdose. The Central Forensic Science Laboratory, in
Haryana does not have the facility to confirm the cases of snake
bites and in a few cases, they reported no common poison could be
detected. In such cases, authors, decide on poisoning based on,
history, clinical signs and symptoms, treatment records and
findings during autopsy. The most common poison cause mortality
in our study is consistent with national studies done by Sharma et
al.[7], Singh et al.[17], Yadav et al.[18]and international study done
by Nesime et al. [12] The studies done in various
developed/western countries report that deaths occur more
frequently due to poisoning by pharmaceutical drugs like narcotic
opioids and carbon monoxide poisoning in the USA [19], New
Zealand [11], Turkey [20], Australia[21] and Greece.[22] The
differences might be attributed to the fact that India is still a
developing country with an agriculture-based economy. The
developed countries are heavily industrialized and exposure of
their population to agriculture-related substances is thus minimal.
[19] The deaths in these countries more commonly occur due to
narcotics and drug overdose this was least common in the present
study. In the present study, 44.44% of cases were intentionally
poisoned by themselves followed by 32.11% cases were
accidentallypoisonedwhileworkinginthefieldortheiroccupation
places and 3.70% cases were poisoned to kill them and other
mechanical injuries were also present over the body. In 19.75% of
cases, the authors were unable to decide the manner of poisoning
due to non-availability of circumstances. The manner of the present
study is consistent with the studies done by Mittal et al. [23], Gupta
etal.[24],Awasthietal.[25],Patiletal.[26]
CONCLUSION: Through the data of the present study authors
attempted to throw the additional light into the dark area of deaths
due to poisoning. The findings demonstrated that a substantial
increase in unnatural deaths due to poisoning is a global problem
and we point to a heavy burden of fatal poisoning, particularly in
young adult male farmers and farmworkers. This is concluded from
the above study that death due to fatal poisoning constitutes
18.75% of total autopsy conducted during the study period. Deaths
due to pesticide poisoning were most commonly encountered
among all fatal poisoning. Among all cases of poisoning; the highest
incidences were suicidal. In this study, trends of this region were
revealed and the result was comparable with previous
international and national studies. The rapid increase in deaths due
to poisonings is acting as an alarm; that requires urgent attention at
the local, national and international levels. Further, the results
reported here are likely to be underestimated because the manner
was not ascertained in 19.75% of cases due to incomplete history,
lackofeyewitnessesandclearcircumstances.
SUGGESTION(S):Advancedhealthcarefacilitiesshouldbemade
available at all levels of healthcare centers, facility of poison
information centers, introducing separate toxicological units in the
districthospitalsand medicalcolleges.Educating,surveystocollect
data on such deaths and awareness of the population regarding the
common symptoms of poison and handling of poison at the
household or agricultural level could significantly reduce the risk of
such deaths. Autopsy examination of such deaths is important to
confirm the alleged cause and manner of death which helps the
variousinvestigatingagenciesincludingpolice.
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