lecture presented online via zoom plateform in the 20th. Aug 2025 in cooperation with مشروع رحلة التعلم العراق Exploaring Sagwa (traditional medicine practice), its component & preparations Sagwa posioning in Iraq, data including exposed population & their age Sagwa effects, adverse event & clinical presentation How to spread awarenss & to document such case with Iraqi pharmcovigilance system

1. Sagwa
Poisoning
ALAA FADHEL HASSAN
MSC. PHARMACOLOGY

3. Entrance, Sagwa:
Component & History

4. Sagwa
▪ Sagwa, a harmful traditional medicine, seems to be a
widespread practice by some witchdoctors, midwives &
elderly women in rural areas as part of conventional
knowledge & wrong beliefs, for the management of
prolonged gastroenteritis (GE) in infants [abdominal
discomfort & diarrhoea].
▪ It’s reported as one of many factors which affect GE besides
antibiotic abuse. According to Ali M. Shukur, 2019 “The use of
herbal products and supplements has increased over the
last three decades with at least 80% of people worldwide
depend on them. Many of these herbs are still unlicensed as
well as their use is not monitored”.

5. Sagwa Components
▪ It’s a strange mixture of many substances obtained from
animals like dead hedgehog, boiled parts of urchin; skin or
meat, mice skin, poisonous substances such as lead, arsenic,
mercury, cademium, tar, bentonite, drugs as lomotil, rose
water, latency, coriander, digitalis & other
herbs as well as cow faeces [is
known to differ among different
places].
▪ Manal M. Younus et al. 2017,reported a test
of sagwa sample; their results showed that it
contains a high percentage of Lead, besides
the presence of about 60
different ingredients.

6. Sagwa
preparation
Herbalist prepare the
segwa by dissolve the
powder (mixture of herbal
preparation) in hot water
and then cool it
She don’t add sugar to
prepared segwa, there 2
ways to give the segwa
a. Tea spoon (powder of
segwa) + ½ cup of tea (30 cc
)
b. Cup spoon (powder of
segwa) + ½ cup water (50
cc)
Numbers of doses per day
ranging from 1 dose / day
to 3 doses / day
The 1st dose was given by
segwor, the other doses
were given at the child
home
As described by Akram K. A. AL-
Timimi & Qusay A. AL-Rahim,
2018

7. Literature review
(simple)

8. Sagwa poisoning
▪ Different reports of sagwa
poisoning were reported in
Iraq, including rural areas
around Baghdad, Diyala,
western Iraq & etc. Reports of
sagwa poisoning have been
documented since 1994, sure
till nowadays.
DATA obtained from the Iraqi
Pharmacovigilance Centre, Iraqi
MOH [till 2024]
‫العدد‬ ‫المستشفى‬ ‫اسم‬
204 .
‫لالطفال‬ ‫العلوية‬ ‫م‬
120 .
‫غريب‬ ‫ابو‬ ‫م‬
61 ) ( .
‫الكرخ‬ ‫المركزي‬ ‫الطفل‬ ‫م‬
22 .
‫واالطفال‬ ‫للنسائية‬ ‫الرمادي‬ ‫م‬
7 .
‫العام‬ ‫الموصل‬ ‫م‬
3 .
‫المحمودية‬ ‫م‬
2 ) ( .
‫الرصافة‬ ‫الصدر‬ ‫الشهيد‬ ‫م‬
1 ) ( .
‫نينوى‬ ‫السالم‬ ‫م‬
1 .
‫البتول‬ ‫م‬
1 .
‫البلدي‬ ‫ابن‬ ‫م‬
1 .
‫واالطفال‬ ‫للنسائية‬ ‫الفلوجة‬ ‫م‬
355 ‫مجهولة‬

9. Let’s explore
▪ In 1994, a study included 225 poisoning cases, of which
segwa poisoning represented about 4.4% of the total cases
(Akram K. A. AL-Timimi & Qusay A. AL-Rahim, 2018).
▪ Akram K. A. AL-Timimi & Qusay A. AL-Rahim, 2018
performed their studyDiyala during period from1st August
2003 to 1st August 2004 , involving 50 cases with sagwa
poisoning.
▪ Throughout 2014-2016, 43 cases of sagwa poisoning were
registered by the Iraqi pharmacovigilance centre in Baghdad
from three different Paediatric Teaching Hospitals (Manal M.
Younus et al. 2017).

10. Let’s explore
▪ Riyadh M. K. Nassrawi 2018, reported a case of an infant presented
to the emergency department in the central hospital for paediatrics
in Baghdad after ingestion of a fork medicine mixture, which is
locally prepared, called Sagwa.
▪ Mohammed et al. 2019 performed a cross-sectional pilot study in
Nov. 2017 - April 2018 involving convenient sample of 200 mothers in
Baghdad. They stated that 17% of their participants used some
herbal preparations, in addition to 11% used some forms of
traditional harmful preparations (Al-Sagwa) to manage diarrhoea.
▪ Ali M. Shukur et al. 2019 performed a prospective case control study
in Diyala that involved 200 patients during Aug. 2017- Feb. 2018, one
hundred of them were presented to the hospital with severe GE
treated by family with herbals (case group, male = 51(51%), female =
49(49%).

11. Let’s explore
The attitude of mothers (%; n=200)
toward the use of either Al-Sagwa or a
herbal formula for the management of
diarrheal episodes of their children
(Mohammed et al. 2019)

12. Exposed patients age

13. Patient’s ages
Zaid R. Al-Ani et al 2018. reported
these ages in their retrospective
hospital-based case-control study
to investigate Childhood accidental
poisoning in western Iraq.

14. Patient’s ages
0 - 27 days
28 days to 23 months
2 - 11 years
12 - 17 years
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Patient age
DATA obtained from the Iraqi
Pharmacovigilance Centre, Iraqi
MOH [till 2024]

15. Yearly
distribution of
the cases
DATA obtained from the Iraqi
Pharmacovigilance Centre, Iraqi
MOH [till 2024]
2017 2018 2019 2020 2021 2022 2023
0%
5%
10%
15%
20%
25%
30%
VigiBase initial date

16. Effects & Adverse
events

17. Adverse event characteristic & severity
(Manal M. Younus et al. 2017)

18. Clinical
presentation of
Sagwa poisoning
PT: Vomiting
PT: Diarrhoea
PT: Dehydration
PT: Pyrexia
PT: Poor feeding infant
PT: Urine output decreased
PT: Feeding disorder
PT: Irritability
PT: Weight decreased
0% 10% 20% 30% 40% 50% 60% 70%
Reported preferred terms (MedDRA)
DATA obtained from the Iraqi
Pharmacovigilance Centre, Iraqi
MOH [till 2024]

19. Clinical
presentation of
Sagwa poisoning
▪ Disturbed level of
consciousness
▪ Lethargy
▪ Rapid breathing
▪ Dyspnea
▪ Cyanosis
▪ Respiratory
embarrassment
▪ Reduce urine output
▪ Oliguria
▪ Anuria
▪ Metabolic acidosis.
▪ Dehydration (severe)
▪ Hypotension
▪ Vomiting (coffee ground)
▪ Diarrhoea
▪ Sepsis
▪ Sever electrolytes
disturbances
▪ Hyperkalemia
▪ Hypernatremia
▪ Bleeding
▪ severe acute malnutrition
▪ Seizures
▪ Irritability
▪ Renal failure
▪ Skin erythema
▪ Skin rash
▪ Pallor
▪ Sunken eye
Reported by other studies considering
sagwa poisoning in Iraq

20. Reported seriousness of the cases
DATA obtained from the IPhVC, Iraqi MOH [till 2024] & PV BULLETIN June 2024
72.2%
27.5%
0.3%
Serious
Yes No Unknown
Seriousness criteria Count Percentage
Death 14 2.0%
Life threatening 453 65.9%
Caused/prolonged hospitalization 33 4.8%
Disabling/incapacitating 2 0.3%
Other medically important
condition 34 4.9%

21. Why this Presentation

22. Help us to stop Sagwa
▪ Share & publish information
▪ Inform your patients & community
▪ Report cases whenever you can

23. Help us to stop Sagwa
Publish & Share
Information

24. Refrences
▪ Riyadh M. Kadhim Nassrawi. 2018. “Acute lead encephalopathy due to
ingestion of certain herbal folk remedies in rural area in Iraq”,
International Journal of Current Research, 10, (12), 76422-76425.
▪ A.. M Shukur, . J.. I Alezzi, and T. J Kadhim, “Morbidity and Mortality
Associated with Community used Herbal (sagwa)use in Children with
Acute Gastroenteritis in Diyala Governorate”, djm, vol. 17, no. 2, pp. 92–
106, Dec. 2019.
▪ Zaid R. Al-Ani, Sahar J. Al-Hiali, Riyadh H. Al-Janabi, Childhood accidental
poisoning in western Iraq: Pattern and risk factors, Alexandria Journal of
Medicine, Volume 54, Issue 4, 2018, Pages 581-586, ISSN 2090-5068,
https://doi.org/10.1016/j.ajme.2017.10.001.(https://www.sciencedirect.co
m/science/article/pii/S2090506817301616)
▪ Akram Kdiar Abass AL-Timimi, Qusay A.AL-Rahim. (2018). Toxic effect of
herbal preparations in children (Segwa poisoning). Int. J. Adv. Res. Biol.
Sci. 5(5): 12-25. DOI: http://dx.doi.org/10.22192/ijarbs.2018.05.05.0 02
▪ Mohammed, Samer Imad, et al. “KNOWLEDGE AND MALPRACTICES IN
PEDIATRICS DIARRHEA MANAGEMENT BY IRAQI MOTHERS”. Asian
Journal of Pharmaceutical and Clinical Research, vol. 11, no. 8, Aug. 2018,
pp. 503-7, doi:10.22159/ajpcr.2018.v11i8.27454.
▪ Manal M. Younus, Noor K. Ali, Hadeel R. Abdulqader. Traditional Medicine
in Iraq, is it still a source of serious adverse events? A documentation of
serious adverse events of Sagwa among infants in Iraqi Paediatric
Hospitals. Iraqi New Medical Journal | July 2017 | Volume 3 | Number 2
▪ Junia Maria, Drumond Cajazeiro, Ana Sofia Rizo Toledo, Florencia
Romero, Daniel Martinez Garcia. SAGWA POISONING IN IRAQ: WE
NEED TO TALK ABOUT IT. MSF Paediatric Days 2019 Poster N 1319
▪ PHARMACOVIGILANCE BULLETIN: Volume 2, Issue 1: January - June
2024