Is poisoning a problem in South Sudan?

Poisoning may result from four main causes:

  • Self-poisoning: this deliberate act may be an attempt to commit suicide or a “cry for help” caused by depression or relationship problems.
  • Accidental poisoning: this is most common in young children. For example, from the ingestion of attractive but poisonous berries or the drinking of a poisonous liquid (e.g. kerosene, weed killer) kept in a soda bottle.
  • Intoxication at a place of employment either from the acute effects of the escape of a toxin (e.g. as may arise from oil-based paint and especially if used in a poorly ventilated place) or the long-term effects of some toxins (e.g. mesothelioma caused by contact with asbestos).
  • Criminal act of poisoning: e.g. “spiking” of a drink at a party.

Poisoning in Uganda

When I was working in Uganda I saw several cases of poisoning with organophosphates and was horrified by the mortality. Almost ten years ago, we carried out a simple study to find how widespread poisoning was in Uganda. We used the questionnaire below to assess the experience of individual Medical and Clinical Officers, in order to gain an indication of the drugs/chemicals taken and the mortality. Excess alcohol consumption was excluded from this study.

Results

Fifty Medical and Clinical Officers at 40 Ugandan hospitals/health centres were approached. Twenty-three replies (46%) were received (representing 20 health units). There were 133 cases reported (mean of six patients per Medical/Clinical Officer) and the findings are set out in Table 1.

 

Table 1. Types of poisoning and related deaths by age

Drugs / chemicals

Age up to 10 years

Age over 10 years

Number (%)

Deaths

Number (%)

Deaths (%)

Aspirin

1(3%)

0

2 (2%)

0

Batteries

2 (5%)

0

2 (2%)

0

Chloroquine

0

0

3 (3%)

0

Chlorpheniramine

0

0

1 (1%)

0

Diazepam

0

0

2 (2%)

0

Herbicide

0

0

1 (1%)

0

Kerosene

21 (55%)

0

1 (1%)

0

Organophosphate

8 (21%)

0

63 (66%)

19 (30%)

Paracetamol

4 (11%)

0

4 (4%)

0

Rat poison

1 (3%)

0

1 (1%)

0

Unknown

1 (3%)

0

15 (16%)

0

Totals

38

0

95

19 (20%)

Comment

This study did not attempt to define the incidence of poisoning. It described the experience of individual Medical/Clinical Officers in health units (hospitals and health centres). There is no indication of the numbers of patients who never arrived at these units. However the study did confirm that there was a serious problem. This was especially so for those over age 10 years among whom 66% had taken an organophosphate. These chemicals accounted for all the deaths. Death among adults from an organophosphate was disturbingly high at 30% although this is similar to international figures. All eight children up to age 10 years who had taken an organophosphate survived.  Kerosene (see next article) was the main poisoning chemical taken by 55% of the children. There were no fatalities in those aged up to 10 years. This may reflect the smaller quantities of agents taken by accident by this group.

            An assessment of the number of poisonings each year in Uganda using this information is difficult. However the annual total number of poisonings in all age groups may well reach 10,000 - 20,000. If 50% of these involve an organophosphate, with an overall mortality of 25%, then there may be 1,250 - 2,500 deaths. It must be emphasised that this is a very approximate calculation. On a worldwide basis it has been estimated that there are 1,000,000 accidental serious pesticide poisonings each year and 2,000,000 deliberate self-poisonings. These could account for a million deaths.

What is the situation in South Sudan?

Do we know how widespread the problem is in South Sudan? I suggest that we carry out a similar study here and then commission a series of articles covering the most common poisoning agents. So I encourage all Medical and Clinical Officers who treat patients with poisoning to complete the questionnaire below and send it to me ([email protected]). When I have received enough responses I will report on the findings in this journal and acknowledge everyone who has sent in a completed questionnaire.

 

Questionnaire to assess type of poisoning and related mortality

Name of reporter:

Name of hospital / health centre:

Address:

E-mail:

Date:

Question

Number

 

Up to age of 10 years

Over age of 10 years

Total

Deaths

Total

Deaths

How many cases of poisoning have you seen and managed in the last six months?

 

 

 

 

What drugs / chemicals had been taken? Please list commercial and chemical names if possible