Acute poisoning in three African countries: Botswana, South Africa and Uganda

Abstract

Acute poisoning constitutes one of the main reasons why patients visit emergency departments of hospitals. However, the burden and pattern of acute poisoning in African countries are not well established, hence the need for this study. This study was conducted in order to compare the patterns of acute poisoning in three countries, namely, Botswana, South Africa, and Uganda. Specifically, this study examined the similarities and differences in the patterns of occurrence of acute poisoning based on the sociodemographic characteristics of the victims, the toxic agents involved, and the circumstances of the incidents.

The study was based on six papers published on the topic. Papers I and II about Botswana covered a period of 24 months (January 2004 - December 2005) and six months (January - June 2005) respectively. The data from Uganda, as reported in Paper III, covered a six-month period (January-June 2005); while studies in South Africa, Papers IV to VI, covered respectively six (January-June 2005) and 18 months (January 2000-June 2001). A re-analysis of data from Papers II to IV was conducted after recoding age category and the grouping of toxic agents.

In total, the six Papers reported data on 1780 patients; 54.8% of them were male. The median age was 24 years in Uganda, but as low as 17 years in Botswana and South Africa. In Botswana and South Africa, acute poisoning incidents occurred mostly in children younger than 12 years old, then decreased among teenagers, and increased again among young adults, before decreasing among patients over 30 years old. On the contrary, in Uganda there was that less than 5% of children younger than 12 years who were victims of poisoning. There was an increase in the prevalence of acute poisoning among teenagers and young adults before a decrease occurred among adults over 30 years old. The overall case fatality rate was 2.1 %, ranging from 1.4% in Uganda, 2.4% in South Africa, to 2.6% in Botswana.

With regard to similarities across the three countries, it was found that among teenagers, girls committed more deliberate self-poisoning than boys; while in young adults, men committed more self-poisoning than women. With regard to toxic agents, household products were involved in fatal Page 9 of 136 outcomes in all three countries; while agrichemicals were more involved in deliberate than accidental poisonings; food poisoning affected more females than males.

With regard to disparities across the three countries, the age and gender of the victims, the circumstances of the incidents and the types of toxic agents played a significant role. With regard to gender, the majority of the victims were males in Uganda, females in South Africa; while in Botswana, females and males were affected equally. Among teenagers, the toxic agents most involved in the poisoning incidents were pharmaceuticals in Botswana; household chemicals in South Africa; but agrichemicals in Uganda.

While the majority of incidents happened by accident in Botswana and South Africa, being respectively 76.7% and 59.1%; in Uganda, 64.5% of acute poisoning cases were deliberate self¬poisoning. Deliberate self-poisoning was responsible for 50% of deaths in Uganda, 30% in South Africa, but no death in Botswana. The majority of deaths occurred among teenagers in South Africa; in Uganda it was among adults over 30years; while in Botswana, the majority of deaths were distributed almost equally amongst children younger than 12years old and young adults.

Diverse products were involved in fatal outcomes. In South Africa, pharmaceuticals, particularly drugs of abuse, cocaine and marijuana; as well as carbon monoxide, and organophosphates were involved in fatalities. While, in Botswana, the products involved were paraffin, traditional medicines, pharmaceuticals, food poisoning, plants, and snake envenomation. In contrast, in Uganda, alcohol intoxication, organophosphates, carbon monoxide, and some unspecified household products lead to fatalities.

Household chemicals were involved in the deaths of victims in all three countries; but the extent of their involvement differed from country to country. This group of products was responsible of 75% of deaths in Uganda, half of deaths in South Africa, and in a third of deaths in Botswana. Agrichemicals were involved in the deaths of victims in Uganda and South Africa, but not in Botswana. They were involved in a quarter of deaths in Uganda and 10% of deaths in South Africa.

Page 10 of 136 Plants and traditional medicines were involved in two-thirds of the deaths only in Botswana; while pharmaceuticals were involved in 40% of fatal outcomes only in South Africa.

In conclusion, the contextual factors of each country led to a pattern of acute poisoning that showed some similarities with regard to the distribution of deliberate self-poisoning among females, teenagers, and young adult victims. However, there were disparities relating to the differential access to toxic agents, based on the age and gender of the victims. Moreover, though the case fatality rate was similar across the three countries, the distribution of deaths based on age, gender, circumstances of poisoning and types of toxic agents involved differed among the three countries.

These findings suggest that multifaceted interventions should be implemented including policy development, enforcement of the existing legislation, and the establishment of a surveillance mechanism, in-service training of clinicians and revision of treatment guidelines. These interventions should be tailored to meet the specific realities of each country.