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Transcript of HEAD DEPARTMENT OF FORENSIC MEDICINE POSTGRADUATE INSTITUTE OF MEDICAL EDUCATION & RESEARCH...
Prof.(Dr.)Dalbir Singh HEAD
DEPARTMENT OF FORENSIC MEDICINE POSTGRADUATE INSTITUTE OF MEDICAL EDUCATION & RESEARCH
CHANDIGARH (INDIA)
EXTENT AND DETERMINANTS OF COSTS OF ACUTE POISONING IN TRICITY OF
CHANDIGARH-AN EXPLORATORY STUDY
MORTALITY DUE TO ACUTE POISONING
HAS AN ENORMOUS MEDICAL, LEGAL,
SOCIAL AND ECONOMICAL
SIGNIFICANCE OWING TO THE
INVOLVMENT OF YOUGER AND
PRODUCTIVE AGE GROUPS
INCREASING INCIDENCE OF
MORTALITY AND MORBIDITY
DUE TO ACUTE POISONING IS A
WORLD WIDE PHENOMENON.
TREMENDOUS ADVANCES IN THE FIELD OF AGRICULTUREINDUSTRIAL TECHNOLOGIES MEDICAL PHARMACOLOGY
IN LAST FEW DECADES
HAVE BEEN PARALLELED WITH REMARKABLE CHANGES IN THE TRENDS OF ACUTE POISONING IN DEVELOPING COUNTRIES INCLUDING INDIA.
WHERE NEW POISONOUS SUBSTANCES HAVE COME TO THE FOREFRONT.
IN DEVELOPED COUNTRIES :
HOUSEHOLD CHEMICAL AGENTS
PRESCRIBED DRUGS
IN DEVELOPING COUNTRIES:
AGROCHEMICALS
MOST COMMON OFFENDERS
WHILE POISONING IN ADULTS HAS BEEN
THE CYNOSURE OF SOME ACADEMICIANS
BUT SUCH SCENARIO IN
CHILDHOOD AND ADOLESCENTS
GENERALLY SUFFER BECAUSE OF SUB-
OPTIMAL PARENTAL SUPERVISION AND
ACCESSIBILITY OF PRODUCT WITH
HAZARDOUS POTENTIAL.
ENORMOUS LITERATURE IS AVAILABLE ON VARIOUS ASPECTS POISONING WORLD OVER BUT ON ITS ECONOMICAL ASPECT IS SCANTY
OBJECTIVES
To ascertain the epidemiological profile of acute poisoning cases in Tri city of Chandigarh (India).
To ascertain the annual direct cost because of acute poisoning in Tri city of Chandigarh (India).
To ascertain the annual productive cost of acute poisoning in Tri city of Chandigarh (India).
To ascertain the determinants of such cost in Tri city of Chandigarh (India).
METHODOLOGY
Punjab
HimachalPardash
Haryana
TRI CITY OF CHANDIGARH (SHADED AREA)
Tricity of Chandigarh
TRICITY OF CHANDIGARH
Study area : Tricity of ChandigarhSource of data: Police /Hospital records of tri city
of ChandigarhNature of data : Information regarding the victims of
acute poisoning from tri city of Chandigarh
Reference period:1st Jan 2011 - 31st Dec 2013
Tools : Structured questionnaire Medical records and bills available
were reviewed
Analysis : IBM Statistics package (SPSS 18)
Distribution of cost
Cost of acute poisoning cases calculated under three categories Direct cost:
Cost incurred on medical treatment like expenditure on
hospitalization, medicines and other emergency services. Indirect cost:
Cost of emergency transport to the hospital and transport during follow up care made by victims or their relatives during treatment.
Productivity cost:
Costs refer to lost production capacity of individuals as a
consequence of acute poisoning divided into 2 headings:
Morbidity cost:
Value of lost output resulting from the reduced productivity including the value of lost workdays and lost housekeeping
days because of acute poisoning.
Mortality cost:
Value of lost output resulting from premature death.
Study Design
Applied the Eligibility Criteria
Resident of tricity of Chandigarh (1799) Not resident of tricity of Chandigarh (111) (Eligible) (Not eligible, Excluded)
Made a list & attempt was made to trace the victim
Traceable (1238) Untraceable (561)
Consent given (1126) Consent not given (112)
cont.
Particulars of 1910 poisoning victims collected from Police stations/ Hospitals
Consent given (1126)
Status of Victim
Alive (1042) Dead (84)
Interview of Victim (398), Family (447) & Relative (197) Interview Family (84)
Distribution of Cost
Direct Cost Indirect Cost Productivity Cost
( $. 82,377.65 ) ( $. 13,391.03 ) ( $. 5,599872.77 )
Total Cost ($. 5,695641.45 )
RESULTS
2011 2012 2013
218
406
502
YEAR WISE DISTRIBUTION OF ACUTE POISONING VICTIMS (N=1126)
Elementry Level High School Secondary School
Graduation
29
65 76
145
Relationship between Educational Qualifica-tion and incidence of acute poisoning among
the students (n=315)
Age and sex wise distribution of acute poisoning victims
Age in years Sex
TotalMale Female
<14
<5 32(61.5%) 20(38.5%) 52(4.6%)
5-10 8(42.1%) 11(57.9%) 19(1.7%)
10-14 5(62.5%) 3(37.5%) 8(0.7%)
Total 45(57%) 34(43%) 79(7%)
14-19 47(39.5%) 72(60.5%) 119(10.6%)
19-26 204(50.0%) 204(50.0%) 408(36.2%)
26-40 186(52.2%) 170(47.8%) 356(31.6%)
40-60 95(68.8%) 43(31.2%) 138(12.3%)
>60 17(65.4%) 9(34.6%) 26(2.3%)
Total 594(52.8%) 532(47.2%)1126(100.0%
)
Urban/rural and marital status wise distribution of acute
poisoning cases
Socio-demographic variable
Group
Sex
Total
Pearson
Chi- Square
p-valueMale Female
AreaUrban
404(52.1%)
371(47.9%)
775(68.8%).388 .533ns
Rural190(54.1
%)161(45.9
%)351(31.2%)
Marital status
Married277(47.7
%)304(52.3
%)581(51.6%)
12.412 .0001**
Unmarried
317(58.2%)
228(41.8%)
545(48.4%)
Total594(52.8
%)532(47.2
%)1126(100.0
%)
Age Wise distribution of mode of acute poisoning
AgeMode of Poisoning
Pearson Chi-
Square
p-valueAccidental Suicidal Homicidal Total
<1479(100.0%
)0(0.0%) 0(0.0%) 79(7.0%)
194.985
.0001**
14-19 36(30.3%) 80(67.2%) 3(2.5%) 119(10.6%)
19-26114(27.9%
)281(68.9%) 13(3.2%) 408(36.2%)
26-40126(35.4%
)226(63.5%) 4(1.1%) 356(31.6%)
40-60 82(59.4%) 53(38.4%) 3(2.2%) 138(12.3%)
>60 17(65.4%) 6(23.1%) 3(11.5%) 26(2.3%)
Total 454(40.3%)
646(57.4%) 26(2.3%)1126(100.0
%)
Sex Wise distribution of mode of acute poisoning
Sex
Mode of PoisoningPearson
Chi- Square
p-value
Accidental Suicidal Homicidal Total
Male 265(44.6%)310(52.2
%)19(3.2%) 594(52.8%)
15.942.0001*
*Female 189(35.5%)
336(63.2%)
7(1.3%) 532(47.2%)
Total454(40.3%)
646(57.4%)
26(2.3%)1126(100.0
%)
Marital status wise distribution of mode of acute poisoning
Marital status
Mode of PoisoningPearso
n Chi-
Square
p-valueAccidental Suicidal Homicidal Total
Married 222(38.2%)348(59.9%
)11(1.9%)
581(51.6%)
3.558 .169ns
Unmarried 232(42.6%)298(54.7%
)15(2.8%) 545(48.4%)
Total454(40.3%)
646(57.4%)
26(2.3%)1126(100.0
%)
Area wise distribution of mode of acute poisoning
Area
Mode of PoisoningPearso
n Chi-
Square
p-value
Accidental Suicidal Homicidal Total
Urban 310(40.0%) 446(57.5%) 19(2.5%) 775(68.8%)
.295 .863ns
Rural 144(41.0%) 200(57.0%) 7(2.0%) 351(31.2%)
Total454(40.3%) 646(57.4%) 26(2.3%)
1126(100.0%)
Occupation wise distribution of mode of acute poisoning
OccupationMode of Poisoning
PearsonChi-
Squarep-value
Accidental Suicidal Homicidal Total
Students 119(37.8%)186(59.0%
)10(3.2%) 315(28.0%)
133.345 .000**
House wives 73(31.7%)154(67.0%
)3(1.3%) 230(20.4%)
Pvt. Job 47(42.3%) 62(55.9%) 2(1.8%) 111(9.9%)
Govt. Job 51(48.6%) 53(50.5%) 1(1.0%) 105(9.3%)
Businessmen 48(51.1%) 42(44.7%) 4(4.3%) 94(8.3%)
Skilled workers 16(19.5%) 65(79.3%) 1(1.2%) 82(7.3%)
Children 49(100.0%) 0(0.0%) 0(0.0%) 49(4.4%)
Unskilled workers 18(37.5%) 28(58.3%) 2(4.2%) 48(4.3%)
Unemployed 8(18.2%) 33(75.0%) 3(6.8%) 44(3.9%)
House maids 10(35.7%) 18(64.3%) 0(0.0%) 28(2.5%)
Farmers 15(75.0%) 5(25.0%) 0(0.0%) 20(1.8%)
Total 454(40.3%)646(57.4%
)26(2.3%)
1126(100.0%)
Relationship between family type and incidence of acute poisoning
(n=1126)
33
217
876
Single memberJointNuclear
Toxic substances causing acute poisoning in males
(n=594)
OPC
/Car
bam
ate
Ther
apeu
tic p
oiso
n
Alcoh
ol
Food
bas
ed p
oiso
n
Domes
tic p
oiso
nALP
Hyd
ro-car
bon
com
...
Corros
ive
Chem
ical
217
157
9254
27 24 17 4 2
Toxic substances causing acute poisoning in females (n=532)
OPC
/Car
bam
ate
Ther
apeu
tic p
oiso
n
Food
bas
ed p
oiso
n
Domes
tic p
oiso
n
Alum
iniu
m p
hosp
hide
Hyd
ro-c
arbo
n co
mpo
...
Chem
ical
Corros
ive
Alcoh
ol
251
171
5424 11 11 5 4 1
Circumstances leading to acute poisoning in males (n=594)
146
114102
93
38 3525
14 11 8 6
Circumstances leading to acute poisoning in females (n=532)
Sickn
ess
Mar
ital
dispute
Fam
ily d
ispute
Accid
enta
l poi
son
Failu
re in
exa
m.
Failu
re in
love
affai
rs
Finan
cial
dispute
/pro
blem
Siblin
g riv
alry
Dow
ry
Unemplo
yem
ent
Lonel
ines
s
Victim
of r
obber
y
131118 113
60
4026 26
10 4 2 2 2
Home Market Working place
733
349
44
Place of procuring the poisonous substances (n=1126)
Place of exposure to poisonous substances (n=1126)
927
91
6048
HomePartyMarketWorking place
Time of exposure to poisonous substances (n=1126)
0-6hrs 6-12hrs 12-18hrs 18-24hrs
26
140
319
641
Monthly distribution of acute poisoning cases (n=1126)
82 80 85 89
113 107 107 106 10396
81 77
Medical help at the site of exposure
Medical help No. of victims Percentage
Yes
Co victim 13 25.5%
Public 30 58.8%
Paramedical/nurse 2 3.9%
Doctor 2 3.9%
Parents 4 7.8%
Total 51 4.5%
No 1075 95.5%
G . Total 1126 100.0%
Escorted to hospitalEscorted to hospital No. of victims Percentage
Self 58 5.2%
Parents 416 36.9%
Relative 422 37.5%
Neighbors 130 11.5%
Police 67 6.0%
Para medical/ nurse 6 0.5%
Spouse 27 2.4%
Total 1126 100.0%
Means of conveyance to hospital (n=1126)
Hired vehicle Police van Ambulance Own vehicle
497
69 18
542
Current status
Doctor AvailablePearson
Chi- Squarep-value
Yes No Total
Alive 1027 15 1042
.463 .496ns
Dead 82 2 84
Total 1109 17 1126
Status of victim and availability of doctor
at first site of treatment
Current status Total Percentage
Non-fatal 1042 92.5%
Fatal 84 7.5%
Total 1126 100.0%
Current status of victims
Current Status of Non-fatal cases of acute poisoning
Current Status Total Percentage
Fully recovered 964 92.5
Having residual health problems
78 7.5
Total 1042 100
Special features and level of significance of explanatory variable by maximum likelihood method for logistic
regression equation
Variables B(SE) Wald p-value
Occupation Students .095(.027) 12.457 .0001**
Time 18-24hrs .051(.017) 8.684 .003**
Type of poison OPC/Carbamate -.785(.061) 165.096 .0001**
Poison procuring place Home -2.103(.191) 121.430 .0001**
Poison consumption place
Home .245(.116) 4.472 .034*
Constant - 3.710(.394) 88.835 .0001**
d.f= 1 for all
Overall financial burden
Distribution of costTotal amount
(USD/`)Average cost per
victim (USD/`)
Direct Cost$ - 82,377.65
`-51,89,792.00$- 74.97
`- 4,722.29
Indirect Cost$- 13,391.03`-8,43,635.00
$- 11.90`-749.23
Morbidity Cost$-94,883.98
`-59,77,690.88$- 100.14`-5,308.78
Mortality Cost
Cremation Ceremony Expenses
$-63,784.79`-40,18,441.60
$-759.34`-47,838.59
lost output resulting from premature death
$- 5,441204`-
34,27,95,832.00
$-64776.23`-40,80,902.76
Total$ - 5,695641.45` - 35,88,25,391.5
Conclusion 764 (68%) victims of acute poisoning were in the age
group of 19 to 40 years with male preponderance (53%) and rural dominance(69%).
Victims below 14 and above 40 years mostly had accidental and in between 14 to 40 years had suicidal poisoning.
52% married females consumed toxic substance with suicidal intent where as 58% unmarried males had accidental poisoning.
There was positive relationship between educational qualification & incidence of acute poisoning among the students.
Sickness followed by financial/family/marital disputes, failure in examination, sibling rivalry were the most common circumstances leading to poisoning.
OPC/Carbamate followed by therapeutic poisons, domestic poisons, food based poisons, aluminum phosphide and alcohol were most common offenders. Cont.
78% of incidence of acute poisoning were in nuclear family.
Students (28%) followed by house wives (20%), employee (19%), businessman (8%), skilled workers (7%) were the most common victims.
In majority of instances place of procurement and exposure was at home.
Most of incidence acute poisoning were between 18 to 24 hours followed by 12 to 18 hours.
In 96% instances, no medical help was available at the site of exposure.
Doctor was available at first site of treatment in most instances (98.5%).
Most of instances (84.4%) relatives/family members were informed from site of exposure to acute poisoning.
Conclusion
ACKNOWLEDGMENT
Authors are thankful to Indian Council of Medical Research New Delhi (India) for providing financial assistance to this study
Thank You
Type of poison Therapeutic poison : Alprex, Amloid, Amoxycillin,Atrazine,
Azothrin, Betadine, Brufen, Cetrizine, Combiflam, Cough syrup,
Diclovin+, Disprin, Envas, Gatequin, Medalor, Mexafied, Neupokine, Neurobion, Paracetamol, Tripride, Tranquil
OPC/Carbamate Aluminum phosphide, Cannabis Fuels: Kerosene oil, Petrol, Diesel, Turpentine
oil
Domestic : LPG inhalation
Chemical : Mercury, Ammonia, Boric Acid
Corrosive : Acid & Alkalis