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Situation of Common Poisoning in Bangladesh Dr Md Robed Amin Associate Professor of Medicine Dhaka Medical College 05.12.2014

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Poisoning >600,000 deaths/year in developing world, (Eddleston, Q J Med 2000) DMC- 2 nd cause of admission(After stroke), More than 5000 case per annum since 2008. 2 nd common cause of hospitalization and 9 th common cause of death(DGHS-Health bulletin-2011)

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Prevalence of top 10 diseases/causes of admission In UHC (DGHS health Bulletin 2014 p49-55) Male (n 762264) Female (n 894425) SerialDiseaseTotal%DiseaseTotal% 1 3 3 4 5 6 7 8 SerialDiseaseNumber%DiseaseNumber% 1Diarrhoea14474218,99Diarrhoea14215715.89 2Assault12589516.52Assault9919611.09 3Peptic ulcer523926.87Peptic ulcer618626.92 4Pneumonia521056.84Pneumonia345673.86 5Enteric267533.51Enteric261082.92 6RTA264553.47Obstructive labour 228972.56 7Bronchial Asthma 234463.08Bronchial Asthma 214992.40 8Viral19 1882.52Anaemia208482.33 9Poisoning186972.45Poisoning196402.20 10HTN103741.36Viral fever184412.11

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Top 10 diseases/causes of admission in upazila health complexes in 2012 and 2013 (DGHS health Bulletin 2014 p49-55) 2013 2012 Percentage trends DiseaseRanking% %Ranking change Diarrhoea116.32117.74 Assault213.59213.51 Peptic ulcer36.9036,43 Pneumonia45.2346.41 Enteric53.1953.48 Bronchial Asthma 62.7162.51 RTA72.3972.40 Poisoning82.3192.23+1 Viral92.3182.24 Anemia101.79101.56

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Prevalence of top diseases/causes of admission In District Hospital Male Female SerialDiseaseTotal%DiseaseTotal% 1 3 3 4 5 6 7 8 SerialDiseaseNumber%DiseaseNumber% 1Diarrhoea5895213.53Diarrhoea5319811.79 2Assault392269.00Assault238995.30 3RTA240845.53Peptic ulcer159943.54 4Pneumonia208194.78Pneumonia140743.12 5Peptic ulcer1418823.26Obstructive labour 115712.56 6Bronchial asthma 123502.83Bronchial Asthma 111402.47 7viral115592.65HTN106872.37 8Poisoning90592.08RTA103972.30 9HTN84511.94Viral99232.20 10CVD81861.88Anxiety/de pression 94412.09 11MI80211.84Poisoning93382.07

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Prevalence of top diseases/causes of admission In Primary, secondary and tertiary care Male Female SerialDiseaseTotal%DiseaseTotal% 1 3 3 4 5 6 7 8 SerialDiseaseNumber%DiseaseNumber% 1Diarrhoea21159114.47Diarrhoea20182712.94 2Assault18349812.55Assault1319878.46 3Pneumonia792615.42Peptic ulcer811575.20 4RTA707254.84Pneumonia537753.45 5Peptic ulcer706424.83Obstructive labour 382902.45 6Bronchial asthma 409012.80Bronchial Asthma 368822.26 7Enteric fever370562.53Enteric fever 347752.23 8Viral fever326772.24Poisoning331052.12 9Poisoning310142.12RTA326822.10 10HTN233071.59Anemia326752.09

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Mortality report of DGHS (ICD based) in 451 public hospital Name of disease Number Percentage Diseases of the circulatory system 1620633.20 Certain conditions originating in the perinatal period 777915.93 Diseases of the respiratory system 678713.90 Injury, poisoning, and certain other consequences of external causes 45219.26

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Baseline Survey Baseline survey: 6 months from Sep 2006 - Feb 2007 in 4 hospitals and 7 health centres: (Prof MA Faiz) 4553 cases (28% pesticide) 14.5% of admissions Mortality 4.1% (88% pesticide)

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Place PesticideSedatives Kerosi ne Snake bite Cu-Sul phate Methan ol Potka fishOthers Total OP Car mate Others Benzod iazepin e Other sedativ e DMCH 27923276018977310251212982318 CMCH 299781119343830313005051390 Coxsbaz ar 9004417000013119 Hathaza ri UHC 26013511600074126 Jenaida4453681713114039537 Sitakun d UHC 290420712010863 Total 11683312373795413943472019374553

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Gender of patients Name of poison/toxic substance PesticideSedativeSnake bite Kerose ne Cu Sul- phate Metha nol OPCarba mate OthersBenzo diazepi ne Other Male6661656391826315 6.9% 86416 15.6%26.5% Female5021767346128119 2.6% 5334 12.7%10.3% Total 1291 28.3% 1675 36.8% 434 9.5% 139 3.0% 720 0.4%

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Survey in Dhaka Medical College Hospital (DMCH) 2008 5932 total cases of poisoning in DMCH 2108/5929 (35%) female; 3821/5929 (65%) male Median age was 25 years (IQR 19-35 years) Overall mortality was 151/5932 (2.6%)

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DMC survey 95% sought initial - Government Hospital. Suicidal attempt -43.8% Family disharmony -37.7% stupifying agent (38.2%). Mortality: 105 OP death among 151 herbal medicine-25%, then OP poisoning- 16%., methanol poisoning-11% and copper sulfate poisoning (9%).

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Major risk factor for mortality rural residence, hindu religion, illiterate, farmer, suicide attempt, deliberate self harm, GCS 100/