Predictors of unintentional poisoning among childern under 5 years of age in Karachi, a matched case control study
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
Objectives: To determine the factors associated with unintentional poisoning among children under- 5 years of age reporting to emergency rooms of tertiary care hospitals in Karachi, Pakistan. Background: Oral ingestion of any noxious substances that can lead to symptoms and signs of organ dysfunction if taken in excessive amount is termed as unintentional poisoning. Poisoning is the fourth leading cause of injury death and a common pediatric emergency in children under 5 years of age. National Health survey of Pakistan estimated 4.3% unintentional poisoning cases among children under-5 years of age. Majority of poisoning incidence among under-5 occur inside home. Common agents responsible for poisoning in children are kerosene, medicines, organophosphates, household chemicals, and cosmetics. However, the factors responsible for poisoning incidence within the household have not explored in our setting earlier. These factors may relate caregivers' behavior and practices, child's behavior and household circumstances. Study setting: This Study was conducted from August 2008 to March 2009. Children under-5 years of age were recruited from emergency room (ER) of three biggest tertiary care hospitals of Karachi one private (Aga Khan University Hospital) and two public sector hospitals (Civil Hospital Karachi) and (National Institute of Child Health). Methodology: A matched case- control study was conducted on 120 cases and 360 controls. Unintentional poisoning in children under 5 years of age when confirmed as final (definite) diagnosis by attending ER physician were included in the study as cases. For each case three (3) control children matched for age and gender with complaints and diagnosis other than poisoning were selected from the same hospitals ER within 48 hours of case identification. Parents were interviewed by using structured questionnaire containing information on socio-dem Ographic factors, child's behavior, and storage practices of hazardous substances of caregivers inside homes. Conditional logistic regression was performed to identify factors associated unintentional poisoning. Results: Accessibility to hazardous chemicals and medicines due to unsafe storage of chemicals and medicines (mOR = 5.6, 95% CI: 1.9-16.7), Child's behavior reported as usually aggressive (mOR = 8.2, 95% CI: 4.6 — 16.1), storage of kerosene oil and petrol in soft drink bottles (mOR = 3.8, 95% CI: 2.0-7.3), low socioeconomic status (mOR = 9.2, 95% CI: 2.8-30.1),low mothers education (mOR = 4.2, 95% CI: 1.8-9.6) and history of previous poisoning (mOR = 8.6, 95% CI: 1.7- 43.5) were independently related to unintentional poisoning. Conclusion: Some of the factors identified within the household of children under 5-years of age are potentially modifiable; such as storage practices of kerosene and petroleum in soft drink bottles, and easy accessibility of chemicals and medicines to children by keeping them in low height (shelves/cupboard). Mother's education and child's behavior would require additional efforts however possibly modifiable through health education and other strategies. Key health messages focusing on safe storage practices of chemicals and medicines may help in reducing the burden of childhood poisoning in Karachi, Pakistan.
Ahmed, B. (2009). Predictors of unintentional poisoning among childern under 5 years of age in Karachi, a matched case control study (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.