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SUBMITTED BY
RESHMA P.K
REMYA RAJAN
REJINA.N
2006 MBBS
CERTIFICATE
DEPARTMENT OF COMMUNITY MEDICINE
GOVERNMENT MEDICAL COLLEGE, TRIVANDRUM
Certified that this report is a bonafide record of a research
project undertaken to fulfil the curriculum requirements of
undergraduate medical education as stipulated by the Medical
Council of India and was done during the year 2009-2010
Guided by
Dr. Reshmi Ramachandran Dr. K. Vijayakumar
Department of Community Medicine Professor & Head
Govt. Medical College Department of Community Medicine
Trivandrum. Govt. Medical College, TVM.
Date :
Place
Office seal Submitted
Reshma. P.K
Remya Rajan
Rejina. N.
CONTENTS
S.I.NO TOPIC PAGE NO
1 ACKNOWLEDGEMENT 1
2 BACK GROUND AND RATIONALE 2-6
3 REVIEW OF LITERATURE 7-9
4 METHODOLOGY 10-11
5 ANALYSIS 12-43
6 CONCLUSIONS 44-47
7 LIMITATIONS OF THE STUDY 48
8 REFERENCE 49
ACKNOWLEDGEMENT
We would like to express our sincere gratitude to Dr. Vijayakumar (Professor and
Head of Department, Community Medicine) for giving us an opportunity for carrying out
are study and for being our guiding lights throughout. We specially thank Dr. Reshmi
(Post Graduate student, Department of Community Medicine) for her invaluable
instructions, suggestions and help.
We also extend our heartfelt gratitude to Dr. B. Jayakumar (Head of
Department of Medicine) for giving us permission and helping us to complete our project
successfully.
We also thank all the patients we included in our study without whose co
operation this study would have been impossible.
Our science thanks also go out to our family and friends for their encouragement
and support.
Last, but not the least, we thank God Almighty for blessing us throughout our
humble endeavours.
1
BACKGROUND AND RATIONAL
In India, according to Government estimates 113914
people committed suicides in the year 2005. The national
suicide rate for the year 2003 was 103/1,00,000 and it varied
from 0.6/1,00,000 to 52 1/1,00,000 in different parts of India.
According to the National Crime Record Bureau, the
official agency responsible for suicide data collection in India,
Kerala, a South Indian state has the highest suicide rate among
Indian states. In 2005, Kerala had an estimated suicide rate of
277/1,00,000 compared to industrialized countries, the
mortality rate for attempted suicide is 10-50 times higher in
rural developing countries.
Poisons are substances that can cause disturbances to the
organisms usually by chemical reaction or other activity on the
molecular scale whom sufficient quantities are absorbed by
the organism. Acute poisoning is the exposure to a poison on
one occasion or during a short period of time. Chronic
poisoning is a long term repeated or continuous exposure to a
poison, where symptoms do not occur immediately or after
each exposure.
The most common agents responsible for poisoning are
pesticides, kerosene, prescription drugs and household
2
chemicals pesticides are widely used in many countries where
agriculture is on important part of economy. Reports from
India, Srilanka and Thailand indicate that common availability
and use of toxic pesticides is responsible for intentional and
unintentional mortality and morbidity.
In 2006, the WHO estimated that nearly 9,00,000 suicides
occurred each year more than from homicides and wars
combined. Of which 2,50,000 occurred from poisoning by
agricultural chemicals. Rat poisoning is the one of the
commonest substance used for self poisoning.
Pesticides poisoning is a significant problem in India.
Organo phosphates compounds cause most self poisoning
deaths in Southern and Control India. Southern India is an area
of intensive agricultural production. So pesticide use is high.
Drug overdose is also one of the major method of
poisoning. Drug overdose describes the ingestion or
application of a drug or other substances in quantities greater
than are recommended or generally practiced. An overdose is
widely considered harmful as it can lead to death.
Cerebra Odollum is an Indian tree with poisonous fruit
used by more people to commit suicides than any other plant in
the world studies proved in Kerala death from odollum
3
averages almost once a week. Poisoning can be accidental or
intentional.
In less traditional societies the causes of suicide are more
difficult to establish. The problem has been approached from
two different angles the sociological, which stresses social
pressures and importance of social integration and the
psychoanalytic which centres on the driving force of guilt and
anxiety and the inverting of aggressive impulses. Factors
associated with attempted suicide should be analysed
separately. It can be family problems, financial, Academic
problems or psychiatric illnesses.
General Guidelines for the management include making
the airway clear, assuring that patient is breathing adequately
and circulation in adequately maintained. A standard clinical
examination should be carried out on every poisoned patient.
Needle marks as precious evidence of self harm should be
sought out. Examination findings such as pupil size,
respiratory rate, heart rate should be noted. In case of toxicity
due to drug ingestion, dose of any antidote at available is to be
calculated. The Glassgow come scale is the method most
frequently used to assess the degree of impaired consciousness.
4
Some present with eye or skin contamination should be
treated with appropriate washing and irrigation. Only patients
who have ingested significant overdoses need further measures
such as gastric decontamination and methods to increase
elimination. In the seriously poisoned patient, meticulous
supportive care including the treatment of seizures, coma and
cardiovascular complications is critical to good outcome.
Cardiovascular support measures are to be taken.
Ventilator support may be required until consciousness returns
and complications such as aspiration pneumonia should be
treated promptly. Patients must be observed closely for signs
of deterioration whilst the effects of the toxin they have taken
wear off.
The methods of preventing absorption or enhancing
elimination are (i) removal of clothing or skin washing with
copious amount of soap and water for chemical or pesticides
exposure (ii) Eye irrigation (iii) Gastric lavage – only if a
potentially life threatening amount of toxin has been ingested
within the last hour. Not to be used for acids, alkali or
petroleum distillates (iv) whole bowel irrigation with
polyethylene glycol solution is given for potentially toxic
ingestion of iron, lithium etc. (vi) urinary alkalinisation:
5
enhances the elimination of salicylates and some pesticides (vii)
Extracorporeal methods of elimination.
Eg: hemodialysis or hemoperfusion (viii) Activated
charcoal. Improves outcome when administered within 1 hour
of ingestion of a potentially toxic amount of a poison which
binds to charcoal. It is the most common method to prevent
drug absorption.
6
REVIEW OF LITERATURE
1. Risk factors of acute poisoning in Sri Lanka
Abstract
Summary: This report describes the characteristics of
patients with acute pesticide poisoning in a rural area of
Srilanka, and for intentional self poisoning cases, explores the
relative importance of the different determinants. Data were
collected for 239 acid pesticide poisoning cases, which were
admitted to two rural hospitals in Srilanka. Socio-
demographic characteristics, negative life events and
agricultural practices of the intentional self poisoning cases
were compared with a control group. Most cases occurred
among young adults and the large majority (84%) was because
of the intentional self-poisoning. Care fatality was 18% with
extremely high care fatality for poisoning with the insecticide
endosulfan and the herbicide paraquat. Cases were generally
younger than controls, of lower educational stabun and were
more often unemployed. No agricultural risk factors were
found but a family history of pesticide poisoning and having
ended on emotional relationship in the past year was clearly
associated with intentional self – poisoners. The presence of
mental disorders could only be assesed for a subsample of the
7
cases and controls and this showed that alcohol dependence was
a risk factor. This study shows that acute pesticide poisoning in
Srilanka is determined by a combination of socio demographic
and psychological factors. Suggestions are given for
interventions that could control the morbidity and mortality due
to a acute pesticide poisoning in developing countries.
2. Study conducted at Kasturba Medical College,
Mangalore, India to characterize the poisoning cases
admitted.
All cases admitted to the emergency department of the
hospital between January 2001 to May 2003 evaluated
retrospectively. Data obtained from the hospital medical
records and included of the following factors Socio –
demographic characteristics agents and route of intake and time
of admission of the acutely poisoned patients.
Results of the total 33,207 patients admitted in the
hospital for treatment, 325 patients were for the acute
poisoning. This was 1% of all emergency admissions of these
709, well males and 30% females. The majority (36%) cases
were from age group of 21-30 years. Most (72%) poisonings
were intentional and only 27% were unintentional. The most
important agents of acute poisoning were agrochemical
8
pesticides (99%) followed by drugs (17%) and alcohols (13%),
Forty-eight (15%) patients died. The poisons responsible for
most of the mortality were organophosphate pesticides (65%)
and aluminium phosphide (15%). In summary, the prevention
and treatment of poisoning due to organo phosphate and
aluminium phosphide should merit high priority in the health
care of the indigenous population of South India (Dakshina
Kannada district).
9
METHODOLOGY
Study design : Hospital based case series study
Study setting : Medicine wards Govt. Medical College
Hospital, Trivandrum.
Study population
Inclusion criteria : All the poisoning cases, admitted in the
medicine wards during 3/10/2009 to
15/12/2009.
Exclusion criteria : Case admitted due to snake bites and other
unknown bites are excluded from the study.
Sample size : 65 cases
Sampling technique: Purposive Sampling
Data Collection : Semi structured Questionnaire
Ethical consideration : Consent was taken from the patient,
Head of the department of medicine and
community Medicine, Medical College,
Trivandrum.
Study period : 3/10/2009 – 15/12/2009
Data collection method
1. Study subjects were identified and purpose of study
explained.
2. Consent was obtained from those who agreed to
participate in the study
3. The data collected was analysed.
DATA ANALYSIS
A)FREQUENCY ANALYSIS
1)TABLE 1
GENDER FREQUENCY TABLE
Frequency percentage Cumulative percentage
Male 45 69.2 69.2
Female 20 30.8 100
Total 65 100
INTERPRETATION:
Out of total 65 cases, 69.2% of them were males and
30.8% were females.
2) TABLE 2)
RESIDENCE FREQUENCY TABLE
Frequency percentage Cumulative percentage
Urban 25 38.5 38.5
Rural 40 61.5 100
total 65 100
INTERPRETATION :
Out of total 65 cases, 61.5% cases were reported from
rural areas.
TABLE 3)
EDUCATION –FREQUENCY TABLE
Frequency percentage Cumulative
percentage
Illiterate 3 4.6 4.6
Primary 14 21.5 26.2
Secondary 29 44.6 70.8
Higher 30 20 90.8
secondary
Graduate 6 9.2 100
Total 65 100
INTERPRETATION :
Majority (44.6%) of the cases had a level of secondary
education
TABLE 4)
OCCUPATION- FREQUENCY TABLE
Frequency percentage Cumulative percentage
Unskilled 23 35.4 35.4
Semiskilled 5 7.7 43.1
Skilled 6 9.2 52.3
House wife 8 12.3 64.6
Student 8 12.3 76.9
Unemployed 15 23.1 100
Total 65 100
INTERPRETATION : Almost one-third of the cases were
unskilled (35.4%),followed by unemployed(23.1%).
TABLE 5)
SOCIOECONOMIC STATUS –FREQUENCY TABLE
Frequency percentage Cumulative percentage
APL 30 46.2 46.2
BPL 35 53.8 100
Total 65 100
APL : Above poverty line
BPL : Below poverty line
INTERPRETATION :
Out of total 65 cases , 46.2% cases were APL and
53.8% were BPL.
TABLE 6)
NATURE OF POISONING –FREQUENCY TABLE
Frequency percentage Cumulative
percentage
Organophosphates 23 35.4 35.4
Drugs 26 40 75.4
Chemicals 9 13.8 89.2
Plant products 2 3.1 92.3
Corrosives 5 7.7 100
Total 65 100
INTERPRETATION:
The most important agents of acute poisoning were
drugs (40%) followed by organophosphates (35.4%) and
chemicals (13.8%).
TABLE 7)
MODE OF POISONING FREQUENCY TABLE
Frequency Percentage Cumulative
percentage
Accidental 2 3.1 3.1
Intentional 63 96.9 100
Total 65 100
INTERPRETATION :
Most of the poisoning were intentional(96.9%)
And only 3.1% were accidental.
TABLE 8)
CAUSE OF POISONING FREQUENCY TABLE
Frequency Percentage Cumulative
percentage
Family 19 29.3 29.3
problems
Financial 21 32.3 61.5
problems
Love 9 13.8 75.4
failure
Academic 7 10.8 86.2
problems
Others 9 13.8 100
Total 65 100
INTERPRETATION:
Most of the poisoning cases are caused due to
financial problems(32.3%). Family problems stand
second(29.3%). Other leading causes are in the order love
failure(13.8%) ,academic problems(10.8%) and others(13.8%).
TABLE 9)
METHOD OF POISONING FREQUENCY TABLE
Frequency Percentage Cumulative
percentage
Mixed with food 3 4.6 4.6
Mixed with 24 36.9 41.5
alcohol
Taken as such 38 58.5 100
INTERPRETATION:
Of the total cases 58.5 % had taken poison a
such.36.9% of them preferred it along with alcohol and 4.6%
along with food.
TABLE 10)
HISTORY OF MENTAL ILLNESS FREQUENCY TABLE
Frequency Percentage Cumulative percentage
Present 13 20 20
Absent 52 80 100
Total 65 100
INTERPRETATION:
The study revealed that 20% of the total cases
had the history of previous mental illness.
TABLE 11)
ADDICTIONS FREQUENCY TABLE
Frequency Percentage Cumulative percentage
Alcoholism 12 18.5 18.5
Smoking 10 15.4 33.8
Both 17 26.2 60
Tobacco 2 3.1 63.1
Nil 24 36.9 100
Total 65 100
INTERPRETATION:
Out of the total case,26.2% were both
alcoholics and smokers.
TABLE 12)
ASSOCIATED OTHER DISEASES FREQUECY TABLE
Frequency Percentage Cumulative percentage
Present 22 33.8 33.8
Absent 43 66.2 100
Total 65 100
INTERPRETATION:
33% of the cases had associated co-morbid
diseases while the rest were free of co-morbidities.
TABLE 13)
FIRST AID FREQUENCY TABLE
Frequency Percentage Cumulative
percentage
Received 31 47.7 47.7
Not 34 52.3 100
received
Total 65 100
INTERPRETATION:
47.7% of the cases received first aid after
poisoning while the rest did not.
TABLE 14)
PRIOR HOSPITALIZATION FREQUENCY TABLE:
Frequency Percentage Cumulative percentage
Yes 33 50.8 50.8
No 32 49.2 100
Total 65 100
INTERPRETATION:
Of the total cases, 50.8% were getting prior
treatment from local hospitals while the rest were taken directly
to the medical college.
TABLE 15)
STOMACH WASH FREQUENCY TABLE
Frequency Percentage Cumulative percentage
Yes 58 89.2 89.2
No 7 10.8 100
Total 65 100
INTERPRETATION:
More than ¾ th of the total cases 89.2% undervent
stomach wash.
TABLE 16)
ICU ADMISSION FREQUENCY TABLE:
Frequency Percentage Cumulative percentage
Yes 12 8.5 18.5
No 53 81.5 100
Total 65 100
INTERPRETATION:
Only 18.5% of the cases needed ICU
admission.
TABLE 17)
RYLES TUBE INTUBATION FREQUENCY TABLE
Frequency Percentage Cumulative percentage
Present 64 98.5 98.5
Absent 1 1.5 100
Total 65 100
INTERPRETATION:
98.5% of the case needed ryles tube intubation.
TABLE 18)
PREVIOUS ATTEMPTS OF POISONING FREQUENCY
TABLE
Frequency Percentage Cumulative percentage
Yes 7 10.8 10.8
No 58 89.2 100
Total 65 100
INTERPRETATION:
Only 10.8% cases had a history of previous
attempts of poisoning.
TABLE 19)
OUTCOME OF MANAGEMENT FREQUENCY TABLE
Frequency Percentage Cumulative percentage
Survived 51 78.5 78.5
Death 14 21.5 100
Total 65 100
INTERPRETATION:
The proportion of survival among poisoning
cases treated in the medical college hospital is 78.5% and the
case fatal rate is 21.5%.
TABLE 20)
ASSOCIATION BETWEEN GENDER AND MODE OF
POISONING
Mode
Accidental Intentional Total
Male 1 44 45
Gender Female 1 19 20
Total 2 63 65
Chi square value : 0.358
Degree of freedom : 1
P value : 0.549
INTERPRETATION :
There is no association between gender and mode of
poisoning.
TABLE 21)
ASSOCIATION BETWEEN SOCIO ECONOMIC
STATUS AND OUTCOME
Outcome Percentage
Percentage death
Total
survived
Survived Death
27 3 30 90 10
APL
SES 24 11 35 68.5 31.5
BPL
51 14 65
TOTAL
Chi square value : 4.389
Degree of freedom : 1
P value : 0.036
INTERPRETATION : There is association between
socioeconomic status and outcome of poisoning.Mortality rates
were found to be high in BPL class(31.5%) as compared to
APL (10%).
TABLE 22)
ASSOCIATION BETWEEN RESIDENCE AND
OUTCOME
Outcome
Survived Death
Total
Urban 22 3 25
Rural 29 11 40
Residenc
e
Total 51 14 65
Chi square value : 2.187
Degree of freedom : 1
P value : 0.139
INTERPRETATION :
There is no association between residence of the
patient and outcome of poisoning .
TABLE 23)
ASSOCIATION BETWEEN NATURE OF POISON AND
OUTCOME
Outcome
Survived Death Total Percentage Percentage
survived death
Organophosphates 12 11 23 52.17 47.83
Drugs 26 0 26 100 0
Nature Chemicals 8 1 9 88.8 11.12
Plant products 2 0 2 100 0
Corrosives 3 2 5 60 40
Total 51 14 65 78.46 21.54
Chi square value : 18.679
Degree of freedom :4
P value : 0.001
INTERPRETATON : There is significant association
between nature of poisoning and outcome.The highest mortality
rates were found to be in Organophosphates poisonings.
TABLE 24)
ASSOCIATION BETWEEN METHOD OF POISONING
AND OUTCOME
Outcome Total
Survived Death
Mixed
with
3 0 3
food
Mixed
Method with
16 8 24
alcohol
Taken 32 6 38
as such
Total 51 14 65
Chi square value : 3.542
Degree of freedom :2
P value : 0.170
INTERPRETATION : There is no association between
method of poisoning and outcome
TABLE 25)
ASSOCIATION BETWEEN ADDICTIONS AND
OUTCOME OF POISONING
Outcome
Total Percentage Percentage
survived death
Survived Death
Alchlsm 10 2 12 83.3 16.6
Smking 8 2 10 80 20
Addictions Both 8 9 17 47.09 52.95
Tobaco 2 0 2 100 0
Nil 23 1 24 95.80 4.17
Total 51 14 65 78.96 21.54
Chi square value : 14.937
Degree of freedom : 4
P value : 0.005
INTERPRETATION: There is significant association between
addictions and outcome. Mortality rates were higher among
cases with both alcoholism and smoking(52.95%) followed by
smoking(20%) and alcoholism (16.6%).
TABLE 26)
ASSOCIATION BETWEEN FIRST AID AND OUTCOME
Outcome
Survived Death Total
25 6 31
Yes
First aid
No 26 8 34
Total 51 14 65
Chi sqare value : 0.167
Degree of freedom : 1
P value : 0.683
INTERPRETATION : There is no association between
outcome of poisoning and first aid
TABLE 27)
ASSOCIATION BETWEEN OTHER CO-MORBID
DISEASE AND OUTCOME
Outcome
Total Percentage Percentage
Survived Death death
survived
Yes 8 14 22 36.36 63.64
Co-
morbid
diseases No 43 0 43 100 0
Total 51 14 65 78.46 21.54
Chi square value : 38.875
Degree of freedom : 1
P value : o.ooo
INTERPRETATION : There is significant association etween
the outcome and co-morbid diseases. Mortality rates among
cases with other co-morbid diseases were found to be 63.64%.
TABTE 28)
ASSOCIATION BETWEEN OUTCOME AND OTHER
HOSPITAL ADMISSIONS
Outcome
Survived Death Total
Other Present 27 6 33
hospital
admissions
Absent 24 8 32
Total 51 14 65
Chi square value : 0.447
Degree of freedom : 1
P value : 0.504
INTERPRETATION :
There is no association between outcome in
cases getting prior treatment in other hospitals and those getting
directly admitted.
TABLE 29)
ASSOCIATION BETWEEN NATURE OF POISONING
AND ICU ADMISSIONS
ICU
admission
Total %
ICU
Yes No Admn
organophosphates 11 12 23 47.82
drugs 1 25 26 3.84
Nature of chemicals 0 9 9 0
poisoning
Plant products 0 2 2 0
corrosives 0 5 5 0
Total 12 53 65 18.86
Chi square value : 20.487
Degree of freedom : 4
P value : 0.000
INTERPRETATION : there is association between nature of
poisoning and ICU admissions.Majority of ICU admissions
were seen in cases of organophosphate poisoning.(47.9%).
TABLE 30)
ASSOCIATION BETWEEN OTHER CO-MORBID
DISEASES AND ICU ADMISSIONS
ICU Percentage
admissions of ICU
Total
admissions
Yes No
Co – Present 11 11 22 50
morbid
diseases
Absent 1 42 43 2.3
Total 12 53 65
Chi square value : 21.974
Degree of freedom : 1
P value : 0.000
INTERPRETATION :
There is association between ICU
admissions & presence of other co- morbid diseases in the
poisoning cases.Almost 50% of the cases with co-morbid
conditions needed ICU admissions.
TABLE 31)
ASSOCIATION BETWEEN ICU ADMISSIONS AND
OUTCOME
Outcome % %
Total survived death
Survived Death
ICU Yes 3 9 12 25 75
admissions
No 48 5 53 90.5 9.5
Total 51 14 65 78.46 21.54
Chi square value : 24.890
Degree of freedom :1
P value : 0.000
INTERPRETATION : There is association between outcome
and ICU admission of cases.Mortality rate among ICU
admissions were found to be 75%.
TABLE 32)
ASSOCIATION BETWEEN SOCIOECONOMIC STATUS
AND CAUSE OF POISONING
SES Total Percentage
APL BPL APL BPL
Family
problems
12 5 17 40 14.2
Causes of Financial
poisoning problems
4 17 21 13.3 48.5
Love failure 5 4 9 16.6 11.4
Academic 5 2 7 16.6 5.71
problems
Others 4 7 11 I3.3 20
Total 30 35 65 100 100
Chi square value : 13.019
Degree of freedom : 5
P value : 0.023
INTERPRETATION : There is association between causes of
poisoning & SES of the cases.The major cause of poisoning
among APL group was family problems(40%), while financial
problems were found to be the major cause among
BPL(48.5%).
CONCLUSION
Of the total 65 patients admitted in the Medical College
Hospital for the treatment of poisoning, 69.2% were males of
30.8% females. The majority of the poisoning were intentional
(96.9%) and only 3.1% were accidental. The most important
agents of acute poisoning were drugs (40%) followed by
organophosphates (35.4%) ,chemicals (13.8%), corrosives
(7.7%) and plant products (3.1%). Of the total cases 14 patients
(21.5%) died. The poisons responsible for most of the
mortality were organophosphates (48%) followed by
corrosives (40%). If the total cases 61.5% cases were reported
from rural areas. Majority of cases (44.6%) had a secondary
level education. Almost 2/3rd of the cases were unskilled
workers( 35%) followed by unemployed(23%). 45% of the
cases belong to APL group while rest 54% were BPL. The
cause of poisoning were mostly attributed due to financial
problems (32%), family problems (29%), love failure (13%),
academic problems (10%) and others (13%).
If the total cases, 58.5% had taken poison as such 36%
preferred it along with alcohol and 4.6% with food. The study
revealed that 20% of total cases had history of previous mental
illness. 26% of total cases were both alcoholics and smokers.
33% of cases were also associated with other co-morbid
conditions. Only 10% of cases had previous attempts.
It is found that 52% of cases didn’t receive any first aid.
If the 50.8% of cases were getting critical treatment from
local hospitals while the rest were taken directly to Medical
College. More than 3/4th of cases (89%) underwent stomach
wash either at MCH or at periphery only 18% of cases needed
ICU admission. 98% of cases were Ryles tube intubated.
The proportion of survival among poisoning cases
treated in Medical College hospital is 78.5% and case fatality
rate is 21.5%.
According to the study , there is significant association
between outcome and socioeconomic status, nature of
poisoning, addition associated co-morbidities and ICU
admissions.
It was found out that there is significant association
between nature of poisoning and ICU admissions,
socioeconomic status and cause of poisoning, death rate among
APL cases were less (10%) as compared to that of BPL cases
(31%).
Organophosphates causes the highest mortality rate of
4%, followed by corrosives (40%) and chemicals (11%). 47%
of organophosphorus poisoned cases were admitted in ICU.
Death rate were found to be highest in persons having
both smoking and alcoholism (53%). Death rate among
persons with co morbid diseases were found to be high
(63.6%). Mortality rate among ICU admissions were found to
be 75%,
It was found that 30% of the cases having co morbid
diseases required ICU admission while only 2.8% of other
category required it.
There is an urgent need to improve hospital facilities for
the treatment of acute poisoning including intension care and
assistance ventilation.
Preventive intervention should be multi pronged. For
primary prevention, community based social support systems
should be commenced to enhance the coping skills of youth.
There should also be improvement in community mental health
services to detect early and treat serious mental illness. The
easy availability of pesticides and toxic chemicals should be
restricted, although this world probably be of short term benefit.
For secondary prevention to be effective, the negative attitudes
of health personnel towards parasuicides should be changed.
This can changed. This can only be achieved by fundamental
changes in curriculum so as to emphasize the importance of a
holistic approach to patient case.
LIMITATIONS OF THE STUDY
Small sample size
Sampling errors
Small period of time
Discrepancies in the administration of the questionnaire
REFERENCES
PARK’S TEXTBOOK OF PREVENTIVE AND
SOCIAL MEDICINE
DAVIDSONS’ TEXTBOOK OF INTERNAL
MEDICINE
WWW.WIKEPEDIA.COM
WWW.WHO.COM
