Intentional organophosphate poisoning: A study in three hospitals in Johannesburg

Abstract

Background: In 2016, suicide deaths were estimated to be 800 000, suicide rate of 10.5 per 100 000 population. Information collected between 1990 and 2007 reported that 30% of global suicides are due to pesticide poisoning, which happen mostly in the low and middle income countries. In 2012, the global suicide attempt was estimated to be 20 times higher than the suicide rates. Previous intentional self-harm has been shown that it is a predictor for death by suicide. The prevalence of intentional self-poisoning differs from country to country and it is a common method of suicide/suicide attempt in the African, East Asia and Western Pacific Regions. Aim: To determine the socio-demographic and medical profiles of patients admitted with intentional organophosphate (pesticide) and non-organophosphate poisoning (non-pesticide) in the three study hospitals and identify factors that might influence their outcome (such as duration of hospital admission and case fatality rate). Methodology: An analytical cross sectional study design was used for this study. Record review and face-to-face interviews were done to collect data from the three study sites (Chris Hani Baragwanath Academic Hospital, Leratong Hospital, and Sebokeng Hospital) in Gauteng between September in 2011 and December in 2013. The study population consisted of all patients above 18 years of age who were identified by the admitting doctor as having intentionally ingested poison and then admitted to the medical ward, the intensive care unit (ICU) or/and the high care ward (HCW) during the study periods at the three study sites. The study was initiated after obtaining permission from the University of the Witwatersrand Human Research Ethics Committee (WHREC), and Chris Hani Baragwanath Academic Hospital as the central and tertiary hospital. Results: Six hundred and forty-eight participants were recruited into the study from three study sites. The study participants were young, median age was 26 years and the interquartile range (IQR) was from 18 to 63 years and the majority (61.6%) were females. Most (59%) of the study participants had ingested other substances and only forty-nine percent had ingested a pesticide. Age, sex, ethnicity, relationship status and being on medication were significantly associated with the type of poison taken for intentional self-poisoning on the multivariate analysis. The median length of stay for the study population was three days and ethnicity, type of poison taken and having a medical condition were significant predictors of the length of stay. The case fatality rate was 2.6%. The group that had ingested a pesticide had a higher fatality rate than those that had ingested other substances. Conclusion: The findings of this cross-sectional study conducted in three hospitals in the Gauteng Province demonstrated how access to means for intentional self-harm was a problem. It showed the population vulnerable to self-poisoning and that there is inadequate implementation of legislation and policies in South Africa for limiting access to pesticides. Addressing this problem would require a multifaceted, context specific approach. Health promotion activities should be implemented to reduce the prevalence of intentional self-poisoning.