A Prospective Study of Mortalities because of Aluminium Phosphide Poisoning

Thakur Amit K.¹*, Singh Khileswar² and Masih John¹

¹Assistant Professor, Medicine, Govt. Medical College, Jagdalpur (Bastar) 494 001, India

²Associate Professor, Medicine, Govt. Medical College, Jagdalpur (Bastar) 494 001, India

ABSTRACT:

History: Poisoning is one of the commonest mode of suicide. In India, the first case of Aluminium Phosphide Poisoning was reported in 1981 from MGM Medical College, Indore (M.P.) Since then Aluminium Phosphide Poisoning is on rise.

Objective: To assess the impact of time elapsed after ingestion of poison and reaching the hospital on mortalities in respect of age, gender and residence of the victim. Material and method: Sixty five cases of Aluminium Phosphide Poisoning of both sexes, 11 and above years of age and their residence area (rural and urban).

Observations and discussion: On analysis of the collected data, it has been revealed that 87.69 % cases were from 11 to 40 years of age group which is quite productive age group in all aspects, which is a matter of real concern as it shows that youth are very much frustrated from their life, which can be prevent by providing moral and ethical teaching during schooling. There were 43.07 % male and the remaining 56.92 % females, this is in accordance to the findings of various studies that more proportion of females fall victim of poisoning than their male counter parts.87.69 % deceased were from rural background Out of these only 07.01 % brought to hospital within one hour in comparison to their 37.5 % urban counter parts.

Conclusion and recommendations: This may be due to pathetic condition of roads, none or late availability of transport, their illiteracy and ignorance about health and disease including poisoning particularly in rural areas. This poor state of affairs may be changed by judicious use of old or traditional and new, modern or latest technologies and whenever chances arises can co-exist like never before, will be helpful in bringing awareness in the community about various aspects of health and disease including poisoning and there will be increase in the utilization of health facilities which at present under utilize. At present a vicious circle of poverty and illness and illness again will increase poverty and poverty further make the people ill and so on i.e. there is a direct relation between poor health and poverty is in existence, may be broken which is very much necessary to improve the health status of the community which automatically improve the economic status of the community.

KEYWORDS: Awareness, Ignorance, Illiteracy, Co-exist.

INTRODUCTION:

Aluminium Phosphide Poisoning (ALP) deaths first became public in 1983 when 37 cases from Udaipur Medical College Hospital, R.J. in one year were reported to the press trust of India, Kabra et al (1). In M. P. the first case was reported in 1981 from MGM Medical college Indore, Since then, the incidence of ALP is increasing progressively, so much so, that it is now the single frequent suicidal method in North India, Meena et al (2).Death due to

Table-I. Mortalities in relation to time elapsed in reaching hospital as per deceased age

Time elapsed in hour after ingestion of poison	11-20 n=16	21-30 n=28	31-40 n=13	41-50 n=05	51-60 n=01	61 and above years of age n=02
<1	02(12.5)	03((10.71)	01(07.69)	01(20.00)	00(00.0)	00(00.0)
1 to 4	11(68.75)	19(67.85)	06(46.15)	02(40.00)	00(00.0)	02(100.00)
>4	03(18.75)	06(21.42)	06(46.15)	02(40.00)	01(100.00)	00(00.0)
Total	16(100.00)	28(100.00)	13(100.00)	05(100.00)	01(100.00)	02(100.00)

Figures in parenthesis indicate percentage

Table –II. Mortalities in relation to time elapsed in reaching hospital as per deceased Gender

Time elapsed in hour	Male n=28	Female n=37
<1	04(14.28)	03(08.10)
1 - 4	17(60.71)	23(62.16)
>4	07(25.00)	11(29.72)
Total	28(100.00)	37(100.00)

Figures in parenthesis indicate percentage

There were 43.07% male and the remaining 56.92% females, this is in accordance to the findings of various studies that more proportion of females fall victim of poisoning than their male counter parts (Table-II). On further analysis table reveals that higher proportion (14.28%) of male in comparison to their (08.10%) female counter parts were brought to hospital within one hour of ingestion of poisoning. This may be because of discrimination against females, as prevalent in other parts of the country, as news poured in from time to time. To eliminate this discrimination, a new curriculum for the schoolchildren with the objective of "mind set about gender perspective must be changed" and fees free –girl-education (have knowledge, be prosperous) with special provision for the families living under poverty line for compensation as incentives for wages, the girl child suppose to earn during her study period, will certainly help in the progress and empowerment of the girls (no amount is high enough to achieve the noble task of the progress and empowerment of the girls). As per trustee ship principle of the father of the nation "Mahatma Gandhi", the affluent class of the society should bear the expenses, incurred on this noble task and the whole amount should be exempted from income tax etc., Bansal A. K. et al (6). The highest award "Bharat-Ratna" may be conferred on those who deserve for his/her price less contribution in this wholly task.

Table further reveals that 85.71% males and 91.89% females took one and more hours in reaching hospital out of these 25.00%male and 29.72%females even took more than four hours after ingestion of poison in reaching hospital.

Table –III. Mortalities in relation to time elapsed in reaching hospital as per deceased residential background

Time elapsed in hour	Rural n=57	Urban n=08
<1	04(07.01)	03(37.5)
1 - 4	36(63.15)	04(50.00)
>4	17(29.82)	01(12.5)
Total	57(100.00)	08(100.00)

Figures in parenthesis indicate percentage

Table-III, shows that 87.69% deceased were from rural background. Out of these only 07.01% brought to hospital within one hour in comparison to their 37.5% urban, counter parts. This wide gap of proportion amongst rural and urban patients because of poor road conditions, on or late availability in convenience and above all rural people's illiteracy and ignorance of seriousness of the problem. On further analysis table reveals that 63. 15 and 50.00% patients of rural and urban background took from one to four hours in reaching hospital. Table also shows that 29.82 and 12.5 % percent victims were brought to hospital even after four or more hours of ingestion of poison. The findings of the present study were more or less in accordance of the findings of other studies conducted throughout the globe by different authors from time to time.

Male to female ratio was 2:1 in a study conducted in Chandigarh. The agriculture community is more on risk due to illiteracy and easy availability of pesticide in the house hold, Aggarwal et al (7) Shankar et al (8)expressed the view that the importance of gastric lavage which if carried out within hour of ingestion of poison than only it is possible to remove significant amount of toxic substance

CONCLUSION AND RECOMMENDATIONS:

From above observations and discussion the authors reached to the conclusion that more than three fourth cases were from 11 to 40 years of age group which is quite productive age group in all aspects, which is a matter of real concern as it shows that youth are very much frustrated from their life, which can be prevent by providing moral and ethical teaching during schooling.

There were also more than 50 % females, this is again shows the mentality of the society towards females which is to be changed, this is again possible by only inculcating good thoughts about not discriminate on account of gender. This is possible if the curriculum of schoolchildren includes the lesson about the same.

As 87.69%, deceased were from rural background out of these only 07.01% brought to hospital within one hour in comparison to their 37.5% urban counter parts. This shows the pathetic condition of the rural areas. This delay may be due to poor condition of roads, none or late availability of vehicles in rural areas and above all ignorance/illiteracy about seriousness of the problem. However, many efforts have been done but still a lot have to done, which needs to be addressed as early as possible. A flow chart has been developed on the lines of Garg Narendra K et al (5), by judicious use of old or traditional and new, modern or latest technologies and whenever chances arises can co-exist like never before, will be helpful in bringing awareness in the community about various aspects of health and disease including poisoning and there will be increase in the utilization of health facilities which at present under utilize. Thus, a vicious circle of poverty and illness and illness again will increase poverty and poverty further make the people ill and so on i. e. there is a direct relation between poor health and poverty is in existence, may be broken which is very much necessary to improve the health status of the community which automatically improve the economic status of the community.

ACKNOWLEDGEMENT:

The authors expresses their sense of gratitude to Dr. A.K. Bansal, Ex-Professor and H.O.D., Department of Community Medicine, Govt. Medical College, Jagdalpur (Bastar) 494 001, India, for his constant encouragement and expert guidance in preparing this manuscript.

REFERENCES:

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6. Bansal AK, Agarwal Ashok K, and Govila AK : Status of the girl child amongst tribes and non tribes in the un-reached rural India : J.of Ravshankar University;Vol.11-12; No.B (Science) :1998-99; pp.31-36

7. Aggarwal BK, Aggarwal MP, Jain S: Aluminium Phosphide Poisoning, a study of 40 cases JAPI; 1989; 37:66

8. Shankar PS: Emergency management of poisoned patients. JAPI 1997:Suppi 2; Medical Emergencies;14-17

Received on 27.09.2012

Modified on 20.10.2012

Accepted on 28.11.2012

Research J. Pharmacology and Pharmacodynamics. 5(1): January –February 2013, 39-42