Dalbir Singh HEAD DEPARTMENT OF FORENSIC MEDICINE POSTGRADUATE INSTITUTE OF MEDICAL EDUCATION amp RESEARCH CHANDIGARH INDIA EXTENT AND DETERMINANTS OF COSTS OF ACUTE POISONING IN TRICITY OF CHANDIGARHAN EXPLORATORY STUDY ID: 459318
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Slide1
Prof.(Dr.)Dalbir Singh
HEADDEPARTMENT OF FORENSIC MEDICINE POSTGRADUATE INSTITUTE OF MEDICAL EDUCATION & RESEARCH CHANDIGARH (INDIA)
EXTENT AND DETERMINANTS OF COSTS OF ACUTE POISONING IN TRICITY OF CHANDIGARH-AN EXPLORATORY STUDYSlide2
MORTALITY DUE TO ACUTE POISONING HAS AN ENORMOUS MEDICAL, LEGAL, SOCIAL AND ECONOMICAL SIGNIFICANCE OWING TO THE INVOLVMENT OF YOUGER AND PRODUCTIVE AGE GROUPSSlide3
INCREASING INCIDENCE OF MORTALITY AND MORBIDITY DUE TO ACUTE POISONING IS A WORLD WIDE PHENOMENON.Slide4
TREMENDOUS ADVANCES IN THE FIELD OF AGRICULTUREINDUSTRIAL TECHNOLOGIES
MEDICAL PHARMACOLOGYIN LAST FEW DECADESHAVE BEEN PARALLELED WITH REMARKABLE CHANGES IN THE TRENDS OF ACUTE POISONING IN DEVELOPING COUNTRIES INCLUDING INDIA. WHERE NEW POISONOUS SUBSTANCES HAVE COME TO THE FOREFRONT.Slide5
IN DEVELOPED COUNTRIES :HOUSEHOLD CHEMICAL AGENTS
PRESCRIBED DRUGSIN DEVELOPING COUNTRIES:AGROCHEMICALS MOST COMMON OFFENDERSSlide6
WHILE POISONING IN ADULTS HAS BEEN THE CYNOSURE OF SOME ACADEMICIANS BUT SUCH SCENARIO IN CHILDHOOD AND ADOLESCENTS GENERALLY SUFFER BECAUSE OF SUB-OPTIMAL PARENTAL SUPERVISION AND ACCESSIBILITY OF PRODUCT WITH HAZARDOUS POTENTIAL.Slide7
ENORMOUS LITERATURE IS AVAILABLE ON VARIOUS ASPECTS POISONING WORLD OVER BUT ON ITS ECONOMICAL ASPECT IS SCANTYSlide8
OBJECTIVES
To ascertain the epidemiological profile of acute poisoning cases in Tri city of Chandigarh (India).To ascertain the annual direct cost because of acute poisoning in Tri city of Chandigarh (India).
To ascertain the annual productive cost of acute poisoning in Tri city of Chandigarh (India).
To ascertain the determinants of such cost in Tri city of Chandigarh (India). Slide9
METHODOLOGYSlide10
TRI CITY OF CHANDIGARH (SHADED
AREA)
Tricity of Chandigarh
Slide11
TRICITY OF CHANDIGARHSlide12
Study area :
Tricity of Chandigarh
Source of data:
Police /Hospital records of tri city
of
Chandigarh
Nature of data :
I
nformation regarding the victims of
acute poisoning from tri city of
Chandigarh
Reference period:
1
st
Jan
2011
- 31
st
Dec
2013
Tools :
Structured questionnaire
Medical records and bills available were reviewed
Analysis :
IBM Statistics package (SPSS 18)Slide13
Distribution of cost
Cost of acute poisoning cases calculated under three categories
Direct cost:
Cost incurred on medical treatment like expenditure on
hospitalization, medicines and other emergency services
.
Indirect cost:
Cost of emergency transport to the hospital and transport during follow up care made by victims or their relatives during treatment.
Productivity cost:
Costs refer to lost production capacity of individuals as a
consequence of acute poisoning divided into 2 headings
:
Morbidity cost:
Value of lost output resulting from the reduced productivity including the value of lost workdays and lost housekeeping days because of acute poisoning.
Mortality cost:
Value of lost output resulting from premature death. Slide14
Study Design
Applied the Eligibility Criteria
Resident of tricity of Chandigarh (
1799
) Not resident of tricity of Chandigarh (
111
)
(
Eligible
) (
Not eligible, Excluded
)
Made a list & attempt was
made to trace the victim
Traceable (
1238
) Untraceable (
561
)
Consent given (1126) Consent not given (112) cont.
Particulars of
1910
poisoning victims collected from Police stations/ HospitalsSlide15
Consent given (1126) Status of Victim
Alive (
1042
) Dead (
84
)
Interview of Victim (
398
), Family (
447
) & Relative (
197
) Interview Family (
84
)
Distribution of Cost
Direct Cost Indirect Cost Productivity Cost
(
$.
82,377.65 ) ( $. 13,391.03 ) (
$. 5,599872.77
)
Total Cost (
$. 5,695641.45
) Slide16
RESULTSSlide17
YEAR WISE DISTRIBUTION OF ACUTE POISONING VICTIMS
(N=1126)Slide18Slide19
Age and sex wise distribution of acute poisoning victims
Age in years Sex
Total
Male
Female
<14
<5
32(61.5%)
20(38.5%)
52(4.6%)
5-10
8(42.1%)
11(57.9%)
19(1.7%)
10-14
5(62.5%)
3(37.5%)
8(0.7%)
Total
45(57%)
34(43%)
79(7%)
14-19
47(39.5%)
72(60.5%)
119(10.6%)
19-26
204(50.0%)
204(50.0%)
408(36.2%)
26-40
186(52.2%)
170(47.8%)
356(31.6%)
40-60
95(68.8%)
43(31.2%)
138(12.3%)
>60
17(65.4%)
9(34.6%)
26(2.3%)
Total
594(52.8%)
532(47.2%)
1126(100.0%)Slide20
Urban/rural and marital status wise distribution of acute poisoning cases
Socio-demographic variable GroupSex
Total
Pearson
Chi- Square
p-value
Male
Female
Area
Urban
404(52.1%)
371(47.9%)
775(68.8%)
.388
.533ns
Rural
190(54.1%)
161(45.9%)
351(31.2%)
Marital status
Married
277(47.7%)
304(52.3%)
581(51.6%)
12.412
.0001**
Unmarried
317(58.2%)
228(41.8%)
545(48.4%)
Total
594(52.8%)
532(47.2%)
1126(100.0%)Slide21
Age Wise distribution of mode of acute poisoning
Age
Mode of Poisoning
Pearson
Chi- Square
p-value
Accidental
Suicidal
Homicidal
Total
<14
79(100.0%)
0(0.0%)
0(0.0%)
79(7.0%)
194.985
.0001**
14-19
36(30.3%)
80(67.2%)
3(2.5%)
119(10.6%)
19-26
114(27.9%)
281(68.9%)
13(3.2%)
408(36.2%)
26-40
126(35.4%)
226(63.5%)
4(1.1%)
356(31.6%)
40-60
82(59.4%)
53(38.4%)
3(2.2%)
138(12.3%)
>60
17(65.4%)
6(23.1%)
3(11.5%)
26(2.3%)
Total
454(40.3%)
646(57.4%)
26(2.3%)
1126(100.0%)
Slide22
Sex Wise distribution of mode of acute poisoning
SexMode of Poisoning
Pearson
Chi- Square
p-value
Accidental
Suicidal
Homicidal
Total
Male
265(44.6%)
310(52.2%)
19(3.2%)
594(52.8%)
15.942
.0001**
Female
189(35.5%)
336(63.2%)
7(1.3%)
532(47.2%)
Total
454(40.3%)
646(57.4%)
26(2.3%)
1126(100.0%)
Slide23
Marital status wise distribution of mode of acute poisoning
Marital status
Mode of Poisoning
Pearson
Chi- Square
p-value
Accidental
Suicidal
Homicidal
Total
Married
222(38.2%)
348(59.9%)
11(1.9%)
581(51.6%)
3.558
.169ns
Unmarried
232(42.6%)
298(54.7%)
15(2.8%)
545(48.4%)
Total
454(40.3%)
646(57.4%)
26(2.3%)
1126(100.0%)
Slide24
Area wise distribution of mode of acute poisoning
AreaMode of Poisoning
Pearson
Chi- Square
p-value
Accidental
Suicidal
Homicidal
Total
Urban
310(40.0%)
446(57.5%)
19(2.5%)
775(68.8%)
.295
.863ns
Rural
144(41.0%)
200(57.0%)
7(2.0%)
351(31.2%)
Total
454(40.3%)
646(57.4%)
26(2.3%)
1126(100.0%)Slide25
Occupation wise distribution of mode of acute poisoning
OccupationMode of Poisoning
Pearson
Chi- Square
p-value
Accidental
Suicidal
Homicidal
Total
Students
119(37.8%)
186(59.0%)
10(3.2%)
315(28.0%)
133.345
.000**
House
wives
73(31.7%)
154(67.0%)
3(1.3%)
230(20.4%)
Pvt. Job
47(42.3%)
62(55.9%)
2(1.8%)
111(9.9%)
Govt. Job
51(48.6%)
53(50.5%)
1(1.0%)
105(9.3%)
Businessmen
48(51.1%)
42(44.7%)
4(4.3%)
94(8.3%)
Skilled
workers
16(19.5%)
65(79.3%)
1(1.2%)
82(7.3%)
Children
49(100.0%)
0(0.0%)
0(0.0%)
49(4.4%)
Unskilled
workers
18(37.5%)
28(58.3%)
2(4.2%)
48(4.3%)
Unemployed
8(18.2%)
33(75.0%)
3(6.8%)
44(3.9%)
House
maids
10(35.7%)
18(64.3%)
0(0.0%)
28(2.5%)
Farmers
15(75.0%)
5(25.0%)
0(0.0%)
20(1.8%)
Total
454(40.3%)
646(57.4%)
26(2.3%)
1126(100.0%)
Slide26
Relationship between family type and incidence of acute poisoning (n=1126)Slide27
Toxic substances causing acute poisoning in males (n=594)Slide28
Toxic substances causing acute poisoning in females (n=532)Slide29
Circumstances leading to acute poisoning in males (n=594)Slide30
Circumstances leading to acute poisoning in females (n=532)Slide31
Place of procuring the poisonous substances (n=1126)Slide32
Place of exposure to poisonous substances (n=1126)Slide33
Time of exposure to poisonous substances (n=1126)Slide34
Monthly distribution of acute poisoning cases (n=1126)Slide35
Medical help at the site of exposure
Medical helpNo. of victimsPercentage
Yes
Co victim
13
25.5%
Public
30
58.8%
Paramedical/nurse
2
3.9%
Doctor
2
3.9%
Parents
4
7.8%
Total
51
4.5%
No
1075
95.5%
G . Total
1126
100.0%Slide36
Escorted to hospital
Escorted to hospitalNo. of victimsPercentage
Self
58
5.2%
Parents
416
36.9%
Relative
422
37.5%
Neighbors
130
11.5%
Police
67
6.0%
Para medical/ nurse
6
0.5%
Spouse
27
2.4%
Total
1126
100.0%Slide37
Means of conveyance to hospital (n=1126)Slide38
Current statusDoctor Available
Pearson Chi- Square
p-value
Yes
No
Total
Alive
1027
15
1042
.463
.496ns
Dead
82
2
84
Total
1109
17
1126
Status of victim and availability of doctor
at first site of treatmentSlide39
Current status
Total
Percentage
Non-fatal
1042
92.5%
Fatal
84
7.5%
Total
1126
100.0%
Current status of victimsSlide40
Current Status of Non-fatal cases of acute poisoning
Current Status
Total
Percentage
Fully recovered
964
92.5
Having residual health problems
78
7.5
Total
1042
100Slide41
Special features and level of significance of explanatory variable by maximum likelihood method for logistic regression equation
Variables
B(SE)
Wald
p-value
Occupation
Students
.
095(.027)
12.457
.0001**
Time
18-24hrs
.
051(.017)
8.684
.003**
Type of poison
OPC/Carbamate
-.
785(.061)
165.096
.0001**
Poison
procuring
place
Home
-
2.103(.191)
121.430
.0001**
Poison consumption place
Home
.
245(.116)
4.472
.034*
Constant
-
3.710(.394)
88.835
.0001**
d.f
= 1 for allSlide42
Overall financial burden
Distribution of costTotal amount (USD/`)
Average cost per
victim (USD/
`
)
Dir
ec
t
Cost
$ - 82,377.65
`
-51,89,792.00
$-
74.97
`
-
4,722.29
Indirect
Cost
$- 13,391.03
`
-8,43,635.00
$- 11.90`-749.23 Morbidity
Cost
$-94,883.98`
-59,77,690.88
$- 100.14`-5,308.78
Mortality Cost
Crem
ation Ceremony Expenses
$-63,784.79`
-40,18,441.60
$-759.34`-47,838.59
lost output resulting from premature death
$- 5,441204
`
- 34,27,95,832.00
$-64776.23
`-40,80,902.76
Total
$ - 5,695641.45` - 35,88,25,391.5Slide43
Conclusion
764 (68%) victims of acute poisoning were in the age group of 19 to 40 years with male preponderance (53%) and rural dominance(69%).Victims below 14 and above 40 years mostly had accidental and in between 14 to 40 years had suicidal poisoning.52% married females consumed toxic substance with suicidal intent where as 58% unmarried males had accidental poisoning.There was positive relationship between educational qualification & incidence of acute poisoning among the students. Sickness followed by financial/family/marital disputes, failure in examination, sibling rivalry were the most common circumstances leading to poisoning.
OPC/Carbamate followed by therapeutic poisons, domestic poisons, food based poisons, aluminum phosphide and alcohol were most common offenders. Cont.Slide44
78% of incidence of acute poisoning were in nuclear family.Students (28%) followed by house wives (20%), employee (19%), businessman (8%), skilled workers (7%) were the most common victims.In majority of instances place of procurement and exposure was at home.
Most of incidence acute poisoning were between 18 to 24 hours followed by 12 to 18 hours.In 96% instances, no medical help was available at the site of exposure.Doctor was available at first site of treatment in most instances (98.5%). Most of instances (84.4%) relatives/family members were informed from site of exposure to acute poisoning.
ConclusionSlide45
ACKNOWLEDGMENT Authors are thankful to Indian Council of Medical Research New Delhi (India) for providing financial assistance to this studySlide46
Thank YouSlide47
Type of poisonTherapeutic poison : Alprex,
Amloid, Amoxycillin,Atrazine, Azothrin, Betadine, Brufen, Cetrizine, Combiflam
, Cough syrup,
Diclovin
+,
Disprin
,
Envas
,
Gatequin
,
Medalor
,
Mexafied
,
Neupokine
,
Neurobion
,
Paracetamol
,
Tripride
, Tranquil
OPC/
Carbamate
Aluminum phosphide, CannabisFuels: Kerosene oil, Petrol, Diesel, Turpentine oilDomestic : LPG inhalationChemical : Mercury, Ammonia, Boric AcidCorrosive : Acid & Alkalis