Toxicología ambiental y analítica

Background: Over the years, synthetic pesticides use in Uganda has been on the rise mainly in combating pests, disease pathogens, and disease vectors, both in agriculture and public health. Although there is an increased import and use, the limited user knowledge has resulted into exposure to the toxic products causing both intentional and non-intentional poisonings. This study evaluates a simple tool to register acute pesticide poisoning cases in selected community health facilities.

Method: In 2013, a total of 66 health care workers from 66 health facilities serving a population of 367,169 and 2.007 million in Pallisa and Wakiso districts respectively were trained on diagnosis, treatment, registration and reporting of acute pesticide poisoning. In addition over 250 members of Village Health Teams were trained to sensitise and refer any victims of pesticide poisoning to nearby health care facilities. Thereafter 1300 copies of case registration forms were distributed to trained health care workers in the 66 health facilities to capture attributes to pesticide poisonings including; patient demographic information, name of poisoning agent, type of poisoning exposure, observed signs and symptoms by patient, first aid/treatment administered, outcome of poisoning or referral to a higher facility. Partnering health facilities were visited on a monthly basis to collect filled forms and discuss any upcoming challenges. Also a feedback meeting with the health facility in charge were organised on a quarterly basis to rectify the data collection challenges. Collected data was entered, cleaned and analysed using Stata/SE14.0 Statistical package and graphs constructed with MS. Excel 13. A total of 393 acute pesticide poisoning cases were registered in 43/66 health facilities in a period of 5 years (2013-2017), with an annual average of 78.6 cases and 65.2% reporting. The mean age was 20.6 years (SD ± 17.4 years). Male cases were significantly older than females (p<0.05), with a mean age of 22 years and 17 years respectively and formed the majority of the cases 215/393 (55.2%). By Age group, children <12 years formed the majority of cases, 146/393 (37.2%), followed by >30 years, 127/393 (32.3%). A majority of 215/393 (54.7%) cases were non-intentional poisoning of which 37/215 (17.2%) were occupational poisoning cases and 178/215 (82.8%) accidental poisoning cases, while 82/393 (20.9%) were intentional poisonings and the rest 96/393 (24.4%) listed among others. The health workers faced a challenge of inability to obtain names of pesticides that caused majority 301/393 (76.6%). However, known registered poisonings 58/393 (14.8%) by chemical group included; majority being Organophosphates 29/58 (50.0%), followed by Rodenticides (Coumarin & metal phosphide) 11/58 (19.0%), Pyrethroids 7/58 (12.1%), Phosphonates 5/58 (8.6%), Acaricides 3/58 (5.2%), Carbamates 1/58 (1.7%), Thiocarbamate 1/58 (1.7%) and phenoxy acids 1/58 (1.7%).

Conclusion: Acute Pesticides Poisoning (APP) is an on-going health challenge that has not been prioritised yet by the country’s health sector. Organophosphate poisoning is the major cause of the poisonings. A majority of the poisonings were accidental poisonings seen in young age groups, followed by self-harm and occupational poisonings. This pilot serves as a guide for the country to build a robust pesticide poisoning surveillance system and pesticide access control mechanisms from end user to treatment facilities.