Pattern and risk factors of acute poisoning in a tertiary hospital of Central Bangladesh

Objective: Acute poisoning is a common cause of hospital admission in Bangladesh. But, risk factors and characteristics of victims of different modes of poisoning have not been evaluated for possible intervention strategies. So, in this study we aimed to describe the pattern of acute poisoning in central Bangladesh as well as identifying risk factors for various mode of poisoning. Methods: A prospective observational study was undertaken in Dhaka Medical College Hospital in 2015. Consenting adult acute poisoning victims were included as study subjects. A pretested structured case record form was used to systematically record the cases. The poisoning cases were defined by clinical toxidrome (sympathomimetic, antimuscarinic, opioids, cholinergic, sedative, etc) during acute presentation with suspected poisoning and groups accordingly. SPSS 20 was used for data analysis and statistical tests including mean ± standard division (SD), percentage, t test and chi-square were used accordingly. Results: Total poisoning cases were 1155. Suicidal (62.25%, n = 719), commuter poisoning (24.16%, n = 279) and accidental poisoning (12.38%, n = 143) were main types of poisoning. Risk factors of suicidal poisoning were young females of 11 to 30 years, married, housewives and students (P < 0.0001). Stressful relationship was the commonest reason of suicidal poisoning. Pesticides and sedatives were frequently chosen for easy availability. Commuter poisoning was common in males and urban areas (P < 0.0001). Accidental poisoning was more in males and rural areas (P < 0.0001) and snake envenomation was the main cause. Conclusion: Poisoning burden is high in central Bangladesh. Identified risk factors will help develop poisoning prevention strategies

Bans of WHO Class I Pesticides in Bangladesh –Suicide Prevention without Hampering Agricultural Output

Pesticide self-poisoning is a major problem in Bangladesh. Over the past 20-years, the Bangladesh government has introduced pesticide legislation and banned highly hazardous pesticides (HHPs) from agricultural use. We aimed to assess the impacts of pesticide bans on suicide and on agricultural production.We obtained data on unnatural deaths from the Statistics Division of Bangladesh Police, and used negative binomial regression to quantify changes in pesticide suicides and unnatural deaths following removal of WHO Class I toxicity HHPs from agriculture in 2000. We assessed contemporaneous trends in other risk factors, pesticide usage and agricultural production in Bangladesh from 1996 to 2014.Mortality in hospital from pesticide poisoning fell after the 2000 ban: 15.1% vs 9.5%, relative reduction 37.1% [95% confidence interval (CI) 35.4 to 38.8%]. The pesticide poisoning suicide rate fell from 6.3/100 000 in 1996 to 2.2/100 000 in 2014, a 65.1% (52.0 to 76.7%) decline. There was a modest simultaneous increase in hanging suicides [20.0% (8.4 to 36.9%) increase] but the overall incidence of unnatural deaths fell from 14.0/100 000 to 10.5/100 000 [25.0% (18.1 to 33.0%) decline]. There were 35 071 (95% CI 25 959 to 45 666) fewer pesticide suicides in 2001 to 2014 compared with the number predicted based on trends between 1996 to 2000. This reduction in rate of pesticide suicides occurred despite increased pesticide use and no change in admissions for pesticide poisoning, with no apparent influence on agricultural output.Strengthening pesticide regulation and banning WHO Class I toxicity HHPs in Bangladesh were associated with major reductions in deaths and hospital mortality, without any apparent effect on agricultural output. Our data indicate that removing HHPs from agriculture can rapidly reduce suicides without imposing substantial agricultural costs

Analysis of Recent Situation of Pesticide Poisoning in Bangladesh: Is There a Proper Estimate?

Background: Pesticide poisoning is a common method of suicide attempt and less commonly accidental poisoning in Bangladesh. This review for the first time estimated the extent and characteristics of pesticide poisoning in Bangladesh and explored existing limitations in methodologies of studies done on poisoning in the country. Methods: A narrative search in electronic medical databases including MEDLINE, Google Scholar and Banglajol was carried out. Search terms used were "Bangladesh", "pesticide", "poisoning" and "organophosphate". Relevant studies were collected and assessed for their originality. Organization reports were also collected. Studies after the year 2000 were only selected. Methodologies of the studies were carefully scrutinized. Results: Estimated case load of poisoning in hospitals of Bangladesh was 7.1% (CI 6.9-7.2) of total admissions. Pesticide poisoning accounted for 39.1% (CI 37.6-40.6%) of total poisoning cases admitted in different levels of hospitals in Bangladesh. Majority of them were due to WHO class-II pesticides (moderately hazardous). Reported frequency of different pesticides includes organophosphate compounds (OPCs) in 89.8%, rodenticides in 4.3%, carbamates in 4.0%, unknown compounds in 1.6% and pyrethroids in 0.3% of cases. Pesticide poisoning was responsible for 72.6% (CI 68.0-76.8) of total poisoning related deaths. Approximately 0.7 deaths per 100,000 population was due to pesticide poisoning. Reporting the frequency of chemical nature of pesticides varied significantly with methodology used for case identification (P < 0.001). In studies that toxidromic assessment was used, most cases were treated as OPC poisoning. In studies that applied sample identification by evaluation of container/pack and reading its label, over 30% of cases were due to carbamates. Presence of only one toxicological analysis center in the country has made routine chemical identification practically impossible.  Conclusion: Pesticide poisoning is responsible for great number of admissions and deaths in Bangladesh. Creating a register of commercially available pesticides in each region for rapid identification of nature of the pesticide is recommended

Comparative frequency and allelic distribution of ABO and Rh (D) blood groups of major tribal communities of southern Bangladesh with general population and their determinants

Background: Allelic distribution of major blood groups (ABO and rhesus) has not been defined in Bangladeshi population. Determinants of blood group frequency in this region have not been studied properly. Aim: To determine ABO and rhesus blood group frequency and allelic distribution in a multiethnic area of Bangladesh and to explore possible genetic, racial and environmental factors influence as determinants of major blood groups. Subjects and methods: Data collected retrospectively from blood group register of Rangamati General Hospital (2006–2011). Four tribal (Chakma, Marma, Tanchangya and Tripura) and general Bengali population were included in the study. Results: Collectively all tribal had distinct ABO phenotypic frequency (B > A > O > AB) which is different from Bengali population (O > B > A > AB). Tripura’s showed a unique pattern of A > B > AB > O. Overall tribal had higher frequency of B and AB group (P  B > A in all study groups except Tripura (A > O > B). Rhesus negative group was very uncommon in study groups. Data among tribal suggest their common origin as well as drift from original population due to possible founder effect among Tripura’s. Despite being malaria endemic zone the protective group O was less (P < 0.0001) among native tribal (23%) and high among migrating Bengali (34%)

Alcohol Use and Alcohol Use Disorders in Bangladesh

Background: This review was performed to evaluate the trend of alcohol use, characteristics of consumers, alcohol use disorders and toxic alcohol intoxications in Bangladesh. In addition, sources and sales figures of alcoholic beverages, and number of legal permits issued for alcohol consumption are reported and analyzed. Methods: A narrative search was performed on available medical literature in online medical databases including Medline, Embase, Google Scholar and Bangladesh Journal online (Banglajol) to obtain articles related to alcohol use and related disorders in Bangladesh. Governmental legislations and reports related to alcohol use were also collected and reviewed. The main estimates are based on the data reported during 2006 to 2011.  Results: Estimated frequency of alcohol users in general population of Bangladesh is about 1.9% (CI 1.7-2.1). Prevalence of alcohol consumption is 3.6% (CI 3.3-4.1) among men and 0.3% (CI 0.2-0.5) among women. The majority of alcohol consumers are within 25 to 44 years of age (76.3%). Total number of alcohol use permits has increased by 49.0% during 2006 to 2011. In total, 80637 permits have been issued up to 2011, and therefore it can be estimated that 79/100,000 people are legal alcohol consumers in Bangladesh. The estimate of alcohol use prevalence (1.9%) is approximately 24 times higher than estimated legal consumers (0.08%). There is a growing trend over alcohol use in Bangladesh, as alcohol per capital consumption has increased by about 100 times during 1973 to 2010. Heavy episodic drinking has been reported in 20.2% (CI 16.3-24.8) of Bangladeshi drinkers. Alcohol dependence was estimated to be 0.7% in general population. Conclusion: Alcohol use is on the rise in Bangladesh and it is particularly higher among some specific populations. Targeted intervention programs may help stop this increasing trend