A CAJM clinical report on acute poisoning of infants studied at a hospital children ward  in Harare, Zimbabwe.Forty two cases of acute poisoning were studied retrospectively over a two year period (1990 to 1991, inclusive) in the paediatric Intensive Care Unit (ICU), at Parirenyatwa Hospital in Harare. This formed 8,6 pc of the total admissions into the unit over the same period. The four commonest types of poisons were organophosphates, 38,1 pc; paraffin, 26,2 pc; traditional medicines (muti), 14,3 pc and miscellaneous drugs, such as chloroquine, aspirin, chloropromazine, diazepam and gama-benzene, 9,5 pc. The results suggest poor living conditions, local beliefs, customs and ignorance of the dangers of chemicals, as the risk factors associated with acute poisoning.
Eighty eight pc of all admissions were children below the age of five years. The mortality rate in this series was 21 pc. Compared to the overall mortality rate of all ICU admissions of 30,9 pc over the same period, death due to acute poisoning was 1,8 pc of all ICU deaths

Chitsike, I.

Central African Journal of Medicine

English

IDS OpenDocs

CONTENTS November, 1994Vol. 40, No. 11 
ORIGINAL ARTICLES
M T Mbizvo, S Ray, M Bassett, W McFarland,
R Machekano, D Katzenstein................................ 294
*
R T Erasmus, C Uyot, T Pakeye...........................299
S A Tswana, C Berejena, SR Moyo,
O Mudyarabikwa..................................................... 303
N Lukwa................................................................... 306
A P R ecler................................................................ 309
Acute poisoning in a paediatric intensive care unit
in Harare.................................................................... IC hitsike.................................................................. 315
Umbilical hernia in Bulawayo: some observations
from a hospital based study..................................... G Mawcra, GI M uguti.............................................319
CASE REPORTS
Traveller’s loiasis in Zimbabwe: a case report.....  LM Bordon, M M aurice......................................... 323
Symptomatic polycystic liver disease: a c a se .....  LM Bordon, L Chivete...........................................327
Condom use and the risk of HIV infection: who is 
being protected?.......................................................
Plasma cholesterol distribution in a rural Nigerian 
population -  relationship to age, sex and body mass
Cross sectional sero-epidemiological prevalence 
of poliovirus antibodies post immunization with 
three doses of T O PV ...............................................
Do traditional mosquito repellent plants work as 
mosquito larvicides?................................................
A preliminary investigation into psychological 
disorders in Mozambican refugees: prevalence 
and clinical features.................................................
C i :i 'i> m )'n .'ii n v  r m  a v n r m r  a t A in g o r i f T V
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 40, No. 11,1994
Acute poisoning in a 
paediatric intensive care 
unit in Harare
I CHITS IKE 
SUMMARY
Forty two cases of acute poisoning were studied retro­
spectively over a two year period (1990 to 1991, 
inclusive) in the paediatric Intensive Care Unit (ICU), 
at Parirenyatwa Hospital in Harare. This formed 8,6 pc 
of the total admissions into the unit over the same 
period. The four commonest types of poisons were 
organophosphates, 38,1 pc; paraffin, 26,2 pc; tradi­
tional medicines (muti), 14,3 pc and miscellaneous 
drugs, such as chloroquine, aspirin, chloropromazine, 
diazepam and gama-benzene, 9,5 pc. The results sug­
gest poor living conditions, local beliefs, customs and 
ignorance of the dangers of chemicals, as the risk 
factors associated with acute poisoning.
Eighty eight pc of all admissions were children 
below the age of five years. The mortality rate in this 
series was 21 pc. Compared to the overall mortality rate 
of all ICU admissions of 30,9 pc over the same period, 
death due to acute poisoning was 1,8 pc of all ICU 
deaths.
Correspondence and reprint requests to:
Dr / Chitsike
Department o f Paediatrics and Child Health
School o f Medicine
P.O.BoxA178
Avondale
Harare, Zimbabwe
315
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 40, No. 11,1994
INTRODUCTION
Anumber of studies which reflect the pattern of poison­
ing in African children have been published before.1-3 
These studies were all based on hospital admission 
cases and not on patients admitted to the intensive care 
unit. The circumstances of poisoning in most of these 
cases were either accidental during the course of treat­
ment,1"* or accidental around the home.1
The types of poisons associated with hospital admis­
sion incidences in Zimbabwe have been reported be­
fore and include paraffin5 and other household chemi­
cals,6 orthodox medicines, (therapeutic drugs),7 tradi­
tional medicines,2-3 snake venoms,8 insect stings,9 food 
poisoning10 and heavy metals.11 Acute poisoning in 
children has also been studied and reported in India,12 
England13 and Afghanistan.14
The objective of the present study is to evaluate the 
pattern of poisoning seen in the paediatric intensive 
care unit in a developing country like Zimbabwe.
MATERIALS AND METHODS
A retrospective study of all cases of acute poisoning 
admitted to the paediatric ICU at Parirenyatwa Hospi­
tal over a period of two years, (1st January 1990 to 31st 
December 1991) was carried out. The data for this 
study was retrieved from a register kept in the ICU and 
from case notes of the patients obtained from the 
hospital records department. Parirenyatwa, is a teach­
ing hospital and one of the four main referral hospitals 
in Zimbabwe. It is the only hospital in the country with 
a paediatric intensive care unit. The ICU has facilities 
to care for a maximum of seven patients at any one time.
RESULTS
Age and sex distribution: Over SO pc of the patients 
were under the age of two years. The youngest was a 
three day old who was given traditional medication for 
ritual purposes. There was a four day old baby who was 
given corrosives. Eighty eight pc of the patients were 
below the age of five years. Eleven pc were over the age 
of five years. The eldest was a 10 year old who had 
swallowed chloropromazine and diazepam in a sui­
cidal bid. The age group distribution of the patients is 
as shown in Table I below.
Types of poisons: Table II shows types and fre­
quency of poisons. Over 78 pc of the poisons were by
Table /: Age distribution o f patients (n = 42).
Age group 
(Years) Total Number pc Total
0 -1 12 28,6
> 1 -2 10 23,8
> 2 -3 8 19,0
> 3 -4 3 7,1
> 4 -6 4 9,5
>5 5 11,9
Total 42 99,9
three agents i.e. organophosphates, paraffin and tradi­
tional medicines. Other poisoning included fish poi­
soning (4,8 pc), rat poison, snake bite and other corro­
sives contributing to 2,4 pc each as indicated. Thera­
peutics accounted for approximately 10 pc.
Agents associated with death: O f the total patients 
admitted (42) nine died (21 pc). Common agents asso­
ciated with death were traditional medicine, paraffin 
and organophosphates. Most of the deaths 66 pc oc­
curred within the first 24 hours of admission.
Table II: Types and frequency o f  poisons (n -  42).
T y p e d  Poison Number (cases) PC
Organophosphates 16 38,1
Paraffin 11 26,2
Traditional Medicines 6 14,3
Fish Poisoning 2 4.8
Rat Poison 1 2,4
Snake bite 1 2,4
Corrosives 1 2,4
Chloroquine 1 2,4
Aspirin 1 2,4
Chloropromazine/Diazepam 1 2,4
Gama-benzene 1 2,4
Total 42 100,2
316
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol.40.No.il,1994
Table III: Agents associated with death.
Typo of Poison
Total Number 
cases
Number of 
deaths PC
Paraffin 11 3 27,3
Traditional Medicines 6 3 50,0
Organophosphates 16 1 6,3
Chloroquine 1 1 100,0
Corrosives 1 1 100,0
Total 35 9 99,9
DISCUSSION
During the two year period, 42 patients were admitted 
to the ICU with acute poisoning. The total number of 
patients admitted to the ICU during the same period 
was 488. Acute poisoning accounted for 8,6 pc percent 
of the total ICU admissions. Of the 42 patients with 
acute poisoning, 27 were males and 15 females.
Hospitalisation from acute accidental poisoning in 
children is infrequent despite the fact that poisoning is 
a common occurrence. B wibo,1 from Uganda reported 
an incidence of 0,65 pc of the paediatric admissions as 
being due to poisoning. This is similar to the figure of 
0,64 pc reported by Singh,12 from India. Figures from 
more industrialised countries also show a small per­
centage of hospital admissions due to poisoning.1*'14 
Not much has been published on acute poisoning 
admissions into paediatric ICUs in developing coun­
tries. In this study the incidence of admission of acute 
poisoning in the paediatric ICU was 8,6 pc. This high 
figure could either be due to severity of symptom 
presentation or that doctors are more likely to admit 
children presenting with poisoning into the ICU if 
resources for such management are available. The age 
and sex distribution in the study population is similar to 
that reported by several workers using data from gen­
eral hospital admissions.51215
All the cases were accidental poisoning except for 
two, i.e. a four day old baby who was intentionally 
given corrosives by a parent in a murder bid and a 10 
year old child (the oldest patient), who took multiple 
therapeutic agents to commit suicide. It is interesting to 
note that this latter patient who ingested multiple drugs 
followed an “adult pattern” of self-poisoning as re­
ported from Zimbabwe5 and Uganda and from 
industrialised countries such as Scandinavia15 and 
France.16
The three most common agents causing poisoning 
were identified as organophosphates, paraffin and tra­
ditional medicines. Organophosphates, the most widely 
used pesticides are easily available in most agricultural 
or hardware stores/shops where virtually anybody can 
purchase them. The easy availability and accessibility 
of organophosphates is related to the agricultural base 
of Zimbabwe’s economy and most other developing 
countries. These chemicals are poisonous, even more 
so to the children.
The relatively high incidence of poisoning due to 
paraffin is associated with frequent use of paraffin 
which is a cheaper and affordable source of fuel in the 
low income bracket families such as in most high 
density suburbs and in the rural areas. In addition, lack 
of safe storage means for paraffin which is often sold 
in soft drink bottles/containers increases the risk of 
accidental ingestion by children.5
The common use of traditional medicines is related 
to socio-cultural and traditional beliefs. Almost all the 
adult Black Zimbabwean population have at one time 
or another been treated with traditional medicines.17 
The belief in the efficacy of traditional medicines is 
invariably passed on to the succeeding generations. 
Traditional medicines are acceptable because there is 
a long history through folklore of their use and they are 
considered safe and effective. In addition, the use of 
these medicines is officially practised by the Zimba­
bwe National Traditional Healers Association 
(ZINATHA).17
Acute poisoning from orthodox medicines was re­
corded in only three cases i .e. 7,1 pc. On the other band, 
acute poisoning admissions in the general population, 
due to orthodox medicines accounted for 47,8 pc of all 
acute poisoning admission.7 It seems therefore, that 
acute poisoning due to orthodox medicines in children 
below 10 years of age is uncommon.
The case fatality rate, 50 pc in the present study, was 
highest in acutepoisoning due to traditional medicines. 
It is important to note that a positive history of prior 
“muti” administration can be obtained in a significant 
proportion of children admitted into hospital with 
various conditions e.g. gastroenteritis with metabolic 
acidosis, meningitis, pneumonia, etc. The severe meta­
bolic acidosis associated with gastroenteritis in these 
children has been attributed to the use of “muti”, hence 
the clinical diagnosis “muti poisoning”. Nkrumab et
317
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 40, No. 11,1994
a F  did not find any association between “muti” and 
metabolic acidosis. Hence the recommendation that 
the clinical diagnosis “muti poisoning” which is used to 
categorise such children be abandoned.
However, in this study some of the children who 
were previously healthy had been given “muti” for 
ritual purposes. Other studies from Zimbabwe have 
shown that “muti” administration for treatment pur­
poses does not cause poisoning.2’4 Therefore, more 
research has to be done on the pharmacological effects 
of “muti”. In addition, the public should be educated on 
its potential harmful effects.
Only one patient died due to organophosphate (OP). 
Although there were more OP admissions compared to 
paraffin, there were more deaths from paraffin. This 
could be due to the fact that health personnel are more 
likely to admit poisoning cases of OP than paraffin 
because they are not familiar with the treatment of OP. 
On the other hand, health personnel are more familiar 
with management of paraffin poisoning. Hence only 
the very severe cases are admitted to ICU. This will 
explain the higher case fatality rate of paraffin com­
pared to OP.
The pattern of acute poisoning in this study seems to 
indicate a socio-economic and cultural association. 
This is similar to findings of Singh et al from India.12 
Paraffin is widely used as a source of fuel in the less 
affluent communities. Use of traditional medicines is 
prevalent in the rural areas where orthodox medicine is 
not widely available. Acute poisoning due to tradi­
tional medicines is also common in urban areas,2 4 and 
this once more relates to socio-cultural and traditional 
beliefs which seem to pervade even urbanisation.
The present study suggests a high correlation of 
acute poisoning ICU admissions with socio-economic 
status, socio-cultural beliefs and agro-chemical eco­
nomic base of the society.
ACKNOWLEDGEMENTS
I would like to thank the Medical Superintendent, 
Parirenyatwa Hospital, personnel in ICU and Medical 
Records Department for their collaboration during the 
study. My acknowledgements extend to Prof CFB 
Nhachi, Department of Clinical Pharmacology and 
Prof OMJ Kasilo, Drug and Toxicology Informative 
Service, Department of Pharmacy, University of Zim­
babwe Medical School for their comments.
REFERENCES
1. Bwibo NO. Accidental poisoning in children in 
Uganda. Br Med J  1969;4:601-2.
2. Kasilo OMJ, Nhachi CFB. The pattern of poi­
soning from traditional medicines in urban Zim­
babwe. S A fr Med J  1992;82:187-88.
3. Lewis HH, Cronje RE, Naude SP, Van der Berg 
C. Accidental poisoning in childhood. S Afr 
M edJ  1989;76:429-31.
4. Nyazema NZ. Herbal toxicity in Zimbabwe. 
Trans R Soc Trop Med Hyg 1986;80:448-50.
5. Kasilo OMJ, Nhachi CFB. A pattern of acute 
poisoning in children in urban Zimbabwe. A ten 
year experience. Human and Experimental Toxi­
cology 1992; 11:335-40.
6. Nhachi CFB, Kasilo OMJ. Household chemical 
poisoning in urban Zimbabwe. Human and Ex­
perimental Toxicology 1994;13:69-72.
7. Nhachi CFB, Hobane T, Satumba P, Kasilo 
OMJ. Aspects of orthodox medicines (thera­
peutic drugs) poisoning in urban Zimbabwe. 
HumanandExperimentalToxicology 1992;329- 
33.
8. Kasilo OMJ, Nhachi CFB. Poisoning due to 
snake venom in urban Zimbabwe. Human and 
Experimental Toxicology 1993;12:15-18.
9. Nhachi CFB, Kasilo OMJ. Poisoning due to 
insect and scorpion stings/bites. Human and 
Experimental Toxicology 1993;12:123-25.
10. Kasilo OMJ, Nhachi CFB. Food poisoning in 
urban Zimbabwe. Human Experimental Toxi­
cology 1994;13:77-82.
11. Kasilo OMJ, Nhachi CFB. Survey o f chemicals 
(mostly metals) poisoning cases as reflected in 
hospital admissions in urban Zimbabwe. Bull 
Environmental Contamination and Toxicology 
50:260-65.
12. Singh S, Narang A, Walia BMS, Mehta S, 
Kumar L. Accidental poisoninginchildren.Ten 
years experience. Indian Paediatr 1981 ;18:163- 
66.
13. Wiseman HM, Guest K, Murray VSG, Volans 
GN. Accidental poisoning in childhood. A 
multicentre survey, 1. General Epidemiology. 
Human Toxicology 1987;6:293-301.
318
14. Choudhry VP, Jalali AJ, Haider G, Qureshi 
MA. Spectrum of accidental poisonings among 
children in Afghanistan. Ann Trop Paediatr 
1987;7:278-81.
15. Jacobsen D, Bakken AF, Halvorsen K, 
Marstrander J, Sunde K. Acute poisonings of 
children in Oslo. A one year prospective study. 
Act Paediatr Scand 1983;72:553-57.
16. Baner P, Maire B, Weber M, Pierre-Edward B, 
Larean A. Lambert H. Full recovery after a 
choloroquine suicide attempt. Clin Toxicol 
1991;29:23-30.
17. Arkovitz MS, Mamley M. Specialisation and 
referral among the n’anga (traditional healers) 
of Zimbabwe. Trop Doctor 1989;20:109-10.
18. Nkrumah FK, Nathoo KJ, Gomo ZAR, Pivie 
DJ. Severe metabolic acidosis and “muti” (tra­
ditional herbal medicine) ingestion in young 
children. Cent Afr J  Med 1990;36:16-19.
Umbilical hernia in 
Bulawayo: some 
observations from a 
hospital based study
G MAWERA, G I MUGUTI 
SUMMARY
We present a retrospective study of 40 consecutive 
patients admitted with umbilical hemiae to Mpilo Cen­
tral Hospital between January 1990 and December 
1993. The majority of the patients 95 pc (38/40) were 
children and only 5 pc (2/40) were adults. The study 
included 18 males and 22 females giving aM :F ratio of 
1:1,2. In children the age range was from 1 month to 13 
years with 63 pc (24/38) occurring in the zero to five
Department o f Surgery 
Mpilo Central Hospital 
Bulawayo, Zimbabwe 
Correspondence to:
GIMuguti
Department o f Surgery 
Mpilo Central Hospital 
P O  Box 2096 
Bulawayo, Zimbabwe
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 40, No. 11,1994
year age group. The commonest indication for admis­
sion was obstruction of the umbilical hernia in 37,5 pc 
(15/40) of cases. Other indications included: large 
umbilical hemia 30 pc (12/40), recurrent discomfort 
and peri-umbilical pain 20 pc (8/40), incidental finding 
in patients admitted for some other problem 7,5 pc (3/ 
40), one case of recurrent hemia and one case of 
accidental injury.
Spontaneous reduction of obstructed umbilical hefi- 
niae occurred in 86 pc (13/15) of cases and operative 
reduction was carried out in 14 pc (2/15) of cases. There 
was no mortality recorded in this series.
It is clear from our findings in this study that obstruc­
tion of the umbilical hemia in children in our practice 
although relatively uncommon , is a  well recognised 
surgical emergency. On the basis of our findings we 
would recommend that prophylactic umbilical hemia 
repair should be performed in all girls over two years of 
age and in all children over four years of age.
INTRODUCTION
Three forms of umbilical hemia are recognised in 
clinical practice.1 The congenital variety occurs as a 
result of faulty union of the visceral plates in the 
midline. The infantile variety occurs soon after birth 
due to yielding of the umbilical cicatrix after separation 
of the cord and lastly, the adult variety occurs later in 
life.
U m bilical abdom inal wall defects such as 
gastroschisis and omphalocele are thought to be devel­
opmental in origin, whereas an umbilical hemiaresults 
from severe stresses and strains against the fresh um­
bilical wound or weak cicatrix produced by coughing, 
crying, vomiting and possibly multiple pregnancies in 
women in later life.2 As with other external abdominal 
wall hemiae it is conceivable that other factors causing 
raised intra-abdominal pressure (e.g. chronic cough, 
constipation, ascites and distal obstructive uropathy) 
can predispose to umbilical hemia in later life. This 
study is concerned primarily with the infantile type and 
to a lesser extent the adult type of umbilical hemia.
Although umbilical hemia is a common clinical 
condition in Black African children there is very little 
data on this condition in the African medical literature. 
Indeed, no serious study on umbilical hemia has been 
carried out to date in Zimbabwe. It would appear from 
these observations that umbilical hemia is generally 
regarded as a harmless condition in our sub-region. It is
319
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Acute poisoning in a paediatric intensive care unit in Harare

Forty two cases of acute poisoning were studied retrospectively over a two year period (1990 to 1991, inclusive) in the paediatric Intensive Care Unit (ICU), at Parirenyatwa Hospital in Harare. This formed 8,6 pc of the total admissions into the unit over the same period. The four commonest types of poisons were organophosphates, 38,1 pc; paraffin, 26,2 pc; traditional medicines (muti), 14,3 pc and miscellaneous drugs, such as chloroquine, aspirin, chloropromazine, diazepam and gama-benzene, 9,5 pc. The results suggest poor living conditions, local beliefs, customs and ignorance of the dangers of chemicals, as the risk factors associated with acute poisoning.

Eighty eight pc of all admissions were children below the age of five years. The mortality rate in this series was 21 pc. Compared to the overall mortality rate of all ICU admissions of 30,9 pc over the same period, death due to acute poisoning was 1,8 pc of all ICU deaths

Chitsike,  I.

National Research Database of Zimbabwe

https://opendocs.ids.ac.uk/opendocs/bitstream/20.500.12413/7007/1/Chitstike%20I%20The%20CAJM%20Vol%2040%20no%2011.pdf

Acute poisoning in a paediatric intensive care unit in Harare

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