Abstract
Background
This study aimed to evaluate the burden of chemical poisoning and its associated factors at the Chemical, Biological, Radiological, and Nuclear (CBRN) pilot surveillance sites in the Amhara region, Northwest Ethiopia. The analysis of burdens and contributing factors is intended to inform targeted interventions and enhance public health strategies.
Methods
A cross-sectional study was conducted at TibebeGhionComprehensive Specialized Hospital(TGCSH) and FelegeHiwot Comprehensive Specialized Hospital(FHCSH) in the Amhara region of Ethiopia from June to November 2021. Data were collected using structured tools and analyzed with SPSS version 26. Descriptive statistics assessed the burden of chemical poisoning, while Chi-square analysis identified significant factors associated with the burden of chemical poisoning.
Results
The study reported a total of 184 chemical poisoning cases at TGCSH and FHCSH in the Amhara region, with a case fatality rate of 17%. The most affected age group was 16 to 25 years, and females accounted for 60% of the cases. Geographic distribution showed that Bahir Dar had the highest incidence, contributing to 64.7% of the cases, while the South Gondar zone, particularly the Fogera district, accounted for 30.88%. Organophosphates emerged as the most prevalent toxic agents, responsible for 53% of the cases. Chi-square analysis highlighted several significant associations with a higher burden of chemical poisoning, including being female (X² = 4.463, p = 0.035), being 35 years or younger (X² = 4.629, p = 0.031), ingestion of rodent poison (X² = 4.154, p = 0.042), intentional poisoning (X² = 7.488, p = 0.006), and inhalation exposure (X² = 4.154, p = 0.042) and educational level (X² = 5.764, p = 0.016).
Conclusions and recommendations
The study reveals a significant burden of chemical poisoning in the Amhara Region, Ethiopia, with a 17% fatality rate, predominantly impacting young adults and females, particularly in areas with high pesticide use, such as Bahir Dar and South Gondar. Key issues include cases with no antidotes, inhalation exposure, and intentional poisoning. Recommendations: Implement stricter chemical regulations, limit pesticide sales, enhance community education on safe handling, and improve mental health support for high-risk groups. Develop sustained CBRN surveillance systems and conduct further research on regional disparities and chemical agent assessments.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-024-20190-9.
Keywords: Chemical Poisoning, Organophosphates, Chi-Square Analysis, Public Health interventions, Amhara Region
Introduction
Chemical poisoning, involving purposeful or unintentional exposure to harmful substances through ingestion, inhalation, or skin absorption, presents a significant health threat. Such exposures can occur from medications, xenobiotic substances, or various chemicals that contact the body through different routes [1, 2]. Common toxins include organophosphates, caustic agents, carbon monoxide, and chemicals in household products, insect repellents, and herbal supplements [3, 4]. The widespread use of chemicals in domestic and environmental settings, as well as their presence in food, contributes to the frequency of poisoning incidents [5, 6].
Initially, many individuals exposed to chemicals may remain asymptomatic, but serious health effects, including morbidity and mortality, can arise depending on the dose and duration of exposure [7]. Organophosphates, used extensively in agriculture and for chemical warfare, pose high risks of both acute and chronic toxicity. Suicide attempts involving organophosphates account for a significant proportion of cases, with rates ranging from 10 to 36.2% in developed countries and 65–79.2% in developing countries [8, 9].
Herbicides, though effective for increasing agricultural productivity, pose considerable health risks and environmental hazards. Pesticide poisoning, including herbicide exposure, is a major public health issue globally, with an estimated 1 to 5 million cases annually and approximately 220,000 deaths, predominantly intentional in developing countries [10, 11]. The World Health Organization estimates that herbicides and pesticides contribute to one in five suicides globally, underscoring the need for better regulatory measures and surveillance, particularly in developing regions [12].
Rodent and pesticide poisoning frequently result in severe health conditions, including acid-base imbalances and respiratory problems, and are significant causes of death in developing countries. Such poisoning often leads to respiratory acidosis and metabolic acidosis [13, 14]. Chemical poisoning is responsible for approximately 6% of all deaths worldwide, making it the third leading cause of unintentional accidents, following traffic accidents and drowning [15].
Addressing chemical poisoning requires concerted international and regional efforts to manage, prevent, and control these incidents. This study aims to identify risk factors for chemical poisoning-related deaths to inform policy, strategy, and regulatory development, enhancing public health responses [16, 17].
Methods
Study design, period, and settings
We conducted a cross-sectional study from June to November 2021 among chemical poisoning patients Chemical, Biological, Radiological, and Nuclear (CBRN)pilot surveillance site health facilities in the region. These included TibebeGhion Comprehensive Specialized Hospital (TGCSH), FelegeHiwot Comprehensive Specialized Hospital (FHCSH), Shumabo Health Center, and Textile Clinic.TGCSH and FHCSH were chosen due to the sufficient number of cases available for the study.
Study participants
The study population included all chemical poisoning cases that occurred during the study period at TGCSH and FHCSH. We conducted a total survey of all chemical poisoning cases admitted to the Chemical, Radiological, and Biological (CRB) pilot surveillance site health facilities in the region from June to November 2021. The selected facilities were TGCSH, and FHCSH. By including all cases recorded during this period, the study provided a comprehensive overview of chemical poisoning incidents, making sample size calculation unnecessary. This approach ensured that the data collected was robust and inclusive, capturing the full scope of chemical poisoning cases in the region for detailed analysis.
Data collection and tool development
Data were obtained by directly interviewing clients of poisoned patients at the hospitals. The data collection tool for this study was a structured questionnaire designed to evaluate the burden and contributing factors of chemical poisoning in the Amhara Region, Ethiopia. The questionnaire was developed following an extensive review of existing literature and consultations with experts in toxicology and public health. It included sections on sociodemographic, educational level and economiclevel information, chemical exposure, knowledge and attitudes towards chemical safety, health outcomes, and preventive measures. A pilot test was conducted with a small sample of chemical poisoning patients admitted at Borumeda Hospital to ensure the questionnaire’s clarity and relevance. Based on feedback from the pilot, the questionnaire was refined to enhance its understandability and ensure it was appropriately targeted for the respondents(Supplementary File).
Data collection procedures
Data collection was conducted through face-to-face interviews using the finalized questionnaire. Trained data collectors were deployed to gather information from chemical poisoning patients at TGCSH and FHCSH. To ensure the accuracy and reliability of the data, the principal investigator reviewed the collected data daily. The data collection process was closely supervised to maintain high-quality standards. During data entry, a thorough review was conducted to prevent missing data and ensure the accuracy of the recorded information. This meticulous process ensured that the dataset was complete and reliable, providing a solid foundation for subsequent analysis and interpretation of the study’s findings.
Data management and analysis
The collected data were carefully coded and entered into Epi Data version 4.6, a data management software designed for the accurate and efficient handling of large datasets. Once data entry was completed, the dataset was exported to SPSS Version 26 for statistical analysis. Descriptive statistics, including frequencies and percentages, were utilized to summarize and present the demographic and clinical characteristics of the chemical poisoning cases. These statistics provided a clear overview of the burden of the chemical poisoning within the study population.
To assess the statistical significance of various factors associated with chemical poisoning at TGCSH and FHCSH, a Chi-square test was conducted. This test allowed for the identification of relationships between categorical variables, such as age, gender, type of chemical agent, route of exposure, educational level, socioeconomic level and the intentionality of the poisoning incident. The Chi-square analysis helped determine whether these factors significantly influenced the burden and outcomes of chemical poisoning cases at the study sites, providing valuable insights into the patterns and determinants of chemical poisoning in the region.
Result and discussion
Sociodemographic characteristics of the patients
The data indicates that the majority of chemical poisoning cases and associated deaths occurred predominantly among individuals aged 16 to 25 years. This age group experienced the highest frequency of both poisoning incidents and fatalities. Following this, the next most affected group was individuals aged 26 to 35 years, who also showed a significant number of cases but to a lesser extent(Fig. 1). Additionally, a significant portion of the cases, about 60%, involved female patients(Fig. 2). This demographic information highlights the need for targeted prevention and intervention strategies, particularly focusing on young adults and women, to address the underlying causes and reduce the incidence of chemical poisoning.
Fig. 1.
Age-Based classification of chemical poisoning cases at TGCSH and FHCSH, Amhara Region, Ethiopia (2021)
Fig. 2.
Gender analysis of chemical poisoning cases at TGCSH and FHCSH, Amhara Region, Ethiopia (2021)
The data highlights that chemical poisoning cases in the Amhara Region, Ethiopia, are notably associated with education level and socioeconomic status. The majority of cases (32.6%) are among individuals with secondary education, followed by those with primary education (27.2%), suggesting that limited awareness of chemical safety and higher occupational exposure risk among these groups contribute to increased poisoning incidents. In contrast, fewer cases are observed among those with higher education, like a diploma or degree, indicating better access to information and safer work environments, though they are still at risk due to certain occupational hazards. Socioeconomic status is also crucial, with nearly half of the poisoning cases (48.9%) occurring among low-income groups, likely due to inadequate safety measures, poor chemical storage, and limited healthcare access. Middle-income individuals account for 38.0% of cases, reflecting that poisoning risks extend beyond just the poorest populations. High-income groups have the lowest incidence (13.0%), suggesting that better economic status often equates to safer living conditions and better healthcare, thereby reducing the risk of chemical poisoning (Table 1).
Table 1.
Distribution of chemical poisoning cases by education level and socioeconomic status
| Education Level | Low Income | Middle Income | High Income | Total Cases | Percentage (%) |
|---|---|---|---|---|---|
| No Formal Education | 25 | 5 | 0 | 30 | 16.3 |
| Primary Education | 40 | 8 | 2 | 50 | 27.2 |
| Secondary Education | 15 | 40 | 5 | 60 | 32.6 |
| Higher Education (Diploma) | 7 | 15 | 2 | 24 | 13.0 |
| Higher Education (Degree) | 3 | 2 | 19 | 24 | 13.0 |
| Total | 90 | 70 | 24 | 184 | 100.0 |
Chemical poisoning case distribution by place
Nearly 64.7% of the chemical poisoning cases were reported from the Bahir Dar city administration zone, indicating a higher prevalence in this urban area. This could be attributed to factors such as increased access to chemicals, higher population density, and possibly more extensive reporting systems. In comparison, 15.8% of the cases originated from the South Gondar zone (Table 2), suggesting regional variations in exposure or reporting. This distribution highlights the need for region-specific public health interventions and awareness campaigns to address the risks of chemical poisoning effectively.
Table 2.
Chemical poisoning case distribution by place
| Zone | Number of cases | Percentage |
|---|---|---|
| Awi | 3 | 1.6 |
| Bahirdar | 119 | 64.7 |
| Central Gonder | 3 | 1.6 |
| East Gojjam | 3 | 1.6 |
| South Gonder | 29 | 15.8 |
| West Gojjam | 27 | 14.1 |
Sex distribution of Chemical poisoning cases
The gender analysis of chemical poisoning cases at TGCSH and FHCSH in the Amhara Region, Ethiopia, for 2021 reveals a significant gender disparity. Female patients constituted approximately 60% of the cases, indicating a higher prevalence of chemical poisoning among women compared to men. This gender imbalance suggests potential differences in exposure, vulnerability, or healthcare-seeking behavior between men and women. It underscores the need for gender-sensitive approaches in public health interventions and prevention strategies, particularly in addressing the specific risks and factors contributing to chemical poisoning in female populations (Fig. 2).
Chemical poisoning cases by hazard type
A study on chemical poisoning cases at TGCSH and FHCSH revealed that 53% of the incidents were due to organophosphate exposure, followed by cases involving methalophosphates (Table 3). Organophosphates are commonly used in agriculture and are known for their high toxicity, which can lead to severe health effects and increased mortality rates. The study’s findings highlight the critical need for public awareness and preventive measures, especially in rural and agricultural areas, to reduce the incidence and impact of chemical poisonings.
Table 3.
Chemical poisoning cases by hazard type at TGCSH and FHCSH, Amhara Region, Ethiopia (2021)
| Type of Chemical Agents | Number of Cases | Percentage |
|---|---|---|
| Alcohol Intoxication | 6 | 3.3% |
| Benzene | 2 | 0.5% |
| Bleach (Sodium Hypochlorite) | 8 | 4.4% |
| Carbon Monoxide | 5 | 2.7% |
| Drug Overdose | 10 | 5.5% |
| Methalophosphetes | 56 | 30.6% |
| Organophosphates | 97 | 53.0% |
The magnitude of chemical poisoning
In the six-month study period, there have been 184 chemical poisoning cases, with 32 resulting in death, yielding a case fatality rate of 17%(Fig. 3). It indicates poisoning chemicals are available abundantly for agricultural and other purposes and used by unqualified users in developing countries. This study’s findings align with research from Saudi Arabia, Turkey, and rural India, where chemical poisoning rates also demonstrate significant health impacts [18–20]. However, these results are higher than those from studies in Lusaka, Zambia, and Victoria, while being lower compared to findings from Alexandria Main University Hospital and Soonchunhyang University Cheonan Hospital in Korea [21–23]. The variation in findings across different regions and periods reflects the influence of socioeconomic, cultural, and behavioral factors on poisoning rates [24, 25].
Fig. 3.
Burden of chemical poisoning at TGCSH and FHCSH, Amhara Region, Ethiopia (2021)
Factors associated with high burden of chemical poisoning
The chi-square test findings provide valuable insights into the factors associated with a higher burden of chemical poisoning at TGCSH and FHCSH (Table 4).Factors associated with the high burden of chemical poisoning include gender, age, type of poison, route of exposure, and intentionality. Chi-square test results indicated that females (p-value = 0.035) experience a disproportionately higher burden of chemical poisoning, potentially due to gender-specific risks and behavioral patterns [26, 27]. Additionally, individuals aged 35 years or younger (p-value = 0.031) are at higher risk, possibly due to risky behaviors and gaps in safety awareness [28]. Rodent poison ingestion (p-value = 0.042) was significantly associated with severe outcomes, emphasizing the need for stricter regulations and public education [29–31]. Inhalation as a route of exposure (p-value = 0.042) is linked to severe health consequences, stressing the importance of protective measures [32]. Intentional poisoning (p-value = 0.006) was also a significant risk factor, underlining the need for mental health interventions and suicide prevention programs [33–35].
Table 4.
Chi-Square analysis of factors contributing to chemical poisoning burden at TGCSH and FHCSH, Amhara Region, Ethiopia (2021)
| Variables | Categories | Chemical Poisoned Patients | Chi-Square Value | P-value | |
|---|---|---|---|---|---|
| Alive | Death | ||||
| Sex | Male | 64 | 10 | ||
| Female | 88 | 22 | 4.463 | 0.035 | |
| Age | < 35 | 124 | 24 | 4.629 | 0.031 |
| >=35 | 28 | 8 | |||
| Chief of Complaint | Gastro-intestine | 60 | 13 | ||
| Loss of consciousness | 92 | 19 | 0.236 | 0.627 | |
| Route of Exposure | Inhalation | 52 | 24 | 4.154 | 0.042 |
| Ingestion | 100 | 8 | |||
| Means of Taking | Intentional | 92 | 21 | 7.488 | 0.006 |
| Unintentional | 59 | 12 | |||
| Cause of Poison | Rodent poison | 19 | 12 | 4.154 | 0.042 |
| Pesticides | 133 | 20 | |||
| Educational Level | Primary | 40 | 10 | 5.764 | 0.016 |
| Secondary | 68 | 14 | |||
| Diploma/Degree | 44 | 8 | |||
| Economic Status | Low | 76 | 14 | 1.932 | 0.165 |
| Middle | 58 | 12 | |||
| High | 18 | 6 | |||
The analysis also shows that educational level is a significant factor in chemical poisoning cases (p = 0.016), with a higher prevalence among individuals with primary and secondary education. This suggests that limited awareness of chemical safety practices or higher occupational exposure risks among less educated groups may contribute to increased poisoning incidents. In contrast, economic status is a non-significant factor (p = 0.165), indicating that the burden of chemical poisoning is not strongly correlated with economic status. This finding implies that, regardless of their economic background, individuals in the study context may face similar risks of chemical exposure and poisoning.This findings also highlight the significance of educational level and the non-significance of economic status in chemical poisoning cases, align with research from rural India and Saudi Arabia. These studies have similarly shown that lower educational levels correlate with higher rates of poisoning due to limited knowledge about chemical safety and handling practices [36, 37]. Conversely, our study’s finding that economic status is non-significant contrasts with results from Alexandria, Egypt, where lower socioeconomic status was associated with a higher risk of poisoning, primarily due to poor access to healthcare and inadequate safety measures [38]. This discrepancy may be due to differences in regional factors such as regulatory frameworks, safety information availability, and healthcare access. Thus, while educational level consistently emerges as a significant factor, the impact of economic status on chemical poisoning risk may vary based on local conditions and necessitate context-specific public health strategies [39].
The study has faced the following limitations and biases that should be considered. Firstly, as a cross-sectional study, it is limited in its ability to establish strong causal relationships between variables and outcomes. The snapshot nature of the data provides insights into associations but does not enable the determination of cause-and-effect dynamics. Secondly, the selection of TGCSH and FHCSH—comprehensive hospitals with a higher capacity for handling severe cases—may introduce selection bias. These hospitals are likely to manage more critical and severe instances of chemical poisoning compared to smaller or less equipped facilities, which could affect the representativeness of the data. Consequently, the findings may not fully reflect the burden of chemical poisoning across the entire region. Lastly, relying on data from comprehensive hospitals could lead to an overrepresentation of severe cases, potentially skewing the understanding of the overall prevalence and patterns of chemical poisoning in the community. This limitation may impact the generalizability of the results to other healthcare settings or populations.
Conclusions and recommendations
Conclusion
The study underscores a significant burden of chemical poisoning at TGCSH and FHCSH, with a case fatality rate of 17%. Young adults, particularly females, are disproportionately affected, with organophosphate poisoning and intentional ingestion being prevalent. Regional variations indicate higher severity in areas like Bahir Dar and South Gondar. Significant associations with increased poisoning severity were found for factors such as gender, age, type of poison, and route of exposure. The continued high burden of chemical poisoning calls for comprehensive action.
Recommendations
To address this issue, it is crucial for the Federal Ministry of Health, Regional Health Bureau, and other stakeholders to develop and implement innovative strategies to reduce burden of chemical poisoning. This includes establishing stringent regulations on the distribution and use of harmful chemicals, restricting open sales of pesticides, and enhancing community education on safe chemical handling. Additionally, targeted interventions and mental health support are necessary, focusing on high-incidence areas and populations at risk. Strengthening public education and safety measures, along with conducting further research to understand regional disparities, will be essential in effectively mitigating the impact of chemical poisoning.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Acknowledgements
We would like to thank Bahir Dar University, Debre Tabor University, FHCSH, TGCSH, as well as the data collectors, for their kind assistance throughout the data collection process.
Abbreviations
- CI
Confidence Interval
- TGCSH
TibebeGhion Comprehensive Specialized Hospital
- FHCSH
FelegeHiwote Comprehensive Specialized Hospital
Author contributions
C.Y. and A.G.Y. wrote the main manuscript text A.A. and M.S. prepared Figures as well as Tables. All authors reviewed the manuscript.
Funding
We have no specific grant for this research from any funding agency.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
Ethical approval for the study was obtained from the Institutional Review Board (IRB) of Debre Tabor University, with reference number DTU/RCS/205/21, in accordance with the Declaration of Helsinki. A formal letter of cooperation was sent to the hospitals, and permission was secured from both the inpatient wards and the intensive care units. Informed consent was obtained from all participants prior to their inclusion in the study. To protect patient privacy, no personal identifiers were included in the data collection tools.
Consent for publication
In light of the absence of any identifying images or personal details that could compromise participant anonymity, the Consent for Publication is Not Applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
No datasets were generated or analysed during the current study.