PESTICIDE POISONING CASES ATTENDING FIVE MAJOR HOSPITALS OF NEPAL

Abstract

Although some hospital-based data are available, there are no large scale or nationwide
data available on the problem of pesticide poisoning in Nepal. This study was
done to fill up this gap to some extent and was carried out at five major hospitals of
Nepal - Bir Hospital, Patan Hospital and Tribhuvan University Teaching Hospital
(TUTH) in Kathmandu, Western Regional Hospital (WRH) in Pokhara, and B. P.
Koirala Institute of Health Sciences (BPKIHS) in Dharan. A harmonized Pesticide
Exposure Record (PER), which was finalized during the "WHO Regional Workshop
on Pesticide Poisoning Database in SEAR Countries" held in 1999 in Delhi,1 was used
in the study. Data collection was done for a period of six months in each of the five
hospitals.
Altogether there were 256 patients in the present study. There were 98 patients from
Bir hospital, 48 from Patan hospital, 45 from TUTH, 36 from BPKIHS, and 29 from
WRH. Of the 256 patients, 112 were males and 144 females. The most common age
group involved in pesticide poisoning was 15-24 years. In most of the cases patient's
arrival to hospital was within three hours after pesticide exposure. In the majority of
cases the nature of exposure was intentional and the route of exposure oral. Most
poisonings occurred in urban set-up and at home.
Organophosphorous compounds were found to be the most common pesticides involved
(in >50% cases), followed by zinc phosphide and aluminium phosphide. All cases
were given first aid treatment in the Emergency Room of the study hospitals, following
which most of the cases (n=197) were admitted; the rest were discharged or referred
to other hospitals. Systemic effects of poisoning were recorded to have been present in
95% of cases. For nearly two-third (65.6%) of the cases the poisoning severity score
was recorded in the PER as "moderate" or "severe." More than 16% of patients had
fatal outcome.

Improved regulation on availability of pesticides, strict registration of vendors,
modification in packaging of pesticides, adequate provision of information to the
public, further research on pesticide poisoning (including community-based studies),
creation and regular revision of national/local standard treatment guidelines (STGs),
regular training of health care providers based on such STGs, better availability of
drugs/antidotes, establishment of poison information centers, and enhanced regional
linkages are some of the measures that will help reduce the problem of pesticide
poisoning in Nepal.

Key Words: Pesticide poisoning, Organophosphates, Zinc phosphide, Aluminium
phosphide, Pesticide exposure record, Hospital, Nepal.