Epidemiological Studies of Chemical Poisoning in Malaysia DR' ROZLAN ISHAK Environmental Health Unit

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Epidemiological Studies of Chemical Poisoning in
MalaysiaDR. ROZLAN ISHAKEnvironmental Health
UnitDisease Control DivisionMinistry of
HealthMalaysia
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Introduction

• In most hospitals in the Western World the
  commonest reason for acute admission of young
  people to a medical ward is acute poisoning.
• Such poisoning is usually by self-administration
  of prescribed or over-the-counter medicine.
• Occasionally, however, toxic agents are
  accidentally ingested or inhaled at home or work
  or administered with criminal intent.
• 1.Clinical Medicine Kumar Clark 1994.

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Introduction

• In majority of cases ( 80 ) of self-poisoning
  do not require intensive medical management but
  all require a sympathetic and caring approach to
  their problems.
• Both the patients and the family may require
  psychiatric help and the social services should
  be contacted to help with social and domestic
  problems.
• Clinical Medicine Kumar Clark 1994.

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Introduction

• In England and Wales there are over 100 000
  hospitals admission each year for self-poisoning.
  
• The commonest being with benzodiazepines and
  anti-depressants, followed by paracetamol and
  then aspirin.
• In 1992 there were 3947 deaths from poisoning
  with medicinal agents and non-medicinal
  substances.

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Malaysians experiences

• In Malaysia, the main causal factor in poisoning
  was not well documented.
• This paper was prepared to understand the trend
  and describe the status of poisoning in Malaysia
  for the year 1999.

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Classification of Toxic Agents

• For the purpose of this paper, poisoning was
  classified based on ICD-10 Classification.
• It was based on sources and functional values of
  the chemicals.
• Many plants and animals secrete chemicals
  designed to keep them from being eaten by their
  predators.
• Natural or biological occurring compounds or
  toxin can be derived from plants, bacteria,
  invertebrates and vertebrates.

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Classification of Toxic Agents

• But there are many synthetic chemicals used as
  industrial reagents, by products or products and
  pharmaceuticals products, which are available in
  the market that have potential risk to poison to
  the population.

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The Objective of the Study

• 1.    To describe the mortality and morbidity
  trends of poisoning cases admitted in government
  hospital in Malaysia for the year 1999.2.   To
  describe the distribution of poisoning cases by
  place (state) and person in Malaysia.
• 3. To suggest and make recommendations towards
  reducing the incidence of poisoning through
  better preventive and protective strategies and
  intervention initiatives in Malaysia.

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 Methodology

• The study concentrated among patients admitted
  into all government hospitals throughout
  Malaysia.
• The patient particulars were recorded on
  discharged by trained record officers based on a
  standardized format HMIS Format.
• The disease classifications are based on the ICD
  10 (International Coding of Diseases) used
  internationally.

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The list of variables record was -

• i.             Name
• ii.            Age
• iii.           Date of birth
• iv.           Address
• v.            Ethnicity
• Vi Religion
• vi.           Name of Hospital
• vii.          Date of admission
• viii.         Date of discharge
• ix.          Final Diagnosis
• x.           Status on discharge.

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Results and Findings
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Poisoning Cases in Malaysia, 1999
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The distribution of Poisoning Cases by Gender and
ethnicity in Malaysia, 1999
?2 465.32 df 6 p lt 0.05
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Deaths from Chemical Poisoning in Malaysia, 1999
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Discussions
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Facts

• Bites from animals such as snakes still
  contributed to the highest admission in
  government hospitals. ( 5788 cases or 44.07 )
  and pesticides ( 1150 cases or 8.76 ).
• Agriculture based states such as Perak, Kedah,
  Sabah, Sarawak, Terengganu have the highest
  admissions from poisoning.
• Admission rate for poisoning were higher in
  Perlis, Kedah, Terengganu and Perak.
• More male are admitted for poisoning than
  female.

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Facts

• There is significance difference by ethnicity and
  gender with ?2 465.32, df 6 p lt 0.05.
• The poisoning cases are higher at 0-4 years and
  20 29 Years.
• Majority of cases admitted were Malays, followed
  by Chinese and Indians.

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Facts

• Pesticides poisoning contributed to the highest
  number of deaths. ( 199 or 74.5 )
• Case fatality rate for pesticides poisoning is
  the highest ( 17 per 100 cases).
• States with the highest fatality rate are Negeri
  Sembilan,Sabah, Selangor, Perak and Sarawak.
• 54 males are exposed to poison and 61.8 of
  deaths are males.
• The peak age for deaths due to poisoning were at
  15-19 years for females and 15 44 years for
  males.

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Facts

• Orang asli and Indians are the highest fatality
  due to poisoning especially higher in female for
  Orang Asli and males in Indians, Chinese,
  Bumiputra Sarawak and Sabah.
• Age specific for poisoning and fatality rate
  increase with age. There are three peaks in
  poisoning cases I.e from 0-4 years, 15 19 years
  and more than 60 years.
• Married people are more prone to deaths from
  poisoning followed by bachelors.

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Questions need to be answered

• Why some people still got bitten by venomous
  animals?
• Why agriculture based states have the highest
  number admissions from poisoning?
• Why admission rate are higher in Perlis, Kedah,
  Terengganu and Perak?
• Why male are more prone to poisoning than
  female?
• Why at the age of 0-4 years and 20 29 years are
  most admitted for poisoning?
• Why the state of Negeri Sembilan,Sabah, Selangor,
  Perak and Sarawak recorded the highest case
  fatality rate
• Why are death higher among male?
• Why the peak age for deaths at 15-19 years for
  females and 15 40 years for males?.

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Conclusion

• There still many questioned unanswered.The
  finding just provide more questions.
• The ability to answer the question through
  further research will help to dig out more
  answer.
• But, intervention program should be planned to
  minimize and reduce the incidence of poisoning in
  Malaysia.

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Conclusion

• This review of data retrieved from Health
  Information and Documentation Unit is an initial
  stage of findings solution to the incidence of
  poisoning cases in Malaysia.
• We need to arrest the problems together and find
  some solution.