Angel Subramani, (2022) Changing Spectrum of Pesticide Poisoning - Past and Present - in the Context of Policy Changes Related to Pesticide Bans. Masters thesis, Christian Medical College, Vellore.
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Abstract
OBJECTIVES: To document changes in the spectrum of pesticide compounds in patients with self-poisoning, before and after the pesticide ban in 2016 and to observe the resultant changes in the profile of compounds, clinical manifestations and morbidity, ICU care, ventilator days and mortality. METHODOLOGY: This study includes prospective data collection from the year 2019 to 2021 on all patients who are admitted with a diagnosis of pesticide poisoning, either self or accidental. Retrospective data was collected from Medical records in an unlinked anonymized manner from 2015 to 2016 before the ban. The data were analyzed with SPSS software and changing trends with regards to spectrum of pesticide compounds, the number of admissions into critical care unit, ventilator days and mortality was assessed. This study included both retrospective and prospective arms, with a comparative analysis aimed at studying the spectrum and outcomes of pesticide poisoning, in the context of a ban on certain pesticides. RESULTS: There were 240 patients in the retrospective arm (24 months) and 74 patients in the prospective arm (13 months). Both the arms were compared and the number of patients requiring ICU stay, with the outcome on mortality was assessed. The overall number of patients in the pre ban period was 240 with 48.3% requiring ICU admission, ventilation and intensive care. Of these patients, the mortality rate was 11.6%. In the post ban period, the total number of patients was 74 with 35.1% requiring ICU care and mortality of 10.8%. There was significant decline in patients requiring ICU care, 49.2% in pre-ban period to 32.4% in the post- ban period (odds ratio of 0.4 with a CI of 0.2 to 0.85 with a Pvalue of 0.011). There has been a non-significant reduction in mortality by 0.8 % with an odds ratio of 1.08 and a confidence interval of 0.4-2.5 with a P-value of 0.83%. Class I compound poisoning showed a declining trend following the ban (33% pre-ban vs. 20.3% post-ban). The odds ratio is 0.51 with a confidence interval of 0.27 -0.97 and a P-value of 0.03. Class II compounds showed a non-significant increase following the ban (19.6% pre-ban to 20.3% post-ban) and Class III compounds disappeared following the ban (2.5% preban to 0% post-ban). Organophosphate compounds with pyrethroid increased from 20.4% pre-ban to 24.3% post ban (non-significant). There was a decrease in ICU admission and mortality due to Class I compounds (Mortality due to Class I a pre-ban 2.7% to 0.8% post ban and Mortality due to Class I b pre-ban 2.5% to 1.4% post ban). There was increase in mortality due to OP+ pyrethroids from pre-ban of 2.9% to post-ban of 6.7%. Other compounds contributing to the mortality in the post- ban period were yellow phosphorus, zinc phosphide and paraquat poisoning. CONCLUSION: Following the ban being imposed by the Anupam Verma committee with the gradual phasing of pesticides in 2016, and a recent phased ban in 2018 and 2020, the following changes were noted in the spectrum of agrochemical poisoning: There has been a shift away from Class I and Class III organophosphates to OP/pyrethroid combination poisonings. There is also an increase in herbicide, fungicide and rodenticide poisoning. The mortality due to Class I organophosphates has reduced but the mortality due to OP/pyrethroid poisoning has increased. There is also mortality due to rodenticide and herbicide poisoning. There has been a significant decrease in need for ICU care and mechanical ventilation in pesticide poisoning, but there has been no overall change in mortality following the ban. The agrochemical poisoning spectrum from our centre shows the benefit of regulation of pesticides. Banned compounds, compounds under restriction and compounds listed for phasing out have showed elimination or marked reduction. However they have been replaced by combination pesticides with organophosphate and pyrethroids. These results suggest the need for on-going monitoring of the spectrum and mortality due to pesticide poisoning towards on-going regulation.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201811451 |
| Uncontrolled Keywords: | Changing spectrum, Pesticide poisoning, Past and present, context of Policy changes, pesticide bans. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 24 Jun 2021 14:13 |
| Last Modified: | 09 Jan 2024 11:16 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/17608 |
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