The spectrum of accidental childhood poisoning in the Caribbean

Objective. To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with results of other reports from the English-speaking Caribbean and from the United States of America. Design and Methods. We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holbertson Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America. Results. In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45 percent) were in 1-year-old children, 69 (27 percent) were in 2-year-old children, and 26 (10 percent) were in 3-year-old children. These proportions in Antigua and Barbuda are similiar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20, 000 children below 13 years of age, for a rate of 1.3 per 1,000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing. Conclusions. There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step (AU)

Trauma aetiology and cost in the Accident and Emergency Unit of the University of the West Indies

Trauma accounted for 37 percent of 22,311 patients seen in the Accident and Emergency Unit (A&E) at the University Hospital of the West Indies (UHWI) during 1996. Thirty-nine percent of injuries were intentional and 18 percent were due to motor vehicle accidents. Knives, machetes and rocks accounted for 75 percent of the injuries compared with 5 percent for gunshot wounds. Passengers were injured in about 40 percent of motor vehicle accidents and pedestrians in 19 percent. The admission rate was 16 percent and the orthopaedic clinic received 75 percent of the patients referred to specialist clinics. Victims of motor vehicle accidents made up a greater proportion of admissions (24 percent) than those of unintentional violence (13 percent). The average cost of caring for each patient in the A&E Unit was US$70 resulting in an annual cost of US$578,000.(AU)

Emergency orthopaedic presentation and outcomes among adolescents and young adults at the University Hospital of the West Indies (UHWI)

Orthopaedic injuries continue to be a major public health problem as they contribute to increased morbidity and mortality. This retrospective study was done among adolescents and young adults presenting during the period 30th November 1995 to 1st January 1996 and examined orthopaedic presentations and outcomes in adolescents and young adults at the Accident and Emergency Unit of the University Hospital of the West Indies (UHWI). Data was collected using a data collection sheet; 108 cases were collected during the period. Males accounted for 67 percent of the orthopaedic injuries, and females, 32.5 percent of injuries. Bone injuries were the commonest, accounting for 55.2 percent of injuries, liagments/soft tissue 22.8 percent, blood vessels 13.8 percent, muscle 4.0 percent, tendons 1.6 percent, nerves 1.6 percent, joints 0.8 percent. Falls and slips were the major contributor to injuries, with 52.7 percent followed by violence with 24 percent, motor vehicular accidents with 20.3 percent and sporting injures with 2.7 percent. Most patients were treated as out patients. Of this category, 91.6 percent received outpatient care and 8.3 percent impatient care, while 97.2 percent received closed reduction and 2.7 percent open reduction. Many patients received drug therapy, 69.3 percent (75 patients). The outcome varied with 64.8 percent being able to function partially and 32.4 percent fully functional on discharge in comparison to the 25 percent follow up, in which 20 percent was partially ambulant, unlike 80 percent who were fully functional within 3 months of follow up. A small number, 20 percent were affected for a longer period. The majority of injuries were outside of school time and therefore did not affect attendance. (AU)

Trauma in children presenting at the University Hospital of the West Indies in January and February 1996

Trauma in children continues to be a major public health problem and contributes significantly to mortality and morbidity rates. This cross-sectional study was aimed at describing children 0-10 years who presented at the University Hospital of the West Indies (UHWI) with trauma over two months and examined the aetiological agents and the impact of injury on each child. The socio economic status of children was also investigated. This study allowed for comparison with that of Bean (1995). Data was collected through an administered questionaire from 57 respondents. The findings revealed that 22 percent of the total number of children seen were trauma cases. There was a higher percentage of trauma among males (65 percent) as compared to females (35 percent). The 5-10 years age group was the one most affected. Limb injury ranked highest followed by head injury, and deep wound and bruising accounted for the highest percentage of injuries sustained. One child perished from choking while eating. A relative including mother or father supervised the child on 67 percent of times. The need of constant supervision of the child must be stressed. Health education and health promotion programmes using an intersectoral approach, with full community participation is important. Special target groups and the population at large should be involved. Alliances should be made with the electronic and print media to promote injury prevention messages all year round. (AU)

Treatment of diving accidents in Barbados

A brief look at diving accidents in Barbados and the importance of immediate treatment for the victims

Risks of HIV transmission to health care workers

A brief look at the risks of transmission of the HIV virus to health care workers and what preventative measures should be employed to lower these risks. The article mentions briefly the use of protective barriers and emphasizes the importance of the implementation of recommendations such as initial orientation and training about the epidemiology, modes of transmission and prevention of transmission of HIV and other blood borne infections. Provision of equipment and supplies necessary to minimize the risk of infection

Child morbidity in the Kingston metropolitan area, Jamaica 1983

The case reports of all children admitted to public and private hospitals in the Kingston metropolitan area were examined for an analysis, by special areas, of spatial variations in child morbidity. A poison probability test was applied in order to determine areas of significant excesses in admission rates and three special areas selected for a child health survey. At the 0.025 significance level 20 of the 72 special areas had significantly higher and three significantly lower levels of admission. The survey confirmed the pattern revealed by hospital admissions and suggested that the children of young, unemployed and single women may be particularly vulnerable.(AU)

Workshop on the prevention and care of motor vehicle injuries in the Caribbean, 12-15 June 1984: final report

This report records the discussions and recommendations of twenty one delegate from nine Caribbean countries who set out to: i) identify the nature, extent and actiology of traffic accidents in the Caribbean area ii) suggest methods for reducing the frequency and impact of traffic accidents iii) develop a Caribbean plan for the reduction of traffic accidents

Some aspects of paediatric trauma in Trinidad

A review is presented of 1,694 children in the first decade of life who were admitted, after trauma, to a general hospital over a 54-month period. Falls constituted the most frequent aetiological agent in the first three years of life, and motor vehicle accidents in the 4 to 6-year age group. The latter were much more likely to cause severe injury regardless of age. The head and neck was the region most commonly traumatised, and the extent of neurological injury was the major determinant of outcome. However, abdominal involvement frequently occurred in the more seriously injured. Implications for prevention and management are discussed (AU)

Paediatric head injury - abstract

All paediactric head injury cases admitted to the Port-of-Spain General Hospital, Trinidad in the 12 months from August 1981- July 1982 were studied. There were 306 cases of which 187 (61 percent) were males and 119 (39 percent) females. Causes of injury were falls 221 (72 percent), road traffic accidents 71 (23 percent) other accidents 12(3 percent) and child abuse (2 cases). The commonest clinical features were loss of consciousness 124 (40 percent), nausea and vomiting 114 (37 percent), scalp haematomas 102 (33 percent), scalp lacerations 57 (19 percent), headaches 39 (13 percent), bleeding from ear or nose 19 (6 percent), seizures 18 (6 percent), focal deficits 6 (2 percent). Skull fractures were present in 29 (9 percent). Surgical interventions was necessary in 9 cases. Elevation of compound depressed fractures 3, craniotomy for evacuation of acute subdural haematomas 1 and multiple exploratory burr holes 5 showing cerebral contusions 3, and cerebral oedema 2 cases. Mortality was only 3, all with brain stem injuries. Regarding mobidity, 2 patients had hemiparesis 1 abnormal mental state and 5 continued treatment for seizures. These figures compare well with studies done in UK the United States and Canada regarding sex incidence, causes of injury and symptomatology; however, they differ considerably from the adult head injury in Trinidad where males account for 90 percent, road traffic accidents 59 percent, fights 27 percent, and other causes only 14 percent. These figures also indicate that paediatric head injury demands vigorous treatment despite the initial findings, as the result may be much better than initially predicted (AU)

A 5-year review of poisoning in children in Barbados

Of 4,272 paediatric medical admissions to the Queen Elizabeth Hospital between April, 1975 and March, 1980, 471 (11.5 percent) were diagnosed as cases of poisoning. Fifty-seven per cent were males and 43 percent were females. The ages ranged between 2 weeks and 12 years with a mean of 2 years. The ages of the patients and the incidence of various types of poisoning were analysed. Kerosene, tranquilizers, bleaches, alcohol, aspirin and rat poison were among the most commonly ingested substances. In all cases, poisoning was accidental. Seventy per cent of children who ingested poisons were less than three years of age. The mortality in this series was 0.2 percent. Our findings indicate that there is a high incidence of childhood poisoning in Barbados and emphasize the need for better methods for the prevention of childhood poisoning in our region (AU)

A fatal episode of accidental methomyl poisoning

Three fatalities from the accidental ingestion of methomyl, a carbamate pesticide, are reported. The methomyl had been stored in an unlabelled tin can and was accidentally used in preparing "roti," an Indian dish. The identification of the source of the poison through animal tests and further chemical identification is described. The lethal dose of methomyl was estimated to have been between 12 and 15 mg/kg body weight. (Summary)