Childhood Drug and Non-Drug Poisoning in Nigeria: An Economic Appraisal.

BACKGROUND: The dearth of information on the economic cost of childhood poisoning in sub-Saharan Africa necessitated this study. OBJECTIVE: This study has investigated the prevalence of childhood drug and non-drug poisoning, treatment modalities and economic costs in Nigeria. METHOD: A retrospective study of childhood drug and non-drug poisoning cases from January 2007 to June 2014 in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria was carried out. Medical records were analysed for demographic and aetiological characteristics of poisoned children (0-14 years of age), as well as fiscal impact of poisoning cases. FINDINGS: Of the 100 poisoned patients, 46% were male and 54% female, with female/male ratio of 1.17:1. Most of the children were under five years of age. Paracetamol, amitriptyline, chlorpromazine, ferrous sulphate, kerosene, organophosphates, carbon monoxide, snake bite, alcohol and rodenticides were involved in the poisoning. The average cost of poison management per patient was about $168, which is high given the economic status of Nigeria. CONCLUSION: Childhood poisoning is still a significant cause of morbidity among children in Nigeria and accounts for an appreciable amount of health spending, therefore preventive strategies should be considered.

Economic implications of unintentional carbon monoxide poisoning in the United States and the cost and benefit of CO detectors.

BACKGROUND: Unintentional non-fire-related (UNFR) carbon monoxide (CO) poisoning has been among the leading causes of poisoning in the United States. Current estimation of its economic burden is important for an optimal allocation of resources for UNFR CO poisoning prevention. OBJECTIVE: This study was to estimate the morbidity costs of UNFR CO poisoning. We also compared the costs and benefits of installing CO detectors in residences. METHODS: We used 2010-2014 charges and cost data from Healthcare Cost and Utilization Project (HCUP), and Truven© Health MarketScan Commercial Claims and Encounters and Medicare Supplemental data. We directly measured the morbidity cost as the summation of costs for different healthcare services. Benefit of installing CO detector was estimated by summing up the avoidable morbidity cost and mortality cost (value of life). Cost of CO detectors was calculated using the average market price of CO detectors. We also calculated the benefit-to-cost ratio by dividing the benefit by its cost. All expenditures were converted into 2013 U.S. dollars. RESULTS: For UNFR CO poisoning, total annual medical cost ranged from $33.6 to $37.7 million. Annual non-health-sector costs varied from $3.7 to almost $4.4 million. The benefit-to-cost ratio can be as high as 7.2 to 1. CONCLUSION: UNFR CO poisoning causes substantial economic burden in the U.S. The benefit of using CO detectors in homes to prevent UNFR CO poisoning can considerably exceed the cost of installation. Public health programs could use these findings to promote broad installation of CO detectors in homes.

Cost effectiveness of residential carbon monoxide alarms.

BACKGROUND: While residential carbon monoxide (CO) alarms are now required in a majority of states, the cost effectiveness of the devices is unknown. This analysis was performed to determine the degree of prevention efficacy necessary from home carbon monoxide alarms for their expense to be cost-effective. METHODS: Data regarding numbers of individuals affected in the United States annually from accidental, non-fire, residential non-fatal and fatal carbon monoxide poisoning were obtained from published literature. Federal governmental estimates of societal costs associated with medical care, lost wages and earnings, value of pain and suffering, and value of a statistical life were applied. The cost of uniform residential carbon monoxide alarm installation was compared to those societal costs in order to calculate what degree of efficiency makes alarms cost-effective. RESULTS: Societal costs for accidental, non-fire, residential CO poisoning are approximately $3.47 billion annually. With an estimated cost of $348 million annually for alarms, prevention of greater than 10% of residential CO poisoning costs must be achieved in order for alarms to be cost-effective. CONCLUSIONS: While the true effectiveness of residential carbon monoxide alarms has yet to be determined, current state legislation requiring residential installation of CO alarms is probably cost-effective. .

Temporal patterns of charcoal burning suicides among the working age population in Hong Kong SAR: the influence of economic activity status and sex.

BACKGROUND: Charcoal burning in a sealed room has recently emerged as the second most common suicide means in Hong Kong, causing approximately 200 deaths each year. As charcoal burning suicide victims have a unique sociodemographic profile (i.e., predominantly economically active men), they may commit suicide at specific times. However, little is known about the temporal patterns of charcoal burning suicides. METHODS: Suicide data from 2001 to 2008 on victims of usual working age (20-59) were obtained from the registered death files of the Census and Statistics Department of Hong Kong. A total of 1649 cases of charcoal burning suicide were analyzed using a two-step procedure, which first examined the temporal asymmetries in the incidence of suicide, and second investigated whether these asymmetries were influenced by sex and/or economic activity status. Poisson regression analyses were employed to model the monthly and daily patterns of suicide by economic activity status and sex. RESULTS: Our findings revealed pronounced monthly and daily temporal variations in the pattern of charcoal burning suicides in Hong Kong. Consistent with previous findings on overall suicide deaths, there was an overall spring peak in April, and Monday was the common high risk day for all groups. Although sex determined the pattern of variation in charcoal burning suicides, the magnitude of the variation was influenced by the economic activity status of the victims. CONCLUSION: The traditional classification of suicide methods as either violent or nonviolent tends to elide the temporal variations of specific methods. The interaction between sex and economic activity status observed in the present study indicates that sex should be taken into consideration when investigating the influence of economic activity status on temporal variations of suicide. This finding also suggests that suicide prevention efforts should be both time- and subgroup-specific.

Hospital burden of unintentional carbon monoxide poisoning in the United States, 2007.

BACKGROUND: Unintentional, non-fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the United States, but the overall hospital burden is unknown. This study presents patient characteristics and the most recent comprehensive national estimates of UNFR CO-related emergency department (ED) visits and hospitalizations. METHODS: Data from the 2007 Nationwide Inpatient and Emergency Department Sample of the Hospitalization Cost and Utilization Project were analyzed. The Council of State and Territorial Epidemiologists' CO poisoning case definition was used to classify confirmed, probable, and suspected cases. RESULTS: In 2007, more than 230,000 ED visits (772 visits/million) and more than 22,000 hospitalizations (75 stays/million) were related to UNFR CO poisoning. Of these, 21,304 ED visits (71 visits/million) and 2302 hospitalizations (8 stays/million) were confirmed cases of UNFR CO poisoning. Among the confirmed cases, the highest ED visit rates were among persons aged 0 to 17 years (76 visits/million) and 18 to 44 years (87 visits/million); the highest hospitalization rate was among persons aged 85 years or older (18 stays/million). Women visited EDs more frequently than men, but men were more likely to be hospitalized. Patients residing in a nonmetropolitan area and in the northeast and midwest regions of the country had higher ED visit and hospitalization rates. Carbon monoxide exposures occurred mostly (>60%) at home. The hospitalization cost for confirmed CO poisonings was more than $26 million. CONCLUSION: Unintentional, non-fire-related CO poisonings pose significant economic and health burden; continuous monitoring and surveillance of CO poisoning are needed to guide prevention efforts. Public health programs should emphasize CO alarm use at home as the main prevention strategy.

The contribution of charcoal burning to the rise and decline of suicides in Hong Kong from 1997-2007.

BACKGROUND: There has been scant research exploring the relationship between choice of method (means) of self-inflicted death, and broader social or contextual factors. The recent emergence and growth of suicide using carbon monoxide poisoning resulting from burning charcoal in an enclosed space (hereafter, "charcoal burning") was related to an increase in the overall suicide rate in Hong Kong. The growth of this method coincided with changing economic conditions. This paper expands upon previous work to explore possible relationships further. PURPOSE: This study aims to discern the role of charcoal burning in overall suicide rate transition during times of both economic recession and expansion, as captured in the unemployment rate of Hong Kong, and to examine whether there was evidence of an effect from means-substitution. METHODS: Age and gender specific suicide rates in Hong Kong by suicide methods from 1997 to 2007 were calculated. To model the transition of suicide rate by different methods, Poisson regression analyses were employed. RESULTS: Charcoal burning constituted 18.3% of all suicides, 88% of which involved individuals drawn from the middle years (25-59) of life. During both periods of rising and declining unemployment, charcoal burning played an important role in the changing suicide rates, and this effect was most prominent among for those in their middle years. Means-substitution was found among the married women during the period of rate advancement (1997-2003). CONCLUSIONS: Compared to others, working-age adults preferentially selected carbon monoxide poisoning from charcoal burning.

Occupational carbon monoxide poisoning among West Virginia workers' compensation claims: diagnosis, treatment duration, and utilization.

Incidence rates and characterizations of occupational carbon monoxide (CO) poisoning in terms of sources of exposures, diagnosis, treatment, and health care utilization are critical for public health planning. We identified 182 CO poisoning cases occurring over a 6-year period (IR = 4.3/100000 worker-years) in the West Virginia workers' compensation data. Frequent sources of poisoning were gas-powered engines (28%) and furnaces (20%). Minimum treatment duration ranged from 1 day to 8 years with significant differences in mental health comorbidities between cases treated within 1 year compared with cases treated for more than 1 year (OR = 20.75; 95% CI = 3.5-128.4). The average cost (medical and wage loss replacement) for CO claims was dollars 2130 and median lost time was 45 days. CO poisoning could lead to prolonged disability and treatment in patients with mental health comorbidities, suggesting a possible role for early intervention.

Carbon monoxide poisoning in Kentucky.

Fatal and nonfatal cases of carbon monoxide (CO) poisoning continue to be widespread. Hospital discharge data were used to identify cases of CO poisoning in Kentucky during 1998-1999. Additional data collection was conducted through medical record abstraction. Information was collected on 205 cases at 33 Kentucky hospitals. Over half of the CO poisoning cases occurred in residential settings. The most common types of equipment operating at the time of exposure were motor vehicles and gas heating sources. Eighteen percent of the cases required hospitalization. Almost half of the incidents occurred during December, January, and February. Incidents of CO poisoning can be reduced through education and implementation of appropriate prevention strategies. Public health professionals and health care professionals should provide education about the sources of CO and the hazards of exposure. Recommendations for prevention are provided.