Poisoning While Traveling (Transport Poisoning): Is It A New Entity?

摘要

Objective: Poisoning is one of the most hazardous public health problems in Bangladesh, causing major morbidity and mortality. Although self harm is claimed as commonest mode of poisoning but recently travel related poisoning is alarmingly increasing. Methods: This is a prospective observational study done in Chittagong Medical College Hospital in one medicine unit where transport related poisoning cases were seen. Results: 440 number of poisoning cases amongst which Organophosphorus compound poisoning were 98 and poisoning happened while traveling is 32 cases. There was no female victim. Most of the victims related to journey happened while they were in bus(64.5%), train, rickshaw, taxi. All of the victims presented in the hospital with complete disorientation; Most of them suffer from central depression for variable period without any other specific feature of toxication. Various methods and various food items have been applied for homicide. Conclusions: The personal and social harassment of transport poisoning cannot be ignored. It needs intensive public notification and awareness about the possible health hazards while in travel. Introduction Poisoning is an important health problem in Bangladesh leading around 16000episodes and 1500 deaths per year( Bangladesh Health Bulletin 1996).Induced poisoning by robbers during travel and using public transport is an emerging social and public health emergency in Bangladesh, which has not been adequately addressed before. The trends of pattern of induced poisoning from Dhutura to unidentified stupefying agent particularly during journey is a major concern of health care facility(1). The miscreants usually offer food and drinks during chat while in travel. The victims get trapped, become drowsy and unconscious. The miscreant then easily robs the valuable things and let the victim helpless with no money and no identity. Usually Police or some kind people bring them to the hospital. This is a very painful experience for the victim, doctors, nurses, and the police concerned. The incidence of this type of induced poisoning in cities like Dhaka, Chittagong, Rajshahi, Khulna is increasing during religious festival time like Eid ul fitr, Eid ul azha, Durga Puja.(2,3) Definite diagnosis is not always possible. Standard guidelines and facilities with ICU for case management is limited. Rehabilitation is limited especially for the victims who are confused and certainly embarrassed with the scenario. There is no clear cut data about travel related poisoning as no remarkable studies has been done in this issue(4).On average, 1-2 patients with induced poisoning duringjourney used to get admitted during festival . (Uddin M J et al 2002, Jain A et al 2000). Few papers and common experiences from working hospital showed that the mode of poisoning is usually food like green coconut water, soft drinks, tea, coffee, biscuits, fruits, fruit Juice, jal mori, iftari, for the purpose in bus, train, launch, railway station, maxy stand, bus stand. Sometimes they offer medication of low price for some diseases like skin disease, asthma, hemorrhoids. Use and methods of delivery of poisons is also not uniform An attempt of recording the induced poisoning during travel was attempted in 1999 in a tertiary care hospital naming Chittagong Medical College Hospital(CMCH) in Bangladesh. Methodology Study siteThe study was performed in the adult medicine unit at the Chittagong Medical College Hospital (CMCH) in Chittagong, Bangladesh. The hospital is a 1000 bed tertiary referral hospital for Chittagong City and the surrounding districts covering around 10 million populations. The study received approval from the Ethical Review Committee of the CMCH. From all patients informed written or verbal consent was taken.Study population and MethodThis is a prospective observational study . The unconscious patients attended by police or other rescue peoples were included initially. During hospital stay and on clinical and labora