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Toxicoepidemiology in Zimbabwe: Pesticide Poisoning Admissions to Major Hospitals

Background. Acute pesticide poisoning (APP) is a well-recognized cause of morbidity and mortality but is not well described in developing countries. We describe the toxicoepidemiology of APP in Zimbabwe. Methods. All cases of APP admitted to eight major referral hospitals in Zimbabwe from January 1998 to December 1999 (inclusive) were identified using ICD-9 codes and ward registers and relevant information recorded on a standard data collection sheet. Results. There were a total of 914 single pesticide exposures. Almost half (49.1%) resulted from oral exposure to rodenticides, 42.2% from anticholinesterase-type pesticides (AChTP), mostly organophosphates (OP) that were responsible for over 90% of admissions from AChTP. Accidental and deliberate self-poisoning (27.1% and 58.6%, respectively) accounted for most cases with only eight homicides. The case fatality rate (CFR) in deaths/100 admissions was 6.8 [62 deaths; 95% Confidence Interval (CI) 5.2–8.6] and was significantly higher in males (9.4) than females (4.1) (CI for difference in proportions; 2.0–8.5). In addition, the CFR for deliberate self-poisoning (DSP), 6.5 deaths/100 admissions, was also significantly higher than that for accidental poisoning (0.8 deaths/100 admissions) (CI for difference in proportions 3.2–7.9). Organophosphates were implicated in 70.9% of all fatalities, with over 20% resulting from oral exposure to rat poison (RP). Conclusion. Organophosphates and rat poison (RP) are the leading causes of APP admissions to major referral hospitals in Zimbabwe, with most of the admissions being the result of deliberate self-poisoning. Greater control in the sale and use of these products could help prevent significant morbidity and mortality.