Hrev_master Abstract Childhood Poisoning is a common cause of emergency room presentation, more so in underdeveloped countries where it con- tributes to a high incidence of hospitalization with variability in morbidity and mortality. This study retrospectively assessed the sociodemographic profiles, poisoning agents, clinical features and management of cases of childhood poisoning admitted at Enugu State University Teaching Hospital, Enugu. It was a 10-year retro- spective study of all the cases of childhood poisoning admitted within the period of study at the Children’s Emergency Room of Enugu State University Teaching Hospital (ESUTH), Enugu. The prevalence of childhood poisoning in the study was 0.3%. Of all the subjects, 78.4% were ≤5 years and more than half were males and from lower socioeconomic classes. Accidental poisoning accounted for 70.3%; the predominant agents were kerosene and organophosphates. Palm oil was used by 67.6% of the participants as an intervention before presentation. Pneumonitis was the most common complication. Patients with peripheral oxygen saturation (SpO2) < 95% were 14 times more likely to have complications than those with SpO2 ≥ 95%. The duration of hospital stay was ≤3 in 59% of the cases and no mortality was recorded in this study. Childhood poisoning remains prevalent in our environment with kerosene being the commonest agent. Palm oil administration as a predominant pre-hospital intervention worsens outcomes. Duration of hospitalization depends on SpO2 at presentation, need for antibiotic therapy, and intention. Introduction Poisoning is injury or death due to swallowing, inhaling, touching, or injecting various drugs, chemicals, venoms, or gases.1 Childhood poisoning is a major problem in the pediatric popula- tion and remains an important public health challenge.2,3 The curiosity and innocence of children in exploring their environment puts them at a significant risk of inadvertently ingesting poisonous substances.4 As a result, poisoning is a common cause of emergen- cy room visits, particularly in underdeveloped countries.2 This trend contributes to an increasing incidence of hospitalizations and places a significant financial burden on healthcare systems.5 Most cases of childhood poisoning are commoner among males, possibly because they are more curious and active.6–9 Woyessa et al., however, recorded more females in Ethiopia.5 Concerning age, children less than 5 years are more exposed to childhood poisoning.7–10 The incidence of childhood poisoning varies across regions of the world.2,3 Gauvin et al.11 reported an incidence of 0.06% in Washington, USA; Lee et al.7 reported 0.27% in Taiwan and Mintegi et al.12 reported 0.28% in Spain. In Nigeria, the incidence Emergency Care Journal 2024; volume 20:12351 [Emergency Care Journal 2024; 20:12351] [page 38] Childhood poisoning: a 10-year experience in a tertiary hospital in Enugu State, Nigeria Chukwunonso Chigozie Iheji,1 Ngozi Nancy Onu,1 Obinna Chukwuebuka Nduagubam,1 Joshua Alexander Usuah,1 Grace Ugochi Iheji,2 Ikenna Kingsley Ndu1 1Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu State, Nigeria; 2Basildon University Teaching Hospital, United Kingdom Correspondence:Chukwunonso Chigozie Iheji, Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, PMB 1030, Enugu, Enugu State, Nigeria. Tel.: +2347033806550 E-mail:gozieprimenet@yahoo.com Key words: childhood poisoning, morbidity, mortality, emergency room, complications, hospitalization. Contributions: CCI and IKN, study concept and methodology draft; CCI and JAU, data collection supervision and manuscript draft review; CCI and IKN, statistical analysis and results draft; NNO and IKN, discussion draft; OCN and GUI, abstract and discussion draft. Conflict of interest: the authors declare no potential conflicts of interest. Disclaimer: the views expressed in the submitted article are those of the authors and not an official position of Enugu State University Teaching Hospital. Ethics approval: ethical approval was obtained from the Ethics and Research Committee of the ESUTH, Enugu (REF NO: ESUTHP/C- MAC/RA/034/VOL.3/204). Informed consent: all patients participating in this study signed a written informed consent form for participating in this study. Patient consent for publication: written informed consent was obtained from a legally authorized representative(s) for anonymized patient information to be published in this article. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Received: 3 February 2024. Accepted: 16 May 2024. Early view: 12 June 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Emergency Care Journal 2024; 20:12351 doi:10.4081/ecj.2024.12351 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Non -co mmerc ial us e o nly is similar across the regions. In Kano, Northwest, Belonwu et al.9 reported an incidence of 1.2%, Oba-Daini et al.8 reported 1.4% in Sagamu and Olatunya et al.13 1.54% in Ekiti, both in Southwest Nigeria. While in Enugu, Southeast, Ndu et al.14 reported 0.5%. These variations between the developed and developing countries may reflect the lifestyle and health-seeking behavior in those set- tings. Various agents are implicated in childhood poisoning. Some of the common agents include kerosene, organophosphates, pesti- cides/herbicides, medications, caustic soda, hypochlorite, carbon monoxide, and alcohol-based herbal concoctions.8 Whilst in the developed nations, drugs seem to be commoner,2,7,12 the story is not the same in the developing nations. Kerosene and other hydrocar- bons were reported to be commoner in Ethiopia and Nigeria.3,4,5,8,11,15 The clinical features and complications recorded among cases of poisoning in children vary widely. These are reflective of vari- ous factors including the type of poison, quantity ingested, pre- hospital intervention, and quality of healthcare among many oth- ers.7,8 The mortality following childhood poisoning is least in devel- oped countries. Sahin et al.2 in Anatolia and Lee et al.,7 in Taiwan recorded no mortality among the cases seen in their center. In Ethiopia, a mortality rate of 7.10% was recorded by Woyessa et al.5 Similarly, Oba-Daini et al.8 and Olatunya et al.13 recorded case fatality rates of 3.2% and 6.2% respectively. The outcome of chil- dren with poisoning has been linked to the predisposing condi- tions/agents and the quality of medical facilities available.4,15 This study retrospectively assessed the sociodemographic pro- files, poisoning agents, clinical features and management of cases of childhood poisoning admitted at Enugu State University Teaching Hospital, Enugu. Materials and Method Study setting and period This study was conducted in the Children’s emergency room of Enugu State University Teaching Hospital (ESUTH), Enugu. It covered a 10-year period from January 2013 to December 2022. Study design It was a retrospective study of all the cases of childhood poi- soning admitted within the period of study. Data collection The case notes numbers of children who presented with child- hood poisoning within 10 years were obtained from the admission register. The case notes were retrieved from the hospital records library; thereafter relevant data were extracted from the case notes and entered into a proforma designed for the study. Data obtained from the case notes included the socio-demographic data (age, sex, place of domicile, socioeconomic class),16 poison ingested, dura- tion before presentation, accidental/non-accidental, comorbidities, presenting symptoms and signs, home remedy, complications, duration of hospital stay and outcome. Data processing and analysis The data was analyzed using SPSS version 20 (IBM Inc., Chicago, Illinois, USA). Results were presented in prose and tables. Ethical considerations Ethics approval was obtained from the Ethics and Research Committee of the ESUTH, Enugu (REF NO: ESUTHP/C- MAC/RA/034/VOL.3/204). Results Out of the 12,534 admitted within the 10-year study period, 37 were cases of childhood poisoning, giving a prevalence of 0.3%. Twenty-nine (78.4%) of the subjects were ≤5 years and the mean age was 4.29. There were more male (56.8%) participants than Article Table 1. Poisoning circumstances and home intervention. Frequency Percent Period of the year 1st quarter 8 21.6 2nd quarter 6 16.2 3rd quarter 13 35.1 4th quarter 10 27.0 Time Before Presentation <5 hrs 21 56.8 ≥5 hours 16 43.2 Agent Organophosphate 12 32.4 Kerosene 18 48.6 Hydraulic fluid 1 2.7 Bleach 1 2.7 PCM 2 5.4 Alcohol 3 8.1 Accident Accidental 26 70.3 Non-accidental 11 29.7 Intervention Palm oil 25 67.6 Herbal concoction 2 5.4 Milk 2 5.4 None 8 21.6 Table 2. Clinical features. Clinical Features Frequency Percent Symptoms Vomiting 15 40.5 Difficulty/fast breathing 19 51.4 Altered consciousness 5 13.5 Weakness 9 24.3 Fever 8 21.6 Cough 8 21.6 Diarrhea 3 8.1 Convulsion 2 5.4 Excessive cry/restless 2 5.4 Signs Tachypnoea 18 48.6 Tachycardia 17 45.9 Crepitations 8 21.6 Rhonchi 6 16.2 Dehydration 4 10.8 Pallor 3 8.1 Arrhythmia 1 2.7 [page 39] [Emergency Care Journal 2024; 20:12351] Non -co mmerc ial us e o nly females, and 97.3% resided in the urban area. More than half of the participants (59.4%) were from the lower socioeconomic class, while 29.7% and 10.8% were from the middle and upper socioeco- nomic class respectively. Table 1 shows that 35.1% and 27% of the cases, respectively, occurred in the 3rd and 4th quarters of the year while 56.8% presented to the hospital less than 5 hours after the poisoning. The predominant agents were kerosene (48.6%) and Organophosphate (32.4%). Of all the cases, 70.3% were acciden- tal. Palm oil was used by 67.6% of the participants as an interven- tion before presentation. Table 2 shows that difficulty/fast breath- ing (51.4%) and vomiting (40.5%) were the commonest symptoms at presentation while tachypnea (48.6%) and tachycardia (45.9%) were the commonest signs. Nine (24.3%) of the cases were com- plicated: eight (21.6%) had pneumonitis while one (2.7%) had meningitis. Six of the eight cases of pneumonitis had chest X-ray changes while chest X-ray was not done for the other two, thus the diagnosis of pneumonitis was made clinically. The duration of hos- pital stay for 59% and 41% of the participants is ≤3 days and >3 days respectively. Table 3 shows no significant association between the demographic characteristics and duration of hospital stay (p>0.05). Table 4 shows that peripheral oxygen saturation (SpO2) was significantly associated with the duration of hospital stay (p=0.017, OR = 0.170, 95% C.I = 0.040-0.726). Patients with SpO2 less than 95% were less likely to have shorter (1-3 days) duration of hospital stay than those with SpO2 ≥ 95%. Participants whose ingestion was accidental were significantly 7 times more likely to have shorter (1-3 days) duration of hospital stay than the non-accidental victims. Twenty-two patients had empirical antibi- otics. Patients on antibiotics were significantly associated with longer duration of hospital stay (p = 0.043, OR = 0.208, 95% C.I Article [Emergency Care Journal 2024; 20:12351] [page 40] Table 3. Association between demographic characteristics and duration of hospital stay. Duration of hospital stay (days) 1 – 3 n (%) >3 n (%) 2 p Age ≤5 18 (62.1) 11 (37.9) 0.690* >5 4 (50.0) 4 (50.0) Sex Male 14 (66.7) 7 (33.3) 1.046 0.306 Female 8 (50.0) 8 (50.0) Domicile Urban 21 (58.3) 15 (41.7) 1.000* Rural 1 (100.0) 0 (0.0) Socioeconomic class 1 0 (0.0) 0 (0.0) 2.869 0.412 2 3 (75.0) 1 (25.0) 3 6 (54.5) 5 (45.5) 4 12 (66.7) 6 (33.3) 5 1 (25.0) 3 (75.0) Period 1st quarter 4 (50.0) 4 (50.0) 1.312 0.726 2nd quarter 4 (66.7) 2 (33.3) 3rd quarter 9 (69.2) 4 (30.8) 4th quarter 5 (50.0) 5 (50.0) *Fisher’s exact significance. Table 4. Association between SpO2, Intent, intervention, and duration of hospital stay. Duration of hospital stay (days) ≤3 n (%) >3 n (%) p OR 95% C.I for OR SpO2 <95% 7 (38.9) 11 (61.1) 0.017 0.170 0.040 – 0.726 ≥95% 15 (78.9) 4 (21.1) Accident Accidental 19 (73.1) 7 (26.9) 0.014 7.238 1.484 – 35.310 Non-accidental 3 (27.3) 8 (72.7) Antibiotics Yes 10 (45.5) 12 (54.5) 0.043 0.208 0.046 – 0.951 No 12 (80.0) 3 (20.0) Steroid Yes 7 (53.8) 6 (46.2) 0.609 0.700 0.178 – 2.750 No 15 (62.5) 9 (37.5) SpO2, peripheral oxygen saturation. Non -co mmerc ial us e o nly = 0.046-0.951). Table 5 shows that SpO2 was significantly associ- ated with complications (p=0.018, OR=14.400, 95% C.I = 1.567- 132.311). Patients with SpO2 < 95% were 14 times more likely to have complications than those with SpO2 ≥ 95%. Similarly, Patients on steroids were significantly 6 times more likely to have complications than those not on steroids (p = 0.031, OR = 6.000, 95% C.I = 1.177-30.581). There was no recorded mortality from poisoning within the study period. Discussion Childhood Poisoning remains a major and important public health challenge.2,3 Identifying predictors of morbidity and mortal- ity following childhood is very important in its management and prevention. Over a decade, poison-related cases comprised only 0.3% of the total morbidities observed in our pediatric emergency department. This finding, notably, falls below the range document- ed in prior research conducted in Nigeria, where rates varied from 0.43% to 1.54%.8,9,11,15,17 This lower incidence could be related to heightened awareness efforts and the recent prohibition of certain agricultural chemicals by the National Agency for Food and Drug Administration and Control (NAFDAC).18 In this study, the majority of the patients (78.4%) were under five years, with a mean age of 4.91. Several authors have observed similar findings in both developed and developing coun- tries.2,3,4,7,8,11-13,15 Children in this age group are more explorative and more likely to put foreign objects/liquids including medicine and chemicals into their mouth, especially when they are colorful or stored in colorful packages/containers. Similar to previous stud- ies involving comparable age groups, there was also a higher prevalence among males.2,3,4,7,8,11,13,15 This is not surprising as boys are usually very adventurous and prone to danger, especially in childhood.8 However, in adolescence and adulthood, intentional poisoning has been reported more commonly in females.5,7,11,19 The majority of poisoned patients belonged to the lower socioeconomic class, aligning with previous reports from Nigeria.2,8,9,11,14,17 Most cases occurred in the second half of the year, with the highest rate between July to September, correspond- ing to the peak of the rainy and farming season when most farmers use organophosphates as either pesticides or herbicides. Kerosene poisoning was the most commonly observed form, consistent with previous reports from Nigeria.3,4,8,9,13,15,17 It is well established that a geographical area’s social, economic, and cultural norms impact the profile of poisoning.2,3,4,7 People in the lower socioeconomic class are more likely to be subsistent farmers and unskilled work- ers with poor living conditions, lacking adequate storage facili- ties/spaces, have a higher tendency to poorly supervise their chil- dren, and use kerosene as biofuel for the household. The common use of kerosene as a biofuel in Nigeria is still alarming despite other renewable energy alternatives. The storage of kerosene and its color may also be a contributor to it as a common agent of poi- soning. Kerosene is colorless and typically stored in non-child- proof plastic containers, thus increasing the likelihood of young children mistaking it for water. Despite this alarming rate of poi- soning of children with kerosene, minimal effort has been made to implement policies that should curtail this ugly trend. Organophosphate poisoning was also common, with a preva- lence of 32%. This is higher than was observed in the same locality less than a decade ago by Edelu et al.17 Organophosphates in recent times have gained negative popularity in Nigeria for non-acciden- tal poisoning, especially in cases of suicide and suicide attempts.18 The policies governing the sale and use of these agents in Nigeria have been poorly implemented, facilitating easy access and misuse of these substances. Although the study revealed kerosene and organophosphates as the leading agents of poisoning, reports from other parts of the world differ. 2,6,7,10-12 A consistent variation in poi- soning agents has been observed across different regions. In Nepal, organophosphates and carbamates, commonly used pesticides in agricultural areas, and household insecticides, respectively, are the primary poisoning agents.6 In Taiwan7 and Washington11, pharma- ceutical agents have been the most common agents responsible for poisoning. Additionally, as noted by Martin and Brinkman, the range and complexity of substances responsible for poisoning tend to expand with improving economic conditions, leading to a decrease in hydrocarbon and plant ingestions and an increase in chemical and medication ingestions. This evidence supports the hypothesis that these differences may be attributed to socioeco- nomic disparities among these nations.10 The majority of the cases of poisoning observed in this study were accidental. This is not unexpected, given that most of the patients were under the age of reason. The few nonaccidental cases were among older children and adolescents as has been observed by other researchers.5,7,11,12,19 Article Table 5. Association between SpO2, intent, intervention and complications. Complications Yes n (%) No n (%) p OR 95% C.I for OR SpO2 <95% 8 (44.4) 10 (55.6) 0.018 14.400 1.567 – 132.311 ≥95% 1 (5.3) 18 (94.7) Accident Accidental 8 (30.8) 18 (69.2) 0.187 4.444 0.484 – 40.837 Non-accidental 1 (9.1) 10 (90.9) Antibiotics Yes 9 (40.9) 13 (59.1) NA NA NA No 0 (0.0) 15 (100.0) Steroid Yes 6 (46.2) 7 (53.8) 0.031 6.000 1.177 – 30.581 No 3 (12.5) 21 (87.5) SpO2, peripheral oxygen saturation. [page 41] [Emergency Care Journal 2024; 20:12351] Non -co mmerc ial us e o nly The management of poisoned patients is based on decontami- nation, stabilization, and supportive care measures, as well as the initiation of specific treatment as early as possible.21 In these patients, the outcome usually depends on the timing and effective- ness of the interventions, hence the need for appropriate pre-hospi- tal care.21 It was observed that all of the study participants who had any intervention before the presentation had the wrong care. A great proportion of these patients had palm oil administered, simi- lar to reports by other authors in our clime. 3,4,8,9,15,17,22 Local myths hold that palm oil is a potent antidote capable of neutralizing most forms of poisoning and its administration is capable of inducing emesis, however, there is no scientific proof to this notion. On the contrary, palm oil ingestion following poisoning may be very detri- mental especially in cases of aspiration during its forceful inges- tion or following emesis post poisoning. This use of palm oil anti- dote may explain the common clinical features of respiratory chal- lenges, tachycardia, vomiting, and weakness seen in this study. Aspiration of palm oil results in lipoid pneumonitis, which may present with severe acute respiratory distress requiring ventilatory support or chronic respiratory challenges.22 Clinical features of severe acute respiratory distress suggestive of pneumonitis were the commonest complication noted in this study, thus further but- tressing the detrimental effects of inappropriate and harmful inter- ventions. More than half of the study participants spent less than three days on admission, indicating minimal toxic poisoning effect. Reports from Nigeria, India, and Taiwan similarly reported short hospital stay durations in most cases.3,4,7,17,22 Determinants of duration of hospitalization recorded in our study were SpO2, intent, and need for antibiotic use. Oxygen saturation ≥ 95% at presenta- tion was associated with a shorter duration of hospitalization. Oreh et al.22 in their case series, reported a shorter duration of hospital stay in poisoned children with optimal SpO2. Similarly, Reda et al.23 noted a longer duration of hospitalization and a higher risk of mortality in cases of poisoning at SpO2 less than 95%. The obser- vation that SpO2 could predict the duration of hospitalization may be attributed to its role as a marker of tissue oxygenation. Indeed, abnormal SpO2 levels may indicate pulmonary and/or cardiac complications, thereby increasing the risk of a prolonged hospital stay. Another significant predictor of the duration of hospitaliza- tion in this study was the victim’s intention. This is such that vic- tims who became poisoned accidentally were significantly seven times more likely to have shorter (1-3 days) duration of hospital stay than the non-accidental victims. Lin et al. 24 similarly observed that children with intentional poisoning had a significant- ly longer length of hospital stay than those with accidental poison- ings, and children who were admitted to the PICU for critical care were all intentional cases. This could be because most cases of intentional poisoning are associated with suicide or self-harm, leading individuals to ingest significant amounts of toxins, result- ing in systemic toxicity and consequently necessitating a longer hospital stay. This study also identified a significant association between antibiotic use and extended hospitalization duration. While antibiotic therapy typically does not directly address child- hood poisoning, it may be warranted in cases complicated by chemical pneumonitis, which can increase susceptibility to sec- ondary lower respiratory tract bacterial infections.25 Therefore, the use of antibiotics often subtends the development of complica- tions, thus explaining its predictive value for hospital stay duration in our study. The immature physiology of children makes them vulnerable to toxic exposures with a higher risk for complica- tions.21 About a quarter (24.3%) of the cases managed within the study had features suggestive of systemic affectation. The com- monest complication observed was pneumonitis, the other being neurological involvement. Ahmed et al.4 in Abuja, Nigeria, observed features suggestive of pneumonitis in the majority of their cases. Likewise, Venkatesh et al.26 in India also recorded fea- tures of pneumonitis as the most common complication in their cohort. The finding of kerosene as the most prevalent agent of poison- ing in the above studies is similar to our observation, and this explains the high prevalence of pneumonitis noted. Kerosene is a volatile hydrocarbon that causes lung parenchymal injury and inflammation even in very minute quantities when aspirated into the lungs alone or in combination with palm oil.26,27 In this study, the presence of complications was found to be significantly asso- ciated with lower levels of oxygen saturation at presentation and the use of steroids. Steroid use may be beneficial in some cases of hydrocarbon poisoning even though its efficacy has not been thor- oughly evaluated.28-30 Some authors have suggested that using steroids may lessen inflammation and the ensuing lung fibro- sis following chemical pneumonitis.28-30 There was no recorded mortality from poisoning within the study period. Oguche et al.3 in Maiduguri and Orisakwe et al.15 in Nnewi, Nigeria, also recorded zero mortality. World Health Organization estimates a low mortality rate of 1.84 per 100,000 cases of childhood poisoning globally.31 Despite this low mortality rate recorded and the low mortality rate estimated by WHO, a study from Nigeria has reported a mortality rate as high as 18%.4 The zero mortality recorded may be related to the fact that the commonest agent of poisoning, kerosene, rarely causes fatalities except in cases complicated by chemical pneumonitis. Moreover, the early institution of appropriate intervention including the judi- cious use of steroids in suspicion of pneumonitis may have improved recovery in such cases. In conclusion, Childhood poisoning is prevalent in our envi- ronment. Kerosene and organophosphates remain the most com- mon agents of poisoning. In most cases, palm oil administration is the pre-hospital intervention of choice and can worsen the out- come. Duration of hospitalization is dependent on SpO2 at presen- tation, need for antibiotic therapy, and intention. Low oxygen sat- uration at presentation and steroid use were associated with com- plications. It is advisable to implement comprehensive educational programs covering safe and proper storage of kerosene and appro- priate post-poisoning care, particularly targeting the lower socioe- conomic class. Relevant agencies should enhance monitoring and regulation of organophosphate insecticide usage in Nigeria. Furthermore, it is recommended to assess peripheral oxygen satu- ration of all poisoning cases upon presentation at emergency/health facilities to predict the risk of morbidity and enable early implementation of appropriate interventions. References 1. Poisoning: First aid - Mayo Clinic. Accessed 2023 Jan 11. Available from: https://www.mayoclinic.org/first-aid/first-aid- poisoning/basics/art-20056657 2. Sahin S, Carman KB, Dinleyici EC. Acute poisoning in chil- dren; data of a pediatric emergency unit. Iranian J Pediatr 2011;21:479. 3. Oguche S, Bukbuk DN, Watila IM. Pattern of hospital admis- sions of children with poisoning in the Sudano-Sahelian North eastern Nigeria. Nigerian J Clinical Pract 2007;10:111–5. 4. Ahmed PA, Nwatah VE, Ulonnam CC. Childhood accidental poisoning among hospitalised children in a tertiary health care Article [Emergency Care Journal 2024; 20:12351] [page 42] Non -co mmerc ial us e o nly in North Central Nigeria - A two year prospective report. Nigerian J Paediatr 2020;47(3). 5. Woyessa AH, Palanichamy T. Patterns, Associated factors, and clinical outcomes of poisoning among poisoning cases present- ed to selected hospitals in western Ethiopia: hospital-based study. Emerg Med Internat 2020;2020:1–9. 6. Koirala DP, Rao KS, Malla KK, Malla T. A study of clinical features, management and outcome of organophosphate and carbamate poisoning in children. J Nepal Paediatr Soc 2013;33:85–90. 7. Lee J, Fan NC, Yao TC, et al. Clinical spectrum of acute poi- soning in children admitted to the pediatric emergency depart- ment. Pediatr Neonatol 2019;60:59–67. 8. Oba-Daini OU, Ogunlesi TA, Adekanmbi AF, and Akodu SO. Childhood poisoning in Sagamu, Southwest, Nigeria. Niger J Paediatr 2020;47:1–5. 9. Belonwu RO, Adeleke SI. A seven-year review of accidental kerosene poisoning in children at Aminu Kano Teaching Hospital, Kano. Nigerian J Med 2008;17:380–2. 10. Martin TC, Brinkman W. The spectrum of accidental child- hood poisoning in the Caribbean. Revista Panamericana de Salud Pública 2002;12:313–6. 11. Gauvin F, Bailey B, Bratton SL. Hospitalizations for pediatric intoxication in Washington State, 1987-1997. Arch Pediatr Adolesc Med 2001;155:1105-10. 12. Mintegi S, Azkunaga B, Prego J, et al. International epidemio- logical differences in acute poisonings in pediatric emergency departments. Pediatr Emerg Care 2019;35:50–7. 13. Olatunya OS, Isinkaye AO, Ogundare EO, et al. Childhood poisoning at a tertiary hospital in South West Nigeria. J Nepal Paediatr Soc 2015;35:103–10. 14. Ndu IK, Uleanya ND, Nwokoye IC, et al. Pattern of morbidity and mortality at the children emergency unit of Enugu State Teaching Hospital, Park Lane, Enugu. J Exp Res 2016;4:48- 54. 15. Orisakwe OE, Egenti L, Orish C. Childhood non-drug poison- ing in Nnewi, Nigeria. Tropical Doctor 2000;30:209–11. 16. Ogunlesi A, Dedeke I, Kuponiyi O. Socio-economic classifica- tion of children attending specialist paediatric centres in Ogun State, Nigeria. Niger Med Pract 2008;54:21–5. 17. Edelu BO, Odetunde OI, Eke CB, et al. Accidental childhood poisoning in Enugu, South East, Nigeria. Ann Med Health Sci Res 2016;6:168-71. 18. National Agency for Food and Drug Administration and Control (NAFDAC). Press Release On The Regulation And Control Of Pesticides In Nigeria. Accessed 2023 Nov 23. Available: https://www.nafdac.gov.ng/press-release-on-the- regulation-and-control-of-pesticides-in-nigeria/#:~: text=In%202020%2C%20the%20Agency%20in,public%20he alth%2C%20and%20bearing%20in 19. Jose A, Sivanandam S, Matthai J. Poisoning in children from an educationally and economically advanced urban area of south India. Asian J Epidemiol 2012;5:123. 20. Eze JN, Ndu IK, Edelu BO. Teenage organophosphate insecti- cide poisoning: An ugly trend in Enugu, Nigeria. J Comm Med Primary Health Care 2018;30:99-108. 21. Calello DP, Henretig FM. Pediatric toxicology: specialized approach to the poisoned child. Emerg Med Clinics 2014;32:29-52. 22. Oreh AC, Uchemefuna I, Mmamelu N, et al. Accidental kerosene oil ingestion in under-five age children in Nigeria– The need for vigilance in primary care settings in low-and mid- dle-income countries (LMICs). J Fam Med Primary Care 2023;12:796. 23. Reda GB, Abate HK, Mekonnen HM, et al. Outcome of poi- soning and associated factors among patients admitted at refer- ral hospitals in northwest Ethiopia, 2022: multicenter retro- spective study. Open Access Emerg Med 2023;2023:415-25. 24. Lin YR, Liu TH, Liu TA, et al. Pharmaceutical poisoning expo- sure and outcome analysis in children admitted to the pediatric emergency department. Pediatr Neonatol 2011;52:11-7. 25. Das S, Behera SK, Xavier AS, Selvarajan S. Prophylactic use of steroids and antibiotics in acute hydrocarbon poisoning in children. J Pharmacy Pract 2020;33:90-5. 26. Venkatesh C, Sriram P, Adhisivam B, Mahadevan S. Clinical profile of children with kerosene aspiration. Tropical Doctor 2011;41:179-80 27. Kumar S, Kavitha TK, Angurana SK. Kerosene, camphor, and naphthalene poisoning in children. Indian J Crit Care Med 2019;23:S278. 28. Das S, Behera SK, Xavier AS, Selvarajan S. Prophylactic use of steroids and antibiotics in acute hydrocarbon poisoning in children. J Pharm Pract 2020;33:90-5. 29. Yasui H, Yokomura K, Suda T. A severe case of acute exoge- nous lipoid pneumonia treated with systemic corticosteroid. Respirat Med Case Rep 2016;17:64-7. 30. Graham JR. Pneumonitis following aspiration of crude oil and its treatment by steroid hormones. Transact Am Clin Climatol Assoc 1956;67:104. 31. Peden M, Oyegbite K, Ozanne-Smith J, et al., editors. World Report on Child Injury Prevention. Geneva: World Health Organization; 2008. 6, Poisoning. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310644/ Article [page 43] [Emergency Care Journal 2024; 20:12351] Non -co mmerc ial us e o nly