Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Global Health, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA.
J Glob Health. 2023 Dec 29;13:04173. doi: 10.7189/jogh.13.04173.
There are significant disparities in the burden of disease due to poisoning between children in low- and high-income countries (HICs). However, there is limited data on the impact of increasing pharmaceutical access in low income countries (LICs) and low-middle income countries (LMICs) on the epidemiology of and risk factors associated with poisoning in children in these settings. Furthermore, while strategies in HICs have effectively reduced the burden of disease due to poisonings in children, there is limited information regarding the efficacy of these interventions in LICs/LMICs.
We conducted a systematic review in eight databases for literature published between January 2000 to April 2022 to evaluate the epidemiology and risk factors associated with poisonings due to pharmaceuticals and effective strategies to prevent and manage them in children in LICs/LMICs. From 16 061 retrieved articles, 41 were included in the final analysis.
Pharmaceuticals were a common cause of poisoning in children in LICs/LMICs, occurring in between 12.4% and 72.36% of cases. Major risk factors were unsafe medication storage and inadequate caregiver knowledge. Delayed access to care and younger age were associated with increased mortality. Prevention strategies that included education demonstrated improvements in knowledge; however, their impact on incidence and mortality was unclear. Management strategies detailed individual patient care interventions, most commonly gastric lavage and activated charcoal. Meanwhile, delayed presentation, limited provider knowledge, and inadequate laboratory resources to support therapeutic monitoring hindered optimal management.
The combination of educational interventions for prevention, along with regulatory processes to maximise medication storage and formulation safety, could be effective in reducing the burden of poisoning in LICs/LMICs. The development of national or regional protocols for the management of common medication poisonings, augmented by the development of poison control centers and expansion of laboratory access in facilities may help reduce the morbidity and mortality associated with pharmaceutical poisonings in children in LICs/LMICs. Further evidence regarding contextual factors, risk and benefit profiles, the pattern of poisoning, and the impact of preventive and treatment interventions specific to LICs/LMICs is needed to better refine recommendations in these settings.
PROSPERO: CRD42022315686.
在儿童中毒负担方面，低收入国家（LICs）和中低收入国家（LMICs）与高收入国家（HICs）之间存在显著差异。然而，关于增加低收入国家（LICs）和中低收入国家（LMICs）药物可及性对这些国家儿童中毒的流行病学和相关风险因素的影响的数据有限。此外，尽管 HIC 国家的策略已有效降低儿童中毒的疾病负担，但关于这些干预措施在 LICs/LMICs 中的效果的信息有限。
我们在 8 个数据库中进行了系统评价，以评估 2000 年 1 月至 2022 年 4 月期间发表的文献中与 LICs/LMICs 儿童中与药物相关的中毒的流行病学和相关风险因素以及有效预防和管理这些中毒的策略。在检索到的 16061 篇文章中，有 41 篇被纳入最终分析。
药物是 LICs/LMICs 儿童中毒的常见原因，在病例中占 12.4%至 72.36%。主要风险因素是不安全的药物储存和护理人员知识不足。治疗延迟和年龄较小与死亡率增加相关。包括教育在内的预防策略显示出知识的提高；然而，它们对发病率和死亡率的影响尚不清楚。管理策略详细介绍了针对个别患者的护理干预措施，最常见的是洗胃和活性炭。同时，就诊延迟、提供者知识有限以及支持治疗监测的实验室资源不足，阻碍了最佳管理。
预防方面的教育干预措施与最大限度地提高药物储存和配方安全性的监管流程相结合，可能有助于降低 LICs/LMICs 中毒的负担。制定常见药物中毒管理的国家或地区方案，并辅之以中毒控制中心的发展和设施中实验室资源的扩大，可能有助于降低 LICs/LMICs 儿童与药物中毒相关的发病率和死亡率。需要进一步了解与 LICs/LMICs 相关的背景因素、风险和效益概况、中毒模式以及针对 LICs/LMICs 的预防和治疗干预措施的影响，以更好地完善这些环境中的建议。
PROSPERO：CRD42022315686。
