Unintentional Poisoning among Preschool Children in Jeddah, Saudi Arabia (2014-2016) a Retrospective Cohort Study

Background: Acute unintentional home intoxication in preschool age is a major cause of preventable morbidity and mortality. In the United States, 2012 around half of youngsters younger than 6 years were accounted for as a poison occasion. Aim of the work: To estimate family and poison injury characters of preschool children who had unintentional home poisoning at poisoning department center under public health administration in Jeddah City, Saudi Arabia during the duration between 2014-2016 and to recognize the relationship between unintentional poison' risk factors (personal, family character and injury factors) and poison types. Methodology: This retrospective cohort study was proceeded in the Jeddah poison center. All preschool children (0-5) years involved reported as household unintentional harm (poisoning) cases at the chosen center. The questionnaire had developed and validated "from three public health experts" which filed from center files and completed by a researcher telephone call to child-parent. Result: 41.5% of the affected child were occupied the (>12-24 months) age cluster. 62.6% of the participants were male and most of the kids 44.4% had a low social class. Conclusion: inadvertent poisoning was associated with age cluster (1-2 years), male gender, families that having greater than 3 children, mother higher education, medicine poisoning and powder form, oral route, and morning time.


INTRODUCTION
Harming [poison] was characterized as an introduction of a person to a substance that can cause manifestations and indications of organ brokenness prompting injury or dying. Acute unintentional house poisoning in the preschool age is a significant reason of preventable morbidity and mortality. In the United States, 2012 more than 1.4% were under 20 years' elderly participants and approximately 50% of kids aging less than 6 years were reported as a poisoning event [1] .
The toxin conditions and its related danger factors change generally across various geographic areas worldwide due to variation in social, environmental & economic factors and its accessibility and availability [3] .
Unintentional injuries are a main reason of about 90% of youngster passing's coming about because of wounds or force [4] .
The house is the most ordinary for inadvertent youth injuries, where they spend most of their time. Low and moderate-pay nations hold over 95% of the child's injuries and 80% of its mortality. It likewise influence wellbeing, instruction, and family economy of the harmed [poisoned] youngsters [5] .
Related to the kind of poison, Studies have recorded kerosene, petrol, medicines, insecticides, and household cleaning products are the major hazards for poisoning incidents among young children [6] .

AIM OF THE WORK
1.To assessment the personal, family and poison injury characters of the preschool kids who had an unexpected house harming by the poison at the poisoning department center under the public health administration in Jeddah city, Saudi Arabia during the duration between 2014-2016.
2.To identify the link between the unintentional poison' risk factors [personal, family and injury factors] and the poison types among the preschool children who had an unintentional home poisoning at the same place and duration.

MATERIALS AND METHODS
The current review accomplice retrospective cohort study was led in Jeddah poison center for three years. The institutional ethical board approved the study, and all the participants were informed about the study, and consent was obtained from all. All preschool children [0][1][2][3][4][5]  Machines Corporation which is an American multinational technology-company headquartered in Armonk, New York]. Ceased to exist which is now fully integrated into the IBM Corporation, and is one of the brands under. The data was described and cleaned before analysis. The numerical data was represented by mean and standard deviation [SD]. Proportions and Chi-Square described the qualitative variables. Regression models were used for a multivariable analysis that was done to detect risk factors. A P value of ≤ 0.05 was viewed significant.

DISCUSSION
In the current study, the most affected age group with acute unintentional poisoning was >12-24 months (41.5%), >24 months (39.8%), while the age class 0-24 months occupied 18.7%. Other [3] reported that age category 2-4 years were highest in acute unintentional poisoning [51.0%] then 1-2 years (35.7%) and 4-5 years (13.3%). Children <6 years are at higher danger of unintentional poisoning as they pass the most time at house, and unable to manage hazards [7] . Infants are less affected due to the failure to move around, limited capacity to open containers, and attention paid to them by family. On the contrary, others [8] reported the most of harming happened at aged 12-24 months.
In the present study, low social class has the greatest poisoning incidence [44.4%], then middle class [38.0%] and lastly, high class [17.5%]. Meanwhile, others [3] observed an insignificant relation between economic problems and poisoning.
This study showed higher childhood poisoning between parents with higher education for mothers [42.7%] as another literature [12] . The poisoning percentage declined with increased parents' education level in India [13] and Sri Lanka [3] .
In the persisted study, accidental poisoning increased with elevated family members >3 [88.3%] and siblings ≥2 children [89.5%] as children become neglected by their families as others [14] . Also, the existing results mentioned that when the kids rank is 1 st or 2 nd are more vulnerable to poisoning [65.5%], that explained by less information regarding the handling of 1st or 2nd child. In contrast, Halawa et al. [12] announced that second and third conceived kids were at elevated poison injury hazard. The poisoning incidence observed in the running study was higher among children with divorced parents [60.2%]. Greater inadvertent harming hazard related with youngsters not living with the two guardians [15] . Meanwhile, Ahmed [8] reported an insignificant association between parents living apart and poisoning. Others [3] observed that lacking management was multiple times more normal among kids with unexpected harming versus control.
Medicine was the generality poisoning cause among children [40.9%] then cleaning agents [30.4%] and lastly pesticides/ insecticides [28.7%] in the present study. The same toxicity patterns were noticed in the Middle East [16] , Europe [17] , and North America [18] where drugs were commonest poisons. Medicine poisoning was highest between low class [52.6%] while, cleaning agents and pesticides were highest in-between high class [36.7% and 40.0%]. Other [7] detailed that relative being on long haul drug was related with a fundamentally higher danger for therapeutic harming. In Saudi Arabia, childproof caps are not widely used in medication packaging. In this study, non-pharmaceutical pediatric poisonings were cleaning agents [30.4%] and then pesticides/ insecticides [28.7%]. Dayasiri et al. [7] reported that pesticides were the least normal kind of toxin as guardians were more forewarned in pesticide stockpiling. The commonest poisoning agent was pesticides in India [19] , cosmetics and personal nursing products in the United States [1] , cleansing products in China [20] , and kerosene in Kuwait [21] , Bahrain [22] , Nigeria [23] . The introduction recurrence reflects item accessibility, home openness to a youngster, and bundling, as opposed to inalienable poisonousness. Poison form in this study was mostly powder [44.4%] than liquid [35.1%] and lastly solid [20.5%], like findings from neighboring countries [24] . Solid is a high risk for medical poison [OR 21.823 [9] reported that most guardians left their youngsters solo without supervision when they were in the toilet, in 76% of cases harms were either effectively congenial or didn't have appropriate capacity place [26] .  [27] . Dayasiri et al. [7] watched gastro-intestinal side effects as the commonest clinical sign followed by respiratory and neurological indications. Commonest symptoms in kids with acute poisoning were neurological in many studies from West Asia [28] and Europe [28] . In other study, the commonest symptoms were respiratory [62.8%] [23] . Variations cause clinical symptoms of patients related to type and amount of poison taken.
In the current study, 55.0% of poisoning accidents happened in the first part of the day, in accordance with Northern Jordan where poisoning incidence during working hours was 80% [29] . In India, poisoning occurred between 8.00-11.00 A.M., a time when housewives were busy in their home chores [30] . Full working parental management is required to be at night. Meanwhile, others reported that most poisoning occurs in the evening as it is children's playtime where home injuries are mostly reported during playtime [31] .
In this study, health care arrival was not delayed in majority of the cases [93.0%]. Dayasiri et al. [7] noticed that 69.1% of children were brought to a initially care hospital/emergency unit within 1 hour of poison ingestion. In other study done in Saudi Arabia, 69% sought medical assistance within 2 hours, while 31% waited >4 hours [32] . Deferred introduction to the emergency unit is related with expanded inconveniences hazards.

Conclusion:
On basis of the present study, it can be concluded that age category between 1-2 years, male gender, mothers that having greater than 3 children, mother higher education, medicine poisoning and powder form, oral route, and morning time were commonest associated with accidental poisoning. Gastrointestinal signs were the most presented signs, and most of them were in stable condition when reached the hospital.
Recommendation: Upgrading information and mindfulness through setting up workshops, public media, schools, wellbeing, and clinical focuses about poison types and how to forestall and manage them are significant strides in keeping up youngsters' wellbeing.