A Retrospective Observational Study of Accidental Carbamate Poisoning Among Children Referred to a Tertiary Care Center in Rural Maharashtra, India

Background: Carbofuran  is  a  widely-used  carbamate  insecticide  which  is  listed  as  highly hazardous (Class 1b) by the World Health Organization (WHO) classification of pesticides. We report the poisonings among children following exposure to carbofuran crystal form, which is used as a household remedy for head lice infestation.

Methods: The  medical  case  records  from  June  2016  to  January  2019  of  a  Tertiary  Care  Hospital  in  rural  Maharashtra,  India,  were  examined  for  the  pediatric  poisoning  due  to exposure to blue crystals in sachets being sold as medication for head lice infestation and its confirmation as being carbofuran. A total of 14 such exposures were found among 64 cases of pediatric poisoning (excluding bites and sting envenomation), recorded in the above period. The children were evaluated for their presentations, manner of unintentional poisonings, clinical profile, and outcomes.

Results: The results in carbofuran poisonings showed universal unintentional exposure with the majority of patients being infants and toddlers. It was the most significant single cause of poisoning, excluding bites and envenomation, in the above period. The clinical features of
excessive cholinergic activity were consistent with the characteristics of carbamate poisoning. Comparison with other poisonings during the period did not show significant differences concerning variables such as age, sex, religion, and length of hospital stay.

Conclusion: Unintentional poisoning of the class1 pesticide carbofuran, among younger children, is associated with misuse and availability in the environment. Our obtained data about the agent, host, and environmental factors related to the poisoning are consistent with
data available on the literature.