the world health organization ( who ) has reported that globally more than 200,000 people die of pesticide poisoning . lifestyle changes as well as changing social frameworks are the major reasons for the increased incidence of poisoning cases . apart from this , easy availability , low - cost and unrestricted sale of pesticides are the other key reasons . a high incidence of pesticide poisoning is usually associated with socio - demographic pattern of the population and limited pesticide regulation . we thus conducted a hospital - based study to assess the pattern of pesticide poisoning in this region . the study protocol was approved by the institutional ethics committee ( jsscp / dpp / irb/009/2013 - 14 dated on 05/09/2013 ) who also granted a consent waiver . udhagamandalam is the capital of the nilgiris district , situated in the state of tamil nadu in the western ghats of southern india , and has a population of 233,374 . a retrospective analysis of data from october 2008 to september 2013 . from the medical records , information regarding age , gender , marital status , manner of poisoning , religion , diurnal variation in poisoning , and the causative agents for poisoning of patients admitted was gathered . . cow dung dye , commonly used synthetic floor cleaning agent in the southern region of india which is identified in green and yellow colours composed of malachite green and auramine o respectively , were included as poisoning agents in the study . physicians determined the causative agent based on the residue in the container / packet brought along with the patients and/or the circumstances from the patient 's caretakers and/or the clinical manifestations of the patients . incidence , case fatality , and mortality rates were calculated from the collected data using the following formulae . incidence rate = ( number of new cases of a disease occurring in the population during a specific period of time  number of persons who are at risk of developing the disease during that period of time )  1000 . mortality rate = ( number of deaths occurring during a period of time  size of the population among which deaths occurred )  1000 . case fatality rate = ( number of individuals dying during a specified period of time due to a specific condition  number of individuals affected with that condition )  1000 . the chi - square test was used to assess association between descriptive measures on occurence of poisoning and death due to poisoning . data obtained in this study were analyzed through the software graphpad prism version 6.00 for windows . the study protocol was approved by the institutional ethics committee ( jsscp / dpp / irb/009/2013 - 14 dated on 05/09/2013 ) who also granted a consent waiver . udhagamandalam is the capital of the nilgiris district , situated in the state of tamil nadu in the western ghats of southern india , and has a population of 233,374 . from the medical records , information regarding age , gender , marital status , manner of poisoning , religion , diurnal variation in poisoning , and the causative agents for poisoning of patients admitted was gathered . . cow dung dye , commonly used synthetic floor cleaning agent in the southern region of india which is identified in green and yellow colours composed of malachite green and auramine o respectively , were included as poisoning agents in the study . physicians determined the causative agent based on the residue in the container / packet brought along with the patients and/or the circumstances from the patient 's caretakers and/or the clinical manifestations of the patients . incidence , case fatality , and mortality rates were calculated from the collected data using the following formulae . incidence rate = ( number of new cases of a disease occurring in the population during a specific period of time  number of persons who are at risk of developing the disease during that period of time )  1000 . mortality rate = ( number of deaths occurring during a period of time  size of the population among which deaths occurred )  1000 . case fatality rate = ( number of individuals dying during a specified period of time due to a specific condition  number of individuals affected with that condition )  1000 . the chi - square test was used to assess association between descriptive measures on occurence of poisoning and death due to poisoning . data obtained in this study were analyzed through the software graphpad prism version 6.00 for windows . the average case fatality and mortality rates were found to be 40.51 and 0.07 , respectively . socio - demography and annual occurrence of poisoning cases and mortalities the mortality rate was higher among married men ( 40.75% ) . the highest incidence was seen among young adults within the age group of 21 - 30 years ( n = 767 ; 41.24% ) , followed by the age group 10 - 20 years ( n = 454 ; 24.57% ) . fewer cases were observed at the extremes of age ( patients of less than 10 years of age [ 2.79% ] and more than 60 years of age [ 1.61% ] ) . a significant association was found between age and the fatality rate ( p = 0.0013 ) . the occurrence of poisoning fatalities as per age ( in years ) was in the following order 21 - 30 ( 6.52% ) > 10 - 20 ( 3.96% ) > 31 - 40 ( 3.46% ) > 41 - 50 ( 1.10% ) . year wise distribution of poisoning cases as per age group deliberate self - harm was found to be the most common reason for poisoning ( n = 1755 , 94.35% ) with accidental poisoning seen only in ( n = 85 ) 4.57% cases . in the remaining 20 cases ( 1.08% ) , a significant correlation was observed between the intention of poisoning and the fatality rate ( p < 0.0001 ) . the death rate was found to be the highest among the undetermined category ( 30% ) , followed by accidental ( 21.18% ) , and suicidal intent ( 3.19% ) [ table 2 ] . estimates of fatality among survey population poisoning was seen higher among hindus ( n = 1,654 ; 88.92% ) , followed by 126 muslims ( 6.77% ) and 80 christians ( 4.30% ) . the time of presentation to the hospital was most commonly night ( 1,143 ; 61.45% ) , followed by day ( 717 ; 38.55% ) . the agents were classified into 11 categories according to their properties as shown in table 3 . among these agents , organophosphates , the agents used for the poisoning that could not be identified were termed as  unknown  while agents like eucalyptus oil , carbon monoxide , turpentine oil , ink , and stick gum used for poisoning were collectively termed  others . the graphical representation of the various agents and their year - wise usage for poisoning is given in figure 2 . among agrochemicals , organophosphate compounds were more frequent causes ( 24.78% ) and also caused more fatalities ( n = 33 ) , followed by unknown poisoning ( 16.29% , number of deaths : 14 ) and paraquat poisoning ( 11.34% , n = 14 ) . poisoning agents used and related death for 5-year study period the total number of reported poisoning cases fatality associated to poisoning agent , a year - wise profile the average case fatality and mortality rates were found to be 40.51 and 0.07 , respectively . the highest incidence was seen among young adults within the age group of 21 - 30 years ( n = 767 ; 41.24% ) , followed by the age group 10 - 20 years ( n = 454 ; 24.57% ) . fewer cases were observed at the extremes of age ( patients of less than 10 years of age [ 2.79% ] and more than 60 years of age [ 1.61% ] ) . a significant association was found between age and the fatality rate ( p = 0.0013 ) . the occurrence of poisoning fatalities as per age ( in years ) was in the following order 21 - 30 ( 6.52% ) > 10 - 20 ( 3.96% ) > 31 - 40 ( 3.46% ) > 41 - 50 ( 1.10% ) . year wise distribution of poisoning cases as per age group deliberate self - harm was found to be the most common reason for poisoning ( n = 1755 , 94.35% ) with accidental poisoning seen only in ( n = 85 ) 4.57% cases . in the remaining 20 cases ( 1.08% ) a significant correlation was observed between the intention of poisoning and the fatality rate ( p < 0.0001 ) . the death rate was found to be the highest among the undetermined category ( 30% ) , followed by accidental ( 21.18% ) , and suicidal intent ( 3.19% ) [ table 2 ] . estimates of fatality among survey population poisoning was seen higher among hindus ( n = 1,654 ; 88.92% ) , followed by 126 muslims ( 6.77% ) and 80 christians ( 4.30% ) . the time of presentation to the hospital was most commonly night ( 1,143 ; 61.45% ) , followed by day ( 717 ; 38.55% ) . the agents were classified into 11 categories according to their properties as shown in table 3 . among these agents , organophosphates , the agents used for the poisoning that could not be identified were termed as  unknown  while agents like eucalyptus oil , carbon monoxide , turpentine oil , ink , and stick gum used for poisoning were collectively termed  others . the graphical representation of the various agents and their year - wise usage for poisoning is given in figure 2 . among agrochemicals , organophosphate compounds were more frequent causes ( 24.78% ) and also caused more fatalities ( n = 33 ) , followed by unknown poisoning ( 16.29% , number of deaths : 14 ) and paraquat poisoning ( 11.34% , n = 14 ) . poisoning agents used and related death for 5-year study period the total number of reported poisoning cases fatality associated to poisoning agent , a year - wise profile the present study examines the incidence , mortality , and case fatality rates among patients presenting with poisoning in one hospital in southern india . the availability of other public hospitals in the nilgiris district reduces the chances of admission of patients those who are not belonging to udhagamandalam region to this study site . the cases of immediate death at spot due to poisoning ( intentional or unintentional ) are also admitted to the emergency unit of the same study center for the postmortem analysis , as this hospital is the only center for that . we found an increase in incidence , mortality , and case fatality rate with successive years . this is limited by the assumption that patients that presented to us are representative of all those with poisonings in our local population . the mortality rate indicates the extent of death happening due to severe poisoning and conditions in which there was difficulty in early detection of the used agent . for instance , physicians may find it difficult to detect the exact chemical class of the pesticide used due to a large variety of brands available in the market . we found the average incidence rate of self - poisoning cases in this population is 1.60 per 1000 population , whereas the incidence rate of self - poisoning given by the who for sri lanka , thailand , and central america ( el salvador and nicaragua ) were 1.8 , 0.178 , and 0.35 per 1000 respectively . further , the death because of self - poisoning is less than the accidental poisoning which is different from earlier reports from the country . financial burden , family disharmony , and stress could be the reasons for the increased rate of poisoning among married people . the same may also be interpreted and considered as the reason for the largely male preponderance . the occurrence of poisoning cases is more among younger population ( between 21 - 30 years ) as this is comparable to studies conducted in other parts of india and may be due to the high stress and other pressures in this age group . the larger number of poisoning reported in the hindu community is in all likelihood due them forming a large part of the population . the majority of the patients consumed poison during the night which may be due to their intention to avoid the attention of others . psychological guidance programs are known to decrease the depression levels by developing personal skills , including self - esteem and problem - solving capacity . as india is an agricultural country , many people have access to agrochemicals that could lead to both deliberate and accidental poisoning . the high death rate due to organophosphate compounds is similar to the rate with  unknown  poisoning cases . the study is limited by being retrospective , and being a single center study , though two smaller hospitals are functioning in this district . also , cases admitted to private hospitals were not captured ( though medicolegal cases would have eventually been referred ) . as nilgiris is a hill station with a population of about 0.234 million , this report may not reflect the country 's actual enormity of the problem . the study does show that poisonings and mortality due to poisonings is a significant problem . regulations regarding the sale of agrochemicals by policy makers along with psychological guidance would go a long way in addressing the problem .
objective : to ascertain the trend of poisoning cases admitted to the government district headquarters hospital , a secondary care center in udhagamandalam , nilgiris district , tamil nadu , india , over a five - year period.materials and methods : the number of cases that presented to the hospital annually ( incidence , mortality , and case fatality rates ) , socio - demographic pattern , and the nature of the poison were noted.results:a total of 1860 poisoning cases ( 80 deaths ) were reported during the period from october 2008 to september 2013 . 
 the incidence of poisoning was found to increase every year . 
 the average incidence was 1.60 per 1000 population , while the average case fatality rate and mortality rates were 40.51 and 0.07 , respectively . 
 a total of 1148 ( 62% ) were males . 
 the majority of cases were seen in the 21 - 30 age group ( 41.24% ) . 
 the poisonings were largely deliberate self - harm ( n = 1,755 ; 94.35% ) , followed by accidental ( n = 85 ; 4.57% ) . 
 agrochemicals were the main choice of poisoning agents and among these , organophosphates were the major cause.conclusion:the data generated can help policy makers take decisions on the sale and availability of pesticides in this region .