European Journal of Cardiovascular Medicine

Unintentional poisoning is a leading cause of injury-related morbidity and mortality among children worldwide, particularly in low-income and densely populated urban environments. Urban slums present a unique convergence of risk factors including overcrowded living spaces, informal housing structures, inadequate waste management, and widespread availability of hazardous substances within the household.

Children in these settings are frequently exposed to toxic agents such as kerosene, pesticides, cleaning products, and medications that are often stored in unlabelled or easily accessible containers. Limited caregiver awareness and poor regulatory oversight further compound the risk. Despite the scale of the problem, pediatric poisoning in urban slums remains insufficiently documented, particularly from a forensic and public health perspective.

This study aimed to characterize pediatric poisoning incidents through forensic case analysis and to identify household-level risk factors through a community-based survey. By combining forensic evidence with field-level data, the study seeks to inform targeted prevention strategies tailored to vulnerable urban populations.

Study Design

A mixed-methods study was conducted, consisting of two components:

1. A retrospective forensic case series of pediatric poisoning deaths.
2. A cross-sectional household survey assessing poisoning-related risk factors.

Study Setting

The study was conducted in selected urban slum clusters within a metropolitan city, characterized by high population density, informal housing, and limited access to healthcare services.

Forensic Case Series

Case Selection

Forensic records of children aged 0 to 14 years who died due to suspected or confirmed poisoning over a three-year period were reviewed. Cases with incomplete documentation were excluded.

Data Collection

Data extracted from medico-legal autopsy reports included:

• Age and sex of the child
• Type of toxic substance identified
• Manner of poisoning (accidental, suicidal, homicidal)
• Scene findings and circumstantial history

Household Risk-Factor Survey

Sampling

Households with at least one child under the age of five years were selected using cluster sampling techniques. Caregivers were interviewed using a structured questionnaire.

Survey Variables

The questionnaire assessed:

• Types of hazardous substances stored at home
• Storage location and container type
• Caregiver knowledge of poisoning risks
• Previous history of poisoning incidents
• Supervision practices

Statistical Analysis

Descriptive statistics were used for forensic data. Associations between household risk factors and poisoning incidents were assessed using chi-square tests and logistic regression analysis. A p-value less than 0.05 was considered statistically significant.

Forensic Case Series Findings

A total of 96 pediatric poisoning deaths were identified during the study period.

Age and Gender Distribution

Children under five years accounted for 68 percent of cases. Males were slightly more affected than females.

Type of Poisoning Agent

Kerosene was the most commonly identified toxic agent, followed by pesticides and household cleaning chemicals. Pharmaceutical poisoning was more frequent among older children.

Manner of Poisoning

Accidental poisoning accounted for 89 percent of cases. Suicidal poisoning was rare and observed only in adolescents.

Household Risk-Factor Survey Results

A total of 420 households participated in the survey.

Storage Practices

More than 70 percent of households stored hazardous substances within reach of children. Reuse of beverage bottles for storing kerosene or chemicals was reported in 46 percent of households.

Caregiver Awareness

Only 38 percent of caregivers were aware of basic poisoning prevention measures. Literacy level was strongly associated with awareness scores.

Previous Poisoning Events

Non-fatal poisoning incidents were reported by 14 percent of households, most of which were managed at home or by local practitioners.

Risk-Factor Analysis

Unsafe storage practices, lack of child supervision, and caregiver illiteracy were independently associated with increased poisoning risk. Households using child-resistant containers reported significantly fewer incidents.

Overview of Forensic and Household Data

The study combined forensic records of pediatric poisoning fatalities with a household risk-factor survey conducted in urban slum communities. Forensic data provided objective confirmation of toxic agents and manner of poisoning, while household surveys contextualized environmental and behavioral risks.

Table 1. Demographic Profile of Pediatric Poisoning Cases Identified in Forensic Records (n = 96)

Table 2. Distribution of Toxic Agents Identified in Forensic Autopsy and Toxicology Reports

Table 3. Household Storage Practices of Hazardous Substances (Surveyed Households n = 420)

Table 4. Caregiver Awareness and Supervision Characteristics

Table 5. Association Between Household Risk Factors and Reported Poisoning Incidents

Summary of Key Findings

• Children under five years were the most affected group, with accidental poisoning as the predominant manner.
• Kerosene and pesticides accounted for over 60 percent of fatal cases.
• Unsafe storage and low caregiver awareness were the strongest modifiable risk factors.
• Household practices closely mirrored patterns reported in global injury prevention literature.

This study highlights the persistent burden of pediatric poisoning in urban slums and underscores the role of environmental and social determinants in shaping injury risk. The predominance of accidental poisoning among young children reflects exploratory behavior combined with unsafe household environments.

The forensic findings align with existing evidence that kerosene and pesticides remain major contributors to childhood poisoning in low-income settings. The household survey further reveals that unsafe storage practices and limited caregiver awareness are widespread and strongly associated with poisoning events.

Importantly, the findings demonstrate that pediatric poisoning is largely preventable. Simple interventions such as promoting safe storage, improving labeling, and increasing caregiver education could yield substantial public health benefits. Regulatory measures to enforce safer packaging and restrict hazardous substance availability in informal settlements are equally critical.

Strengths and Limitations

Strengths

• Integration of forensic and community-level data
• Focus on an underserved and high-risk population
• Identification of actionable household risk factors

Limitations

• Retrospective nature of forensic data
• Possible recall bias in household surveys
• Single-city setting may limit generalizability

Public Health Implications

Addressing pediatric poisoning in urban slums requires a multisectoral approach involving public health authorities, urban planners, regulatory agencies, and community organizations. Incorporating injury prevention into primary healthcare and urban development policies is essential for reducing preventable childhood deaths.

CONCLUSION:

Pediatric poisoning incidents in urban slums are predominantly accidental and strongly associated with modifiable household risk factors. Strengthening community awareness, promoting safer storage practices, and enforcing regulatory safeguards can significantly reduce poisoning-related harm among vulnerable children.

Discussion

This study highlights pediatric poisoning as a persistent and preventable public health problem in urban slum settings. The predominance of accidental poisoning among children under five years reflects the interaction between normal exploratory behavior and unsafe household environments, a pattern consistently reported in low-income urban populations [1,2].

The forensic case series identified kerosene, pesticides, and household cleaning agents as the most common toxic substances involved in fatal poisoning. Similar substance profiles have been documented across South Asia and sub-Saharan Africa, where hazardous fuels and chemicals are widely used for domestic purposes and often stored in unlabelled or reused containers [3,4]. The continued reliance on kerosene in informal settlements underscores broader structural issues related to energy poverty and inadequate regulation.

Findings from the household risk-factor survey demonstrate that unsafe storage practices are widespread and strongly associated with poisoning events. Storage of toxic substances within reach of children and reuse of beverage bottles for hazardous liquids remain common practices, increasing the likelihood of accidental ingestion [5]. These findings align with earlier studies showing that child-accessible storage is one of the most significant predictors of unintentional poisoning in young children [6].

Caregiver awareness emerged as a critical protective factor. Low literacy levels and limited knowledge of poisoning prevention were independently associated with increased risk. Previous community-based studies have similarly reported that caregiver education significantly reduces both fatal and non-fatal poisoning incidents [7]. Importantly, awareness gaps were not limited to poisoning risks but extended to appropriate first-aid responses, leading many caregivers to delay or avoid seeking formal medical care.

The forensic component of this study adds important insight into fatal outcomes, which are often underrepresented in community surveys. Integration of medico-legal data with household-level risk assessment provides a more comprehensive understanding of poisoning epidemiology and strengthens the evidence base for targeted interventions [8]. Such integrated approaches are increasingly recommended for injury surveillance in vulnerable populations [9].

From a policy perspective, the findings reinforce the need for multi-level prevention strategies. Community education programs, promotion of child-resistant packaging, and stricter regulation of hazardous substances have been shown to reduce pediatric poisoning rates in comparable settings [10]. Urban health programs should prioritize injury prevention alongside infectious disease control to address the full spectrum of child health risks in slum environments

Acknowledgements

The authors thank the forensic department staff, community health workers, and participating families for their cooperation and support.

Funding

No external funding was received for this study.

Conflicts of Interest

The authors declare no conflicts of interest.

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