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Background: This qualitative study presents an in-depth evaluation of the contributory psycho-socio-cultural and physical-economic factors related to paediatric poisoning in rural Sri Lanka. Method: The study was conducted at paediatric wards of Anuradhapura teaching hospital (THA) over a period of two years (2012 – 2014). Main methods of data collection were participants’ narrative and focus group discussions (FGDs). All parents of children with acute poisoning were recruited to FGDs. The structure of phenomena was developed based on descriptive phenomenological inquiries and key themes were identified at data analysis stage. Results: 383 parents participated in focus group discussions. Data were categorized to four domains; (1) parental awareness of poisoning risks, (2) presence of child, parent and environment related risk factors, (3) issues related to first aid care and provision of care until child was brought to emergency care unit, and (4) possible measures to prevent further poisoning. Interaction of multiple risk factors was observed in children with both intentional and unintentional poisoning. Accidental poisonings were associated with certain cultural practices, unsafe environment and unsafe storage of poisons. Children with intentional poisoning frequently had disrupted family relationships. Harmful first aid measures and delayed presentation at the primary care unit had negative impact on poisoning related outcomes. Parents believed community education, safe storage of poisons, and safe environment would likely bring down poison related morbidity. Conclusion: Person, poison and environment related risk factors can lead to acute poisoning emergencies in children in rural Sri Lanka. Often multiple risk factors interact to bring about the poisoning event. Avoidance of harmful first aid measures and early presentation at the primary care unit would bring down poisoning related morbidity. Effect of community education, safe storage of poisons and safe environment should be evaluated in the view of preventing poisoning. [ABSTRACT FROM AUTHOR]

Background: Non-accidental poisoning in the paediatric age group is uncommon and international literature on this subject is limited. There are no Sri Lankan paediatric studies on non-accidental poisoning to date. The objective of the current study was to explore the predisposing factors and profile of children less than 12 years in rural Sri Lanka who had non-accidental poisoning. Method: This cross-sectional study was conducted at Anuradhapura teaching hospital for two years (from February 2012 to January 2014) involving all children below 12 years and presented with either a history of acute non-accidental self-poisoning or non-accidental poisoning by another person. Quantitative data were collected using a structured questionnaire and qualitative data to explore the background socio-cultural factors were collected using focused group discussions. Both quantitative and qualitative data were analysed separately in the two groups. Results: Nineteen children with non-accidental poisoning were recruited among 383 acute poisoning admissions over two years. The majority of children were male - 13 (68.4%). All children who had non-accidental self-poisoning were at least eight years of age while the mean age of children poisoned by another person was 4.6 years. Children mostly ingested pesticides (9/14-64.3%) followed by plant poisons and medicinal poisons. No child was reported to have ingested household chemicals including kerosene oil or miscellaneous substances intentionally. Children with non-accidental self-poisoning often had acute psychological distress and an immediate preceding event which resulted in the poisoning event. Verbal abuse by parents, poor family relationships, psychiatric disorders in children and emotional disturbances were often predisposing factors. Four children had morbidity secondary to aspiration pneumonia, respiratory arrest, and cardiac arrhythmias. Case fatality rate was 14.3% among children with non-accidental selfpoisoning. Children with non-accidental poisoning by another person often did not have acute psychological distress prior to the poisoning event. When the perpetrator was one of the parents, those families had major disruptions in family relationships and functioning. Conclusion: Non-accidental poisoning in paediatric age could be either non-accidental self-poisoning or non-accidental poisoning by another person. The risk factors for the two types of non-accidental poisonings are different and multitudinous. These predisposing factors need to be further evaluated through community-based studies. [ABSTRACT FROM AUTHOR]