Epidemiology, risk factors, and strategies to prevent and manage poisonings due to pharmaceuticals in children in low income and low-middle income countries: A systematic review

Background There are significant disparities in the burden of disease due to poi-soning between children in low- and high-income countries (HICs). However, there is limited data on the impact of increasing pharmaceutical access in low income countries (LICs) and low-middle income countries (LMICs) on the epidemiology of and risk factors associated with poisoning in children in these settings. Further-more, while strategies in HICs have effectively reduced the burden of disease due to poisonings in children, there is limited information regarding the efficacy of these interventions in LICs/LMICs. Methods We conducted a systematic review in eight databases for literature pub-lished between January 2000 to April 2022 to evaluate the epidemiology and risk factors associated with poisonings due to pharmaceuticals and effective strategies to prevent and manage them in children in LICs/LMICs. From 16 061 retrieved ar-ticles, 41 were included in the final analysis. Findings Pharmaceuticals were a common cause of poisoning in children in LICs/ LMICs, occurring in between 12.4% and 72.36% of cases. Major risk factors were unsafe medication storage and inadequate caregiver knowledge. Delayed access to care and younger age were associated with increased mortality. Prevention strate-gies that included education demonstrated improvements in knowledge; however, their impact on incidence and mortality was unclear. Management strategies de-tailed individual patient care interventions, most commonly gastric lavage and ac-tivated charcoal. Meanwhile, delayed presentation, limited provider knowledge, and inadequate laboratory resources to support therapeutic monitoring hindered optimal management. Conclusions The combination of educational interventions for prevention, along with regulatory processes to maximise medication storage and formulation safety, could be effective in reducing the burden of poisoning in LICs/LMICs. The develop-ment of national or regional protocols for the management of common medication poisonings, augmented by the development of poison control centers and expan-sion of laboratory access in facilities may help reduce the morbidity and mortali-ty associated with pharmaceutical poisonings in children in LICs/LMICs. Further evidence regarding contextual factors, risk and benefit profiles, the pattern of poi-soning, and the impact of preventive and treatment interventions specific to LICs/ LMICs is needed to better refine recommendations in these settings.