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      Toxicovigilance Systems and Practices in Africa

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          Abstract

          African consumers and citizens are growingly aware of the wide range of toxic poisoning scenarios from different products and hazards. Recurrent episodes on poisoning that have been reported in Africa include toxic hazards in consumers’ products ranging from food to herbal medicine, drugs, and cosmetics. Chemical poisoning remains an issue that is overlooked by public health stakeholders in Africa. Available information on toxicovigilance systems and practices in African countries is reviewed in terms of increasing development, organization and articulation levels. Less than nine out of 54 African countries have a legally recognized toxicovigilance system. Of these, the majority have created toxicovigilance systems recently, and are facing many challenges in developing them, at regional and country levels. Basic structures for a good toxicovigilance system include a phone line service (available 24/7), and hospital facilities. Pesticides emerge as the hazard recognized by all of the toxicovigilance systems, and may represent a prototypic toxicant towards a toxicovigilance system that is inclusive of a wider spectrum of toxicological hazards for the protection of community health. Toxicovigilance today is more reactive than preventive in Africa, but some milestones are present that constitute some promising seminal efforts.

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          Most cited references33

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          The changing trends of childhood poisoning at a tertiarychildren's hospital in South Africa

          CONTEXT: Information on childhood poisoning in the developing world, including South Africa, is scarce, despite its contribution to morbidity and mortality. OBJECTIVE: We describe the profile of children with exposures and poisonings presenting to Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, South Africa, from 2003 to 2008 and compare the trends of causative agents over the past two decades METHODS: Cases were identified by review of the RCWMCH case records. RESULTS: Of the total incidents (N=2 872), paraffin (kerosene) was the commonest agent (n=692, 24%) with 124 poisonings including two deaths. Drugs were the most common toxin group (n=988, 34%), including 139 single-drug poisonings with 5 deaths; 4 associated with traditional medicine use. Household cleaning product incidents (n=302, 10%) resulted in 29 singleproduct poisonings with no deaths. Pesticide incidents (n=311, 10%) included 6 deaths; 203 (65%) incidents were due to organophosphates or carbamates. The suburban distribution of the main toxin groups varied. Comparing 1987 and 2008, the number of incidents decreased from 1 116 to 447; drug and paraffin incidents decreased respectively (from 673 to 150 and from 332 to 87), household cleaning products and cosmetics increased (21 to 69) and pesticide incidents increased (7 to 69). CONCLUSION: Despite a decrease in the overall number of incidents over two decades at RCWMCH, paraffin and drugs remain the principal agents responsible for paediatric exposures and poisonings, with increasing incidents due to household cleaning products and pesticides. Identification of these toxin groups coming from specific suburbs allows for targeted prevention initiatives.
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            Poisoning in Zimbabwe: a survey of eight major referral hospitals.

            A retrospective study of the pattern of poisoning cases admitted to eight major urban referral hospitals in Zimbabwe over a 2-year period (1998-1999 inclusive) was conducted to describe the pattern of poisoning at these centres. There were a total of 2764 hospital admissions due to poisoning, involving a total of 2846 toxic agents. Accidental poisoning (AP) and deliberate self-poisoning (DSP) accounted for 48.9% (1352 cases) and 41.3% (1142 cases), respectively. With AP, the highest number of cases (45.9%) occurred in children below the age of 5 years, with half of these due to chemicals, mainly paraffin. In the DSP group, however, more than 60% of all cases occurred in the 16-25-year age group. In addition, twice as many females as males were admitted for DSP compared with an overall male/female ratio of 1 : 1.2. Pesticides (31.4%) and pharmaceuticals (30.4%) were the most common groups of toxic agents responsible for the hospital admissions. Unknown toxins, natural toxins and pesticides showed the highest mortality rates (15.4%, 8.3% and 6.7%, respectively). Compared with the last major survey of poisoning in Zimbabwe, the pattern of poisoning at referral hospitals has changed over the last decade, with an increase in pesticide and pharmaceutical cases and a marked fall in cases of traditional medicine poisoning. Educational and legislative interventions may be required to address these changes. There is the need also to investigate further the high mortality rates associated with traditional medicine poisoning. Copyright 2002 John Wiley & Sons, Ltd.
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              A large outbreak of scombroid fish poisoning associated with eating yellowfin tuna (Thunnus albacares) at a military mass catering in Dakar, Senegal.

              On 26 November 2010, an outbreak of scombroid fish poisoning occurred in the French Armed Forces in Dakar, Senegal. This chemical intoxication, due to high histamine concentration in fish, is often mistaken for an allergic reaction. A case-control study was undertaken including the 71 cases and 78 randomly selected controls among lunch attendees. The usual symptoms for scombroid fish poisoning were observed in cases, i.e. flushing (85.9%), headache (83.1%), rapid/weak pulse (59.1%) and diarrhoea (47.9%). Symptoms occurred from within a few minutes to up to 3 h following the meal. Most patients quickly recovered with antihistamine and/or symptomatic treatment. Tuna was the only food item positively associated with illness (odds ratio 36.3, 95% confidence interval 6.3-210.0), with the risk of illness increasing with the quantity of fish consumed. No bacterial contamination was found in leftover food, but histamine concentration in tuna was found to be 4900 mg/kg, almost 50-fold higher than the concentration allowed by European regulations. This report is unique because of the large size of the case series - to our knowledge, the largest event of scombroid fish poisoning ever reported - and the chemical and bacteriological analyses results obtained on leftover food.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Toxics
                Toxics
                toxics
                Toxics
                MDPI
                2305-6304
                28 July 2016
                September 2016
                : 4
                : 3
                : 13
                Affiliations
                [1 ]Food Safety Laboratory, Biotechnology Center, University of Yaounde 1, Cameroon
                [2 ]Department of forensic chemistry, Naif Arab University for security sciences, Riyadh 11452, Saudi Arabia
                [3 ]Laboratory for Public Health Research Biotechnologies, Biotechnology Center, University of Yaounde 1, Cameroon; rangwafor@ 123456yahoo.com
                [4 ]External Relations Office, Istituto Superiore di Sanità, Rome, Italy; chiara.frazzoli@ 123456iss.it
                [5 ]Nutrition, Food Safety and Wholesomeness. Prevention, Education and Research Network (NOODLES), Via Mancinelli, 100, 00199 Rome, Italy
                Author notes
                [* ]Correspondence: guy.pouokam@ 123456noodlesonlus.org (P.G.B.); hatemahmed29@ 123456yahoo.com (H.A.M.A.); Tel.: +237-677-046-789 (P.G.B.)
                Article
                toxics-04-00013
                10.3390/toxics4030013
                5606664
                29051419
                b089d6ba-7023-43eb-afcb-7e84e50b9e0b
                © 2016 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 31 March 2016
                : 23 June 2016
                Categories
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                toxicovigilance,toxicosurveillance,poisoning,africa consumer,risk management

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