Preventing Deaths from Acute Poisoning in Low- and Middle-Income Countries

Aims and objectives We aim to prevent deaths from acute poisoning in low- and middle-income countries (LMIC) by developing new knowledge, diagnostics, treatments, informed policies, and capacity. The Centre will collaborate closely with the World Health Organization (WHO) to strengthen Poison Information Centres (PIC), develop global guidelines, and provide clinical/public health research training. Primary research will address two major problems of WHO interest: methanol and occupational pesticide poisoning. Background There is a global lack of PIC capacity (especially in Africa), lack of standardised guidelines, and much need for research training. Methanol-contaminated illicit alcohol causes thousands of deaths in impoverished communities; local hospitals lack the means to diagnose the condition, producing poor healthcare. Occupational pesticide poisoning harms LMIC farmers; unfortunately, pre-hospital emergency care is unavailable - leading to hazardous hospital transfers during which patients' clinical condition may deteriorate. Effective therapy is needed near the poisoning site. Research questions Our over-arching question is whether increasing global poisoning research and PIC capacity leads to improved care. Specific research questions include: 1. Can a point-of-care (POC) formate assay be used to rapidly diagnose and improve care of methanol poisoning? 2. Is it feasible to provide atropine auto-injectors in rural communities for pre-hospital treatment of pesticide-poisoned patients? What novel pesticides are causing acute and potentially chronic harm as older toxic pesticides are phased out of agriculture? Methods An observational study of a methanol POC test in two hospitals (in Bangladesh, India) will determine the acceptability/accuracy of the assay; a pilot phase-III cluster RCT in six hospitals over 2-years will explore the assay's clinical- and cost-effectiveness. An ethnographic study in six Sri Lankan villages will determine the feasibility of providing pre-hospital atropine auto-injectors for pesticide poisoning; data will also be collected on the health effects of novel pesticides in Sri Lanka. All studies are guided by community engagement/involvement. Working with the WHO and international toxicological societies, we will provide guidelines and training in research and PIC activities globally. Short-course training in clinical toxicology, as well as funds and mentoring for Masters and PhD studies, will improve capacity in LMIC research. Timelines for delivery The phase-II methanol POC study will be completed by month 48; the auto-injector study by month 48. Clinical guidance will also be ready by month 48. Face-to-face and hybrid training at toxicology congresses will start by month 7 and continue twice/year, with online training in-between congresses. Anticipated impact and dissemination The methanol and pesticide studies will provide data with which to design large definitive phase-III studies to transform poisoning healthcare in LMIC. The training will increase national capacity for research and PIC activity that will allow national poisoning problems to be addressed locally and effectively. We will engage with communities, media, Ministries of Health, United Nations, and professional clinical organizations to disseminate data collected by the Centre.