Epidemiology and Health

Original Articles

Mortality from aluminum phosphide poisoning in Kermanshah Province, Iran: characteristics and predictive factors: Seyed Mohammad Navabi, Jafar Navabi, Abbas Aghaei, Zahra Shaahmadi, Ruhollah Heydari; Epidemiol Health. 2018;40:e2018022. Published online May 27, 2018; DOI: https://doi.org/10.4178/epih.e2018022

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297 Download
27 Web of Science
31 Crossref

Abstract

OBJECTIVES
Aluminum phosphide (ALP), also known in Iran as rice tablets, is one of the most effective rodenticides used to protect stored grain. However, ALP poisoning regularly causes mortality in humans. The aim of this study was to evaluate the characteristics and predictive factors of mortality from ALP poisoning.

METHODS

This study evaluated all patients with ALP poisoning referred to Imam Khomeini Hospital in Kermanshah Province, Iran from 2014 to 2015. For each patient, the following information was recorded: age, sex, the number of tablets consumed, the number of suicide attempts, the time elapsed from consumption to treatment, blood pressure, blood pH, HCO3 levels, and PCO2 . Differences between the survivors and non-survivors of ALP poisoning were analyzed using univariate logistic regression and multivariate analysis.

RESULTS

In this study, 48 patients were male and 29 patients were female (total: 77 patients). The average age of the survivors and non-survivors was 28.7 and 31.3 years, respectively. All cases (100%) of ALP poisoning were intentional, with the goal of committing suicide. The main predictive variables of mortality from ALP poisoning were blood pressure, blood pH, and time elapsed from consumption to treatment.

CONCLUSIONS

The likelihood of mortality in patients with ALP poisoning can be predicted using blood pressure, blood pH, and time elapsed from consumption to treatment. These findings may help healthcare providers take more effective measures to treat patients with ALP poisoning.

Summary

Citations

Citations to this article as recorded by

Reversible Atrial Fibrillation and Cardiogenic Shock Following Acute Aluminum Phosphide Poisoning: A Case Report and Literature Review
Chernet T. Mengistie, Biruk T. Mengistie, Ruth S. Belachew, Mikiyas G. Teferi, Zayed H. Tesfaye, Ezikel A. Eneyew
Clinical Medicine Insights: Case Reports.2026;[Epub] CrossRef
Toxicological profile and prognostic factors in phosphide poisoning: insights from a one-year hospital-based study
Ali Hassan Rahmani, Farkhondeh Jamshidi, Maryam Ahadi, Kiandokht Khorshidi, Parmida Etebarfarshi, Peyman Astaraki
International Journal of Emergency Medicine.2026;[Epub] CrossRef
Trimetazidine as a potential adjuvant therapy in acute aluminum phosphide poisoning: A randomized controlled clinical trial
Nadia E. Helal, Asmaa Fady Sharif, Tarek Abdel Hay Mostafa, Bsant Safwat Kasem, Samah M. Elbastawesy
Toxicologie Analytique et Clinique.2026;[Epub] CrossRef
Pesticide exposures and human health in the Eastern Mediterranean Region: a narrative review
Musa Alfaifi, Al Yaqdhan Al Atbi, Nozha Brahmi, Imane Iken, Badria Alhatali, Ziad Kazzi
Toxicology Communications.2026;[Epub] CrossRef
Role of serum glucose/potassium ratio in assessing poisoning severity and adverse outcomes in patients with acute aluminum phosphide poisoning
Ghada N. El-Sarnagawy, Amal S.A.F. Hafez, Mona M. Ghonem
Toxicology Reports.2025; 14: 101947. CrossRef
Electrocardiographic Patterns as Predictors of Mortality in Aluminum Phosphide Poisoning: A Retrospective Cohort Single-Center Study
Noorul Hadi, Asfandiyar ., Amna Saleem, Ashraf ., Rumman ., Zakir Ullah, Mohammad Hashim Khan
Cureus.2025;[Epub] CrossRef
Autopsy findings and histopathological changes in aluminum phosphide-related death: a systematic literature review and meta-analysis
Christopher Daniel Tristan, Novianto Adi Nugroho, Matthew Aldo Wijayanto, Erlangga Masykur Kynaya, Muhana Fawwazy Ilyas
Egyptian Journal of Forensic Sciences.2025;[Epub] CrossRef
Aluminum phosphide: Toxicological profiles, health risks, environmental impact, and management protocols: A review
Selin Çakmakcı Karakaya, Cavit Işık Yavuz
Turkish Journal of Emergency Medicine.2025; 25(3): 178. CrossRef
Metallophosphide poisoning, a rising public health problem in Ethiopia: a systematic review and meta-analysis
Kassaye Demeke Altaye, Bethelhem Yenenew Assefa, Adina Worku Teka, Saron Mulugeta Worku, Geta Bayu Genet, Bikis Liyew, Nahom Worku Teshager
BMC Emergency Medicine.2025;[Epub] CrossRef
Death Related to Aluminum Phosphide Poisoning from 2013 to 2018 in Alborz-Iran and Preventive Measures
Fariba Zamankhani, Aliyehsadat Mousavifar
Shiraz E-Medical Journal.2025;[Epub] CrossRef
Shock and modified shock indices in predicting poisoning severity and outcomes in acute aluminum phosphide poisoned patients
Mona M Ghonem, Amira A Abdelnoor, Aliaa A Hodeib
Toxicology Research.2024;[Epub] CrossRef
AN ASSESSMENT OF PESTICIDE POISONING INCIDENCES PRESENTED AT HEALTH CARE FACILITIES IN MASHONALAND CENTRAL PROVINCE, ZIMBABWE
Kenneth Chipere, Claid Mujaju, Taurai Matyora, Shumirayi Muhera, Shengai Mwale, Peter Ishe Muzofa, Kudzai Kusena, Ivy Getrude Saunyama
Journal of Experimental Biology and Agricultural Sciences.2024; 12(2): 226. CrossRef
Metal phosphide poisoning in a disaster‐stricken area. Can early hemodialysis improve outcomes?
Najjar Abdo, Sekkarie Mohamed, Valerie Luyckx, Alabdullah Mohammad, Sulaiman Abdu el Rahman, Kuhn Christine, Jetter Alexander, Hajj Nasan Khaled, Murad Lina, Rifai Ahmad Oussama, Sami Alasfar, AlhajHusain Ahmad
Hemodialysis International.2024; 28(3): 351. CrossRef
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Habtamu Mesele Gebray, Addisu Liknaw Chekol
Journal of Medical Case Reports.2024;[Epub] CrossRef
The performance of ejection fraction as a predictor of mortality and morbidity in acute aluminium phosphide poisoning
Meray Medhat Shokry Zaghary, Hasnaa Ahmed Ahmed Ali, Asmaa Mohammed Khalaf Ahmed
Toxicology Research.2024;[Epub] CrossRef
Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning
Lokhesh Chockalingam Anbalagan, Ashok Kumar Pannu, Ashish Bhalla, Deba Prasad Dhibar, Navneet Sharma
Turkish Journal of Emergency Medicine.2023; 23(2): 88. CrossRef
Comparing the effectiveness of L-carnitine and paraffin oil in acute aluminum phosphide poisoning using predictive biomarkers and scores: A randomized controlled clinical trial
Walaa G Abdelhamid, Mahmoud L Sakr, Olfat E Mostafa, Dalia Zaafar, Hanan M Abdelwahab
Human & Experimental Toxicology.2023;[Epub] CrossRef
Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning
LokheshChockalingam Anbalagan, AshokKumar Pannu, Ashish Bhalla, DebaPrasad Dhibar, Navneet Sharma
Turkish Journal of Emergency Medicine.2023;[Epub] CrossRef
Aluminum Phosphide Poisoning in the North of Iran: A Register-based Research
Hamid Mohammadi Kojidi, Mirsaeed Attarchi, Morteza Rahbar-Taramsari, Alireza Badsar, Niloofar Faraji, Yalda Rastak, Hadi Sedigh Ebrahim-Saraie
Current Drug Safety.2023; 18(3): 323. CrossRef
The therapeutic effect of a novel parenteral formulation of dihydroxyacetone in aluminum phosphide-intoxicated patients
Hossein Niknahad, Reza Heidari, Ali Jangjou, Vahidreza Asghari, Fatemeh M. Niknahad, Fazel Goudarzi, Nasim Tavakoli, Mitra Rahimi, Amir Mohammad Niknahad, Marziye Rashedinia
Heliyon.2023; 9(11): e22165. CrossRef
Toxicoepidemiology of Phosphide Poisoning in the Central Part of Iran
Nastaran Eizadi-Mood, Mahnaz Momenzadeh, Masoumeh Sadeghi, Ahmad Yaraghi, Ali Mohammad Sabzghabaee, Sam Alfred
Journal of Research in Pharmacy Practice.2023; 12(1): 21. CrossRef
PGI score: prospective validation and correlation with SOFA, SAPS-II, and APACHE-II scores for predicting outcomes in acute aluminum phosphide poisoning
A K Pannu, L Jhuria, A Bhalla, N Sharma
Toxicology Research.2022; 11(2): 361. CrossRef
Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths
Rooholah Valipour, Ahmad Shekari, Mehrdad Setareh, Kambiz Soltaninejad
American Journal of Forensic Medicine & Pathology.2021; 42(1): 23. CrossRef
Clinical Profile and Treatment Outcome of Aluminum Phosphide Poisoning in Felege Hiwot Referral Hospital, Northwest Ethiopia: A Retrospective Study
Dereje Endeshaw Bogale Bogale, Birtukan Demilew Ejigu, Tsigereda Amsalu Muche
Open Access Emergency Medicine.2021; Volume 13: 239. CrossRef
Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades
Maria Safdar, Khalid Imran Afzal, Zoe Smith, Filza Ali, Pervaiz Zarif, Zahid Farooq Baig
BJPsych Open.2021;[Epub] CrossRef
The physicochemical properties and distribution of aluminum in the environment, the effect on living organisms, the reduction of its toxic effect
Victoriia E. Kutai, Vasiliy Yu. Tsygankov
Medical academic journal.2021; 21(2): 25. CrossRef
Global poisoning of aluminum phosphide with its emphasis in Iran: A review
Marzieh Akbari, Rouhullah Dehghani
Journal of Entomological Research.2021; 45(4): 814. CrossRef
Cardioprotective activity of ethanolic extract of Echinophora cinerea against aluminum phosphide poisoning in rats
Sara Haydari, Afshin Nazari, Maryam Moghimian, Mehrnoosh Sedighi, Saber Ghaderpour
Journal of Food Biochemistry.2020;[Epub] CrossRef
Effect of aluminium phosphide (ALP) gas inhalation exposure on adipose tissue characteristics and histological toxicity in male rats
Zoya Tahergorabi, Mahmoud Zardast, Ali Naghizadeh, Borhan Mansouri, Iman Nakhaei, Mohsen Zangouei
Journal of Taibah University for Science.2020; 14(1): 1317. CrossRef
Cardiogenic Shock Due to Aluminum Phosphide Poisoning Treated with Intra-aortic Balloon Pump: A Report of Two Cases
Omid Mehrpour, Sadegh Asadi, Mohammad Ali Yaghoubi, Nahid Azdaki, Nastaran Mahmoodabadi, SeyedYoosef Javadmoosavi
Cardiovascular Toxicology.2019; 19(5): 474. CrossRef
Antidotal Action of Some Gold(I) Complexes toward Phosphine Toxicity
Kimberly K. Garrett, Kristin L. Frawley, Samantha Carpenter Totoni, Yookyung Bae, Jim Peterson, Linda L. Pearce
Chemical Research in Toxicology.2019; 32(6): 1310. CrossRef

Epidemiology and risk factors of voluntary pesticide poisoning in Morocco (2008-2014): Zineb Nabih, Latifa Amiar, Zakaria Abidli, Maria Windy, Abdelmajid Soulaymani, Abdelrhani Mokhtari, Rachida Soulaymani-Bencheikh; Epidemiol Health. 2017;39:e2017040. Published online September 1, 2017; DOI: https://doi.org/10.4178/epih.e2017040

25,419 View
289 Download
13 Web of Science
16 Crossref

Abstract PDF

Abstract

OBJECTIVES
To determine the epidemiological profile and risk factors of voluntary poisoning by pesticides.

METHODS

A retrospective analysis was conducted of all cases of voluntary poisoning by pesticides registered at the AntiPoison and Pharmacovigilance Center of Morocco between January 2008 and December 2014.

RESULTS

During the study period, 2,690 cases of acute pesticide poisoning were registered. The region of Rabat-Salé-Zemmour-Zaer accounted for the largest proportion, with 598 cases. The average age of the patients was 24.63±10.29 years. The sex ratio (female-to-male) was 0.45. Adults and teenagers were most affected by this type of poisoning, with 1,667 cases (62.0%) and 806 cases (30.0%), respectively. Suicide attempts accounted for 98.4% of the cases (2,469 cases). Pesticide poisoning occurred more often in urban zones (64.8%). Insecticides were incriminated in 14.0% of cases, with a mortality rate of 4.2%. Among the 1,635 patients for whom the outcomes were known, 154 died, corresponding to a mortality rate of 5.7%.

CONCLUSIONS

Voluntary intoxication by pesticides presents a real scourge that affects public health, and in this study, we developed an epidemiological profile of this phenomenon. Nevertheless, this study has limitations in that it did not evaluate the impact of the socioeconomic and psychological factors that are important contributors to this type of poisoning.

Summary

Citations

Citations to this article as recorded by

Pediatric neurotoxicity in Morocco: Epidemiology, clinical profile, toxicology findings and outcomes
Sahar Amrani Hanchi, Youssra Metarfi, Fatima Zahrae Bartal, Hajar Ammari, Hasnae Hoummani, Ilham Tadmouri, Sana Chaouki, Sanae Achour
Neurotoxicology and Teratology.2026; 115: 107601. CrossRef
Pesticide exposures and human health in the Eastern Mediterranean Region: a narrative review
Musa Alfaifi, Al Yaqdhan Al Atbi, Nozha Brahmi, Imane Iken, Badria Alhatali, Ziad Kazzi
Toxicology Communications.2026;[Epub] CrossRef
Intoxications graves : état des lieux au service des urgences de l’hôpital du CHU Ibn Rochd
Berdai Ghizlane, Moussaoui Mohammed, Rahmoune Imane, Adounai Bader, Mouhaoui Mohammed, Filali Houda
Toxicologie Analytique et Clinique.2025; 37(3): 347. CrossRef
Retrospective analysis of the poisoning cases in four different regions of the world
Hananeh Kordbacheh, Lamis F. Shishani1, Kübra Kolci, Rim Alomar, Baraa Hamze, Ahmet Aydın
Journal of Research in Pharmacy.2025; 29(2): 616. CrossRef
Current pesticide suicide surveillance methods used across the African continent: a scoping review
Maxine Jonker, Ayanthi Karunarathne, Leah Utyasheva, Michael Eddleston, Flemming Konradsen, Hanna-Andrea Rother
BMJ Open.2025; 15(10): e103770. CrossRef
Situation Analysis of Suicide and Self-Harm in the WHO Eastern Mediterranean Region
Annette Erlangsen, Murad Khan, Wen Su, Khawlah Alateeq, Fatma Charfi, Trine Madsen, Ping Qin, Britt Reuter Morthorst, Morten Thomsen, Aiysha Malik, Piumee Bandara, Alexandra Fleischmann, Khalid Saeed
Archives of Suicide Research.2024; 28(3): 760. CrossRef
Central Venous Catheter Complications in the Poisoning Emergency Center: A 5-Year Cross-Sectional Study
Amirmohammad Bavandipour, Masumeh Safaee, Mohammad Javad Tarrahi, Nastaran Eizadi-Mood
Advanced Biomedical Research.2024;[Epub] CrossRef
Exposure of children to glyphosate in Morocco: Urinary levels and predictors of exposure
Imane Berni, Aziza Menouni, Matteo Creta, Ibrahim El Ghazi, Radu-Corneliu Duca, Lode Godderis, Samir El Jaafari
Environmental Research.2023; 217: 114868. CrossRef
Acute pesticide poisoning in the central part of Iran: A 4-year cross-sectional study
Nastaran Eizadi-Mood, Razieh Mahvari, Mahsa Akafzadeh Savari, Ehsan Mohammadbeigi, Awat Feizi, Parisa Mirmoghtadaei, Ramin Sami, Rokhsareh Meamar
SAGE Open Medicine.2023;[Epub] CrossRef
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Lai Fong Chan, Song Jie Chin, Tsui Huei Loo, Ravivarma Rao Panirselvam, Shu-Sen Chang, Hwei Yuen Chang, Anissa Raudhah Mokhzani, Farynna Hana Ab Rahman, Leah Utyasheva, Michael Eddleston
BMC Psychiatry.2023;[Epub] CrossRef
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Fitria Saftarina, Jamsari Jamsari, Masrul Masrul, Yuniar Lestari
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Achbani Abderrahmane, Ahmed Kharbach, Hajar Azzine, Abdelmajid Lkoul, Youssef Bouchriti, Zakariae Cherrat, Nadia Ezzahir, Mohamed Boukrim, Hasnaa Sine
Revue d'Épidémiologie et de Santé Publique.2022; 70(5): 243. CrossRef
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Biomédica.2022; 42(3): 479. CrossRef
Pesticide Poisoning and the Use of Personal Protective Equipment (PPE) in Indonesian Farmers
Tri Joko, Nikie A. Y Dewanti, Hanan L. Dangiran
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Edgar Remberto Quinteros Martinez, José Alejandro López Vásquez
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Wafa Hassen, Mohamed Neifar, Hanene Cherif, Mouna Mahjoubi, Yasmine Souissi, Noura Raddadi, Fabio Fava, Ameur Cherif
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Exposure to pistachio pesticides and stillbirth: a case-control study: Saeid Razi, Mohsen Rezaeian, Fatemeh Ghani Dehkordi, Azita Manshoori, Reza Goujani, Reza Vazirinejad; Epidemiol Health. 2016;38:e2016016. Published online April 30, 2016; DOI: https://doi.org/10.4178/epih.e2016016

28,136 View
204 Download
7 Web of Science
5 Crossref

Abstract PDF

Abstract

OBJECTIVES
Stillbirth is an undesirable outcome of pregnancy. In light of the increasing use of pesticides and growing concerns about the possible health effects of agricultural pesticides, we investigated the effect of exposure to pistachio pesticides on stillbirth in pregnant mothers.

METHODS

This case-control study was conducted in Rafsanjan, Iran from 2011 to 2012. A total of 125 females who had a recent stillbirth were included as the case group, and 250 controls were selected from females who had a recent live birth. For each case, two controls with the nearest propensity score to the case were selected. Data were collected using a protocol developed by the researcher that involved interviewing respondents and reviewing their medical records. Conditional multivariate and univariate logistic regression analysis were performed and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

The ORs of stillbirth in mothers living in pistachio gardens and those who were exposed to sprayed pesticides, in comparison to the controls, were 14.1 (95% CI, 3.3 to 63.4) and 5.0 (95% CI, 1.2 to 28.6), respectively. No significant differences were found in stillbirth rates according to the distance between the mother’s residence and a pistachio garden or involvement in agricultural activities.

CONCLUSIONS

The results of our study showed that exposure to pistachio pesticides during pregnancy may increase the likelihood of stillbirth in mothers.

Summary

Citations

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Preconception and first trimester exposure to pesticides and associations with stillbirth
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María M. Milesi, Virginia Lorenz, Guillermina Pacini, María R. Repetti, Luisina D. Demonte, Jorgelina Varayoud, Enrique H. Luque
Archives of Toxicology.2018; 92(8): 2629. CrossRef

Commentary

Persistent Organic Pollutants and Obesity-Related Metabolic Dysfunction: Focusing on Type 2 Diabetes: Duk-Hee Lee; Epidemiol Health. 2012;34:e2012002. Published online January 27, 2012; DOI: https://doi.org/10.4178/epih/e2012002

26,742 View
154 Download
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Abstract PDF

Abstract

<p>Even though obesity is a well-established risk factor of type 2 diabetes, there is emerging evidence that persistent organic pollutants (POPs), a variety of lipophilic chemicals accumulated in adipose tissue, may be critically involved in the pathogenesis of type 2 diabetes. Among various POPs, serum concentrations of organochlorine pesticides and polychlorinated biphenyls (PCBs) were the most strongly and consistently linked to type 2 diabetes in both cross-sectional and prospective studies. In particular, obesity did not seem to be related to type 2 diabetes among persons with very low serum concentrations of POPs, suggesting a more fundamental role of chlorinated POPs in the pathogenesis of type 2 diabetes. These POPs were also associated with obesity, insulin resistance, and adverse lipid profiles like high triglyceride and low high-density lipoprotein (HDL) cholesterol among persons without diabetes, all metabolic dysfunctions commonly observed before developing type 2 diabetes. Recent animal studies supported the findings from epidemiological studies. If all these findings on POPs are true, it suggests that any effort to reduce the external and internal exposure to POPs would be necessary to decrease the social burden of type 2 diabetes.</p>

Summary

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