This is a retrospective cross-sectional study that was conducted to investigate Kerosene poisoning cases in Saudi Arabia as documented in the National Poisoning Surveillance System from January 2019 and December 2021. The objectives of the study were to determine the frequency of kerosene poisoning incidents, to investigate the demographic characteristics of affected cases, and the geographical distribution and seasonal variations of incidents over this time.
Over a three-year span, from January 2019 to December 2021, Saudi Arabia recorded 460 cases of kerosene poisoning: 32.2% in 2019, 37.2% in 2020, and 30.6% in 2021.
Males comprised 60.9% of cases while females comprised 39.1%. Most kerosene poisoning cases were reported among Saudi citizens, accounting for 97.6%. The ages of cases ranged from under 1 year to 75 years old and the largest proportion was those between the ages of 1 to 5 years (87.6%), followed by infants under 1 year (5.22%) then children aged 6 to 12 years old (4.78%).
Most kerosene poisoning cases occurred at home (90.7%), and oral ingestion was the predominant route of exposure, accounting for 91.7% of the cases.
A total of 41.3% of cases necessitated hospitalization, among which 17.6% were discharged against medical advice. Antidote treatment was administered to 23.7%.
Variations in incidence of Kerosene poisoning were observed over the regions of the Kingdom, with the AlQurayat region having the highest number of recorded incidents (53%), followed by the Northern Borders region (18%), AlJouf region (15.7%), and Hail region (7%).
The monthly distribution of the cases suggested a distinct trend, with most cases reported in March (16.3%), followed by February (13.3%), January (13.3%), and April (12.2%). The winter season (December to February) demonstrated the highest number of Kerosene poisoning incidents, with 178 cases (38.7%), followed closely by spring (March to May) with 154 cases (33.5%).
Table 1 demonstrates the epidemiologic profile of Kerosene Poisoning incidents reported in the National Surveillance Database Across Saudi Arabia over the period from 2019 to 2021.
Editorial notes: Unintentional injuries remain significant yet preventable public health problems that contribute to 3.16 million deaths every year[1]. Nonfatal repercussions of these injuries make up a substantial proportion leading to potentially permanent disability, serious psychological distress, and consequent financial detriment[2]. Children and teenagers are particularly vulnerable to this type of injury[3]. Unfortunately, poisoning ranks among the primary factors contributing to unintended injuries [4] leading to the loss of 5 million disability-adjusted life-years[5].
Kerosene ingestion is a prevalent type of unintentional intoxication that frequently affects children, especially those below the age of 6 years [6]. If kerosene is ingested or inhaled, it causes serious health problems, and, in extreme cases, death.
Kerosene poisoning is a prevalent public health concern in Saudi Arabia, mostly caused by its use for lighting, warming, and food preparation. However, there is a lack of nationwide studies on the epidemiology of Kerosene poisoning in the Kingdom.
Our study revealed a statistically significant association between kerosene poisoning and male gender (p <0.001), and younger age group of 1 to 5 years old (p <0.001). This is in concordance with the current literature that suggests that children, particularly toddlers, are the most susceptible group to unintentional poisoning [7]. A review by Kumar, Surjeet et al noted that kerosene poisoning is one of the most common causes of accidental intoxication among children. And several local studies on chemical poisoning illustrated the higher incidence of unintentional poisoning among children under the age of five, a surveillance from 2019 to 2021, revealed that children between the ages of 1 and 5 years old were the most affected age group[8].
Another report from the Makkah region, revealed that more than half of the cases occurred in children under the age of five [9]. A study investigating chemical poisoning cases over a 5-year period from 2011 to 2015 in Jeddah revealed that among 994 cases 56% were children under the age of five[10]. Likewise, a study from King Khalid University Hospital in Riyadh reported that, between 2010 and 2016, chemical poisoning accounted for 29% of all pediatric poisoning cases presenting to the hospital [11].
The regional and seasonal difference revealed by this study imply the variability of kerosene demand and need across Saudi Arabia, especially north of the kingdom where it is more commonly used for heating and warmth. This emphasizes the relationship between environmental factors and the occurrence of kerosene poisoning incidents. This finding corroborates the hypothesis that regions with lower temperatures, where kerosene is commonly used for heating purposes[12], are more prone to incidents of kerosene poisoning.
This study can serve as a foundation for additional studies to delve deeper into kerosene poisoning in the kingdom and to examine the extensive range of long-term consequences of kerosene poisoning on affected individuals, particularly young children.
Both the regional and seasonal tendencies stress the necessity for focused public health awareness campaigns during the colder months, focusing on the cooler Northern region of the Kingdom in particular, emphasizing the potential advantage of advocating the use of alternative heating methods and enhancing Safety protocols for the storage and utilization of kerosene.
This study is a step towards a broad and inclusive public health strategy to address Kerosene poisoning in Saudi Arabia, to build strategies that encompass education, policy, and innovation to minimize the impact of kerosene poisoning and ensure the safety and well-being of the community.
Table 1: Epidemiologic Profile of Kerosene Poisoning Cases Reported in the National Surveillance Database Across Saudi Arabia Over the Period from 2019 to 2021
| Category | n (460) | % | p-value | |
| Gender | Males | 280 | 60.9 | <0.001 |
| Females | 180 | 39.1 | ||
| Nationality * | Saudi | 449 | 97.6 | |
| Non-Saudi | 10 | 2.2 | ||
| Age Group | Under 1 year | 24 | 5.2 | <0.001 |
| 1-5 years | 403 | 87.6 | ||
| 6-12 years | 22 | 4.8 | ||
| 13-19 years | 3 | 0.7 | ||
| 20-39 years | 3 | 0.7 | ||
| >39 years | 5 | 1.1 | ||
| Mean age 2.98 years, SD: ± 6.3 years | ||||
| Place where incident occurred | Home | 417 | 90.7 | <0.001 |
| Farm | 2 | 0.4 | ||
| School | 1 | 0.2 | ||
| Outdoor | 1 | 0.2 | ||
| Unidentified | 39 | 8.5 | ||
| Route of Exposure | Oral | 422 | 91.7 | |
| Inhalation | 4 | 0.9 | ||
| Dermal | 1 | 0.2 | ||
| Unidentified | 33 | 7.2 | ||
| Management | Admission into hospital | 190 | 41.3 | |
| No Admission | 144 | 31.3 | ||
| DAMA | 81 | 17.6 | ||
| Transferred | 2 | 0.4 | ||
| Absconded | 1 | 0.2 | ||
| Unidentified | 42 | 9.1 | ||
| Region | AlQurayat | 244 | 53.0 | <0.001 |
| Northern Borders | 83 | 18.0 | ||
| AlJouf | 72 | 15.7 | ||
| Seasonality | Winter | 178 | 38.7 | |
| Spring | 154 | 33.5 | ||
| Summer | 49 | 10.7 | ||
| Autumn | 79 | 17.2 | ||
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