Fatal Poisoning in Southern Tunisia: A 15-Year-Long Study

Introduction: Fatal poisoning is a serious global problem and a leading cause of mortality worldwide and also in Tunisia. Fatal poisoning is considered as a non-natural death, that requires medico-legal investigation, to access whether it is suicidal, criminal, or accidental death. While toxic morbidity can be approximated from statistics from hospital departments, toxic mortality can only be established using data from forensic departments. The exact number of poisoning incidence in Tunisia is not yet compiled. Hence, our work proposes to study the socio-epidemiological characteristics of victims of toxic death in the region of Sfax in order to establish adequate preventive measures. Materials: We performed a retrospective, descriptive and analytical study of all cases of poisoning deaths examined in the forensic medicine department of Habib Bourguiba Hospital in Sfax, Tunisia, between January 1 st , 2006 to December 31 st , 2020. Results: We collected 138 cases of death secondary to a toxic cause.  We observed a slight male predominance (50.7%). The median age was 28.5 years with a percentile [25;75] of [20;44,7]. The age group between 19 and 40 was the most affected (48.6%). Carbon monoxide poisoning was the most common method of toxic deaths (37%). Organophosphate poisoning was the second incriminated product (21.7%). Then, drug and hair dye poisoning caused deaths in 12.3% and 9.4% of the cases, respectively.  Suicidal poisoning was mostly related to organophosphate poisoning (42.8%). However, Accidental poisonings were mostly related to carbon monoxide (69.9%). The presence of a toxic product in the organism was confirmed by toxicological analyzes in 52.2% of cases. The analytical study found that carbon monoxide poisoning victims were mainly active single men from an urban origin, and deaths occurred mostly in winter. However, organophosphate poisoning victims were mainly females from a rural origin. Conclusion: Poisoning is a major public health problem in our region that is difficult to define precisely. Given the frequency of accidental and suicidal forms of toxic deaths in our region, we insist on the major role of prevention. Our study could be a key element to implement specific preventive measures.