**3. Epidemiology**

Annually about 300 000 deaths are reported by pesticides poisoning worldwide (Eddleston & Phillips, 2004). The most reports of acute pesticide poisoning only based on hospital records admission and as a result absolutely reflect a small part of the real incidence. In Asian region about 25 million agricultural workers suffer from an episode of poisoning each year(Jeyaratnam, 1990). In "phosphine" poisonings reported from Germany, 28% were planned and mostly by eating, whereas the majority of the 65% accidental exposures were by inhalation (Lauterbach, et al, 2005). A report has also been publishedfrom the United Kingdom where the majority of 93 aluminum phosphide exposures were accidental and concerned inhalation of phosphine in agricultural locations(Bogle, 2006).

#### **4. Ingestion of phosphides**

Phosphide ingestion is a particular problem in rural India, the origin of most of the data on this topic (Rastogi, et al, 1990; Chugh, et al, 1991, 1998; Singh, 1996; Gargi, et al, 2006). The aluminium salt is most commonly involved. Indeed, in a prospective study of 559 acute poisonings admitted over 14 months to a single hospital in Harayana-Rohtak, India, no fewer than 379 (68%) involved aluminium phosphide (Siwach & Gupta, 1995). Similarly, reports to the National Poisons Centre in Delhi indicate that aluminium phosphide is the pesticide most commonly ingested by children (Gupta, et al, 2003).

Much smaller numbers or only sporadic cases of phosphide poisoning have been reported from the remainder of the world, including Australia (Nocera, et al, 2000), Denmark (Andersen, et al, 1996), France (Anger, et al, 2000), Germany (Alter, et al, 2001), Greece (Frangides & Pneumatikos, 2002), Iran (Pajoumand, et al, 2002), Jordan (Abder-Rahman, et al, 2000), Morocco (Idali, et al, 2005; Hajouji, et al, 2006; Akkaoui, et al, 2007), Nepal (Lohani, et al, 2000), Sri Lanka (Roberts, et al, 2006), Turkey (Bayazit, et al, 2000), the United Kingdom (Stewart, et al, 2003; Lawler & Thomas, 2007), Canada, the United States (Broderick & Birnbaum, 2002, Ragone, et al, 2002), the former USSR (Rimalis & Bochkarnikov, 1978), and Yugoslavia (Curcic & Dadasovic, 2001). A single death from ingestion of a falsely labeled rodenticide bait has been reported (Azoury & Levin, 1998). Phosphide rodenticides were responsible for nine out of 349 deaths in 35,580 poisoning admissions to Loghman Hakim hospital poison center in Tehran (Pajoumand, et al, 2002).

Medline, pubmed and Google Scholar databases. All applicable articles in English were attained. Many isolated case reports and small case series do not appear in the citation list. The ability to highlight important aspects is the only criterion for inclusion in this review. The criteria used in the current review include below criteria: Articles were selected based on the impact of lifestyle, stress, and/or environmental factor/s predisposing aluminium phosphide poisoning exposure. Criteria for selection of the literature used included yes-no responses to the appropriateness of methodology; adequacy of subject numbers; specificity of sex and/or age of subjects, and statistically significant response rates to survey questionnaires. The time frame used was principally 1990-2011 inclusive, although articles of extreme importance from earlier decades were used where appropriate. A multifactorial overview of the factors eschewed concerning aluminium phosphide poisoning exposure was elucidated. It was supposed that collective articles detailing known factors of usage were not necessarily correlated with functionality and health. Collection of materials for the

review started with the published literature or easily available academic research.

concerned inhalation of phosphine in agricultural locations(Bogle, 2006).

pesticide most commonly ingested by children (Gupta, et al, 2003).

hospital poison center in Tehran (Pajoumand, et al, 2002).

Annually about 300 000 deaths are reported by pesticides poisoning worldwide (Eddleston & Phillips, 2004). The most reports of acute pesticide poisoning only based on hospital records admission and as a result absolutely reflect a small part of the real incidence. In Asian region about 25 million agricultural workers suffer from an episode of poisoning each year(Jeyaratnam, 1990). In "phosphine" poisonings reported from Germany, 28% were planned and mostly by eating, whereas the majority of the 65% accidental exposures were by inhalation (Lauterbach, et al, 2005). A report has also been publishedfrom the United Kingdom where the majority of 93 aluminum phosphide exposures were accidental and

Phosphide ingestion is a particular problem in rural India, the origin of most of the data on this topic (Rastogi, et al, 1990; Chugh, et al, 1991, 1998; Singh, 1996; Gargi, et al, 2006). The aluminium salt is most commonly involved. Indeed, in a prospective study of 559 acute poisonings admitted over 14 months to a single hospital in Harayana-Rohtak, India, no fewer than 379 (68%) involved aluminium phosphide (Siwach & Gupta, 1995). Similarly, reports to the National Poisons Centre in Delhi indicate that aluminium phosphide is the

Much smaller numbers or only sporadic cases of phosphide poisoning have been reported from the remainder of the world, including Australia (Nocera, et al, 2000), Denmark (Andersen, et al, 1996), France (Anger, et al, 2000), Germany (Alter, et al, 2001), Greece (Frangides & Pneumatikos, 2002), Iran (Pajoumand, et al, 2002), Jordan (Abder-Rahman, et al, 2000), Morocco (Idali, et al, 2005; Hajouji, et al, 2006; Akkaoui, et al, 2007), Nepal (Lohani, et al, 2000), Sri Lanka (Roberts, et al, 2006), Turkey (Bayazit, et al, 2000), the United Kingdom (Stewart, et al, 2003; Lawler & Thomas, 2007), Canada, the United States (Broderick & Birnbaum, 2002, Ragone, et al, 2002), the former USSR (Rimalis & Bochkarnikov, 1978), and Yugoslavia (Curcic & Dadasovic, 2001). A single death from ingestion of a falsely labeled rodenticide bait has been reported (Azoury & Levin, 1998). Phosphide rodenticides were responsible for nine out of 349 deaths in 35,580 poisoning admissions to Loghman Hakim

**3. Epidemiology** 

**4. Ingestion of phosphides** 
