Methanol Poisoning after Consumption of Local Alcohol in Rivers State, May- June, 2015 Bountain W. Tebeda 1, N. Akpuh 1, K. Njideka 1, N. Bassey 1, I. Katchy 1, O. Ibitein 1, A. Olayinka 2, P. Nguku 1 1 Nigeria Field Epidemiology and Laboratory Training Programme 2 Faculty of Medicine, Ahmadu Bello University and Teaching Hospital, Zaria March, 2016
Introduction Methanol The simplest alcohol, weak odour, slightly sweeter than ethanol, and often added to ethanol to make denatured spirits Reactive metabolites, known to interfere with oxidative metabolism Toxic dose varies depending on the individual and treatment provision Alcoholics and members of lower socioeconomic classes at risk Visual disturbances, the most specific physical diagnostic findings, and survivors may suffer visual impairment 2
Outbreak Notification May 31st, 2015, the Rivers State DSNO notified the Federal Ministry of health of cases of unusual deaths after consumption of local alcohol in 5/23 LGAs June 5th, 2015, team of NFELTP Residents deployed to the affected LGAs for the investigation June 6th 2015, the investigation initiated 3
Objectives To confirm the existence of the outbreak To characterize the outbreak To determine the source of the outbreak To determine the risk factors associated with the outbreak To implement control measures 4
Methods To investigate this outbreak, we employed: Descriptive study Analytic study Laboratory analysis Qualitative study 5
Methanol Outbreak Areas Map of Nigeria highlighting Rivers State Map of Rivers State highlighting affected LGAs 6
Descriptive Study Case Definition Person of any age with history of death, visual impairment, vomiting, with or without breathlessness, headache, unconsciousness within 48 hours of consumption of local alcohol, residing in the incident towns of the 5 LGAs Reviewed records in three health facilities Data collected using line-listing forms Active case search.conducted in 5 affected communities of the 5 LGAs Outbreak characterized by Time Place Person 7
Analytic Study Study Design Retrospective cohort study, exposed=16, unexposed=8 Exposed Person known to have drank the local alcohol suspected to be the cause of death and symptoms of blindness, vomiting, respiratory distress, headache, unconsciousness on 28 th May, 2015 in the affected community of Obio Akpor LGA Unexposed House hold members or friends of exposed who did not drink local alcohol within the same period of time Interviewer-administered structured questionnaires 8
Laboratory Analysis Laboratory Specimens Three blood samples collected from hospital-admitted patients for laboratory analysis Five local alcohol samples taken from sites where outbreak occurred was sent to NAFDAC office for analysis 9
Qualitative Study Done using key informant interviews on Six alcohol sellers 10
Data Analysis Data analyzed with Epi-Info 7 software and Microsoft excel ounivariate analysis for frequencies and descriptive statistics obivariate analysis for associations 11
Results Identified total of 84 cases, mean age 45.6±11.1 years, 72(85.8%) males Total number of death: 70 Overall case fatality rate: 83.3% 4/14(28.6%) survivors lost their sight 12
Age and Sex Distribution of Cases of Methanol Poisoning, Rivers State, May-June, 2015 Age(years) Number of Cases Frequency(%) 20-29 4 4.8 30-39 18 21.4 40-49 26 31.0 50-59 18 21.4 60 9 10.7 Missing 9 10.7 Total 84 100 Sex Male 72 85.7 Female 12 14.3 Total 84 100 13
Socio-demographic Characteristics of the Cases in Rivers State, May-June, 2015 N=55 Marital Status Number Proportion(%) Single 12 21.8 Married 41 74.6 Separated/Divorced 2 3.6 Education Status *Non formal 11 20.0 *Formal 44 80.0 Occupation Fishing 17 30.9 Farming 11 20.0 Business 14 25.5 Security/Labourer 8 14.5 None 5 9.1 *Non formal= No Education; *Formal=Primary, Secondary and Tertiary Education 14
Spot Map of Cases of Methanol Poisoning Outbreak in the affected LGAs of Rivers State, May-June, 2015 N W S E Akwa Ibom Bayelsa Atlantic Ocean 15
Frequency of Symptoms among Cases of Methanol Poisoning in Rivers State, May-June, 2015. 40 35 30 34.0 Perc centages 25 20 15 24.5 17 10 5 9.4 9.4 5.7 0 Blindness Vomitting Resp distress Headache Unconsiousness Others Symptoms Others include malaise, dizziness and non-specific symptoms 16
Case Fatality Rates of the Methanol Outbreak in the Five Affected LGAs of Rivers State, May- June, 2015 Five Affected LGAs of Rivers State Total Cases Number Total Deaths Number Case Fatality Rate(%) Gokana Bonny Obio Akpor Port Harcourt Ahoada West 32 26 15 6 5 84 23 25 11 6 5 70 Total 66.7 96.2 73.3 100 100 83.3 17
Epidemic Curve of the Methanol Poisoning Outbreak in Rivers State, 30 th May- 19 th June, 2015 25 Outbreak Peak Numb ber of cases 20 15 10 5 0 Local Alcohol Exposure Outbreak confirmed and Reported by R/S Govt. Start of Outbreak Information Received Start of Investigation 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 May Date of Onset June Dead Alive End of Investigation 18
Laboratory Analysis All the local alcohol samples analyzed were positive for methanol contamination, Blood samples from admitted cases showed electrolyte derangement and high methanol concentration >20mg/dl *Toxic blood level >20mg/dl and Ref. Range:<0.5mgdl 19
Qualitative Analysis Key Informant Interview (KII) revealed Majority of cases were chronic alcoholics 67(80%) Disbelief of some people that the local alcohol, called Ogogoro can lead to death ogokana is one of the men who did not belief that the local alcohol caused the death of his wife but still took a large quantity of it and became unconscious within few minutes 20
Analytic Study Association between local alcohol exposure and development of poisoning, Woji Town in Obio Akpor LGA, Rivers State, May- June, 2015 Outcome Status Exposure Status Exposed to Local Alcohol Unexposed to Local Alcohol Ill Not Ill Total Risk P-Value 13 3 16 81.3% 0.0024* 1 7 8 12.5% Total 13 11 24 *Statistically significant relationship at 5% sig. level, [RR=6.5 (95% CI: 1.02-41.28)], ARP=84.6% 21
Trace Back Diagram from Local Alcohol Consumers to Alcohol Source, Rivers State, May-June, 2015 5/6(83.3%) identified local alcohol retailers traced source to Nembe Water side in Port Harcourt 22
Conclusion Methanol is the local alcohol contaminant Predisposing factors to methanol poisoning in Rivers State oalcohol addiction o Ignorance and disbelief 23
Public Health Action Conveyance of victims to health facilities for case management Counselled dealers on the need not to sell their product in public interest Sensitization of the public about the local alcohol poisoning. Findings shared with relevant authorities for necessary actions 24
Recommendations Adequate regulation of local alcohol production Proper implementation and enforcement of laws regulating local alcohol trade in the state Sustainable creation of awareness on the danger of local alcohol consumption 25
Thank you 26