Undereporting of Acute Pesticide Poisoning in Tanzania: Modelling Results from two Cross-sectional Studies.

Acute pesticide poisoning (APP) is known to cause serious injuries to end users globally but the magnitude of this problem in Tanzania is not well known. This study aimed to determine the extent and pattern of underreporting of APP in Tanzania to inform the development of a surveillance system and appropriate interventions. This study integrates findings from two recent Tanzanian studies. A household survey established the proportion of poisoned farmers in a typical rural area who reported to hospital for a pesticide poisoning. Only 5 of the 112 farmers who reported attending hospital due to poisonings could be traced in medical records at the facilities they claimed to have attended. The 95% confidence interval for this ratio (5/112) was used to generate a high and low boundary for the estimates. Three under-estimation factors were generated for sensitivity analysis to adjust for under-reporting. A review of health facilities in three regions of Tanzania collected prospective data on admissions for APP in 2006 to generate population-based APP incidence rates stratified by circumstances of poisoning (occupational, accidental, suicide, and unknown). Sensitivity analysis was conducted involving adjustment for high and low boundaries of the under-reporting of occupational APP and an adjustment for different scenario allocations of cases with 'unknown' circumstances to different combinations of known circumstances. The study estimated the rate of occupational poisoning as ranging from 11.3-37.7 cases/million to 84.3-279.9 cases per million. The rate of all poisonings (occupational and non-occupational) ranged from 24.45-48.01 cases per million to 97.37-290.29 cases per million. Depending on the choice of scenario and under-reporting correction factor used, occupational APP could comprise from 52.2 to 96% of all APP cases. The study confirms that data on APP in Tanzanian hospitals are poorly reported and that occupational circumstances are particularly overlooked in routine facility-based surveillance. Occupational APP needs to be taken more seriously in addressing prevention measures. A comprehensive surveillance system for APP should consider multiple data sources including community self-reporting in order to achieve better coverage