Poisoning is a major cause of morbidity and mortality globally and remains a significant medico-legal concern, especially in developing countries like India (1,2). It encompasses the exposure to toxic substances which may result in death or serious health consequences, whether through accidental ingestion, deliberate self-harm, or homicidal intent (3). According to the World Health Organization (WHO), poisoning accounts for hundreds of thousands of deaths annually, with a disproportionately higher burden in low- and middle-income countries (4). India reports a particularly high incidence of poisoning deaths, largely due to the widespread availability and use of agricultural chemicals such as pesticides and herbicides (5).The socio-demographic characteristics of poisoning victims reveal that young adults, especially males in the economically productive age group of 21 to 30 years, are the most affected (6-8). This pattern is influenced by multiple factors including psychological stress, socio-economic challenges, and easy access to toxic substances. Suicidal poisoning predominates the case profile, making it a severe public health and social issue (9). The case fatality rate is amplified by delays in medical intervention, lack of effective antidotes, and limited access to specialized care in rural areas (10).Rural populations are particularly vulnerable due to their close interaction with agricultural environments and easy access to highly toxic compounds, such as organophosphates and paraquat (11,12). In contrast, urban poisoning cases often involve household chemicals, pharmaceutical agents, or industrial toxins (13). This urban-rural disparity underlines the need for localized public health strategies and forensic approaches to manage and prevent poisoning deaths. From a medico-legal perspective, deaths caused by poisoning require comprehensive forensic investigation. Poisoning deaths are unnatural and suspicious, necessitating thorough post-mortem examinations, toxicological analyses, and careful scrutiny of circumstantial evidence to establish cause and manner of death (14). Differentiation between suicidal, accidental, and homicidal poisoning has both legal and social implications, influencing judicial outcomes and preventive policies (15). Forensic toxicology remains a cornerstone for detection and quantification of toxins, facilitating accurate cause-of-death determination and serving as crucial evidence in courts of law (16).Despite existing regulations on the sale and handling of toxic substances, enforcement is inconsistent, and poisoning mortality continues to be a pressing problem (17). Strengthening legal frameworks, increasing public awareness, and establishing poison control centres are critical steps in reducing poisoning-related deaths (18). Moreover, coordinated efforts between medical, forensic, and law enforcement agencies are essential for effective management of poisoning cases from both clinical and medico-legal standpoints (19).This study aims to analyse the medico-legal aspects of poisoning-related deaths among urban and rural populations in and around Guntur, with an emphasis on demographic profiles, types of poisons, circumstances of poisoning, and outcomes. Understanding these factors is pivotal for formulating targeted interventions and improving both forensic and public health responses to poisoning in this region.

The current study was conducted in the Department of Forensic Medicine and Toxicology, Guntur Medical College, from January 2020 to June 2021. The study included the medico-legal autopsy cases of deaths due to poisoning in Guntur, Andhrapradesh. Inclusion criteria : The cases with poisoning were suspected as the cause of death based on clinical history, circumstantial evidence, or preliminary medico-legal examination. Exclusion Criteria: Cases with incomplete records or uncertain cause of death. Demographic details such as age, sex, residence (urban or rural), occupation, and socio-economic status were recorded. Circumstances of poisoning, including the nature (accidental, suicidal, or homicidal), type of poison ingested or exposed to, route and manner of poisoning, and time interval between exposure and death were noted. Forensic autopsies were conducted following standard protocols involving external and internal examination. Specific attention was given to identifying signs of poisoning such as gastric mucosal changes, organ congestion, haemorrhages, and characteristic odour or residue. Samples of viscera (stomach contents, liver, kidney), blood, and urine were collected for chemical analyses. Toxicological investigations were performed at the institutional toxicology laboratory using qualitative and quantitative methods as needed. Commonly employed techniques included colorimetric tests, chromatography, spectrophotometry, and where available, advanced techniques such as gas chromatography-mass spectrometry (GC-MS) to identify and quantify poisons. This methodological approach ensured comprehensive documentation of medico-legal data, aiding in establishing cause and manner of death with forensic precision. All procedures were conducted respecting ethical guidelines and confidentiality. The study aimed to provide an in-depth analysis of poisoning deaths with an emphasis on forensic implications and to contribute to preventive healthcare strategies.

A total of 105 cases of deaths due to poisoning were examined from January 2020 to June 2021. Among these, 62 (59%) victims belonged to rural areas, while 43 (41%) were from urban localities, highlighting a higher incidence in rural populations. The age distribution showed most cases (45.7%) were between 21 and 30 years of age, indicating that poisoning predominantly affects young adults. The second most affected group was 31 to 40 years (20%), followed by 11 to 20 years (15%), illustrating a concentration of deaths in economically productive age groups. The males constituted 75% (79 cases) of the total poisoning deaths, while females accounted for 25% (26 cases),suggesting a male predominance. Socioeconomic data revealed that most victims belonged to lower socioeconomic strata, with a high percentage having limited education levels, which could be associated with risk factors related to occupational exposure and psychosocial stress[Table 1]. The manner of poisoning was predominantly suicidal in 98 cases (93.3%), with accidental and homicidal cases comprising 5(4.8%) and 2 (1.9%) respectively. Organophosphorus compounds were the most common poisons identified in urban cases, accounting for 44.2%, while herbicides such as paraquat predominated in rural cases at 46.8%. The other agents included pharmaceuticals, household chemicals, and industrial toxins in smaller proportions[Table 2]. The interval between poisoning and death varied widely, but most deaths (70%) occurred within 1-3 days following exposure, emphasizing rapid progression in poisoning fatalities [Table 3].The timing of incidents peaked during night hours between 8 PM and 3 AM, possibly reflecting psychological and social factors influencing the act of poisoning. Post-mortem findings commonly included congestion and haemorrhages in various organs, particularly lungs and stomach mucosa, consistent with toxic effects of the poisons involved. Toxicological analyses confirmed the presence of the suspected poisons in biological samples in most cases, playing a crucial role in cause of death determination. Table 1: Age and Sex Distribution of Poisoning Deaths Age Group (years) Male (n, %) Female (n, %) Total (n, %) 11-20 9 (8.6%) 7 (6.7%) 16 (15.2%) 21-30 37 (35.2%) 11 (10.5%) 48 (45.7%) 31-40 18 (17.1%) 3 (2.9%) 21 (20%) 41-50 10 (9.5%) 4 (3.8%) 14 (13.3%) >50 5 (4.7%) 1 (1%) 6 (5.8%) Table 2: Manner and Type of Poisoning by Place of Residence Manner of Poisoning Urban (n, %) Rural (n, %) Total (n, %) Suicidal 39 (37.1%) 59 (56.2%) 98 (93.3%) Accidental 3 (2.9%) 2 (1.9%) 5 (4.8%) Homicidal 1 (1%) 1 (1%) 2 (1.9%) Type of Poison Organophosphates 19 (44.2%) 18 (29%) 37 (35.2%) Herbicides (Paraquat) 7 (16.3%) 29 (46.8%) 36 (34.2%) Pharmaceuticals 6 (14%) 4 (6.5%) 10 (9.5%) Others 11 (25.5%) 11 (17.7%) 22 (21%) Table 3: Time Interval Between Poisoning and Death Time Interval (hours) Number of Cases (n) Percentage (%) <6 22 21% 6-12 18 17% 12-24 25 24% 24-72 30 29% >72 10 9%

The current study highlights several important aspects of poisoning deaths in and around Guntur, reflecting both regional and broader trends observed in India and other developing countries. The predominance of poisoning fatalities among young adults aged 21 to 30 years is consistent with multiple previous reports, where similar age groups were identified as the most vulnerable due to socio-economic pressures and mental health challenges (20,21). The male predominance observed in this study aligns with findings reported by Kumar et al. and Desalew et al., suggesting gender-related differences in exposure risk, occupational hazards, and perhaps help-seeking behaviour(6,22,23).The higher incidence of poisoning deaths in rural areas compared to urban settings concurs with other Indian and international studies (11,24). Easy access to highly toxic agricultural chemicals, particularly organophosphates and herbicides like paraquat, is a major contributing factor to this rural predominance (12,25). Sharma et al. and Gupta et al. similarly reported that rural poisoning cases were mainly due to pesticides, reinforcing the need for targeted preventive measures in agrarian communities (4,26).The overwhelming proportion of suicidal poisoning (93.3%) in this study is a grave public health concern, echoing the national trend of intentional self-poisoning as a common method of suicide in India (9,27). This pattern contrasts with accidental and homicidal poisonings which remain relatively rare but clinically significant. The observation that most deaths occurred within the first 72 hours post-exposure agrees with clinical data emphasizing the rapid toxic progression of common poisons when medical intervention is delayed (10,28). Post-mortem and toxicological findings validated the clinical suspicion and contributed to confirming cause of death, reinforcing the indispensable role of forensic medicine in medico-legal investigations (14,16).These results support guidelines recommending routine toxicological screening in suspected poisoning deaths to aid judicial processes and public health data accuracy (22,29).While regulatory frameworks and public awareness concerning pesticide availability have improved in recent years, the persistent high incidence of poisoning deaths underscores challenges in enforcement and mental health support infrastructure (15,30). Interdisciplinary approaches involving stricter poison control legislation, community education, and improved healthcare access, particularly in rural regions, are crucial to mitigate this continuing problem (17,31).Our findings aiding the formulation of tailored interventions to reduce poisoning mortality. Future research could focus on psychological autopsies and societal factors to provide a more holistic understanding and improved preventive strategies.

This study highlights that poisoning deaths predominantly affect young adult males from lower socioeconomic backgrounds, with suicidal poisoning being the most common cause. Rural cases mainly involve herbicides, while urban cases more frequently involve organophosphates. The findings emphasize the need for timely medical care, stringent poison regulation, and targeted preventive strategies to reduce mortality (32,33). Limitations The study is limited by its regional focus and reliance on retrospective medico-legal and hospital records, which may contain incomplete data. Toxicological analyses had occasional resource constraints, and psychological factors behind poisoning could not be explored in depth. Future Aspects Future research should include larger, multicenter studies and psychological autopsies to better understand causes of suicidal poisoning. Improving forensic toxicology facilities and evaluating the effectiveness of public health interventions will help reduce poisoning deaths. Community mental health and poison awareness programs tailored to local needs are essential (34,35).

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