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Meta-Analysis
. 2019 Sep-Oct;51(5):302-315.
doi: 10.4103/ijp.IJP_246_17. Epub 2019 Nov 26.

A systematic review and meta-analysis of the prevalence and complications of paraphenylenediamine-containing hair dye poisoning in developing countries

Akshaya Srikanth Bhagavathula  1 , Deepak Kumar Bandari  2 , Moien Khan  3 , Abdulla Shehab  1
Affiliations
Meta-Analysis

A systematic review and meta-analysis of the prevalence and complications of paraphenylenediamine-containing hair dye poisoning in developing countries

Akshaya Srikanth Bhagavathula et al. Indian J Pharmacol. 2019 Sep-Oct.

Abstract

Background: Suicide is a public health problem, and the number of paraphenylenediamine (PPD)-containing hair dye poisoning with suicidal intentions is increasing in developing countries. In order to better understand this situation, we aimed to conduct a systematic review and meta-analysis to estimate the prevalence and complications associated with hair dye poisoning in developing countries.

Methods: We conducted a systematic review of epidemiological studies using MeSh terms and text keywords to identify studies from the inception to March 2016 about hair dye poisoning with suicidal intentions in developing countries. A meta-analysis was used to calculate the pooled prevalence proportion of hair dye poisoning and its major complications. Data extraction, data analysis, and risk of bias assessment were performed.

Results: Thirty-two studies were included in the systematic review and 29 of these studies containing 5,559 subjects covering six countries were included in the meta-analysis. The pooled prevalence proportion of hair dye poisoning with suicidal intentions was 93.5% (95% confidence interval [CI] = 91.6-95.4) with a mortality rate of 14.5% (95% CI = 11.1-17.9). Of these, 73.8% were female, and 26.2% were male (sex ratio: 2.7:1). The occurrence of angioneurotic edema in hair poisoning patients was 67.1% (95% CI = 56.6-77.6), and tracheostomy intervention was considered in 47.9% (95% CI = 22.7-73.2) patients with respiratory distress. Acute renal failure was noticed in 54.7% (95% CI = 34.5-74.9) of the pooled samples and mortality rates were 14.5% (95% CI = 11.1-17.9). The pooled rate of the population studied from Asia and Africa showed 94.6% (95% CI = 92.5-96.7) and 82.9% (95% CI = 70.6-95.3), respectively, ingested hair dye with suicidal intentions. Further, studies carried out in Africa showed slightly higher mortality of 15.1% (95% CI = 6.56-23.7) than the Asians 14.3% (95% CI = 10.5-18.1).

Conclusion: This meta-analysis provided clear evidence of the prevalence of hair dye poisoning among individuals with suicidal intentions and had given robust evidence for policy making to curtail emerging PPD-containing hair dye poisoning in developing countries.

Keywords: Developing countries; hair dye poisoning; hair dye toxicity; household poisoning; paraphenylenediamine poisoning; suicides.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow of information
Figure 2
Figure 2
Ingestion of paraphenylenediamine-containing hair dye with suicidal intentions
Figure 3
Figure 3
Cervicofacial edema–angioneurotic edema in hair dye ingested patients
Figure 4
Figure 4
Analysis of tracheotomy intervention in paraphenylenediamine-containing hair dye poisoning
Figure 5
Figure 5
Occurrence of acute renal failure in hair dye poisoning patients
Figure 6
Figure 6
Analysis of hair dye intoxication mortality
Figure 7
Figure 7
Gender differences in hair dye poisoning patients
See this image and copyright information in PMC

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