Epidemiology of kerosene poisoning in Saudi Arabia: a retrospective analysis

Introduction

Globally, unintentional poisoning remains a significant public health challenge. According to the 2022 World Health Statistics, unintentional poisoning caused 84,000 deaths worldwide, with rates ranging between 0.6 and 1.8 per 100,000 individuals (World Health Organization, 2022). This has contributed to the loss of approximately 5 million disability-adjusted life-years (DALYs) (Khan et al., 2023). As per the World Health Organization (WHO), it has been discovered that 91% of casualties due to unintentional accidents and 94% of DALYs are in low- and middle-income countries (Chandran, Hyder & Peek-Asa, 2010).

Children, especially those under the age of five, are the most vulnerable (Ahmed et al., 2015). The American Association of Poison Control Centers (AAPCC) revealed that in 2015 there were 1.3 million children who were exposed to poisonous substances and among them 40% were under 3 years of age (Mowry et al., 2016). In developing countries, pediatric poisoning often stems from household chemicals, with kerosene being a leading cause of unintentional poisoning, accounting for up to 70% of cases in pediatric emergency settings (Prasadi et al., 2018; Oreh et al., 2023).

Kerosene, a combustible oily liquid also known as paraffin or fuel no.1, is widely used for lighting, heating, and cooking in low-resource settings (Maiyoh, Njoroge & Tuei, 2015). Kerosene can cause severe health complications such as aspiration pneumonitis and, in extreme cases, death (Lam et al., 2012; Kumar, Kavitha & Angurana, 2019). Studies from Asia and Africa consistently show that children under 6 years of age are disproportionately affected by kerosene poisoning, largely due to unsafe storage practices, such as the use of unmarked or attractive containers, and a lack of adequate supervision (Anwar et al., 2014). Socioeconomic disadvantages and deficient parental education further exacerbate the risk (Ahmed et al., 2022; Dayasiri, Jayamanne & Jayasinghe, 2017; Edelu et al., 2016; IK et al., 2021; Parekh & Gupta, 2017).

In Saudi Arabia, kerosene continues to be used in many households, particularly in rural and colder regions. However, limited research has been conducted to assess the extent and characteristics of kerosene poisoning at the national level. Existing studies are either regional or general investigations of chemical poisoning (Alshahrani et al., 2023). For example, reports from Makkah and Jeddah highlight that a significant proportion of chemical poisoning cases involve children under five, most occurring in domestic settings (Alnasser, 2022; Alzahrani et al., 2017). However, no study has comprehensively investigated kerosene poisoning across the Kingdom using national data.

Materials and Methods

Results

As presented in Table 1, Saudi citizens were most reported cases of kerosene poisoning (97.6%, p = 0.657). Males are more affected than women, but not significantly (p = 0.912). Most of the cases in the 1–5-year-old age group where the result of data ages was the most vulnerable group, which was the most significant thing found (p = 0.029). The monthly distribution of kerosene poisoning cases from 2019 to 2021 reveals a clear seasonal trend (Fig. 1), with a significant increase in cases during the colder months (January–April and December). The peak occurred in March with 75 cases, followed closely by January and February, each reporting 61 cases. After April, a sharp decline was observed, reaching the lowest point in September with only eight cases. A gradual rise began again in October (26 cases), continuing through November (45 cases) and December (56 cases).

The regional distribution of kerosene poisoning cases as shown in Fig. 2, and Table 2 highlights significant variation across Saudi Arabia (p = 0.000), with the AlQrayat Region consistently reporting the highest number of cases (53%, n = 244), peaking in 2020 (61.4%). The Northern Borders Region contributed 18% of cases (n = 83), while the AlJouf Region exhibited a dramatic increase, rising from 0% in 2019 to 38.3% in 2021 (n = 72). The Hail Region reported 7% of cases (n = 32), and the remaining areas, categorized as “Others,” accounted for 5.2% (n = 24). The Riyadh Region consistently reported the fewest cases (1.1%, n = 5).

Home is where most kerosene poisoning incidents occur (83.7%, p = 0.000), with the proportion increasing notably in 2020 (87.7%) and 2021 (84.4%), underscoring homes as the primary setting for exposure. Other locations, such as farms (0.4%) and schools (0.2%), were rare, while undefined locations accounted for 8.3% of cases (Table 3).

Regarding the route of exposure, oral ingestion was the predominant route (91.7%, p = 0.000), with the highest occurrence in 2020 (95.9%) and 2021 (95%). Inhalation and dermal exposure were minimal, contributing 0.9% and 0.2%, respectively, while undefined routes accounted for 7.2% (Table 3).

Management of kerosene poisoning cases showed significant variation over the study period (p = 0.000). Overall, 41.3% of cases required hospital admission, with the highest proportion in 2020 (48%). Cases with no admission accounted for 31.3% of the total, showing a slight decline in 2021 (28.4%). Notably, the proportion of cases discharged against medical advice (DAMA) increased from 8.1% in 2019 to 28.4% in 2021, totaling 17.6%. Rare outcomes included transfers (0.4%) and absconding (0.2%). The percentage of unidentified management outcomes decreased significantly from 27% in 2019 to 0% in 2021, (Table 4).

Discussion

This study explored the epidemiological characteristics of kerosene poisoning in Saudi Arabia from January 2019 to December 2021 using national surveillance data. Our findings align with global trends and highlight key demographic, seasonal, and geographic variations in kerosene poisoning cases, emphasizing the need for region-specific public health strategies.

Demographically, children aged 1–5 years were the most affected group, accounting for 87.6% of cases, a finding consistent with studies in Nigeria and South Asia that report toddlers’ increased vulnerability due to hand-to-mouth behavior and curiosity-driven exposure (Khan et al., 2023; Oreh et al., 2023). Similar studies in Sri Lanka and Bangladesh confirm that young children are disproportionately impacted by kerosene poisoning (Prasadi et al., 2018; Ahmed et al., 2022). While males (60.9%) were more frequently affected than females, this gender disparity was not statistically significant (p = 0.912), suggesting that both genders remain at risk, aligning with findings from Kumar, Kavitha & Angurana (2019).

Households were identified as the primary site of poisoning (83.7%, p = 0.000), corroborating global studies that emphasize the role of unsafe storage practices (Chandran, Hyder & Peek-Asa, 2010; Alshahrani et al., 2023). Ingestion of kerosene was the predominant route (91.7%), reflecting findings in Nigeria, India, and Sri Lanka, where children often mistake kerosene for water or other consumables due to its storage in accessible or unlabeled containers (Dayasiri, Jayamanne & Jayasinghe, 2017; Anwar et al., 2014; Maiyoh, Njoroge & Tuei, 2015). These results highlight the urgent need for parental education on safe kerosene storage and child supervision.

Regional variations revealed a significant concentration of cases in the AlQrayat Region (53%), followed by the Northern Borders (18%) and AlJouf (15.7%), consistent with reports linking colder climates to increased kerosene use for heating (Khan et al., 2023). Local news and global studies confirm that demand for kerosene rises sharply during winter in northern regions, increasing the risk of poisoning incidents (Lam et al., 2012; Alnasser, 2022). This spatial pattern underscores the relationship between environmental factors and poisoning, necessitating region-specific interventions during winter months.

Seasonal trends demonstrated a clear peak in poisoning cases during January to April and December, aligning with the colder months when kerosene is extensively used for heating. These findings mirror results from studies in low- and middle-income countries (LMICs) such as Bangladesh, Sri Lanka, and India, where seasonal demand drives kerosene use (Ahmed et al., 2022; Parekh & Gupta, 2017). Such trends emphasize the need for preventive efforts, particularly during winter, including awareness campaigns and safer heating alternatives.

While this study provides valuable national-level insights, some limitations must be acknowledged. Data gaps regarding socioeconomic status, parental education, and storage conditions limited our ability to fully explore the underlying factors contributing to kerosene poisoning. Similar limitations have been reported in LMIC settings, where underreporting and incomplete data collection impede the accurate assessment of poisoning trends (Oreh et al., 2023; Almutairi et al., 2023). Future studies should address these gaps and explore the long-term health impacts of kerosene poisoning, particularly respiratory conditions like aspiration pneumonitis (Balme et al., 2015; Tormoehlen, Tekulve & Nañagas, 2014).

Despite these limitations, this study’s strengths include its use of comprehensive, nationally representative surveillance data, providing a clear understanding of kerosene poisoning trends across Saudi Arabia. As the first national-level study on kerosene poisoning, it establishes essential baseline data to inform public health policies and interventions.

Conclusions

This study provides the first national-level analysis of kerosene poisoning in Saudi Arabia, highlighting critical epidemiological patterns between 2019 and 2021. Children aged 1–5 years were identified as the most vulnerable group, with poisoning incidents occurring predominantly in households through oral ingestion. The AlQrayat Region and other northern areas reported the highest case concentrations, particularly during the colder months of January to April and December, reinforcing the seasonal association with kerosene use for heating.

These findings emphasize the need for targeted public health strategies, including parental education on safe kerosene storage, improved supervision of young children, and region-specific interventions, particularly in high-risk areas. Awareness campaigns, safer heating alternatives, and policy-driven solutions are essential to mitigate the risks of kerosene poisoning.

While data gaps limited our ability to fully explore socioeconomic and environmental factors, this study establishes a robust baseline for future research and interventions. Addressing these limitations and exploring the long-term consequences of kerosene poisoning will further strengthen preventive measures and improve child safety in Saudi Arabia.

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