A Sustainable Treatment Protocol for Organophosphate Poisoning in Rural Kenya for Facilities without Intensive Care Units and Where Transfer Is Not Possible

Organophosphate poisoning is a common method of attempting suicide in developing countries, particularly in rural areas. The current WHO protocols emphasize intubation and transfer to a facility with intensive care. Both recommendations are beyond the resources of many rural hospitals in developing countries and their poor patients. Because organophosphate poisoning is a commonly seen condition in Kenya and because intubation is beyond the equipment and training of many rural hospitals, a protocol involving atropine without intubation was developed and used. The protocol includes placement of a nasogastric tube, activated charcoal, intravenous fluids, and atropine along with other supportive measures; the protocol was developed based on a literature search of international medical journals and has been in use for years at Kapsowar Mission Hospital (KMH). Organophosphate poisoning outcome data at KMH were reviewed for 2021-2023. One patient died within minutes of presentation to the Casualty Ward, but the rest survived to discharge using the above protocol. The cost of the atropine protocol is over U.S. $200 in Kenya. The recommendations of the WHO are usually helpful to practitioners in underresourced facilities. In the case of organophosphate poisoning, the recommendations are more appropriate to higher-income countries and highest-level hospitals in low- and middle-income countries, facilities that have intubation capability and large quantities of atropine. A protocol using less atropine could be offered as an alternative.