Poisoning is the injury, dysfunction, illness, or death that occurs when a harmful substance enters the body through swallowing, breathing, skin contact, injection, or other routes, overwhelming the body’s ability to neutralise or eliminate it.

It remains a significant yet under-recognised global public health challenge, with the World Health Organisation estimating that more than 84,000 people died from unintentional poisoning in 2019.

In Ghana, the true incidence of poisoning is not well known, as accurate statistics are still in the works.

However, incidents of poisoning are steadily emerging as a concern for public health, law enforcement, and forensic science.

The spectrum of toxic exposures is diverse and complex.

While many cases remain underreported, recent estimates suggest that Ghanaian health facilities encounter an average of around 20 poisoning or toxic exposure cases per month, spanning accidental exposures in children and adults to adult occupational or intentional poisonings.

Frequently, deaths by poison are varied, mimicking natural illness, eluding early detection, and striking without warning.

In the animal kingdom, toxic exposures - such as pesticide-laced carcasses used by poachers or naturally occurring toxins like anthrax - have led to mass mortalities in wildlife, disrupting ecosystems and posing indirect risks to human communities.

At the heart of Ghana’s national response to poisoning is one crucial, yet under- resourced institution - the Ghana Poison Control Centre (GPCC) - working at the intersection of clinical management, toxicology information, public health, and forensic investigation.

Terminologies – poison, toxin, toxicant

A poison is any substance that can cause harm, illness, or death when introduced into the body in sufficient quantity, regardless of whether it is natural or synthetic.

A toxin is a specific type of poison of biological origin, produced naturally by living organisms, while a toxicant refers to a man-made or synthetic poisonous substance arising from human activities such as industry or agriculture.

Venom is a subset of toxins that is actively injected into a victim through bites or stings, distinguishing it from poisons that act when swallowed, inhaled, or absorbed through the skin.

Toxicity or poisoning describes the degree of harm and the clinical condition resulting from exposure to these substances.

In essence, all toxins and toxicants are considered poisons.

“Poison” is the broadest, often colloquial, term for any substance causing harm, while “toxin” and “toxicant” are narrower, more specific scientific terms based on the substance’s source.

Understanding these distinctions is essential in forensic investigations, clinical toxicology, environmental health, and legal proceedings, where precise terminology can determine cause of death, liability, and policy response.

Types and categories of poisoning

Poisoning may occur accidentally, intentionally (including self-harm or criminal acts), or occupationally, and can produce effects ranging from mild symptoms to sudden death.

Poisoning is broadly categorised by duration of exposure into acute poisoning, resulting from a single or short-term high-dose exposure, and chronic poisoning, arising from repeated or long-term low-dose exposure with cumulative effects.

It is also classified by source or agent, including chemical poisons (such as pesticides, pharmaceuticals, heavy metals, and industrial chemicals), biological toxins (venoms, toxic plants, and microorganisms), food- and beverage-related toxins, toxic gases, and unknown or emerging substances.

Understanding poisoning and forensic toxicology

At its core, forensic toxicology is the discipline that applies scientific principles to detect and interpret the effects of toxic substances on the human body, especially in medicolegal contexts.

Forensic specialists draw on the clinical presentation of symptoms, knowledge of toxic agents, and laboratory analyses to determine whether a death was caused by poisoning.

The process begins long before an autopsy; it often starts at the crime scene or emergency department with detailed history-taking, victim symptomatology, and contextual investigation.

Forensic toxicologists then analyse biological samples - blood, urine, hair, nails, tissues, etc. - to identify and quantify toxic
substances.

The goal is to distinguish death by poisoning from natural causes or other causes of injury, providing evidence that can stand up in court or inform public health interventions.

In many poisoning cases, the signs are subtle and nonspecific - In many poisoning cases, the signs are subtle and nonspecific—such as headache, nausea, and dizziness—yet they portend deeper biochemical disruption in the victim’s body.

A poison can mimic natural disease processes, striking without visible trauma and challenging clinicians and investigators alike to recognise the true cause of death.

This is where toxicology intersects profoundly with forensic investigation: through scientific detection and interpretation, the invisible becomes evident.

The Ghana Poison Control Centre (GPCC): Functions and challenges

Established in 2002 under the Ghana Health Service, the Ghana Poison Control Centre operates as the nation’s primary hub for poison information, detection, collaborative management, and prevention.

Physically located in Accra and extending services nationwideregionally, the Ccentre runs a 24/7 helpline/hotline 020 2222 174 that offers guidance to both healthcare professionals and the general Physically located in Accra and extending services regionally nationwide, the Centre runs a 24/7 helpline/hotline, 020 2222 174, that offers guidance to both healthcare professionals and the general public.

Its inception stemmed from a recognised need to support clinical management
of poisonings, to address the fact that health professionals could not be expected to know about the toxicity of every substance and product on the market that is being produced rapidly, support public health response to chemical incidents/emergencies, to build capacity within the health sector for toxicological surveillance, as well as to provide a focus for toxicological research.

The core functions of the GPCC encompass emergency response and clinical
guidance, data collection and toxicovigilance, training and awareness, as well as the development of toxicological databases.

However, despite its vital role, the GPCC faces significant challenges.

There is a persistent shortage of trained personnel.

Frequently, deaths by poison are varied, mimicking natural illness, eluding early detection, and striking without warning.

In addition, the Centre does not have a complementary toxicology laboratory that can provide toxicological analyses or access to a good toxicology laboratory (in-country or abroad), hindering its ability to conduct comprehensive analyses of biological specimens in suspected poisoning deaths.

Networking with regional health services is weak, and while the poison information database is robust, access to real-time data and broader clinical support remains constrained.

Forensic Investigations: From case to court

In the context of a suspected poisoning death, forensic investigations begin with scene analysis and careful documentation of circumstances - witness accounts, environmental factors, available clinical records, and symptoms observed before death.

Forensic pathologists and toxicologists then work collaboratively to confirm the presence of toxic substances and to interpret toxicological findings.

Where poisoning is established as the cause, this evidence becomes pivotal in criminal investigations and prosecutions.

In cases of chronic poisoning and exposure to sophisticated, rapidly metabolized poisons, the poison may break down in the body or be eliminated before detection, leaving only organ-specific structural and functional damage at autopsy.

This makes the definitive identification of the poison difficult and can mask the confirmation of death by poisoning.

There is therefore a need for prompt and sensitive analytical methods and biomarkers to overcome these challenges and link specific toxic exposures to observed tissue injuries.

This holistic approach underscores why strengthening the GPCC and establishing a
National Forensic Authority is not merely about treating exposures, but about enhancing Ghana’s capacity to detect, respond to, and prevent poisoning-related deaths across the spectrum.

Conclusion

Poisoning in Ghana is a multifaceted public health challenge that demands a
multidisciplinary response.

At the forefront stands the Ghana Poison Control Centre and the need for a forensic regulatory authority - crucial institutions that not only support clinical and emergency responses but also anchor national efforts in toxicovigilance, education, and forensic collaboration.

To unlock their full potential, sustained investment in human resources, toxicological laboratory capacity, availability of antidotes and supportive medications for toxic exposures and poisoning management, and nationwide data integration is essential.

Only then can Ghana transform the silent tragedy of poisonings into a landscape where scientific insight, clinical care, and legal clarity converge to save lives and administer justice.