Healthcare Workers’ Perspectives on Medical Toxicology Needs at a Tertiary Referral Hospital in Abuja, Nigeria: A Qualitative Study

1. Introduction

Nigeria, Africa’s most populous country and one of Sub-Saharan Africa’s largest economies, faces significant healthcare challenges related to infrastructure, resource allocation, and equitable access to care [1]. Poisoning remains an important but under-recognized public health concern in Nigeria, with reported exposures including paraffin ingestion, carbon monoxide poisoning, acute pesticide poisoning, toxic alcohol ingestion, lead exposure, snakebite envenomation, and toxicity associated with traditional medicines [2]. Lower socioeconomic conditions contribute significantly to the poisoning risk in sub-Saharan Africa, with poverty, overcrowded living environments, unsafe storage practices, and reliance on hazardous domestic fuels increasing exposure to toxic substances [1,3]. Cultural health practices and the widespread use of traditional medicines may further shape toxicological risk and healthcare-seeking behavior [4]. In addition, healthcare workers face challenges related to limited toxicology training, inconsistent antidote availability, and restricted access to specialist poison information support [5,6,7].

A needs assessment was deemed essential for understanding the burden and patterns of poisoning in Sub-Saharan Africa [8,9]. It can provide insight into the health system capacity by identifying gaps in resources, services, and the ability to manage poisoning cases, thereby informing policy, resource allocation, and prevention strategies. In sub-Saharan Africa, data on poisoning epidemiology remain limited, with gaps in surveillance systems and published literature that hinder a full understanding of poisoning patterns and their complexity. This study therefore explored healthcare workers’ perspectives on poisoning and medical toxicology needs in Nigeria, focusing on socioeconomic determinants, culturally embedded health practices, educational gaps in medical toxicology, antidote availability, and the need for strengthened poison information services.

2. Methods

This study applied a qualitative design guided by the Contextual Needs Assessment Framework and a pragmatic paradigm, focusing on real-world challenges in healthcare systems [10,11,12]. The study explored healthcare workers’ perspectives on medical toxicology needs at a tertiary referral hospital in Abuja, Nigeria. Semi-structured interviews were the primary data source. The study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) (Supplementary Table S1).

The study population included healthcare professionals involved in the management, prevention, and education of poisoning emergencies at the National Hospital, Abuja, Nigeria. Eligible participants included physicians, pharmacists, nurses, and other healthcare professionals with clinical experience or a demonstrated interest in medical toxicology. We identified potential participants through departmental networks and recommendations from senior clinicians and invited them by email. Fourteen healthcare professionals participated in the study, and no participants withdrew. The interviews provided rich, recurring accounts of the issues explored, with no substantially new themes emerging in later interviews. The principal investigator, a female pharmacist, Specialist in Poison Information, and PhD candidate with postgraduate training in medical toxicology and qualitative research, conducted all interviews. The interviewer had no prior relationship with participants before recruitment. Before consent, participants were informed of the study aims, the researcher’s professional background, and the voluntary nature of participation.

A semi-structured survey questionnaire was emailed to participants four weeks before the interviews. The survey was not used for statistical analysis; it encouraged reflection on participants’ experiences and familiarised them with key topics related to poisoning and medical toxicology. Survey responses informed refinement of the semi-structured interview guide, which was developed from the study protocol and pilot-tested before data collection.

During the site visit to Abuja, face-to-face semi-structured interviews were conducted in July 2026 in a private room at the National Hospital, Abuja. Only the participant and the interviewer were present during the interview. Interviews lasted approximately 40–50 minutes, were audio-recorded with written consent, and field notes were documented immediately after each interview to capture contextual observations and reflections. Reflective listening and clarification techniques were used throughout the interviews to ensure accurate understanding and to encourage participants to elaborate on their responses [13].

Audio-recorded interviews were transcribed verbatim and imported into ATLAS.ti 2025 for data management. Transcripts were returned to participants for verification and correction prior to analysis. Repeat interviews were not conducted. Data were analyzed using reflexive thematic analysis as described by Braun and Clarke [14]. The principal investigator conducted all coding. The transcripts were read several times to become familiar with the data. Initial codes were developed directly from the participants’ responses and grouped into potential themes. These themes were reviewed and refined by comparing them across all transcripts to ensure they accurately reflected the data. Field notes supported interpretation of the findings. Representative quotations are presented to illustrate each theme.

The study was conducted in accordance with the principles of the Declaration of Helsinki. We obtained ethical approval from the Health Research Ethics Committee of Stellenbosch University (S24/11/296) and additional approval from the Health Research Ethics Committee of the National Hospital, Abuja (NHA/EC/104/2024). We obtained written informed consent from all participants and de-identified and anonymized all data to ensure confidentiality.

3. Results

Fourteen healthcare professionals participated in both the electronic survey and in-depth interviews. Participant demographic and professional characteristics are presented in Table 1.

Reflexive thematic analysis generated two overarching themes that captured healthcare workers’ perspectives on poisoning in Nigeria. The first theme, Factors contributing to poisoning and challenges in poisoning management, explored participants’ experiences of the socioeconomic, cultural, and educational factors influencing poisoning and its management. The second theme, strengthening poisoning management in Nigeria, highlighted participants’ recommendations for improving poisoning care through enhanced antidote availability, the establishment of Poison Information Centers, and educational and digital support. The themes, sub-themes, and illustrative codes are summarised in Table 2.

4. Discussion of Findings

4.1. Theme 1: Factors Contributing to Poisoning and Challenges in Poisoning Management

4.1.1. Socioeconomic Determinants of Poisoning

Participants described how economic factors shape household fuel use and poisoning risk. Although some reported a shift from kerosene to cleaner energy sources such as Liquefied Petroleum Gas, this transition was inconsistent and largely influenced by affordability. “There is a shift from the use of kerosene to cleaner sources of energy… like liquefied petroleum gas”. In sub-Saharan Africa, kerosene remains widely used among lower-income households with limited access to alternative fuels [15]. As one participant noted, “The price of kerosene went up, so it was no longer a cheaper alternative… people had other alternatives like charcoal,” while another emphasized that “A lot of people still use kerosene. People who cannot afford gas.” These accounts reflect the broader context described in the literature, where accidental kerosene (paraffin) poisoning remains a significant contributor to childhood morbidity and mortality in Nigeria, particularly among children under five years from low socioeconomic backgrounds [16,17,18].

Participants frequently linked pediatric exposures to unsafe storage practices, particularly those involving beverage containers. As one participant explained, “They store kerosene in beer bottles or Coca-Cola bottles… children assume it is water and drink it.” This finding aligns with existing literature, which identifies storing kerosene in drink containers as a key risk factor for accidental ingestion, as children may mistake the substance for water or a soft drink [16,17].

Several participants reported carbon monoxide poisoning, primarily associated with generator fumes. Most accounts involved severe toxicity, including fatalities. Exposure was commonly linked to generators placed close to homes or within living spaces, often due to concerns about theft or limited space. Participants consistently described incidents in which multiple household members were affected simultaneously, usually during sleep, due to poor ventilation: “They used a generator, the smoke. All of them didn’t wake up… the wife, the husband, and a child”. Generator emissions become particularly hazardous when devices are operated in close proximity to living or working spaces, increasing the risk of severe hypoxic injury and potentially fatal outcomes [19].

Herbal remedies were perceived as accessible, affordable, and effective, particularly among individuals from lower socioeconomic backgrounds. As one participant explained, “Their forefathers or their parents were herbalists… they actually saw effects of the traditional medicine because it is accessible and cheaper for them.” This reflects how socioeconomic constraints and cultural beliefs are closely intertwined in shaping reliance on herbal medicine in Nigeria, underscoring the importance of public health strategies that support the integration of traditional and modern healthcare systems [20]. Participants described a wide range of herbs, plants, and concoctions used for various conditions, including chronic diseases, infections, and even cancer prevention. Commonly mentioned plants included: Moringa, Neem, Hibiscus, Mango leaf, and paw paw leaf. “Some will boil leaves… add all sort of leaves… some herbs …There’s something they call Igbo… one herbal concoction for malaria, typhoid, purging, diabetes, hypertension, even cancer.” Participants identified multiple drivers of traditional medicine use, including cultural beliefs, affordability, accessibility, and perceived effectiveness. “They believe that once it is bitter, it will bring down blood glucose… people buy it, cultivate it”.

When prompted, participants recalled incidents consistent with toxic alcohol exposure, including methanol poisoning outbreaks and adverse effects from home-brewed alcoholic beverages. “There was a strange sickness… people will just go blind, and after some days they die… they traced it to a local brewer… they saw that there was methanol.” “After a while, he became blind… he didn’t stay long… after a while, he died.” Locally produced alcoholic beverages such as Burukutu were frequently mentioned in relation to acute illness and collapse: “What we see sometimes… local alcohols, we call it Burukutu. They make their own home brew… from sorghum and maize. After drinking this kind of concoction, people collapse.”

These accounts reflect how socioeconomic factors shape exposure to unsafe, unregulated alcoholic beverages, where limited access to regulated products and reliance on informal production systems increase the risk of toxic alcohol–related poisoning [21,22,23,24].

Across interviews, socioeconomic factors emerged as a central determinant of substance abuse patterns. Participants described how low-cost, easily accessible substances such as tramadol and sachet alcohol were frequently used, particularly among economically vulnerable groups. As one participant noted, “The poor people will succumb to the one that they can afford, like tramadol.” This is consistent with the literature, which reports high tramadol misuse among individuals with lower educational status and those engaged in manual or strenuous occupations [25]. Inhalant use was highlighted as a particular concern among young men and those in informal work settings, with substances such as glue and adhesives commonly used for intoxication: “They just need to inhale and inhale… and they find themselves in the emergency.” Other hazardous practices were also described, including inhalation of gases from pit latrines: “We see cases where they will be inhaling the smell from the pit latrine.” The literature reports that age and level of education are significantly associated with the occurrence of nonconventional substance abuse, such as the whitish end of lizard dung and hydrogen sulfide gas (sewer gas) [26].

Alcohol use was similarly shaped by cost and availability, with participants highlighting the widespread use of inexpensive, high-strength sachet alcohol: “Some of them are sold in sachets… they are very affordable. “One participant explained, “Lots of alcohol… inhalant drugs. Marijuana, very common too, and sometimes cocaine abuse.” These findings are consistent with existing literature, including the systematic review by Mordecai Oweibia, which highlights the significant public health impact of drug abuse in Nigeria and underscores the role of structural and socioeconomic determinants in driving substance use patterns [27].

Limited access to comprehensive pain management services and the high burden of chronic disease may also contribute to poisoning risks through the misuse of prescribed medications. Participants highlighted pentazocine misuse among patients with sickle cell disease, a genetic disorder that is particularly prevalent in parts of Sub-Saharan Africa [28]. The recurrent, severe pain crises associated with the condition often necessitate frequent analgesic use, which may increase the risk of dependence and misuse where access to structured pain management is limited. As one participant noted, “A lot of sickle cell disease patients are abusing pentazocine.”

Participants consistently described how the widespread availability and low cost of highly toxic pesticides in open markets facilitate their use in self-harm, particularly in settings shaped by poverty and agricultural livelihoods. As one participant explained, “You can buy it in the market, open market… you will see hawkers in the streets selling rat killer all the time,” while another noted that products intended for farming are easily repurposed: “The agricultural companies department sells this pesticide, especially during the rainy season… but those people who are depressed use it to harm themselves. “Commonly implicated agents included locally known products such as Sniper, Commando and Otapiapia, with participants emphasizing both their affordability and lethality: “If they want to kill themselves, it’s that Sniper… it is cheap and works very fast.” Participants highlighted weak enforcement of regulations as a contributor to continued availability: “The National Agency for Food and Drugs Administration Control tried to ban open market sales of Sniper… it is still easily available.” Low cost and accessibility were consistently reported as key factors in intentional poisoning: “They are cheap. They are affordable and accessible, and people know they are very harmful. So those who take them, most of them are intentional.”

Participants described frequent use of pesticides such as organophosphates and aluminium phosphide in self-harm, particularly among adults presenting to hospital units. “In our adult section, we see a lot of self-inflicted poisoning from organophosphates.” Aluminium phosphate… that one is very popular with people who want to commit suicide.” Informal preparation and resale practices, including dilution and repackaging into smaller bottles, were noted to further increase accessibility: “Some people buy the whole pack and dilute it, then get smaller bottles to sell… it’s a thriving business.”

These perspectives align with literature showing that pesticide self-poisoning remains a leading and highly lethal means of suicide in Nigeria and other low- and middle-income countries, where easy access, high toxicity, and limited regulatory control contribute to fatal outcomes [29,30]. The high lethality of these chemicals often prevents timely medical intervention, meaning that impulsive suicide attempts frequently result in death. Unlike more deliberate methods, many individuals do not intend to die but are unable to access help once ingestion occurs [31].

In addition, Nigeria’s heavy reliance on agriculture as a source of livelihood further compounds the risk [32]. Pesticides are widely used in farming and are often stored in rural households, meaning that large portions of the population have easy access to highly toxic compounds. Products such as Sniper and Otapiapia, both 2,2-dichlorovinyl dimethyl phosphate compounds, are frequently implicated in suicides. Otapiapia is extremely cheap, sold without age restrictions, quantity limits, or monitoring, while Sniper has appeared repeatedly in media reports following multiple fatal incidents [29,33,34]. The affordability of pesticides sold in small, repackaged quantities contributes to their widespread availability in rural and peri-urban communities. Weak regulatory enforcement allows this informal practice to continue, increasing access to highly hazardous pesticides and the risk of accidental and intentional poisoning [35].

Snakebite is a significant yet under-recognized public health problem in Nigeria, disproportionately affecting rural and agricultural communities [36]. The concentration of cases in northern regions, such as Plateau State and the North-East (Gombe), reflects the intersection of environmental exposure and occupational risk, particularly among farmers [37]. This was consistently reflected in healthcare workers’ perspectives. “Snakebite… is a common thing, like in Plateau State… it’s quite common.” “Yes, we do see snakes… it’s seasonal… and it’s usually common among farmers…It’s more in the Northeast.”

The burden of snakebite in Nigeria is closely influenced by socioeconomic factors. The higher burden among farmers reflects occupational exposure associated with agricultural livelihoods, particularly in rural and northern regions where structural inequalities and limited access to healthcare persist. These factors influence not only snakebite risk but also access to timely, appropriate treatment. Delayed presentation to healthcare facilities, as described by participants, likely reflects financial constraints, long travel distances, and limited access to emergency care, contributing to poorer outcomes. Participants described severe envenomation, including respiratory distress, bleeding, and death, often occurring before or shortly after arrival at the hospital: “He was almost dying, gasping… he was cyanosed completely…” “At the end of the day… they just died away… not even taken to the hospital.” Died on the farm due to a snake bite.”

Participants reported a range of first aid practices, many of which are inconsistent with evidence-based guidelines and may be harmful. Commonly described interventions included the application of tourniquets and incision at the bite site: “We use rope to tie above the site… to prevent circulation.” They cut open the place with a razor blade… trying to squeeze out blood.”

4.1.2. Cultural Embeddedness of Health Practices, Medicine Use, and Toxicological Risk

Traditional medicine remains a deeply embedded component of healthcare in Nigeria and across Sub-Saharan Africa, reflecting its cultural significance, accessibility, and affordability. Participants highlighted its deep cultural roots, with practices often communicated across generations. “It’s just traditional. That’s what they grew up doing… my dad used to mix this, this, and this, when I have malaria, I will take it for malaria prevention.” The findings of this study highlight that traditional remedies are often used as a first-line approach to care, particularly among lower socioeconomic groups where barriers to accessing formal healthcare persist. This aligns with estimates from the World Health Organization, suggesting that a substantial proportion of the African population relies on traditional medicine for primary healthcare [38].

While traditional medicine holds cultural and social value and therapeutic aid, participants highlighted serious toxicological concerns, particularly the adulteration of herbal remedies with pharmaceutical agents. This practice was described as common and often hidden from consumers. Participants reported the addition of substances such as hypoglycaemic agents, analgesics, tramadol, and sildenafil to herbal preparations to enhance perceived efficacy: “One guy… he buys glibenclamide and adds to the concoction… so you think this is traditional medicine.” “Some local vendors add Tramadol or Sildenafil to treat sexual disorders… they will tell you it works for everything.” These adulterations introduce unpredictable pharmacological effects, increasing the risk of acute toxicity, drug interactions, and delayed diagnosis of underlying conditions [39].

Healthcare workers described a range of clinical consequences associated with traditional medicine use, including toxicity and multi-organ complications. As one participant mentioned, “I’ve seen herbs that interact with routine drugs… people generally come down with organs shut down… sometimes we lose the patients.” These outcomes were linked to the widespread availability of traditional remedies in informal, often unregulated markets. Participants noted, “We have a lot of traditional medicine vendors… most don’t have any license… they sell these products at motor parks… say it can heal everything… at the end of the day, they are nephrotoxic or hepatotoxic. Overall, while cultural beliefs, affordability, and perceived effectiveness continue to drive use, these findings highlight the importance of improved regulation, public awareness, and clinician understanding of potential herb–drug interactions to support safer use [40].

A prominent and consistent theme was the widespread reliance on traditional medicine as the first-line treatment for snakebite. Participants described a range of culturally embedded practices, including herbal remedies, ingestion of substances, and symbolic or ritualistic interventions: “They put [the snake] in cold water… maybe the person will receive healing. “There are some herbs… maybe leaves… once snake bites…They will just find a traditional way to do the treatment. “One frequently quoted intervention was the use of the ‘black stone,’ applied to the bite site: ‘They call it black stone… they dip it inside milk… and put it at the site of the bite.”

The widespread use of traditional practices, such as herbal remedies and the “black stone,” reflects strong cultural beliefs and trust in local healing systems, but these approaches often delay access to formal healthcare and may worsen envenomation, highlighting the need for culturally sensitive interventions that engage communities [41].

4.1.3. Educational Needs

Participants reported minimal exposure to structured toxicology teaching during medical training, with poisoning management often covered only briefly. “Yes, we did poisoning as a course briefly and antidotes. “I’m a family physician, so basic toxidromes I know.” While medical toxicology is integral to the management of poisoning, drug overdose, and adverse drug effects [42], participants in this study consistently described gaps in toxicology education among healthcare workers. Limited formal training in poisoning management and antidote use was commonly reported, which appears to contribute to reduced confidence in clinical decision-making during poisoning emergencies. “There is a serious need… especially because there is an educational gap.”

Participants emphasized a strong need for improved toxicology education, suggesting that current undergraduate and postgraduate training is insufficient to meet clinical demands. This aligns with broader evidence from low- and middle-income health systems, where toxicology is often underrepresented in medical curricula, contributing to gaps in poisoning management capacity [6]. Interviewees said healthcare providers rely heavily on informal sources to guide toxicology-related decision-making, reflecting limited access to formal training and specialist support. Internet searches and emerging digital tools were often used as first-line resources: “The first thing that comes to mind is Google… thankfully there is artificial intelligence now. “Peer consultation was also commonly reported. “Sometimes we consult senior colleagues.” Where available, clinicians referred to existing literature or protocols. “Sometimes you look at literature or protocols that other centres use.”

These accounts suggest an adaptive but unstandardized approach to care, with clinicians drawing on a mix of digital tools, peer networks, and fragmented resources. While this may support immediate decision-making, it also highlights gaps in structured toxicology support. References to artificial intelligence (AI) point to potential opportunities to strengthen practice, although implementation of AI in toxicology remains constrained by systemic challenges, including limited data, infrastructure, financial resources, and ethical considerations [43].

Across interviews, participants highlighted the need for greater emphasis on the management of specific acute poisoning exposures within clinical training, particularly in high-prevalence cases such as pesticide poisoning and snakebite. They also suggested that some exposures may be under-recognized, unfamiliar, or not often seen in clinical practice, underscoring additional educational needs. Scorpion stings were perceived as mild and self-limiting, with no reported severe outcomes. “It’s not serious… usually it’s just pain at the site.” This may reflect a low observed clinical burden but could also indicate under-recognition of severe envenomation or non-presentation of serious cases to healthcare facilities, highlighting a potential gap in awareness and clinical importance [44].

Lead poisoning was rarely encountered in participants’ clinical practice, with awareness largely shaped by the historic Zamfara outbreak in Nigeria, one of the largest and deadliest recorded lead poisoning outbreaks in modern history, which was triggered by unsafe artisanal gold ore processing and resulted in the deaths of more than 400 children [45]. “We’ve heard of reports… maybe Zamfara. But here I haven’t seen any lead poisoning.” This perceived lack of local cases may contribute to the under-recognition of lead poisoning as an ongoing environmental health concern in Nigeria. Emerging evidence suggests that lead exposure sources are more widespread than previously recognized, with informal battery recycling contributing significantly to population-level exposure [46]. Ongoing investigations in Nigeria, including responses by the Africa and Nigeria Centers for Disease Control to suspected outbreaks in Sokoto [47], further indicate that lead poisoning remains an active public health concern rather than a historical problem. Hence, healthcare workers should be trained to recognize and manage lead poisoning, including its clinical features and appropriate treatment.

4.2. Theme 2: Strengthening Poisoning Management in Nigeria

4.2.1. Antidote Availability

Participants reported inconsistent and often unreliable antidote availability across facilities. Naloxone and atropine were described as the most consistently available antidotes and were routinely used in clinical practice. “Naloxone, yes, naloxone is readily available.”“We’ve got enough atropine, but I won’t say 100% availability. “Other essential antidotes were reported as inconsistently available or difficult to access when urgently needed. These included deferoxamine for iron poisoning and N-acetylcysteine (NAC) for paracetamol toxicity. “We couldn’t just lay our hands on deferoxamine”.” “Most of the antidotes are very short in quantity. They are not readily available.”

Antivenom was available in some centres, but affordability was a major barrier, with patients sometimes unable to complete treatment. “Well, we do have [antivenom], but it’s quite expensive, because those people who come with snake bites have low socio-economic status …… we start them on the anti-snake venom and they are not able to complete it”. Studies from Nigeria show that access to antivenom plays a major role in snakebite outcomes. When the government provided antivenom for free, mortality was lower. During periods of stockout, patients had to pay for antivenom from private sources that were often unreliable, and deaths more than doubled. Poor outcomes were also associated with delayed hospital presentation and antivenom administration [48,49].

Antidote availability in Nigeria is uneven, with antivenom and other life-saving antidotes often inconsistently available or difficult to access during emergencies. This reflects broader systemic weaknesses in essential medicine supply chains, where availability does not reliably match clinical need [50]. Strengthening supply chain systems and improving pharmacist engagement in health policy are, therefore, critical priorities. In this context, recent calls by the Nigerian Senate for the mandatory availability of life-saving antidotes and emergency medicines in all public and private hospitals underscore growing recognition of these gaps, particularly in relation to snakebite, poisoning, and drug overdose management [51].

4.2.2. Need for Poison Information Centers

Healthcare professionals highlighted the absence of functional Poison Information Centers (PICs) in Nigeria. Most participants reported that no dedicated poisoning information service was available to support clinicians managing poisoning cases. “Here, as big as we are, we don’t have a functional poisoning center.” Several participants emphasized the urgent need for such services, noting that access to specialist toxicology advice would improve the management of poisoning emergencies. “Yes, we need that. We need that. Actually, we need that 100%.”

Notably, during the interviews, several participants demonstrated limited understanding of the role and function of a poison information center, with some perceiving it primarily as a facility for storing or distributing antidotes rather than as a clinical advisory and information service. The findings reveal a critical gap in both the availability and understanding of Poison Information Centers within the Nigerian healthcare system. The World Health Organization recognizes poison centers as essential services that provide real-time clinical advice, support poisoning management, and contribute to surveillance and prevention [5]. The misconception among healthcare workers that these centers are facilities for stockpiling antidotes highlights limited awareness of their broader role, which may hinder their development and utilization.

Participants reported limited awareness of the Toxicology Information Center (TIC) at the Raw Materials Research and Development Council, which functions as Nigeria’s poison information center [52]. Some participants indicated that although they had heard of the service, they did not have access to its contact details. This reflected a broader gap in the dissemination and practical integration of the Center within frontline healthcare settings. The TIC was developed with training support from Stellenbosch University and the National Institute for Health and Care Research RIGHT4 program [53]. The NIHR is also supporting TIC staff to undertake the Postgraduate Diploma in Medical Toxicology at Stellenbosch University [54], further strengthening local Poison Center Capacity building.

4.2.3. Educational and Digital Support for Poisoning Management

Participants responded positively to proposed capacity-building initiatives and digital support tools. All participants expressed a strong interest in accessing the TOXBASE database [55] and the MyPID patient information capturing system [56] offered through the NIHR RIGHT4 program [53]. They viewed these tools as valuable resources to support clinical decision-making and improve data collection in poisoning cases. In addition, participants welcomed the introduction of a webinar series and indicated enthusiasm for joining a broader Medical Toxicology Network of Sub-Saharan Africa (MTNSSA) [57], recognizing the potential benefits of shared learning, collaboration, and access to specialist expertise.

Participants were also introduced to the educational card game Toxi Trail as part of the engagement process [58]. Healthcare professionals who participated in the game reported that it was a useful and engaging learning tool for understanding toxicology concepts and clinical management. Participants received a copy of the game for future use in training and teaching within their clinical settings.

4.2.4. Practical Implications and Recommendations

The findings suggest that poisoning prevention and management could be strengthened through high-impact, low-cost interventions that optimize existing resources. Although the findings come from healthcare workers at a tertiary referral hospital in Abuja and are not intended to represent Nigeria as a whole, the recommendations may be relevant to other Nigerian hospitals and healthcare settings in sub-Saharan Africa with similar resource constraints.

For Kerosene ingestion, effective prevention strategies include caregiver education on safe storage, provision of child-resistant and clearly labelled containers, and community awareness campaigns [18]. For carbon monoxide poisoning, poorly visible warning labels on portable generators limit awareness of carbon monoxide risks and could be improved. Prevention also requires risk communication and broader solutions, such as improving the electricity supply to reduce generator use [59]. Evidence of toxic alcohol poisonings highlights the need for stronger regulation, quality control, and community education [23,24]. Greater public awareness of key warning signs, such as blindness, is essential to support earlier recognition, prompt care-seeking, and prevention of further harm. In this context, Hovda emphasizes the central role of awareness in addressing methanol poisoning, noting that it “affects families, societies, children,” and highlighting that we have a great opportunity to save lives if we can just get awareness and knowledge out there [24].

In the context of pesticides, a pragmatic first step may be to ban the most hazardous pesticides already identified by the WHO, which could minimize industry resistance and simplify enforcement [60,61]. Furthermore, prevention strategies should include regulatory restrictions on agricultural sales, safe storage education, and community-level mental health initiatives to reduce both impulsive self-harm and fatal outcomes. Addressing pesticide self-poisoning requires a multi-faceted approach that integrates public health, agricultural policy, and mental health services to mitigate this persistent and preventable cause of mortality [62,63].

Traditional medicines are widely used and play an important role in healthcare in many low- and middle-income countries. Further research is needed to better understand their contribution to poisoning presentations and potential drug interactions, and to support their safe integration into clinical practice, healthcare training, and policy development, in line with WHO guidance [64].

This study’s findings support maintaining stocks of key antidotes, including atropine and snake antivenom, using existing supply chains before expanding antidote inventories. Routine audits of antidote availability and use could help guide future improvements in supply chain management. Improved communication and transparency between hospital pharmacies and emergency departments regarding available antidote stock may further support timely poisoning management [65].

Strengthening regional Poison Information Centers serving multiple districts could improve access to specialist toxicology advice. Existing centers, such as the Toxicology Information Center, could be further supported and used as models for expanding poison information center services across Nigeria. Integrating poisoning case reporting into existing public health and hospital reporting systems may strengthen surveillance while minimizing additional resource requirements. Collaboration with funders, including the National Institute for Health and Care Research (NIHR) and other international organizations, could further support poison center capacity building and improve access to important toxicology and patient information databases.

Strengthening medical toxicology capacity could include integrating toxicology teaching into existing continuing professional development programs, with emphasis on the recognition and initial management of common poisonings and toxidromes. Sustained investment in affordable hybrid toxicology training programs, including initiatives at Stellenbosch University, may further support the gradual development of local and regional expertise in resource-limited settings [7,54].

Future research could build on this methodology by conducting multicentre qualitative studies across urban and rural healthcare facilities in Nigeria and other sub-Saharan African countries. Wherever possible, local researchers and institutions should lead these studies to strengthen local ownership, facilitate ethical and regulatory processes, and ensure that study design, implementation, and interpretation are informed by local context and priorities. This approach would enhance the transferability of findings and provide more comprehensive evidence to guide strengthening medical toxicology systems across the region.

5. Limitations

This study has several limitations. Because it was conducted in a single tertiary referral hospital, the findings may have limited transferability to other healthcare settings, particularly rural and primary care facilities where clinical resources, poisoning patterns, and presentation severity may differ. As with most qualitative research, the emphasis on depth rather than breadth means the findings cannot be used to produce broad epidemiological reports on poisoning patterns at the population level. In addition, interpreting qualitative data is inherently influenced by the researcher’s perspective, which may introduce subjectivity, although systematic and transparent analysis methods enhanced rigor.

Despite these limitations, the study generated rich, contextualized insights into healthcare workers’ experiences and medical toxicology needs in a resource-limited setting. These findings provide a strong foundation for future multi-site and mixed-methods research, including quantitative studies to further explore, validate, and expand understanding of the poisoning burden and system-level gaps.

6. Conclusion

Poisoning in Nigeria remains an under-recognized public health challenge, shaped by socioeconomic vulnerability, environmental and occupational exposures, cultural health practices, and health system constraints. This qualitative study, exploring the medical toxicology needs from the perspective of healthcare workers, highlights critical gaps in poisoning prevention, clinical preparedness, workforce training, and access to essential antidotes and poison information services. Importantly, the findings demonstrate that understanding the burden of poisoning requires more than epidemiological data alone; it also requires understanding the experiences of the healthcare workers who diagnose, treat, and manage poisoned patients within the realities and constraints of their health system.

The findings identify clear and achievable opportunities to strengthen poisoning care. Investing in low-cost, context-appropriate prevention strategies, improving hospital readiness through reliable antidote availability, expanding access to poison information services, and embedding medical toxicology into healthcare worker education can strengthen health system capacity and improve patient outcomes. While these findings are grounded in the Nigerian context, they are relevant to many low- and middle-income countries, particularly across sub-Saharan Africa, where similar health system challenges contribute to the burden of acute poisoning. Addressing these gaps should be recognized as a public health and health systems priority to reduce preventable poisoning-related morbidity and mortality.