Paracetamol Overdose in Somali Children Under Five: An Emerging Public Health Concern

Abstract

Abstract: Paracetamol (acetaminophen) is widely used for pain and fever management in children under five; however, accidental overdose is an increasing public health concern in low-resource settings such as Somalia. This narrative review highlights key risk factors, clinical consequences, and prevention strategies relevant to the Somali context based on published literature. Misconceptions about dosing, reliance on age rather than weight, and unrestricted access contribute to inappropriate administration and increased risk of hepatotoxicity and acute liver failure. While metabolic pathways in young children differ from adults, increased vulnerability in this setting is more strongly associated with malnutrition, dosing errors, and delayed access to healthcare. Toxicity results from accumulation of N-acetyl-p-benzoquinone imine (NAPQI), leading to oxidative stress and liver injury. Early treatment with N-acetylcysteine (NAC) is essential, yet delayed presentation and limited availability of antidotes in Somalia worsen outcomes. There is currently limited published data on the incidence of paracetamol overdose and NAC availability in Somalia. Strengthening caregiver education, pharmacy-based counseling, access to essential antidotes, and national poison surveillance systems is critical to reducing preventable pediatric liver injury in Somalia. Keywords: paracetamol, pediatric overdose, hepatotoxicity, Somalia, public health, N-acetylcysteine