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Such complicated surveillance is unlikely to be practical in a broader, non-research public health setting. The toxicity of the poisons ingested in Sri Lanka is such that poisoned patients usually reach the hospital alive and seldom die during transfer or have a worse outcome than patients who present directly to referral hospitals.

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Our findings also help to validate the results of previous studies in anuradjapura Sri Lanka based on the use of data for acute poisoning admissions to referral hospitals. In Sri Lanka, transfers are initiated by physicians in primary hospitals; there are few barriers and no fixed protocol. None of the funding sources had any role in study design, in data collection, analysis or interpretation, or in the preparation or publication of this paper.

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