Abstract
BackgroundThe WHO recognises pesticide poisoning to be the single most important means of suicide globally. Pesticide self-poisoning is a major public health and clinical problem in rural Asia, where it has led to case fatality ratios 20-30 times higher than self-poisoning in the developed world. One approach to reducing access to pesticides is for households to store pesticides in lockable "safe-storage" containers. However, before this approach can be promoted, evidence is required on its effectiveness and safety.Methods/DesignA community-based cluster randomised controlled trial has been set up in 44,000 households in the North Central Province, Sri Lanka. A census is being performed, collecting baseline demographic data, socio-economic status, pesticide usage, self-harm and alcohol. Participating villages are then randomised and eligible households in the intervention arm given a lockable safe storage container for agrochemicals.The primary outcome will be incidence of pesticide self-poisoning over three years amongst individuals aged 14 years and over. 217,944 person years of follow-up are required in each arm to detect a 33% reduction in pesticide self-poisoning with 80% power at the 5% significance level. Secondary outcomes will include the incidence of all pesticide poisoning and total self-harm.DiscussionThis paper describes a large effectiveness study of a community intervention to reduce the burden of intentional poisoning in rural Sri Lanka. The study builds on a strong partnership between provincial health services, local and international researchers, and local communities. We discuss issues in relation to randomisation and contamination, engaging control villages, the intervention, and strategies to improve adherence.Trial RegistritationThe trial is registered on ClinicalTrials.gov ref: NCT1146496 (http://clinicaltrialsfeeds.org/clinical-trials/show/NCT01146496).
Highlights
The WHO recognises pesticide poisoning to be the single most important means of suicide globally
This paper describes a large effectiveness study of a community intervention to reduce the burden of intentional poisoning in rural Sri Lanka
Pesticide self-poisoning is prevalent in Sri Lanka; it is the most common method of suicide [16], is highly lethal [17], and is associated with impulsivity [5,18,19]
Summary
This study is a large community-based cluster randomised control trial of safe storage devices for agricultural pesticides. Focus groups were carried out before the study started to determine whether this offer is sufficient to encourage villages to enter the study despite the risk of being randomised to no intervention These focus groups indicated that villagers consider that the offer of a free safe storage container, together with the great importance of pesticide poisoning to their communities, to be sufficient to encourage villages to enrol. To improve device use with minimal resources, we are planning to provide community level meetings every quarter in all villages; intervention and control, to encourage the local population to keep their pesticides stored safely.
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