Abstract
SummaryBackgroundPesticide poisoning is among the most common means of suicide globally, but can be prevented with regulation of the most hazardous agents. We aimed to compare the lethality of pesticides ingested by our cohort, seek evidence on variation between human and regulatory animal toxicity, and establish change over time in the case fatality of individual pesticides in Sri Lanka.MethodsWe examined the case fatality of agricultural pesticides in a prospective cohort in nine hospitals serving rural populations in Sri Lanka. We included all patients (>11 years) who had presented to a South Asian Clinical Toxicology Research Collaboration study hospital during the study period. Patients were enrolled by clinical research assistants and were regularly reviewed. Identification of the ingested pesticide was generally on the basis of history or positive identification of the container, supported by nested blood analysis.FindingsFrom March 31, 2002, to Dec 31, 2019, 34 902 patients (median age 29 years [IQR 21–40]; 23 060 [66·1%] male) presented with a possible or known pesticide self-poisoning. We identified 23 139 specific pesticides that were ingested. Poisoning was fatal in 2299 (6·6%) patients. Case fatality varied greatly from 0·0% (several substances) to 41·8% (paraquat). The three most toxic agents (ie, paraquat, dimethoate, and fenthion) were banned between 2008 and 2011. Since 2013, the five agents causing the most deaths (ie, profenofos, propanil, fenobucarb, carbosulfan, and quinalphos) had a case fatality of 7·2–8·6%. A steady decline was seen in overall case fatality of pesticide poisoning (10·5% for 2002–06 to 3·7% for 2013–19), largely attributable to pesticide bans. A modest fall in case fatality for non-banned pesticides was also seen.InterpretationDeclines seen in case fatalities of poisonings with non-banned pesticides suggest that medical management improved over time. The human data for acute toxicity of pesticides should drive hazard classifications and regulation. We believe that a global benchmark for registration of pesticides should include a less than 5% case fatality after self-poisoning, which could prevent many deaths and have a substantial effect on global suicide rates.FundingThe Wellcome Trust and the National Health and Medical Research Council of Australia.TranslationsFor the Sinhala and Tamil translations of the abstract see Supplementary Materials section.
Highlights
WHO has reported that pesticide self-poisoning is one of the most common means of suicide globally
We believe that a global benchmark for registration of pesticides should include a less than 5% case fatality after self-poisoning, which could prevent many deaths and have a substantial effect on global suicide rates
Data analysis was done on all patients who had presented to a South Asian Clinical Toxicology Research Collaboration study hospital up until Dec 31, 2019— including those patients reported in an earlier overall cohort analysis
Summary
WHO has reported that pesticide self-poisoning is one of the most common means of suicide globally. It is the most preventable method of suicide, through better pesticide regulation.. Despite a fall in deaths due to pesticide poisonings in the past two decades from around 260 000 a year to 160 000 a year, each year more than 150 000 people die from deliberate ingestion of pesticides accounting for about 20% of the global burden of suicide.. A highly effective strategy to reduce mortality is to restrict access to the more toxic pesticides.. Restriction of agricultural use of acutely toxic, highly hazardous pesticides has repeatedly been shown to reduce overall poisoning and suicide deaths, in Sri Lanka, South A highly effective strategy to reduce mortality is to restrict access to the more toxic pesticides. Restriction of agricultural use of acutely toxic, highly hazardous pesticides has repeatedly been shown to reduce overall poisoning and suicide deaths, in Sri Lanka, South
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