Abstract
BackgroundIn South Asia, up to 20% of people ingesting pesticides for self-poisoning purchase the pesticide from a shop with the sole intention of self-harm. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such high-risk individuals. We aimed to test the feasibility and acceptability of vendor-based restrictions on pesticide sales for such high-risk individuals.MethodsWe conducted a pilot study in 14 (rural = 7, urban = 7) pesticide shops in Anuradhapura District of Sri Lanka. A two-hour training program was delivered to 28 pesticide vendors; the aim of the training was to help vendors recognize and respond to customers at high risk of pesticide self-poisoning. Knowledge and attitudes of vendors towards preventing access to pesticides for self-poisoning at baseline and in a three month follow-up was evaluated by questionnaire. Vendors were interviewed to explore the practice skills taught in the training and their assessment of the program.ResultsThe scores of knowledge and attitudes of the vendors significantly increased by 23% (95% CI 15%–32%, p < 0.001) and by 16% (95% CI 9%–23%, p < 0.001) respectively in the follow-up. Fifteen (60%) vendors reported refusing sell pesticides to a high-risk person (non-farmer or intoxicated person) in the follow-up compared to three (12%) at baseline. Vendors reported that they were aware from community feedback that they had prevented at least seven suicide attempts. On four identified occasions, vendors in urban shops had been unable to recognize the self-harming intention of customers who then ingested the pesticide. Only 2 (8%) vendors were dissatisfied with the training and 23 (92%) said they would recommend it to other vendors.ConclusionsOur study suggests that vendor-based sales restriction in regions with high rates of self-poisoning has the potential to reduce access to pesticides for self-poisoning. A large-scale study of the effectiveness and sustainability of this approach is needed.
Highlights
In South Asia, up to 20% of people ingesting pesticides for self-poisoning purchase the pesticide from a shop with the sole intention of self-harm
The participants were from three categories: twelve shop owners (12/28, 43%), thirteen sales staff (13/28, 46%), and three counter assistants (3/28, 11%)
None had previously participated in any training program related to sales restrictions to customers at high risk of suicide
Summary
In South Asia, up to 20% of people ingesting pesticides for self-poisoning purchase the pesticide from a shop with the sole intention of self-harm. Pesticide self-poisoning is one of the three most common global means of suicides [1]. Since 1995, the suicide rate has declined dramatically, coinciding with bans of the most toxic pesticides [4, 5] Despite this reduction in deaths, pesticide self-poisoning remains the most common method of self-harm in rural Sri Lanka [6]. The Act provides for regulation of the import, formulation, use, sale, packaging, labeling, storage and transport of pesticides. Pesticide vendors are required to participate in a one-day training that covers such issues as labeling, storage, and toxicity of pesticides, and to pass a written license examination to run a pesticide shop. The training does not cover recognition and responding to purchasers at risk of suicide
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