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Weerasinghe M, Jobe L, Konradsen F, Eddleston M, Pearson M, Jayamanne S, Hawton K, Gunnell D, Agampodi S. Differences in the characteristics of people who purchase pesticides from shops for self-harm versus those who use pesticides available in the domestic environment in Sri Lanka. Trop Med Int Health 2023; 28:901-911. [PMID: 37871998 DOI: 10.1111/tmi.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE Data from South Asia indicate that for 15%-20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. METHODS We conducted two comparative studies in rural Sri Lanka: (1) non-fatal shop cases (n = 50) were survivors of self-poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non-fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. RESULTS Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non-farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2-24.4 for non-fatal shop cases, and AOR 4.0, 95% CI 1.5-10.6 for fatal shop cases. Non-fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0-8.9), and ingesting an insecticide (AOR 4.8, CI 1.8-1.0-8.9) than non-fatal domestic cases. CONCLUSION A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self-poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Lei Jobe
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Suneth Agampodi
- International Vaccine Institute, Seoul, South Korea
- Center for Public Health, Anuradhapura, Sri Lanka
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Ismail H, Qadri S, Hussain A. Intentional self-harm in individuals referred to consultation liaison psychiatry services in a tertiary care hospital. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:276. [PMID: 36325231 PMCID: PMC9621367 DOI: 10.4103/jehp.jehp_1531_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Intentional self-harm (ISH) is one of the most important entities of consultation-liaison psychiatry. This study aimed to assess the clinical profile of individuals with intentional self-harm referred to consultation-liaison (CL) psychiatric services in a tertiary care hospital. MATERIALS AND METHODS The present study was a cross-sectional hospital-based study, in which purposive sampling was done for sample selection. A total of 60 subjects of ISH referred for evaluation in a tertiary care psychiatry hospital on specified days were recruited to the study after obtaining informed consent. Demographic and clinical details such as the nature of the self-harm attempt, method of attempt, number of attempts, the reason for the attempt, and regret/remorse about the attempt were documented using the semi-structured proforma. RESULTS A total of 60 subjects were included in the study. About 80% of them were below the age of 30 years. The majority (80%) were females, 65% were from a rural background, 56.7% were married. The most common method of ISH was self-poisoning. Interpersonal conflicts with family members (50%), followed by interpersonal conflicts with the spouse/partner (21.7%) were the commonest reason/precipitating factors that lead to intentional self-harm. Also, 45% of our study population did not have any diagnosable psychiatric illness at the time of assessment, and the most common psychiatric diagnosis was personality disorders (20%). CONCLUSION Intentional self-harm is common in young married females from rural backgrounds. Self-poisoning is the most common method of deliberate self-harm. More than half of the individuals were diagnosed with the psychiatric illness at presentation.
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Affiliation(s)
- Haamid Ismail
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Sabreena Qadri
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Arshad Hussain
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
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Weerasinghe M, Pearson M, Turner N, Metcalfe C, Gunnell DJ, Agampodi S, Hawton K, Agampodi T, Miller M, Jayamanne S, Parker S, Sumith JA, Karunarathne A, Dissanayaka K, Rajapaksha S, Rodrigo D, Abeysinghe D, Piyasena C, Kanapathy R, Thedchanamoorthy S, Madsen LB, Konradsen F, Eddleston M. Gatekeeper training for vendors to reduce pesticide self-poisoning in rural South Asia: a study protocol for a stepped-wedge cluster randomised controlled trial. BMJ Open 2022; 12:e054061. [PMID: 35379621 PMCID: PMC8981379 DOI: 10.1136/bmjopen-2021-054061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Pesticide self-poisoning kills an estimated 110 000-168 000 people worldwide annually. Data from South Asia indicate that in 15%-20% of attempted suicides and 30%-50% of completed suicides involving pesticides these are purchased shortly beforehand for this purpose. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such customers. We have developed a 'gatekeeper' training programme for vendors to enable them to identify individuals at high risk of self-poisoning (gatekeeper function) and prevent such individuals from accessing pesticides (means restriction). The primary aim of the study is to evaluate the effectiveness of the gatekeeper intervention in preventing pesticide self-poisoning in Sri Lanka. Other aims are to identify method substitution and to assess the cost and cost-effectiveness of the intervention. METHODS AND ANALYSIS A stepped-wedge cluster randomised trial of a gatekeeper intervention is being conducted in rural Sri Lanka with a population of approximately 2.7 million. The gatekeeper intervention is being introduced into 70 administrative divisions in random order at each of 30 steps over a 40-month period. The primary outcome is the number of pesticide self-poisoning cases identified from surveillance of hospitals and police stations. Secondary outcomes include: number of self-poisoning cases using pesticides purchased within the previous 24 hours, total number of all forms of self-harm and suicides. Intervention effectiveness will be estimated by comparing outcome measures between the pretraining and post-training periods across the divisions in the study area. The original study protocol has been adapted as necessary in light of the impact of the COVID-19. ETHICS AND DISSEMINATION The Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University, Sri Lanka (ERC/2018/30), and the ACCORD Medical Research Ethics Committee, Edinburgh University (18-HV-053) approved the study. Results will be disseminated in scientific peer-reviewed journals. TRIAL REGISTRATION NUMBER SLCTR/2019/006, U1111-1220-8046.
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Affiliation(s)
- Manjula Weerasinghe
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Melissa Pearson
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Faculty of Medicine, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Turner
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, University of Bristol, Bristol, UK
| | - David J Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Matthew Miller
- Northeastern University, 360 Huntington Avenue, Boston, Massachusetts, USA
| | - Shaluka Jayamanne
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Simon Parker
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | | | | | - Kalpani Dissanayaka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sandamali Rajapaksha
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Dilani Rodrigo
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Dissanayake Abeysinghe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chathuranga Piyasena
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rajaratnam Kanapathy
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Lizell Bustamante Madsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Arafat SMY, Menon V, Bascarane S, Kar SK, Kabir R. Variations in newspaper reporting of suicidal behavior in the WHO-South-East Asian region. J Public Health (Oxf) 2021; 43:e684-e688. [PMID: 32827040 DOI: 10.1093/pubmed/fdaa139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/28/2020] [Accepted: 07/22/2020] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND South-East Asia is a densely populated region, comprising of 11 low- and middle-income countries and contributing to 39% of global suicides. There are serious challenges to suicide prevention in the region such as lack of high-quality suicide data, underreporting and poor quality of media reporting. The current report aimed to assess the variations in newspaper reporting of suicidal behavior in the World Health Organization-South-East Asian countries. METHODS We analyzed the contents of nine research articles on media reporting of suicide, published from four South-East Asian countries (four from Bangladesh, three from India, one each from Indonesia and Bhutan) that used similar methods and presented results in a nearly similar fashion. RESULTS Personal identifying information of the deceased was very frequently mentioned in the newspaper reports across the countries. Suicide notes were reported more commonly in India (9.5-18%) than Bangladesh (4.2-7.5%) and Indonesia (9.5%). No educative material was found in any of the newspaper reports of Bangladesh and Indonesia while it was rarely reported in Bhutan and India. CONCLUSION Our findings from the four South-East Asian countries suggest that there are variations between the countries while presenting the news reports of suicidal behavior. These findings would help to formulate and regulate the media guidelines for the specific country.
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Affiliation(s)
- S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka 1340, Bangladesh
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Sharmi Bascarane
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, 226003, Uttar Pradesh, India
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, UK
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Karunarathne A, Bhalla A, Sethi A, Perera U, Eddleston M. Importance of pesticides for lethal poisoning in India during 1999 to 2018: a systematic review. BMC Public Health 2021; 21:1441. [PMID: 34294076 PMCID: PMC8296580 DOI: 10.1186/s12889-021-11156-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/27/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Poisoning is a major problem in India. However, there is little systematic information on the key poisons responsible for most deaths by geographical area and over time. We aimed to review the literature to identify the poison classes causing the greatest number of deaths in India over the last 20 years. METHODS We performed a systematic literature review in Medline, Embase and Google Scholar (1999-2018), and Indian online medical journals, to find papers that reported deaths from all forms of poisoning in India, with last search 20 April 2020. We included epidemiological studies, observational studies, randomised trials, interventional studies, and case series published from 1999 to 2018 that showed the number of deaths and autopsy studies indicating the specific poisons or poison classes. Studies providing the case fatality for specific poisons or classes, which enabled calculation of the number of deaths, were also included. We excluded deaths due to animal bites and stings, ethanol or methanol poisoning, and gas inhalation as well as papers reporting a single death (case study of single patient). We grouped the papers into 5-year intervals and identified the two most common poison classes in each paper. We used descriptive statistics to summarise the findings over time based on the causative poison and the location of the study. RESULTS We identified 186 papers reporting 16,659 poisoning deaths between 1999 and 2018. The number of publications per 5-year interval showed no clear trend over the period (48, 38, 67, and 36 for consecutive periods). Half of the deaths (n = 8338, 50.0%) were reported during the first 5 years of the study (1999-2003), the number of deaths declining thereafter (to n = 1714 in 2014-2018). Deaths due to pesticide poisoning (94.5%) were dominant across the study period compared to other classes of poison [hair dye paraphenylenediamine poisoning (2.6%), medicine overdose (1.4%) or plant poisoning (1.0%)]. Among the pesticides, aluminium phosphide was the most important lethal poison during the first 10 years before declining markedly; organophosphorus insecticides were important throughout the period, becoming dominant in the last decade as aluminium phosphide cases declined. Unfortunately, few papers identified the specific organophosphorus insecticide responsible for deaths. CONCLUSION Use of the published literature to better understand the epidemiology of lethal poisoning in India has clear limitations, including secular variation in publishing practices and interest in poisoning. Unfortunately, there are no long-term detailed, combination hospital and community studies from India to provide this information. In their absence, our review indicates that pesticides are the most important poison in India, with organophosphorus insecticides replacing aluminium phosphide as the key lethal poison after government regulatory changes in 2001 reduced the latter's lethality. Plant and hair dye poisoning and medicines overdose caused few deaths. Aluminium phosphide deaths mostly occurred in northern Indian states, whereas deaths from organophosphorus insecticide poisoning occurred throughout India. Paraquat poisoning has become a clinical problem in the last 10 years. Lethal pesticide poisoning remains alarmingly common, emphasising the need for additional regulatory interventions to curtail the burden of pesticide poisoning deaths in India. More detailed reporting about the specific pesticide involved in lethal poisoning will be helpful to guide regulatory decisions.
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Affiliation(s)
- Ayanthi Karunarathne
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ashish Bhalla
- Department of Internal Medicine, Nehru Hospital, Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Sethi
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Government of Maharashtra, Mumbai, Maharashtra, India
| | - Uditha Perera
- Usher Institute for Population Health Sciences & Informatics, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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Arafat SMY, Menon V, Kar SK. Media and suicide prevention in Southeast Asia: challenges and directions. J Public Health (Oxf) 2021; 43:e123-e124. [PMID: 32608499 DOI: 10.1093/pubmed/fdaa084] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/10/2020] [Accepted: 05/25/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka 1340, Bangladesh
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow 226003, UP, India
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Jayamanne S, Knipe D, Hawton K, Gunnell D, Agampodi S. Factors associated with purchasing pesticide from shops for intentional self-poisoning in Sri Lanka. Trop Med Int Health 2021; 25:1198-1204. [PMID: 33463883 DOI: 10.1111/tmi.13469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In South Asia, up to one in five individuals who ingest pesticides for self-poisoning and survive purchased them from a shop immediately prior to the event. Thus far, no research has taken place to determine whether interventions implemented through the pesticide sellers might be acceptable or effective, despite the hundreds of thousands of such risk purchases each year. We aimed to investigate factors associated with purchasing pesticides for self-poisoning in Sri Lanka. METHODS We used a case-control study. Cases (n = 50) were individuals who ingested pesticides after purchasing them for the act, and controls (n = 200) were customers who bought pesticides but did not use them for self-harm. Logistic regression analysis was used to assess socio-demographic and purchase-specific risk factors. RESULTS Alcohol intoxication (adjusted odds ratios [AOR] 36.5, 95% confidence intervals [CI] 1.7-783.4) and being a non-farmer AOR 13.3, 95% CI 1.8-99.6 were the main distinguishing factors when purchasing pesticides for self-poisoning. The positive predictive values were 93.3% (95% CI 68.0-99.8%) and 88.2% (95% CI 72.5-96.7%), respectively. One and/or other of these factors characterised 72.0% of cases but only 2.5% controls. CONCLUSION While results need to be interpreted cautiously, sales restrictions to prevent alcohol-intoxicated persons and non-farmers purchasing pesticides for self-poisoning may be effective.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Flemming Konradsen
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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Chen R, Wang Y, Liu L, Lu L, Wilson A, Gong S, Zhu Y, Sheng C, Zeng Y, Li Y, Ou J. A qualitative study of how self-harm starts and continues among Chinese adolescents. BJPsych Open 2020; 7:e20. [PMID: 33331254 PMCID: PMC7791561 DOI: 10.1192/bjo.2020.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is essential to investigate the experiences behind why adolescents start and continue to self-harm in order to develop targeted treatment and prevent future self-harming behaviours. AIMS The aims of this study are to understand the motivations for initiating and repeating nonfatal self-harm, the different methods used between first-time and repeated self-harm and the reasons that adolescents do not seek help from health services. METHODS Adolescents with repeated nonfatal self-harm experiences were recruited to participate in individual, semi-structured qualitative interviews. The interviews were analysed with interpretative phenomenological analysis. RESULTS We found that nonfatal self-harm among adolescents occurred comparatively early and was often triggered by specific reasons. However, the subsequent nonfatal self-harm could be causeless, with repeated self-harm becoming a maladaptive coping strategy to handle daily pressure and negative emotions. The choice of tools used was related to the ease of accessibility, the life-threatening risk and the size of the scars. Adolescents often concealed their scars on purpose, which made early identification insufficient. Peer influence, such as online chat groups encouraging self-harm by discussing and sharing self-harm pictures, could also lead to increased self-harm. The results also included participants' opinions on how to stop nonfatal self-harm and their dissatisfaction with the current healthcare services. CONCLUSIONS The current study provides important implications both for early identification and interventions for adolescents who engage in repeated nonfatal self-harm, and for individualising treatment planning that benefits them. It is also worthwhile to further investigate how peer influence and social media may affect self-harm in adolescents.
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Affiliation(s)
- Runsen Chen
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, China
| | - Yuanyuan Wang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, China; and Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, UK
| | - Li Liu
- Department of Nursing, The Second Xiangya Hospital of Central South University, China
| | - Li Lu
- Bordeaux Population Health Research Center, U1219 Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, France
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, UK
| | - Shuxiao Gong
- Department of Linguistics, University of Kansas, Kansas, USA
| | - Yingrong Zhu
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, UK
| | - Caihua Sheng
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, UK
| | - Ying Zeng
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, UK
| | - Yamin Li
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, UK
| | - Jianjun Ou
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, China
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Iyadurai R, Gunasekaran K, Jose A, Pitchaimuthu K. Calotropis poisoning with severe cardiac toxicity A case report. J Family Med Prim Care 2020; 9:4444-4447. [PMID: 33110881 PMCID: PMC7586564 DOI: 10.4103/jfmpc.jfmpc_783_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/11/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022] Open
Abstract
Calotropis is a widely prevalent plant in the Indian Subcontinent. The extract and various parts of the plant are used by traditional healers for treating miscellaneous diseases. All parts of the plants are toxic; there are many case reports of gastrointestinal, cutaneous and ocular toxicity with Calotropis. The plant contains Cardenolide glycosides which have Digoxin like effects and can cause severe cardiotoxicity. We report a patient who developed cardiovascular collapse after oral ingestion and cutaneous application of Calotropis following snake bite by a traditional healer, this case thus highlights the potential cardiotoxicity of Calotropis.
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Affiliation(s)
- Ramya Iyadurai
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthik Gunasekaran
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arun Jose
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kishore Pitchaimuthu
- Department of Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
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10
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Damerow SM, Weerasinghe M, Madsen LB, Hansen KS, Pearson M, Eddleston M, Konradsen F. Using ex-ante economic evaluation to inform research priorities in pesticide self-poisoning prevention: the case of a shop-based gatekeeper training programme in rural Sri Lanka. Trop Med Int Health 2020; 25:1205-1213. [PMID: 32687625 PMCID: PMC7589374 DOI: 10.1111/tmi.13470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
OBJECTIVES Suicide by pesticide self-poisoning is a major public health challenge in low- and middle-income countries. While effectiveness studies are required to test alternative prevention approaches, economic evidence is lacking to inform decision-making in research priority setting. Therefore, this study aimed to estimate the costs of a shop-based gatekeeper training programme for pesticide vendors seeking to prevent pesticide self-poisoning in rural Sri Lanka and assess its potential for cost-effectiveness. METHODS Ex-ante cost and cost-effectiveness threshold (CET) analyses were performed from a governmental perspective based on a three-year analytic horizon, using 'no programme' as a comparator. A programme model targeting all 535 pesticide shops in the North Central Province and border areas was applied. Total programme costs (TPC) were estimated in 2019 USD using an ingredients approach and 3% annual discounting. The Sri Lankan gross domestic product per capita and life years saved were used as CET and effectiveness measure, respectively. Sensitivity analyses were performed. RESULTS TPC were estimated at 31 603.03 USD. TPC were sensitive to cost changes of training material and equipment and the programme lifetime. The programme needs to prevent an estimated 0.23 fatal pesticide self-poisoning cases over three years to be considered cost-effective. In the sensitivity analyses, the highest number of fatal cases needed to be prevented to obtain cost-effectiveness was 4.55 over three years. CONCLUSIONS From an economic perspective, the programme has a very high potential to be cost-effective. Research assessing its effectiveness should therefore be completed, and research analysing its transferability to other settings prioritised.
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Affiliation(s)
- Sabine Margarete Damerow
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Lizell Bustamante Madsen
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Schultz Hansen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Flemming Konradsen
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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11
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Okuyama JHH, Galvão TF, Silva MT. Poisoning and associated factors to death from pesticides: case-control study, Brazil, 2017. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200024. [PMID: 32401920 DOI: 10.1590/1980-549720200024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pesticide poisoning causes high morbidity and mortality. Surveillance is required for post-marketing monitoring of these products. AIM To assess poisonings and associated factors with lethality by pesticides. METHOD This is a case-control study based on the cases of pesticide poisoning assisted in 2017 by Brazilian Poison Control Centers. Patients who died were the cases and the survivors, the control. The odds ratio (OR) of death and 95% confidence interval (CI) were calculated. From the regression model, a predictive model of death was developed, stratified by age, gender and occupational context to investigate the risk of agricultural workers poisoned by extremely hazardous agents. RESULTS 3,826 patients poisoned by pesticides were identified, of which 146 died. Older people (OR = 4.94; 95%CI 2.49 - 9.80), males (OR = 1.68; 95%CI 1.15 - 2.46), agricultural workers (OR = 2.20; 95%CI 1.15 - 4.24), suicide attempts (OR = 13.27; 95%CI 6.48 - 27.19) and exposure to extremely hazardous products (OR = 2.77; 95%CI 1.84 - 4.16) odds of death from pesticide poisoning. CONCLUSION Out of 100 pesticides poisoning, four died. Elderly, males, working in the agricultural sector, suicide attempts and extremely hazardous products had a higher risk of death.
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Affiliation(s)
| | - Taís Freire Galvão
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Marcus Tolentino Silva
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade de Sorocaba, Sorocaba, SP, Brazil
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Bonvoisin T, Utyasheva L, Knipe D, Gunnell D, Eddleston M. Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends. BMC Public Health 2020; 20:251. [PMID: 32075613 PMCID: PMC7031890 DOI: 10.1186/s12889-020-8339-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/10/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Pesticide self-poisoning is a common means of suicide in India. Banning highly hazardous pesticides from agricultural use has been successful in reducing total suicide numbers in several South Asian countries without affecting agricultural output. Here, we describe national and state-level regulation of highly hazardous pesticides and explore how they might relate to suicide rates across India. METHODS Information on pesticide regulation was collated from agriculture departments of the central government and all 29 state governments (excluding union territories). National and state-level data on suicides from 1995 to 2015 were obtained from the National Crime Records Bureau (NCRB). We used joinpoint analysis and negative binomial regression to investigate the trends in suicide rates nationally and in Kerala, in view of the robust measures Kerala has taken to restrict a number of HHPs, to identify any effect on suicides. RESULTS As of October 2019, 318 pesticides were registered for use in India, of which 18 were extremely (Class Ia) or highly (Class Ib) hazardous according to World Health Organization toxicity criteria. Despite many highly hazardous pesticides still being available, several bans have been implemented during the period studied. In our quantitative analyses we focused on the permanent bans in Kerala in 2005 (of endosulfan) and 2011 (of 14 other pesticides); and nationally in 2011 (of endosulfan). NCRB data indicate that pesticides were used in 441,918 reported suicides in India from 1995 to 2015, 90.3% of which occurred in 11 of the 29 states. There was statistical evidence of lower than expected rates of pesticide suicides (rate ratio [RR] 0.52, 95% CI 0.49-0.54) and total suicides nationally by 2014 (0.90, 0.87-0.93) after the 2011 endosulfan ban. In Kerala, there was a lower than expected rate of pesticide suicides (0.45, 0.42-0.49), but no change to the already decreasing trend in total suicides (1.02, 1.00-1.05) after the 2011 ban of 14 pesticides. The 2005 ban on endosulfan showed a similar effect - lower than expected pesticide suicides (0.79, 0.64-0.99), but no change to the decreasing trend of total suicides (0.97, 0.93-1.02) in 2010. There was no evidence of a decline in agricultural outputs following the bans. CONCLUSION Highly hazardous pesticides continue to be used in India and pesticide suicide remains a serious public health problem. However, some pesticide bans do appear to have impacted previous trends in the rates of both pesticide suicides and all suicides. Comprehensive national bans of highly hazardous pesticides could lead to a reduction in suicides across India, in addition to reduced occupational poisoning, with minimal effects on agricultural yield.
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Affiliation(s)
- Toby Bonvoisin
- Hull University Teaching Hospitals NHS Trust, Hull, UK
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Leah Utyasheva
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Duleeka Knipe
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Population Health Sciences Institute, Bristol Medical School, Bristol, UK
| | - David Gunnell
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Population Health Sciences Institute, Bristol Medical School, Bristol, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
- Population Health Sciences Institute, Bristol Medical School, Bristol, UK.
- Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science University of Edinburgh, Edinburgh, UK.
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Guerra J, Acharya P, Barnadas C. Community-based surveillance: A scoping review. PLoS One 2019; 14:e0215278. [PMID: 30978224 PMCID: PMC6461245 DOI: 10.1371/journal.pone.0215278] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/31/2019] [Indexed: 12/22/2022] Open
Abstract
Background Involving community members in identifying and reporting health events for public health surveillance purposes, an approach commonly described as community-based surveillance (CBS), is increasingly gaining interest. We conducted a scoping review to list terms and definitions used to characterize CBS, to identify and summarize available guidance and recommendations, and to map information on past and existing in-country CBS systems. Methods We searched eight bibliographic databases and screened the worldwide web for any document mentioning an approach in which community members both collected and reported information on health events from their community for public health surveillance. Two independent reviewers performed double blind screening and data collection, any discrepancy was solved through discussion and consensus. Findings From the 134 included documents, several terms and definitions for CBS were retrieved. Guidance and recommendations for CBS were scattered through seven major guides and sixteen additional documents. Seventy-nine unique CBS systems implemented since 1958 in 42 countries were identified, mostly implemented in low and lower-middle income countries (79%). The systems appeared as fragmented (81% covering a limited geographical area and 70% solely implemented in a rural setting), vertical (67% with a single scope of interest), and of limited duration (median of 6 years for ongoing systems and 2 years for ended systems). Collection of information was mostly performed by recruited community members (80%). Interpretation While CBS has already been implemented in many countries, standardization is still required on the term and processes to be used. Further research is needed to ensure CBS integrates effectively into the overall public health surveillance system.
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Affiliation(s)
- José Guerra
- World Health Organization (WHO), Lyon, France
- * E-mail:
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Jayamanne S, Gunnell D, Hawton K, Agampodi S. Potential Interventions for Preventing Pesticide Self-Poisoning by Restricting Access Through Vendors in Sri Lanka. CRISIS 2018; 39:479-488. [PMID: 29932017 DOI: 10.1027/0227-5910/a000525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In South Asia, up to one in five individuals who use pesticides for self-harm purchase them immediately prior to the event. AIMS From reviewing the literature we proposed four interventions: (a) farmer identification cards (ID); (b) prescriptions; (c) cooling-off periods; and (d) training pesticide vendors. We aimed to identify the most promising intervention. METHOD The study was conducted in Sri Lanka. We mapped stakeholders' interest and power in relation to each intervention, and followed this by a ranking exercise. Seven focus group discussions (FGDs) were conducted to assess facilitators and barriers to implementation. RESULTS Vendor training was the most supported intervention, being ranked first by the stakeholders. The participants in the FGDs strongly supported training of vendors as it was seen to be easy to implement and was considered more convenient. Farmer IDs, prescriptions, and cooling-off periods were thought to have more barriers than facilitators and they were strongly opposed by end users (farmers and vendors), who would potentially block their implementation. LIMITATIONS Cost considerations for implementing the proposed intervention were not considered. CONCLUSION Training vendors might be the most appropriate intervention to restrict sales of pesticides to people at risk of suicidal behavior. This requires field testing.
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Affiliation(s)
- Manjula Weerasinghe
- 1 Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,3 Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Flemming Konradsen
- 2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,4 Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Michael Eddleston
- 2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,3 Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, UK.,4 Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Melissa Pearson
- 2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,3 Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Shaluka Jayamanne
- 2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,5 Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - David Gunnell
- 6 Population Health Sciences, University of Bristol, UK
| | - Keith Hawton
- 7 Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
| | - Suneth Agampodi
- 1 Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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15
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Rawat S, Joshi PC, Khan MA, Saraswathy KN. Trends and determinants of suicide in Warangal District Telangana, India: six years retrospective study based on secondary data. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2018. [DOI: 10.1186/s41935-018-0041-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mew EJ, Padmanathan P, Konradsen F, Eddleston M, Chang SS, Phillips MR, Gunnell D. The global burden of fatal self-poisoning with pesticides 2006-15: Systematic review. J Affect Disord 2017; 219:93-104. [PMID: 28535450 DOI: 10.1016/j.jad.2017.05.002] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/03/2017] [Accepted: 05/06/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Agricultural pesticide poisoning is a major contributor to the global burden of suicide. Over the last decade there has been a marked decrease in the incidence of suicide worldwide. It is unclear whether pesticide poisoning still plays a significant role in the global incidence of suicide. METHODS WHO method-specific suicide data were supplemented by a systematic review of the literature between 2006 and 2015, including searches of thirteen electronic databases and Google, citation searching and a review of reference lists and personal collections. Our primary outcome was the proportion of total suicides due to pesticide poisoning. Weighted estimates were calculated for seven WHO regional and income strata. RESULTS We identified data from 108 countries (102 from WHO data, 6 from the literature). A conservative estimate based on these data indicates that there were approximately 110,000 pesticide self-poisoning deaths each year from 2010 to 2014, comprising 13.7% of all global suicides. A sensitivity analysis accounting for under-reporting of suicides in India resulted in an increased estimate of 168,000 pesticide self-poisoning deaths annually, that is, 19.7% of global suicides. The proportion of suicides due to pesticide self-poisoning varies considerably between regions, from 0.9% in low- and middle-income countries in the European region to 48.3% in low- and middle-income countries in the Western Pacific region. LIMITATIONS High quality method-specific suicide data were unavailable for a number of the most populous countries, particularly in the African and Eastern Mediterranean regions. It is likely we have underestimated incidence in these regions. CONCLUSION There appears to have been a substantial decline in fatal pesticide self-poisoning in recent years, largely driven by a reduction in overall suicide rates in China. Nonetheless, pesticide self-poisoning remains a major public health challenge, accounting for at least one-in-seven suicides globally.
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Affiliation(s)
- Emma J Mew
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Prianka Padmanathan
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Michael Eddleston
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK.
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Taipei City, Taiwan.
| | - Michael R Phillips
- Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Departments of Psychiatry and Global Health, Emory University, Atlanta, USA.
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Pedersen B, Ssemugabo C, Nabankema V, Jørs E. Characteristics of Pesticide Poisoning in Rural and Urban Settings in Uganda. ENVIRONMENTAL HEALTH INSIGHTS 2017; 11:1178630217713015. [PMID: 28615953 PMCID: PMC5462555 DOI: 10.1177/1178630217713015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/08/2017] [Indexed: 06/07/2023]
Abstract
Pesticide poisoning is a significant burden on health care systems in many low-income countries. This study evaluates cases of registered pesticide poisonings treated in selected rural (N = 101) and urban (N = 212) health facilities in Uganda from January 2010 to August 2016. In the urban setting, pesticides were the most prevalent single poison responsible for intoxications (N = 212 [28.8%]). Self-harm constituted a significantly higher proportion of the total number of poisonings in urban (63.3%) compared with rural areas (25.6%) where unintentional poisonings prevailed. Men were older than women and represented a majority of around 60% of the cases in both the urban and rural settings. Unintentional cases were almost the only ones seen below the age of 10, whereas self-harm dominated among adolescents and young persons from 10 to 29 years of age. Organophosphorus insecticides accounted for 73.0% of the poisonings. Urban hospitals provided a more intensive treatment and had registered fever complications than rural health care settings. To minimize self-harm with pesticides, a restriction of pesticide availability as shown to be effective in other low-income countries is recommended. Training of health care workers in proper diagnosis and treatment of poisonings and improved equipment in the health care settings should be strengthened.
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Affiliation(s)
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Victoria Nabankema
- PHE-project - coordinating officer, Uganda National Association of Community and Occupational Health, Kampala, Uganda
| | - Erik Jørs
- Department of Occupational Medicine, Odense University Hospital, Odense, Denmark
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Pieris R, Weerasinghe M, Abeywickrama T, Manuweera G, Eddleston M, Dawson A, Konradsen F. Utilization of Boxes for Pesticide Storage in Sri Lanka. J Agromedicine 2017; 22:180-184. [PMID: 28129079 DOI: 10.1080/1059924x.2017.1283280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pesticide self-poisoning is now considered one of the two most common methods of suicide worldwide. Encouraging safe storage of pesticides is one particular approach aimed at reducing pesticide self-poisoning. CropLife Sri Lanka (the local association of pesticide manufacturers), with the aid of the Department of Agriculture, distributed lockable in-house pesticide storage boxes free of charge to a farming community in a rural district of Sri Lanka. Padlocks were not provided with the boxes. These storage boxes were distributed to the farmers without prior education. The authors carried out a cross-sectional follow-up survey to assess the usage of boxes at 7 months after distribution. In an inspection of a sample of 239 box recipients' households, 142 households stored pesticides in the provided box at the time of survey. Among them, only 42 (42/142, 29.65%) households had locked the box; the remaining households (100/142, 70.4%) had not locked the box. A simple hand over of in-house pesticide storage boxes without awareness/education results in poor use of boxes. Additionally, providing in-house storage boxes may encourage farmers to store pesticides in and around houses and, if they are not locked, may lead to unplanned adverse effects.
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Affiliation(s)
- Ravi Pieris
- a South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine , University of Peradeniya , Peradeniya , Sri Lanka
| | - Manjula Weerasinghe
- a South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine , University of Peradeniya , Peradeniya , Sri Lanka.,b Department of Community Medicine, Faculty of Medicine and Allied Sciences , Rajarata University of Sri Lanka , Saliyapura , Anuradhapura , Sri Lanka
| | - Tharaka Abeywickrama
- c Pharmacology, Toxicology & Therapeutics, Centre for Cardiovascular Science , University of Edinburgh , Edinburgh , UK
| | - Gamini Manuweera
- d Department of Agriculture , Office of the Registrar of Pesticides , Peradeniya , Sri Lanka
| | - Michael Eddleston
- a South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine , University of Peradeniya , Peradeniya , Sri Lanka.,c Pharmacology, Toxicology & Therapeutics, Centre for Cardiovascular Science , University of Edinburgh , Edinburgh , UK
| | - Andrew Dawson
- a South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine , University of Peradeniya , Peradeniya , Sri Lanka.,e Sydney Medical School , University of Sydney , Sydney , Australia
| | - Flemming Konradsen
- f Department of Public Health, Global Health Section , University of Copenhagen , Copenhagen , Denmark
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Tekkalaki B, Nischal A, Tripathi A, Arya A. A study of individuals with intentional self-harm referred to psychiatry in a tertiary care center. Ind Psychiatry J 2017; 26:95-98. [PMID: 29456330 PMCID: PMC5810176 DOI: 10.4103/ipj.ipj_53_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intentional self- harm (ISH) is one of the commonest yet neglected entities of Consultation liaison Psychiatry. More researches in the field of ISH are needed to effectively manage this problem. AIM To study the socio-demographic and clinical profile of subjects of ISH referred to Psychiatry in a tertiary care hospital. MATERIALS AND METHODS All subjects of ISH referred to department of Psychiatry, of a tertiary centre, on specified days were recruited in to the study after obtaining an informed consent. Socio-demographic details, details of psychiatric assessment were documented using a semi structured proforma. Appropriate management was done. RESULTS Forty one subjects were included in the study. About two third of them belonged to the age group of 18 to 35 years. 56% of them were males, and 71% were married. House wives and students formed a significant proportion of sample. Most common method of ISH was self-poisoning. About two third of the patients had no diagnosable psychiatric illness. Interpersonal conflicts with family members (47%), conflicts with spouse (22%), broken emotional relationship (18%) were common causes for impulsive acts of ISH. CONCLUSIONS ISH is common amongst young, married males. About two third of those who attempt ISH have no diagnosable psychiatric illness, in rest, neurotic stress related disorders, personality disorders and substance use disorders were predominant.
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Affiliation(s)
| | - Anil Nischal
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Amit Arya
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
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Chettri R, Gurung J, Singh B. A 10-year retrospective study of suicide in Sikkim, India: Sociodemographic profile and risk assessment. Indian J Psychiatry 2016; 58:448-453. [PMID: 28197004 PMCID: PMC5270272 DOI: 10.4103/0019-5545.196712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The present study had been undertaken to investigate the sociodemographic profile of individuals who had committed suicide in Sikkim which may throw light on the vulnerable groups. MATERIALS AND METHODS Ten-year suicide data (2006-2015) obtained from Police Headquarters, Crime Branch, Gangtok, have been statistically evaluated to study the sociodemographic profile. RESULTS The results showed that out of 1604 suicide cases recorded for the past 10 years, 1051 were males (65.5%) and 553 (34.5%) were females. Suicide was found to be common among the age group of 21-30 years (24.4%), Rai community (15.8%), population of rural areas (82.6%), and among the population of eastern districts (50.6%). Hanging (94.8%) was found to be the most common method adopted for suicide. CONCLUSION The study provides preliminary information about the vulnerable groups for suicide in the state which may be vital for taking necessary steps for its prevention shortly.
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Affiliation(s)
- Reshma Chettri
- Department of Zoology, School of Life Sciences, Sikkim University, Gangtok, Sikkim, India
| | - Jiwan Gurung
- Department of Zoology, School of Life Sciences, Sikkim University, Gangtok, Sikkim, India
| | - Bisu Singh
- Department of Zoology, School of Life Sciences, Sikkim University, Gangtok, Sikkim, India
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21
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Cha ES, Chang SS, Gunnell D, Eddleston M, Khang YH, Lee WJ. Impact of paraquat regulation on suicide in South Korea. Int J Epidemiol 2015; 45:470-9. [PMID: 26582846 DOI: 10.1093/ije/dyv304] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ingestion of pesticides (mainly paraquat) accounted for one-fifth of suicides in South Korea in 2006-10. We investigated the effect on suicide mortality of regulatory action, culminating in a ban on paraquat in South Korea in 2011-12. METHODS We calculated age-standardized method-specific suicide mortality rates among people aged ≥15 in South Korea (1983-2013) using registered death data. Negative binomial regression was used to estimate changes in the rate and number of pesticide suicides in 2013, compared with those expected based on previous trends (2003-11). RESULTS Pesticide suicide mortality halved from 5.26 to 2.67 per 100 000 population between 2011 and 2013. Compared with the number expected based on previous trends, the regulations were followed by an estimated 847 [95% confidence interval (CI) -1180 to -533] fewer pesticide suicides, a 37% reduction in rates (rate ratio = 0.63, 95% CI 0.55 to 0.73) in 2013. The decline in pesticide suicides after the regulations was seen in all age/sex/geographical groups. The absolute reduction in the number of suicides was greatest among men, the elderly and in rural areas. The reduction in pesticide suicides contributed to 56% of the decline in overall suicides that occurred between 2011 and 2013. There was no impact of the regulations on crop yield. CONCLUSIONS The regulation of paraquat in South Korea in 2011-12 was associated with a reduction in pesticide suicide. Further legislative interventions to prevent the easy availability of highly lethal suicide methods are recommended for reducing the number of suicides worldwide.
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Affiliation(s)
- Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, and Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK, South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK and
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, and Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea,
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Gunnell D, Hawton K, Jayamanne S, Pabasara C, Jayathilaka T, Dissanayaka K, Rajapaksha S, Thilakarathna P, Agampodi S. Risk factors associated with purchasing pesticide from shops for self-poisoning: a protocol for a population-based case-control study. BMJ Open 2015; 5:e007822. [PMID: 25995242 PMCID: PMC4442210 DOI: 10.1136/bmjopen-2015-007822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pesticide self-poisoning is one of the most frequently used methods of suicide worldwide, killing over 300,000 people annually. Around 15-20% of pesticide self-poisonings occur soon after the person has bought the pesticide from a shop. We aim to determine the characteristics of individuals who purchase pesticides directly from shops and how they differ from individuals who access pesticides from other sources such as home, home garden or farmland. This information will help inform possible vendor/shop-based intervention strategies aimed at reducing access to pesticides used for self-harm. METHODS AND ANALYSIS This study will investigate risk factors associated with purchasing pesticides for acts of self-poisoning from pesticide shops, including cases identified over a 9-month period using a population-based case-control group approach. Four interviewer-administered data collection tools will be used for this study: a semistructured questionnaire, Beck Suicidal Intent Scale (SIS), Clinical Interview Schedule-Sinhalese version (CIS-Sn) and Alcohol Use Disorders Identification Test (AUDIT). Each case (expected n=33) will be compared with two groups of individuals: (1) those who have self-poisoned using pesticides from the home, home garden or farmland and (2) those who bought pesticides from the same shops as the above cases, but not did not self-poison. Logistic regression models will be used to identify risk factors of purchasing pesticides for self-poisoning from shops. ETHICS AND DISSEMINATION The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study. Results will be disseminated in scientific peer-reviewed articles.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Public Health, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Public Health, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - Melissa Pearson
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Shaluka Jayamanne
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Chathurani Pabasara
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Tharidu Jayathilaka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Kalpani Dissanayaka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Sandamali Rajapaksha
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Prasanna Thilakarathna
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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Jordans MJD, Kaufman A, Brenman NF, Adhikari RP, Luitel NP, Tol WA, Komproe I. Suicide in South Asia: a scoping review. BMC Psychiatry 2014; 14:358. [PMID: 25539951 PMCID: PMC4299381 DOI: 10.1186/s12888-014-0358-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, suicide is an important cause of mortality. In low- and middle income settings, it is difficult to find unequivocal data to establish suicide rates. The objective of this review is to synthesize the reporting of suicide incidence in six south Asian countries. METHODS We conducted a scoping review combining peer-reviewed studies (PubMed, PsycINFO, EMBASE) with in-country searches for grey literature in Afghanistan, Pakistan, Sri Lanka, India, Nepal and Bangladesh. The review included mapping reported suicide rates, quality appraisals of the studies, use of definitions of suicide and means of committing suicide. RESULTS In total, 114 studies and reports were included in the review, including 50 peer-reviewed publications. Reported suicide rates varied widely from 0.43/100,000 to 331.0/100,000. The average suicide rate across studies was found to be high compared to the world average, however many studies were of poor quality or not representative. The majority of studies failed to explicitly define suicide (84% of the published articles and 92% of the grey literature documents). Poisoning and hanging were consistently the most common methods of committing suicide on the sub-continent. CONCLUSIONS The reported suicide rates in South Asia are high compared to the global average, but there is a paucity of reliable data on suicide rates in South Asia. Reports are likely to diminish rather than exaggerate the magnitude of suicide rates. There is an urgent need to establish new, or evaluate existing, national suicide surveillance systems in the South Asian countries.
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Affiliation(s)
- Mark JD Jordans
- Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands ,Center for Global Mental Health, Institute of Psychiatry, King’s College London, London, UK
| | - Anne Kaufman
- Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands.
| | - Natassia F Brenman
- Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands.
| | - Ramesh P Adhikari
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, G.P.O Box 8974/ C.P.C. Box 612, Baluwatar, Kathmandu, Nepal.
| | - Nagendra P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, G.P.O Box 8974/ C.P.C. Box 612, Baluwatar, Kathmandu, Nepal.
| | - Wietse A Tol
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Ivan Komproe
- Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands. .,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands.
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Chandramouleeswaran S, Edwin NC, Victor PJ, Tharyan P. The emergency physician's assessment of suicide risk in intentional self-poisoning using the modified SAD PERSONS scale versus standard psychiatric evaluation in a general hospital in South India: a cross-sectional study. Trop Doct 2014; 45:21-6. [PMID: 25358507 DOI: 10.1177/0049475514553985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The reliable identification, by emergency physicians, of those with intentional self-poisoning at risk of repeating attempts is crucial, particularly in countries with a shortfall of mental health professionals. METHODS This cross-sectional study of intentional self-poisoning in India compared an emergency physician's assessment for the need for psychiatric referral, using the modified SAD PERSONS Scale (MSPS) as an interview guide, with a standard psychiatric interview. RESULTS In 67 consecutive adults with intentional self-poisoning, MSPS cut-off scores of 5 or more best approximated psychiatric assessments for the need for psychiatric referral (positive likelihood ratio 2.9, 95% confidence interval [CI] 0.8-10.2; negative likelihood ratio 0.5, 95% CI 0.3-0.8). CONCLUSIONS MSPS-guided emergency physicians' assessments after self-poisoning showed modest concordance with psychiatric assessments of suicide-risk. Concordance with psychiatric assessments may improve if risk factors prevalent in different settings are identified and incorporated in the MSPS.
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Affiliation(s)
| | - Natasha Catherine Edwin
- Assistant Professor, Department of Acute Care Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Peter John Victor
- Professor, Department of Critical Care Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prathap Tharyan
- Professor, Department of Psychiatry, Prof BV Moses Centre for Evidence-Informed Health Care and Health Policy, Christian Medical College, Vellore, Tamil Nadu, India
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Peshin SS, Srivastava A, Halder N, Gupta YK. Pesticide poisoning trend analysis of 13 years: a retrospective study based on telephone calls at the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. J Forensic Leg Med 2013; 22:57-61. [PMID: 24485423 DOI: 10.1016/j.jflm.2013.12.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/11/2013] [Accepted: 12/07/2013] [Indexed: 11/26/2022]
Abstract
The study was designed to analyze the incidence and pattern of pesticide poisoning calls reported to the National Poisons Information Centre (NPIC), AIIMS, New Delhi and highlight the common classes of pesticides involved in poisoning. The telephone calls received by the Centre during the thirteen year period (1999-2012) were entered into a preset proforma and then into a retrievable database. A total of 4929 calls of pesticide poisoning were recorded. The data was analyzed with respect to age, gender, mode and type of poisoning. The age ranged from 1 to 65 years with the preponderance of males (M = 62.19%, F = 37.80%). The age group mainly involved in poisoning was 18-35 years. While 59.38% calls pertained to household pesticides, 40.61% calls related to agricultural pesticides. The common mode of poisoning was intentional (64.60%) followed by accidental (34.40%) and unknown (1%). Amongst the household pesticides, the highest number of calls were due to pyrethroids (26.23%) followed by rodenticides (17.06%), organophosphates (6.26%), carbamates (4.95%) and others (4.86%). In agricultural pesticides group, the organophosphates (9.79%) ranked the first followed by, aluminium phosphide (9.65%), organochlorines (9.31%), pyrethroids (3.87%), herbicides, weedicides and fungicides (3.20%), ethylene dibromide (2.82%), and others (1.70%). The data analysis shows a high incidence of poisoning due to household pesticides as compared to agricultural pesticides, clearly emphasizing the need for creating awareness and education about proper use and implementation of prevention programmes.
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Affiliation(s)
- Sharda Shah Peshin
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
| | - Amita Srivastava
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Nabanita Halder
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
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Koylu R, Dundar ZD, Koylu O, Akinci E, Akilli NB, Gonen MO, Cander B. The experiences in a toxicology unit: a review of 623 cases. J Clin Med Res 2013; 6:59-65. [PMID: 24400033 PMCID: PMC3881991 DOI: 10.4021/jocmr1687w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 11/05/2022] Open
Abstract
Background To evaluate the etiological and demographic characteristics of adult poisoning patients followed up in a toxicology unit in Konya, Turkey. Methods Patients (≥ 15 years old) followed up with the diagnosis of poisoning in our toxicology unit in 2011 were included in this retrospective study. The patients’ medical records were investigated. Age, gender, medical history, the first medical center the patient had been admitted to, the routes and causes of poisoning, the toxins involved, the number of the pills taken, treatments, complications, the length of stay in the hospital and the outcome were recorded. Results A total of 623 patients were included in the study. The mean age of patients was 28.1 ± 15.1. Four hundred and forty-five (71.4%) of patients were female, 541 (86.9%) of them were poisoned via the oral route and 75 (12.0%) of them were poisoned by inhalation. The causes of poisoning were drugs in 408 (65.5%) patients, pesticides/insecticides in 58 (9.3%) patients and carbon monoxide in 49 (7.9%) patients. The commonly used drugs were as follows: analgesics (57.2%), antidepressants (25.4%) and gastrointestinal system drugs (15.8%). The poisonings were suicidal in 489 (78.5%) patients, accidental in 120 (19.3%) patients and overdose in 14 (2.2%) patients. The number of women was higher in the suicide group. At the end of the treatment, 604 (97.0%) of the patients were discharged and 3 (0.4%) of them died. The duration of follow-up was 39.2 ± 37.5 h. Conclusion The most common causes of poisoning are drugs, pesticides/insecticides and carbon monoxide. Health and educational policies at a national level are needed in order to prevent this medicosocial problem. Furthermore, specially equipped toxicology units should be constructed for the treatment and follow-up of the poisoned patients in order to reduce the morbidity and mortality to a significant extent.
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Affiliation(s)
- Ramazan Koylu
- Konya Training and Research Hospital, Emergency Department, Konya, Turkey
| | | | - Oznur Koylu
- Konya Training and Research Hospital, Biochemistry Department, Konya, Turkey
| | - Emine Akinci
- Konya Training and Research Hospital, Emergency Department, Konya, Turkey
| | | | | | - Basar Cander
- Necmettin Erbakan University Meram Faculty of Medicine, Emergency Medicine Department, Konya, Turkey
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Pattern and outcome of Cleistanthus collinus (Oduvanthalai) poisoning in a tertiary care teaching hospital in South India. J Forensic Leg Med 2013; 20:959-61. [DOI: 10.1016/j.jflm.2013.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 07/05/2013] [Accepted: 08/20/2013] [Indexed: 11/21/2022]
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Chrispal A. Cleistanthus collinus poisoning. J Emerg Trauma Shock 2013; 5:160-6. [PMID: 22787347 PMCID: PMC3391841 DOI: 10.4103/0974-2700.96486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 01/10/2011] [Indexed: 11/17/2022] Open
Abstract
Cleistanthus collinus, a toxic shrub, is used for deliberate self-harm in rural South India. MEDLINE (PUBMED) and Google were searched for published papers using the search/ MeSH terms “Cleistanthus collinus,” “Euphorbiaceae,” “Diphyllin,” “Cleistanthin A,” Cleistanthin B” and “Oduvanthalai.” Non-indexed journals and abstracts were searched by tracing citations in published papers. The toxic principles in the leaf include arylnaphthalene lignan lactones — Diphyllin and its glycoside derivatives Cleistanthin A and B. Toxin effect in animal models demonstrate neuromuscular blockade with muscle weakness, distal renal tubular acidosis (dRTA) and type 2 respiratory failure with conflicting evidence of cardiac involvement. Studies suggest a likely inhibition of thiol/thiol enzymes by the lignan-lactones, depletion of glutathione and ATPases in tissues. V-type H+ ATPase inhibition in the renal tubule has been demonstrated. Mortality occurs in up to 40% of C. collinus poisonings. Human toxicity results in renal tubular dysfunction, commonly dRTA, with resultant hypokalemia and normal anion gap metabolic acidosis. Aggressive management of these metabolic derangements is crucial. Acute respiratory distress syndrome (ARDS) is seen in severe cases. Cardiac rhythm abnormalities have been demonstrated in a number of clinical studies, though the role of temporary cardiac pacemakers in reducing mortality is uncertain. Consumption of decoctions of C. collinus leaves, hypokalemia, renal failure, severe metabolic acidosis, ARDS and cardiac arrhythmias occur in severe poisonings and predict mortality. Further study is essential to delineate mechanisms of organ injury and interventions, including antidotes, which will reduce mortality.
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Affiliation(s)
- Anugrah Chrispal
- Department of Medicine, Unit 2, Christian Medical College, Vellore, Tamil Nadu, India
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Weerasinghe M, Pearson M, Peiris R, Dawson AH, Eddleston M, Jayamanne S, Agampodi S, Konradsen F. The role of private pesticide vendors in preventing access to pesticides for self-poisoning in rural Sri Lanka. Inj Prev 2013; 20:134-7. [PMID: 23736739 PMCID: PMC3963527 DOI: 10.1136/injuryprev-2012-040748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 15% to 20% of self-poisoning cases, the pesticides used are purchased from shops just prior to ingestion. We explored how pesticide vendors interacted with customers at risk of self-poisoning to identify interventions to prevent such poisonings. Two strategies were specifically discussed: selling pesticides only to farmers bearing identity cards or customers bearing pesticide ‘prescriptions’. Vendors reported refusing to sell pesticides to people thought to be at risk of self-poisoning, but acknowledged the difficulty of distinguishing them from legitimate customers; vendors also stated they did want to help to improve identification of such customers. The community did not blame vendors when pesticides used for self-poison were purchased from their shops. Vendors have already taken steps to restrict access, including selling low toxic products, counselling and asking customer to return the next day. However, there was little support for the proposed interventions of ‘identity cards’ and ‘prescriptions’. Novel public health approaches are required to complement this approach.
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Affiliation(s)
- Manjula Weerasinghe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, , University of Peradeniya, Peradeniya, Sri Lanka
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Rajapakse T, Griffiths KM, Christensen H. Characteristics of non-fatal self-poisoning in Sri Lanka: a systematic review. BMC Public Health 2013; 13:331. [PMID: 23575389 PMCID: PMC3637511 DOI: 10.1186/1471-2458-13-331] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 04/04/2013] [Indexed: 11/11/2022] Open
Abstract
Background The rate of non-fatal self-poisoning in Sri Lanka has increased in recent years, with associated morbidity and economic cost to the country. This review examines the published literature for the characteristics and factors associated with non-fatal self-poisoning in Sri Lanka. Methods Electronic searches were conducted in Psychinfo, Proquest, Medline and Cochrane databases from inception to October 2011. Results 26 publications (representing 23 studies) were eligible to be included in the review. A majority of studies reported non-fatal self-poisoning to be more common among males, with a peak age range of 10–30 years. Pesticide ingestion was the most commonly used method of non-fatal self-poisoning. However three studies conducted within the last ten years, in urban areas of the country, reported non-fatal self-poisoning by medicinal overdose to be more common, and also reported non-fatal self-poisoning to be more common among females. Interpersonal conflict was the most commonly reported short-term stressor associated with self-poisoning. Alcohol misuse was reported among males who self-poisoned, and data regarding other psychiatric morbidity was limited. Conclusions The findings indicate that pesticide ingestion is the commonest method of non-fatal self-poisoning in Sri Lanka, and it is more common among young males, similar to other Asian countries. However there appears to be an emerging pattern of increasing medicinal overdoses, paralleled by a gender shift towards increased female non-fatal self-poisoning in urban areas. Many non-fatal self-poisoning attempts appear to occur in the context of acute interpersonal stress, with short premeditation, and associated with alcohol misuse in males. Similar to other Asian countries, strategies to reduce non-fatal self-poisoning in Sri Lanka require integrated intervention programs with several key aspects, including culturally appropriate interventions to develop interpersonal skills in young people, community based programs to reduce alcohol misuse, and screening for and specific management of those at high risk of repetition following an attempt of self-poisoning.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
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Chien WC, Lin JD, Lai CH, Chung CH, Hung YC. Trends in poisoning hospitalization and mortality in Taiwan, 1999-2008: a retrospective analysis. BMC Public Health 2011; 11:703. [PMID: 21923913 PMCID: PMC3184073 DOI: 10.1186/1471-2458-11-703] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 09/16/2011] [Indexed: 01/21/2023] Open
Abstract
Background Subjects with non-fatal poisoning may be left with permanent, disabling sequelae, and the resultant long-term use of medical services smay be a burden on the public health care system. The objective of this study was to describe the epidemiology of poisoning in Taiwan from 1999 to 2008. Methods We analyzed poisoning-related data of mortality rates sourced from official Taiwanese vital statistics and of hospitalization from the National Health Insurance (NHI) Research Database. The data were age-adjusted to the year 2000 Standard Population to determine 10-year hospitalization and mortality rate trends, which we stratified according to gender, age, and poisoning agent. Poisson regression was used to investigate the trends. Results There were 20,260 deaths and 210,021 hospitalizations related to poisoning, with mortality and hospitalization rates of 8.21 per 100,000 and 86.30 per 100,000 population, respectively. Males exhibited higher rates of mortality and hospitalization as a result of poisoning, with the highest risk in those aged 65 years or older. Medicinal drugs followed by pesticides were the two most common agents of poisoning. There was an increasing trend of both poisoning-related mortality and hospitalization rates during the study period, with a greater increase occurring in the hospitalization rate than in the mortality rate. Conclusions We found the males aged 65 years or older were at highest risk of poisoning, with medicinal drugs being the leading cause. Hospitalization rates increased more than mortality rates over the 10-year period. Appropriate poisoning prevention programs need to be developed. We should strengthen case management and improve access to health services to increase survival in cases of poisoning.
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Affiliation(s)
- Wu-Chien Chien
- School of Public Health, National Defense Medical Center, No, 161, Section 6, Min-Chuan E, Rd,, Neihu, Taipei, 11490, Taiwan.
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Milner A, McClure R, Sun J, De Leo D. Globalisation and suicide: An empirical investigation in 35 countries over the period 1980–2006. Health Place 2011; 17:996-1003. [DOI: 10.1016/j.healthplace.2011.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 03/14/2011] [Accepted: 03/14/2011] [Indexed: 11/24/2022]
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Eddleston M. Response to Peter and colleagues. Regul Toxicol Pharmacol 2010; 57:338; author reply 339-40. [DOI: 10.1016/j.yrtph.2010.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
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Pattern of pesticide storage before pesticide self-poisoning in rural Sri Lanka. BMC Public Health 2009; 9:405. [PMID: 19889236 PMCID: PMC2777873 DOI: 10.1186/1471-2458-9-405] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 11/05/2009] [Indexed: 11/11/2022] Open
Abstract
Background Deliberate self-poisoning with agricultural pesticides is the commonest means of suicide in rural Asia. It is mostly impulsive and facilitated by easy access to pesticides. The aim of this large observational study was to investigate the immediate source of pesticides used for self-harm to help inform suicide prevention strategies such as reducing domestic access to pesticides. Methods The study was conducted in a district hospital serving an agricultural region of Sri Lanka. Patients who had self-poisoned with pesticides and were admitted to the adult medical wards were interviewed by study doctors following initial resuscitation to identify the source of pesticides they have ingested. Results Of the 669 patients included in the analysis, 425 (63.5%) were male; the median age was 26 (IQR 20-36). In 511 (76%) cases, the pesticides had been stored either inside or immediately outside the house; among this group only eight patients obtained pesticides that were kept in a locked container. Ten percent (n = 67) of the patients used pesticides stored in the field while 14% (n = 91) purchased pesticides from shops within a few hours of the episode. The most common reasons for choosing the particular pesticide for self-harm were its easy accessibility (n = 311, 46%) or its popularity as a suicide agent in their village (n = 290, 43%). Conclusion Three quarters of people who ingested pesticides in acts of self-harm used products that were available within the home or in close proximity; relatively few patients purchased the pesticide for the act. The study highlights the importance of reducing the accessibility of toxic pesticides in the domestic environment.
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