No abstract

Background: Sri Lanka has reduced its overall suicide rate by 70% over the last two decades through means restriction, through a series of government regulations and bans removing highly hazardous pesticides from agriculture. We aimed to identify the key pesticide(s) now responsible for suicides in rural Sri Lanka to provide data for further pesticide regulation. Methods: We performed a secondary analysis of data collected prospectively during a cluster randomized controlled trial in the Anuradhapura district of Sri Lanka from 2011 to 16. The identity of pesticides responsible for suicides were sought from medical or judicial medical notes, coroners' records, and the person's family. Trend analysis was done using a regression analysis with curve estimation to identify relative importance of key pesticides. Results: We identified 337 suicidal deaths. Among them, the majority 193 (57.3%) were due to ingestion of pesticides while 82 (24.3%) were due to hanging. A specific pesticide was identified in 105 (54.4%) of the pesticide suicides. Ingestion of carbosulfan or profenofos was responsible for 59 (56.2%) of the suicides with a known pesticide and 17.5% of all suicides. The increasing trend of suicides due to carbosulfan and profenofos over time was statistically significant (R square 0.846, F 16.541, p 0.027). Conclusion: Ingestion of pesticides remains the most important means of suicides in rural Sri Lanka. The pesticides that were once responsible for most pesticide suicides have now been replaced by carbosulfan and profenofos. Their regulation and replacement in agriculture with less hazardous pesticides will further reduce the incidence of both pesticide and overall suicides in rural Sri Lanka.

Patterns of fish community composition in the Mahaweli ichthyological region of Sri Lanka were examined in agricultural tributaries of the Uma-oya catchment of the upper Mahaweli River in comparison to more pristine streams in a nature reserve in the Amban-ganga catchment. The Uma-oya catchment shows characteristics commonly observed in extensive agricultural exploitation such as impaired water quality and altered riparian vegetation. The most abundant fish species in the two regions were Garra ceylonensis, Devario malabaricus, and Rasbora daniconius, although their relative abundance differed between sites. G. ceylonensis and Neomacheilus notostigma were the only endemic fish species in common but the latter has been extremely depauperate. Endemism is higher in the reference sites (62.5%) than agricultural sites (ca. 25%); some of the reference streams showed greater diversity with unique fish species and a few species that have not been recorded previously in the catchment. The ichthyofaunal similarity between two catchments was 39% and fish species diversity was negatively correlated with stream gradients (Pearson correlation (-0.630); r 2 = 39.6% p = 0.028). Species density and biomass of G. ceylonensis and D. malabaricus were positively associated with some water quality parameters. The presence of exotic fish species were amongst the primary discriminants between human exploited and least-exploited (reference) streams. The possible negative impact of exotic Oreochromis niloticus (Nile tilapia) on indigenous G. ceylonensis is highlighted. This paper provides impetus for making several hypotheses for sustainability of stream fish assemblages in highly exploited agricultural catchments in Sri Lanka.

IntroductionPesticide 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 analysisA 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 disseminationThe 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 numberSLCTR/2019/006, U1111-1220-8046.

No abstract