Effects of a provincial ban of two toxic organophosphorus insecticides on pesticide poisoning hospital admissions

Abstract

Background. Pesticide self-poisoning causes one third of global suicides. Sri Lanka halved its suicide rate by banning WHO Class I organophosphorus (OP) insecticides and then endosulfan. However, poisoning with Class II toxicity OPs, particularly dimethoate and fenthion, remains a problem. We aimed to determine the effect and feasibility of a ban of the two insecticides in one Sri Lankan district.Methods.Sale was banned in June 2003 in most of Polonnaruwa District, but not Anuradhapura District. Admissions with pesticide poisoning to the district general hospitals was prospectively recorded from 2002.Results.Hospital admissions for dimethoate and fenthion poisoning fell by 43% after the ban in Polonnaruwa, while increasing by 23% in Anuradhapura. The pesticide case fatality fell from 14.4% to 9.0% in Polonnaruwa (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.41–0.84) and 11.3% to 10.6% in Anuradhapura (OR 0.93, 95%CI 0.70–1.25; p = 0.051). This reduction was not sustained, with case fatality in Polonnaruwa rising to 12.1% in 2006–2007. Further data analysis indicated that the fall in case fatality had actually been due to a coincidental reduction in case fatality for pesticide poisoning overall, in particular for paraquat poisoning.Conclusions.We found that the insecticides could be effectively banned from agricultural practice, as shown by the fall in hospital admissions, with few negative consequences. However, the ban had only a minor effect on pesticide poisoning deaths because it was too narrow. A study assessing the agricultural and health effects of a more comprehensive ban of highly toxic pesticides is necessary to determine the balance between increased costs of agriculture and reduced health care costs and fewer deaths.

Outcomes of Community‐Based Suicide Prevention Approaches That Involve Reducing Access to Pesticides: A Systematic Literature Review

“…The third study examined the effectiveness of household‐based lockable pesticide storage containers, which were typically installed within the home compound, partially buried within the ground, and locked by household members (Pearson et al., ). The fourth study piloted a selective ban of two insecticides classified as Class II—or “moderately hazardous”—by the World Health Organization (Eddleston et al., ), while the fifth study piloted a selective ban of one highly toxic insecticide (Nandi et al., ). For further detail on these interventions, readers are referred to the original studies.…”

“…However, this did not translate into a sustained reduction in pesticide‐related deaths, despite the promising short‐term effects. There was a 5.4% reduction in case fatality for all pesticides in the intervention district (odds ratio 0.59, 95%CI 0.41, 0.84) and only a 0.7% reduction in the control district (odds ratio 0.93, 95%CI 0.70, 1.25), but this was explained by a contemporaneous reduction in case fatality rates for herbicides and other pesticides that were not targeted, and was not sustained (Eddleston et al., ).…”

“…It is conceivable that two of the interventions we examined, which involved local‐level insecticide bans (Eddleston et al., ; Nandi et al., ), may be operating on the basis of principles similar to those that have been found to be effective in the context of top‐down strategies, such as large‐scale, national‐level bans (Gunnell et al., ). In this context, it is noteworthy that the local ban reported by Eddleston et al.…”

Business conflict and pesticide risk regulation in Costa Rica: supporting data on laws and instructive events, 1998-2014

“…Social science research has slackened. It remains unnoticed by most social scientists that a heterogeneous set of actors have worked intensively on shaping pesticide regulation over the last two decades (Cole et al 2002, 2011, Dalvie et al 2014, Eddleston et al 2012, Jansen and Dubois 2014. Many practices, relationships, and narratives have changed.…”

Use of OpdA, an organophosphorus (OP) hydrolase, prevents lethality in an African green monkey model of acute OP poisoning

“…An estimated 3,000,000 people are acutely poisoned each year, with a case fatality rate in excess of 9% in Sri Lanka (Eddleston et al , 2012). In nearly all countries the deliberate oral ingestion of OP pesticides is the most common method of self-harm (Chang et al , 2012).…”