Emerging pesticides responsible for suicide in rural Sri Lanka following the 2008-2014 pesticide bans

Weerasinghe, Manjula; Pearson, Melissa; Konradsen, Flemming; Agampodi, Suneth; Sumith, J.A.; Jayamanne, Shaluka; Senanayake, S. M. H. M. K.; Rajapaksha, Sandamali; Eddleston, Michael

doi:10.21203/rs.2.11039/v1

Cited by 3 publications

(5 citation statements)

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“…It would be valuable to compare the pesticides ingested by patients surviving hospital admission with those identified in fatal cases from the forensic toxicology laboratories to provide insight into the relative toxicity of the pesticides and identify pesticides for which deaths appear to be occurring before admission to tertiary hospitals. For such an analysis, prospectively collected hospital admissionswith careful recording of the pesticide ingested by experienced researcherswould be essential, as done previously in Sri Lanka [28,29]. A future study should collect these hospital data for comparison with forensic toxicology data.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were most commonly: women (n ¼ 2533, 61.3%; unknown gender n ¼ 15), of the Janajati ethnic group ((n ¼ 1063 27.7%) [16], and aged 16-30 years ((n ¼ 2350, 57.5%). Median age of patients was 25 years (IQR 19-35), with a small difference between sexes (male: 27 ; female 24 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

Section: Pesticide Self-poisoning Among Patients Presenting To Hospitalsmentioning

confidence: 99%

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Intentional pesticide poisoning and pesticide suicides in Nepal

Ghimire

Utyasheva

Pokhrel³

et al. 2021

Clinical Toxicology

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Introduction: Intentional pesticide poisoning is a major clinical and public health problem in agricultural communities in low and middle income countries like Nepal. Bans of highly hazardous pesticides (HHP) reduce the number of suicides. We aimed to identify these pesticides by reviewing data from major hospitals across the country and from forensic toxicology laboratories. Methods: We retrospectively reviewed medical records of 10 hospitals for pesticide poisoned patients and two forensic laboratories of Nepal from April 2017 to February 2020. The poison was identified from the history, referral note, and clinical toxidrome in the hospitals and from gas chromatography analysis in the laboratories. Data on demographics, poison, and patient outcome were recorded on a data collection sheet. Simple descriptive analysis was performed. Results: Among hospital cases (n ¼ 4148), the commonest form of poisoning was self-poisoning (95.8%) while occupation poisoning was rare (0.03%). Case fatality was 5.3% (n ¼ 62). Aluminum phosphide (n ¼ 38/62, 61.3%) was the most commonly identified lethal pesticide for deaths. Forensic toxicology laboratories reported 2535 deaths positive for pesticides, with the compounds most commonly identified being organophosphorus (OP) insecticides (n ¼ 1463/2535; 57.7%), phosphine gas (n ¼ 653/ 2535; 25.7%; both aluminum [11.8%] and zinc [0.4%] phosphide) and organochlorine insecticides (n ¼ 241/2535; 9.5%). The OP insecticide most commonly identified was dichlorvos (n ¼ 273/ 450, 60.6%). Conclusion:The data held in the routine hospital medical records were incomplete but suggested that case fatality in hospitals was relatively low. The pesticides identified as causing most deaths were dichlorvos and aluminum phosphide. Since this study was completed, dichlorvos has been banned and the most toxic formulation of aluminum phosphide removed from sale. Improving the medical record system and working with forensic toxicology laboratories will allow problematic HHPs to be identified and the effects of the bans in reducing deaths monitored.

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Section: Discussionmentioning

confidence: 99%

Section: Pesticide Self-poisoning Among Patients Presenting To Hospitalsmentioning

confidence: 99%

Intentional pesticide poisoning and pesticide suicides in Nepal

Ghimire

Utyasheva

Pokhrel³

et al. 2021

Clinical Toxicology

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“…Comprehensive longitudinal prospective case series from several hospitals across the country, such as has been done for Sri Lanka [14][15][16], would be the ideal sources for information on causes of poisoning death over time, but such studies are only available from Chandigarh (for example ref. [17,18]).…”

Section: Introductionmentioning

confidence: 99%

Importance of pesticides for lethal poisoning in India during 1999 to 2018: a systematic review

et al. 2021

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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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“…2,3 In addition, carbofuran has been implicated as a leading suicidal agent, amounting to 56.2% of suicides committed with a pesticide and 17.5% of all suicides in rural areas. 4 The compound can be inhaled, ingested, and absorbed dermatologically displaying high cholinergic toxicities including vomiting, excessive salivation, diarrhea, and may result in death from respiratory failure. [3][4][5] The present study includes a case report of a 51-year-old Asian man who suffered severe carbofuran toxicity following ingestion of a contaminated mixture and the herein management and treatment of the patient through appropriate antidotal pharmacology.…”

Section: Introductionmentioning

confidence: 99%

“…Due to its widespread use around the world, it has been implicated in the toxic contamination of air, food, and water sources with harmful effects on both humans and wildlife 2,3 . In addition, carbofuran has been implicated as a leading suicidal agent, amounting to 56.2% of suicides committed with a pesticide and 17.5% of all suicides in rural areas 4 . The compound can be inhaled, ingested, and absorbed dermatologically displaying high cholinergic toxicities including vomiting, excessive salivation, diarrhea, and may result in death from respiratory failure 3‐5 .…”

Section: Introductionmentioning

confidence: 99%