Gatekeeper training for vendors to reduce pesticide self-poisoning in rural South Asia: a study protocol for a stepped-wedge cluster randomised controlled trial

Abstract

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.

Surveillance of pesticide poisoning in an East and a West Malaysian hospital: characteristics of pesticide poisoning and the early impact of a national Paraquat ban

“…It includes the identification of suicidal ideation as a proximal target for intervention in at risk individuals who may not necessarily have a diagnosable psychiatric disorder. Randomized-controlled trials are currently being piloted in Sri Lanka to test the effectivenessness of interventions aimed at reducing pesticide self-poisoning attempts at the community level via gatekeeper training for pesticide vendors [ 70 ], as well as hospital-level, nurse-led, single-session counseling for non-fatal self-poisoining patients that focuses on building coping strategies to ameriolate interpersonal conflict-related psychological distress [ 71 ].…”

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

“…Non‐farmers could be prevented at the point of pesticide sale. A large‐scale cluster RCT of ‘gatekeeper’ training for pesticide vendors is underway in rural Sri Lanka to test whether such training reduces sales to people who then ingest them for self‐harm [19].…”

“…It also has a high potential to be cost‐effective [18]. A large‐scale cluster randomised controlled trial (RCT) has since been set up to test the effectiveness and sustainability of this approach [19].…”

“Ad hoc policy decisions” in the news: Media framing analysis of a pesticide import ban in Sri Lanka

“…In this study we aimed to explore how the import ban was framed in Sri Lankan newspaper articles between 20 April and 31 October 2021. We focus solely on framings about the banning of pesticides due to its relevance at a global level as a suicide prevention strategy and our interest in interventions to reduce harm from pesticide poisoning [ 24 ]. The study period covered the announcement of the ban, the promulgation of the law, and the two main agricultural seasons ( Fig 1 ).…”