Self-poisoning in rural Sri Lanka: small-area variations in incidence

Abstract

Background: Self-poisoning is one of the most common methods of suicide worldwide. The intentional ingestion of pesticides is the main contributor to such deaths and in many parts of rural Asia pesticide self-poisoning is a major public health problem. To inform the development of preventive measures in these settings, this study investigates small-area variation in self-poisoning incidence and its association with area-based socioeconomic and agricultural factors.

Geographical variation in admissions due to poisoning in Sri Lanka: a time series analysis

“…Monaragala and Badulla had higher rates but these rates were much lower than in Anuradhapura and Polonnaruwa districts. The lack of a clear association between poverty and poisoning rates in Sri Lanka have been reported previously in several studies [19,20].…”

“…The data does not differentiate between accidental and deliberate self-poisoning. Previous studies suggest that admissions due to accidental poisoning may be around 10% [4,20,21]. Therefore it is reasonable to assume that the changing trends are mainly due to changes in patterns of self poisoning.…”

Suicide and poverty in low-income and middle-income countries: a systematic review

“…One study 34 reporting positive association between non-fatal SIB (suicidal ideation, severe suicidal ideation, suicide plan) and financial status in rural China, reported a positive association between non-fatal SIB (suicidal ideation, severe suicidal ideation) and degree of rurality using multivariate analysis. Another study 52 conducted amongst completed suicide and suicidal attempters by self-poisoning in rural Sri Lanka, where about 60% of the suicides were due to selfpoisoning, 69 found null association between unemployment and both completed suicide and suicidal attempts, but positive association with being employed in agriculture (with easier access to lethal means) using multivariate analysis. This is the first systematic review to our knowledge to explore the association between SIB and poverty in LMICs.…”

“…We assessed 29 (78%) studies to be of high [30][31][32][33][34][35][36][37][38][39][40][41][42][43] or acceptable [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] quality (Table 3). Eight studies [59][60][61][62][63][64][65][66] were of low quality due to problems with risk of bias: performance, attrition and detection bias (interrupted-time series); selection bias, unclear case definitions, detection bias, lack of adjustment for confounding factors (case-control studies); detection bias, lack of adjustment for confounding factors (cross sectional and ecological studies).…”

“…Among the seven studies reporting on completed suicide, three 31,51,62 reported a positive and one 38 a null association between completed suicide and unemployment using bivariate analysis. Results were mixed when studies used multivariate analysis, with one 59 showing a positive association with female low labour force participation in Iran (r=-0•38),one 52 reporting null association with unemployment rates amongst the working age population in Sri Lanka (IRR=1•29, 95% CI 0•96-1•72), and another 49 unclear association with unemployment rates amongst men and women in Belarus.…”