The Importance of Poisoning vs. Road Traffic Injuries as a Cause of Death in Rural Sri Lanka

Abstract

BackgroundRoad traffic crashes are considered by the WHO to be the most important global cause of death from injury. However, this may not be true for large areas of rural Asia where road vehicles are uncommon. The issue is important, since emphasising the importance of road traffic crashes risks switching resources to urban areas, away from already underfunded rural regions. In this study, we compared the importance of road traffic crashes with other forms of injury in a poor rural region of South Asia.Methodology/Principal FindingsWe collected data on all deaths from injury in the North Central Province of Sri Lanka (NCP; population 1,105,198 at 2001 census) over 18 months using coronial, hospital, and police data. We calculated the incidence of death from all forms of intentional and unintentional injury in the province. The annual incidence of death from injury in the province was high: 84.2 per 100,000 population. Half of the deaths were from self-harm (41.3/100,000). Poisoning (35.7/100,000)—in particular, pesticide self-poisoning (23.7/100,000)—was the most common cause of death, being 3.9-fold more common than road traffic crashes (9.1/100,000).Conclusions/SignificanceIn poor rural regions of South Asia, fatal self-harm and pesticide self-poisoning in particular are significantly more important than road traffic injuries as a cause of death. It is possible that the data used by the WHO to calculate global injury estimates are biased towards urban areas with better data collection but little pesticide poisoning. More studies are required to inform a debate about the importance of different forms of injury and how avoidable deaths from any cause can be prevented. In the meantime, marked improvements in the effectiveness of therapy for pesticide poisoning, safer storage, reduced pesticide use, or reductions in pesticide toxicity are required urgently to reduce the number of deaths from self-poisoning in rural Asia.

Population-based estimates of injuries in Sri Lanka

“…Likewise, we found a low incidence of poisoning and other self-inflicted injuries, which could be an underestimate, again, due to stigma related with these injuries and because we collected proxy data on the injured individuals. Similar findings have also been reported previously,35 36 although self-poisoning is a leading cause of death in Sri Lanka 10 37…”

“…The data from the Registrar General of Sri Lanka for year 2001 show that nearly one-third of injury deaths were each due to mechanical injuries and intentional self-harm, and 14% due to RTI 10. Intentional self-harm is reported to be the leading cause of injury mortality, followed by RTI and animal attacks, based on data from secondary referral hospitals in the North Central Province in Sri Lanka 37. We did not have any case of intentional self-harm in our study.…”

Validity of referral hospitals for the toxicovigilance of acute poisoning in Sri Lanka

“…This probably reflects easy access to the public health system and the fact that the most toxic pesticides that can cause a rapid death are banned. 12,13 Data on "all admissions", used by the government to derive the population incidence, overestimated the incidence of self-poisoning by about 60%. In 2007, 5118 cases of acute poisoning occurred in Anuradhapura district, for an official incidence of 639 per 100 000.…”

Predictors of Mortality in Critically Ill Patients with Poisoning: A Single Center Experience

“…5 On the contrary, there are studies conducted at Sri Lanka and USA suggesting that mortality related to poisoning is higher in young adolescents between 15 and 19 years age. 18,28 This may be due to cultural diversity and frequent oc- In our study, the mortality rate related to accidental poisoning was significantly higher compared to the mortality related to suicide. This might have been caused by the fact that eventual intention might have been to draw attention rather than death in some cases.…”