Case fatality of agricultural pesticides after self-poisoning in Sri Lanka: A prospective cohort study
Open accessAbstract
BACKGROUND: Pesticide poisoning is among the most common means of suicide globally, but can be prevented with regulation of the most hazardous agents. We aimed to compare the lethality of pesticides ingested by our cohort, seek evidence on variation between human and regulatory animal toxicity, and establish change over time in the case fatality of individual pesticides in Sri Lanka. METHODS: We examined the case fatality of agricultural pesticides in a prospective cohort in nine hospitals serving rural populations in Sri Lanka. We included all patients (>11 years) who had presented to a South Asian Clinical Toxicology Research Collaboration study hospital during the study period. Patients were enrolled by clinical research assistants and were regularly reviewed. Identification of the ingested pesticide was generally on the basis of history or positive identification of the container, supported by nested blood analysis. FINDINGS: From March 31, 2002, to Dec 31, 2019, 34 902 patients (median age 29 years [IQR 21-40]; 23 060 [66·1%] male) presented with a possible or known pesticide self-poisoning. We identified 23 139 specific pesticides that were ingested. Poisoning was fatal in 2299 (6·6%) patients. Case fatality varied greatly from 0·0% (several substances) to 41·8% (paraquat). The three most toxic agents (ie, paraquat, dimethoate, and fenthion) were banned between 2008 and 2011. Since 2013, the five agents causing the most deaths (ie, profenofos, propanil, fenobucarb, carbosulfan, and quinalphos) had a case fatality of 7·2-8·6%. A steady decline was seen in overall case fatality of pesticide poisoning (10·5% for 2002-06 to 3·7% for 2013-19), largely attributable to pesticide bans. A modest fall in case fatality for non-banned pesticides was also seen. INTERPRETATION: Declines seen in case fatalities of poisonings with non-banned pesticides suggest that medical management improved over time. The human data for acute toxicity of pesticides should drive hazard classifications and regulation. We believe that a global benchmark for registration of pesticides should include a less than 5% case fatality after self-poisoning, which could prevent many deaths and have a substantial effect on global suicide rates. FUNDING: The Wellcome Trust and the National Health and Medical Research Council of Australia. TRANSLATIONS: For the Sinhala and Tamil translations of the abstract see Supplementary Materials section.
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Psychiatrists are seldom directly solicited by suicidal patients.
“At the same time, psychiatrists are seldom directly solicited by these patients [56,58,59,60].”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [60]
The Introduction discusses pesticide self-poisoning and suicide prevention, while Methods > Study design and participants describes patients presenting to hospitals and their clinical care. Neither addresses how often suicidal patients directly seek out psychiatrists; searches for direct solicitation and psychiatric consultation found no relevant passage. Page numbers are unavailable in our copy. (LLM, conf=0.76)
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Self-citationPretilachlor poisoning in India-a case report
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SUBSTYTUCJA EGZOGENNYCH CHOLINESTERAZ W LECZENIU CIĘŻKICH ZATRUĆ ZWIĄZKAMI FOSFOROORGANICZNYMI
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Self-citation
- Authors
- Buckley, N. A., Fahim, M., Raubenheimer, J., Gawarammana, I. B., Eddleston, M., Roberts, M. S., & Dawson, A. H.
- Affiliations
- University of Peradeniya (LK)
- Corresponding author
- Buckley, Nicholas A
- ORCID
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 9
- Issue
- 6
- Pages
- e854-e862
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC8131203
- OpenAlex
- W3159885350
- Cited by
- 80
- References
- 28
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 16 · 2023: 12 · 2022: 14 · 2021: 11
- FWCI
- 8.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UniSA Research Outputs Repository (University of South Australia) (acceptedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Silicon Valley Community Foundation
- Wellcome Trust (GR063560MA, GR071669MA)
- National Health and Medical Research Council (1030069, 1055176, 268053)
- Topics
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Pesticide Exposure and Toxicity
- Health Sciences › Medicine › Surgery › Paraquat toxicity studies and treatments
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Keywords
- pesticide self-poisoning, case fatality, agricultural pesticides, suicide, paraquat, pesticide ban, pesticide regulation, acute toxicity, quinalphos, carbosulfan, dimethoate, fenthion, Sri Lanka, rural population, clinical toxicology, mortality trends
- MeSH terms
- Suicide, Completed, Adult, Female, Humans, Male, Pesticides, Prospective Studies, Sri Lanka, Young Adult
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