Regional variation in suicide rates in Sri Lanka between 1955 and 2011: a spatial and temporal analysis.

BACKGROUND: Between 1955 and 2011 there were marked fluctuations in suicide rates in Sri Lanka; incidence increased six-fold between 1955 and the 1980s, and halved in the early 21st century. Changes in access to highly toxic pesticides are thought to have influenced this pattern. This study investigates variation in suicide rates across Sri Lanka's 25 districts between 1955 and 2011. We hypothesised that changes in the incidence of suicide would be most marked in rural areas due to the variation in availability of highly toxic pesticides in these locations during this time period. METHODS: We mapped district-level suicide rates in 1955, 1972, 1980 and 2011. These periods preceded, included and postdated the rapid rise in Sri Lanka's suicide rates. We investigated the associations between district-level variations in suicide rates and census-derived measures of rurality (population density), unemployment, migration and ethnicity using Spearman's rank correlation and negative binomial models. RESULTS: The rise and fall in suicide rates was concentrated in more rural areas. In 1980, when suicide rates were at their highest, population density was inversely associated with area variation in suicide rates (r = -0.65; p < 0.001), i.e. incidence was highest in rural areas. In contrast the association was weakest in 1950, prior to the rise in pesticide suicides (r = -0.10; p = 0.697). There was no strong evidence that levels of migration or ethnicity were associated with area variations in suicide rates. The relative rates of suicide in the most rural compared to the most urban districts before (1955), during (1980) and after (2011) the rise in highly toxic pesticide availability were 1.1 (95% CI 0.5 to 2.4), 3.7 (2.0 to 6.9) and 2.1 (1.6 to 2.7) respectively. CONCLUSIONS: The findings provide some support for the hypothesis that changes in access to pesticides contributed to the marked fluctuations in Sri Lanka's suicide rate, but the impact of other factors cannot be ruled out.

A public health initiative for reducing access to pesticides as a means to committing suicide: findings from a qualitative study.

Widespread use of pesticides among farmers in rural India, provides an easy means for suicide. A public health initiative involving storage of pesticides in a central storage facility could be a possible strategy for reducing mortality and morbidity related to pesticide poisoning. This qualitative study explored community perceptions towards a central pesticide storage facility in villages in rural South India. Sixteen focus group discussions held with consenting adults from intervention and control villages were followed by eight more a year after initiation of the storage facility. Analysis revealed four themes, namely, reasons for committing suicide and methods used, exposure to pesticides and first-aid practices, storage and disposal of pesticides, and perceptions towards the storage facility. The facility was appreciated as a means of preventing suicides and for providing a safe haven for pesticide storage. The participatory process that guided its design, construction and location ensured its acceptability. Use of qualitative methods helped provide deep insights into the phenomenon of pesticide suicide and aided the understanding of community perceptions towards the storage facility. The study suggests that communal storage of pesticides could be an important step towards reducing pesticide suicides in rural areas.

Environmental hazards associated with pesticide import into Costa Rica, 1977-2009.

Raw pesticide import data from 1977 to 2009 obtained from the Ministry of Agriculture in Costa Rica were processed and analyzed. The quantity of specific active ingredients (a.i.), and chemical groups were calculated by year and presented in ten-year periods. Three sets of environmental hazard indicators were constructed: one for general pesticides exposure to monitor tendencies in time, including total quantities imported divided by significant denominators, such as hectares of protected and wetland areas. The second indicator calculates pesticide use on the Pacific or Caribbean slope. The third one is an assessment of environmental hazards intended to estimate fate and toxicity to aquatic biota. A review of Costa Rican aquatic ecosystems' contamination with pesticides is presented. The annual average import as well as the quantity of pesticides capable of reaching water bodies increased during the analyzed period. The same was observed for harmful a.i., 98% of the pesticides imported were classified as acutely toxic for fish and crustaceans and 73% for amphibians. Approximately 8.4 kg of a.i. were imported per hectare of protected areas and 24.3 kg of a.i. per hectare of wetlands. The contamination of aquatic systems over time by specific pesticides matches quite well the list of imported ones. We recommend using data of pesticide imports as a source of information to evaluate environmental risk exposure and promote changes to reduce impacts on aquatic systems.

Monitoring pesticide use and associated health hazards in Central America.

We established methods for monitoring pesticide use and associated health hazards in Central America. With import data from Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama for 2000-2004, we constructed quantitative indicators (kg active ingredient) for general pesticide use, associated health hazards, and compliance with international regulations. Central America imported 33 million kg active ingredient per year. Imports increased 33% during 2000-2004. Of 403 pesticides, 13 comprised 77% of the total pesticides imported. High volumes of hazardous pesticides are used; 22% highly/extremely acutely toxic, 33% moderately/severely irritant or sensitizing, and 30% had multiple chronic toxicities. Of the 41 pesticides included in the Stockholm Convention on Persistent Organic Pollutants (POPs), the Rotterdam Convention on Prior Informed Consent (PIC), the Montreal Protocol on Substances that Deplete the Ozone Layer, the Pesticide Action Network (PAN) Dirty Dozen, and the Central American Dirty Dozen, 16 (17% total volume) were imported, four being among the 13 most imported pesticides. Costa Rica is by far the biggest consumer. Pesticide import data are good indicators of use trends and an informative source to monitor hazards and, potentially, the effectiveness of interventions.

DDT and personal violence (suicide and homicide).

For 12 industrialized nations in 1965, suicide and homicide rates were not associated with the per capita use of DDT.

Pesticide use patterns among small-scale farmers: a case study from Phitsanulok, Thailand.

In this study, 130 small-scale farmers were surveyed regarding pesticide use patterns in rural Phitsanulok, northern Thailand using a structured questionnaire administered via personal interviews and an observational checklist of farmer pesticide storage practices. The survey was conducted during December 2007-January 2008. The results indicate pesticides are readily available and widely used in crop production. This includes the use of endosulfan which has been banned by the Thai government since 2004. Overall, pesticide use was inappropriate. Farmers did not wear suitable personal protection, apply pesticides in an appropriate fashion, or discard the waste safely. They frequently relied on commercial advertisements for the best pesticide to use. Pesticide use patterns among small-scale farmers in Thailand need improvement. Educational interventions are essential for promoting safety during all phases of pesticide handling. Public policies should be developed to encourage farmers to change their pest management methods from chemical based to methods that are healthier and more environmentally friendly.

[The UNESCO brand in the prosecco hills: opportunity or new health risk?] / Il marchio UNESCO sulle colline del prosecco: opportunità o nuovo rischio per la salute?

The historical hill-site zone of Prosecco's wine production was recognised as a UNESCO World Heritage Site. This area is part of the province of Treviso, an area where in recent years many lands have been occupied by the viticulture to produce this type of wine, due to a growing demand of prosecco, especially on international markets. Currently viticulture occupies 31% of the total agricultural area of the province. This is determining an important alteration of the landscape of the area, with serious loss of biodiversity. Even more, this intensive cultivation requires the use of many pesticides (in 2018, 4,622 tons were sold, equivalent to more than 36 kg per hectare of arable land), that are harmful to the health of the population. They can cause acute effects by inhalation or contact during the treatment of the vines, and chronic effects for the continuous intake of small doses through contaminated waters. To safeguard the environment and health, two actions are needed: to reduce the use of pesticides by promoting organic production; to restore biodiversity by promoting other crops besides the vineyards. Our hope is that belonging to the UNESCO heritage world list favours these actions.

Acute pesticide poisoning in the U.S. retail industry, 1998-2004.

OBJECTIVE: This study was conducted to describe the national magnitude and characteristics of acute pesticide poisoning among workers and customers in retail establishments. METHODS: Analyses included retail employees 15-64 years of age and customers with acute pesticide poisoning identified from the Sentinel Event Notification System for Occupational Risks-Pesticides (SENSOR-Pesticides) and California Department of Pesticide Regulation from 1998 to 2004. Pesticide poisoning incidence rates and incidence rate ratios (IRR) were calculated. RESULTS: A total of 325 cases of acute pesticide poisoning were identified. Of these cases, 287 (88%) were retail employees and 38 (12%) were customers. Overall, retail employees had a significantly lower acute pesticide poisoning incidence rate compared with non-agricultural, non-retail employees (IRR=0.53; 95% confidence interval 0.47, 0.59). However, significantly elevated pesticide poisoning incidence rates were observed for four retail occupations (janitors, stock handlers/baggers, bakery/deli clerks, and shipping/receiving handlers). In addition, workers employed in two retail industry sectors (farm supply stores and hardware stores) had significantly elevated acute pesticide poisoning incidence rates. Incidence rates among the retail employees demonstrated a quadratic trend, monotonically decreasing from 1998 to 2000 and monotonically increasing from 2000 to 2003. The rates appear to have leveled off in 2003 and 2004. CONCLUSIONS: Preventive measures to decrease acute pesticide poisoning incidence in the retail sector include adoption of unbreakable and tear-resistant container requirements, increased utilization of integrated pest management strategies, and advisement to store managers, employees, and customers about poisoning prevention.

The global distribution of fatal pesticide self-poisoning: systematic review.

BACKGROUND: Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. METHODS: We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990-2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning. RESULTS: We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm. CONCLUSION: Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.

Community uptake of safe storage boxes to reduce self-poisoning from pesticides in rural Sri Lanka.

BACKGROUND: Acute poisoning by agricultural pesticides is a well established global public health problem. Keeping pesticides under safe storage is now promoted as a potential way to reduce the number of severe poisoning cases. However, there have been no published studies documenting the feasibility of such an approach. Therefore, the objective of the study presented here was to determine community perceptions and use of in-house safe storage boxes for pesticides in rural Sri Lanka. METHODS: Boxes with a lock, to be used for the in-house safe storage of pesticides, were distributed to 200 randomly selected farming households in two agricultural communities. A baseline survey determined pesticide storage practices and household characteristics prior to distribution. The selected households were encouraged to make use of the box at community meetings and during a single visit to each household one month after distribution. No further encouragement was offered. A follow-up survey assessed storage practices seven months into the project. RESULTS: Following the distribution of the boxes the community identified a number of benefits including the protection of pesticide containers against exposure from the rain and sun and a reduced risk of theft. Data were analysed for 172 households that reported agricultural use of pesticides at follow-up. Of these, 141 (82%) kept pesticides in the house under lock against 3 (2%) at baseline. As expected, the distribution of boxes significantly reduced the number of households storing pesticides in the field, from 79 (46%) at baseline to 4 (2%) at follow-up. There was a significant increase in the number of households keeping pesticides safe from children between baseline (64%) and seven months after the distribution of boxes (89%). The same was true for adults although less pronounced with 51% at baseline and 66% at follow-up. CONCLUSION: The farming community appreciated the storage boxes and made storage of pesticides safer, especially for children. It seems that additional, intensive promotion is needed to ensure that pesticide boxes are locked. The introduction of in-house safe storage boxes resulted in a shift of storage into the farmer's home and away from the field and this may increase the domestic risk of impulsive self-poisoning episodes. This increased risk needs attention in future safe storage promotion projects.

Pesticide practices and suicide among farmers of the sundarban region in India.

BACKGROUND: Deliberate self-poisoning by ingesting pesticides is a serious health problem among farmers, especially in low- and middle-income countries. Preventing these suicides is a priority for a public mental health agenda. OBJECTIVE: To examine the role of pesticide poisoning in suicide and nonfatal deliberate self-harm, and clarify awareness of risks, safe practices concerning storage and use of pesticides, and associated self-injury, both unintentional and intentional, within farmer households of the Sundarban region, India. METHODS: Retrospective record review of adult cases of deliberate self-poisoning at the Block Primary Health Centres of 13 Sundarban Blocks was performed to analyze the relative roles of various methods of self-harm and their lethality. Focus group discussions, questionnaires, and in-depth interviews were undertaken in a community study of farmer households to examine pesticide-related views and practices, with particular attention to storage, use, and health impact. RESULTS: Pesticide poisoning was the most common method of deliberate self-harm in both men and women. Pesticide storage in most households was unsafe and knowledge was inadequate concerning adverse effects of pesticides on health, crops, and the environment. CONCLUSIONS: An intersectoral approach linking the interests of public health, mental health, and agriculture is well suited to serve the collective interests of all three agendas better than each in isolation. Such an approach is needed to reduce morbidity and mortality from unintentional and intentional self-injury in low-income agricultural communities like those of the Sundarban region.

Challenges and opportunities in suicide prevention in South-East Asia.

Suicide is a global public health problem, with over 800 000 people worldwide dying by suicide in 2012, according to the World Health Organization (WHO). The WHO South-East Asia Region is especially affected, with 39% of global suicides occurring in the 11 countries in this region. Women are a particularly vulnerable population, for a variety of social and cultural reasons. In India specifically, deaths by suicide for women peak in the age range 15-29 years. There is sufficient evidence to show that reduction of easy access to means of suicide is an effective prevention strategy. A common method of suicide in the region is by ingestion of pesticides. Strategies that have targeted limiting access to pesticides as a means of preventing suicide, such as the use of central storage and locked boxes, have shown promising results. Given the limited human and economic resources in these countries, it is essential to involve all stakeholders, including health services, voluntary and community organizations, teachers, social workers, traditional healers and other gatekeepers, in suicide prevention. A multisectoral approach, specifically targeting women and reducing easy access to pesticides, should be the way forward to reducing suicides in this region. In addition, more research is needed, to identify cost-effective and sustainable strategies.

Use of point-of-sale data to track usage patterns of residential pesticides: methodology development.

BACKGROUND: Residential-use pesticides have been shown to be a major source of pesticide exposure to people in the United States. However, little is understood about the exposures to household pesticides and the resultant health effects. One reason that little is known about home-use pesticide exposure is the lack of comprehensive data on exposures to pesticides in the home. One method to help ascertain the amount of pesticides present in the home is use of point-of-sale data collected from marketing companies that track product sales to obtain the volume of pesticides sold for home-use. This provides a measure of volume of home-use pesticide. METHODS: We have constructed a searchable database containing sales data for home-use permethrin-containing pesticides sold by retail stores in the United States from January 1997 through December 2002 in an attempt to develop a tracking method for pesticide. This pilot project was conducted to determine if point-of-sale data would be effective in helping track the purchase of home-use permethrin containing pesticides and if it would stand as a good model for tracking sales of other home-use pesticides. RESULTS: There are several limitations associated with this tracking method, including the availability of sales data, market coverage, and geographic resolution. As a result, a fraction of sales data potentially available for reporting is represented in this database. However, the database is sensitive to the number and type of merchants reporting permethrin sales. Further, analysis of the sale of individual products included in the database indicates that year to year variability has a greater impact on reported permethrin sales than the amount sold by each type of merchant. CONCLUSION: We conclude that, while nothing could completely replace a detailed exposure assessment to estimate exposures to home-use pesticides, a point-of-sale database is a useful tool in tracking the purchase of these types of pesticides to 1) detect anomalous trends in regional and seasonal pesticide sales warranting further investigation into the potential causes of the trends; 2) determine the most commonly purchased application types; and 3) compare relative trends in sales between indoor and outdoor use products as well as compare trends in sales between different active ingredients.

Critical use of methyl bromide for soil disinfestation in Belgium during 2005.

During 2005, Belgium enforced a strict procedure for the assignment of critical-use permits for methyl bromide (MeBr) as a soil disinfestant. This procedure involved an inspection of the site before disinfestation by a representative of a registered institute, and a mandatory demonstration of the presence of a pest or disease for which a critical use permit could be granted according to the Critical Use Nominations (CUNs). The procedure was subject to random inspections by an independent institute. The results of these inspections demonstrated proper and timely evaluation of the permit requests. A total of 113 requests for a MeBr disinfestation permit were submitted in 2005. Out of these, 105 referred to applications in 2005. The remaining 8 requests referred to applications in 2006 and were denied a permit based on the lack of MeBr quotum granted to Belgium for 2006. Of the 105 requests for applications in 2005, 93 received a MeBr application permit for soil disinfestation. These 93 permits represented 15911 kg or 37.3% of the total quotum assigned to Belgium in 2005 (42676 kg). Most of the quotum was used for butterhead lettuce (11456 kg or 72% of the applied MeBr). For most commodities, a surplus in quotum was available. However, for chrysanthemum, the amount requested for critical use exceeded the available quotum. The most important pests and diseases for which a permit was assigned were Meloidogyne, Sclerotinia, Rhizoctonia, Olpidium, Pythium, Pyrenochaeta, Verticillium, and a combination of these fungi and nematodes. The 12 requests for which no permit was granted represented 2010 kg or 11.3% of the total amount requested. In addition, institutes carrying out the assignment procedure reported at least 62 extra cases where they had been contacted by a grower but where no official permit request was filed based on the first inspection. When including those cases, the total reduction of the potentially used amount of MeBr is about 44 %. When adding an estimated 10 to 15% reduction due to the use of alternatives by growers who did not start the permit assignment procedure, the total reduction is approximately 50-55%.

Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation.

Understanding factors affecting the use of personal protective equipment (PPE) during handling of plant protection products (PPPs) is of major importance for the design of tailored interventions to minimize exposure among farmers. However, data regarding this issue are highly limited. Factors related to the use of PPE during handling of PPPs were explored in a survey of cotton farmers in northern Greece. Data were collected through face-to-face interviews with the farmers based on a questionnaire with structured items on the frequency of use of various personal protective devices during handling of PPPs. New evidence on patterns of PPE use and potential exposure of farmers to PPPs is provided. Most farmers (49.3%) showed potentially unsafe behaviour with respect to PPE use. Hat and boots were the most commonly used protective items during PPPs use, but most of the farmers surveyed reported low frequency of use for gloves, goggles, face mask, coveralls, and respirator. Especially the respirator was reported to be the least used PPE item amongst farmers. Farmers who perceived PPPs as harmful substances or those who had an episode of intoxication in the past reported more frequent use of several PPE items. Stepwise multiple regression analysis revealed that the variable episode of intoxication in the past exerted the strongest positive influence on PPE use, followed by the perception of PPPs being hazardous substances, upper secondary education, previous training on PPPs (i.e., spraying equipment, application parameters, risks to human health and environment, safety issues) and farm size under cultivation. Old age exerted a significant negative influence on PPE use, namely, elderly farmers tended not to use PPE. Strategies to maximize the protection of applicators of PPPs from hazardous exposures still require innovation to achieve increased effectiveness. Emphasis on lifelong training and education of farmers about hazards and risks of PPPs is crucial for changing wrong behaviours in handling of PPPs.

Reducing acute poisoning in developing countries--options for restricting the availability of pesticides.

Hundreds of thousands of people are dying around the world each year from the effects of the use, or misuse, of pesticides. This paper reviews the different options to reduce availability of the most hazardous chemicals, focusing on issues in developing countries. Emphasis is placed on the fatal poisoning cases and hence the focus on self-harm cases. Overall, it is argued here that restricting access to the most hazardous pesticides would be of paramount importance to reduce the number of severe acute poisoning cases and case-fatalities and would provide greater opportunities for preventive programmes to act effectively. The aim should be to achieve an almost immediate phasing out of the WHO Classes I and II pesticides through national policies and enforcement. These short-term aims will have to be supported by medium- and long-term objectives focusing on the substitution of pesticides with safe and cost-effective alternatives, possibly guided by the establishment of a Minimum Pesticide List, and the development of future agricultural practices where pesticide usage is reduced to an absolute minimum. Underlying factors that make individuals at risk for self-harm include domestic problems, alcohol or drug addiction, emotional distress, depression, physical illness, social isolation or financial hardship. These should be addressed through preventive health programmes and community development efforts.