CPSP is setting up a study in India that aims to identify the most important pesticides for suicide across the country.

It is a collaboration with the Department of Medicine, Christian Medical College, Vellore (Prof Anand Zachariah, Dr Punitha JV) and with the Emmanuel Hospital Association (Dr Pratibha Milton) and with 20 hospitals across 13 Indian states (figure).

India is second-most populous country in the world with a population of more than 1.3 billion in 2017. The National Crime Records Bureau of India has estimated that about 135,000 suicides occurred during 2010. A 2012 publication (Patel et al, Lancet) using data from 2001-3 estimated that 187,000 suicide deaths occurred in India during 2010, with about 50% of suicides (92,000) being due to poisoning, particularly pesticide self-poisoning. Suicide death rates were higher in rural than in urban areas, perhaps due to the higher availability of pesticides together with poorer access to emergency medical care.

India has carried out extensive series of pesticide regulations to reduce the hazards associated with their use. The effect of these regulations on pesticide suicides is not yet known. This study aims to fill this gap.

After ethics approval, we plan to collect clinical and pesticide data for pesticide poisoned patients admitted to study hospitals.  We will also collect data from forensic medicine autopsy records and from police records to identify the pesticides responsible for deaths after pesticide poisoning in people who do not reach hospital alive. To complement this information, we will identify the range of pesticides for sale in local shops.

These data will be analysed to identify the highly hazardous pesticides currently responsible for the majority of pesticide suicides in India. These data will be presented to the Indian pesticide regulatory authority so that decisions can be made about priority pesticide regulation. We expect that such actions will result in markedly fewer pesticide suicides and overall national suicide numbers.

Patel V, Ramasundarahettige C, Vijayakumar L, et al. Suicide mortality in India: a nationally representative survey. Lancet 2012; 379:2343-2351.