CPSP is setting up a study in Nepal that aims to identify the most important pesticides for suicide across the country.
It is a collaboration with the Director General, Department of Agriculture, Ministry of Agricultural Development (Dr Dilli Ram Sharma) and with the Department of Medicine, Tribhuvan University Teaching Hospital (Dr Rakesh Ghimire), and ten hospitals across Nepal (figure).
Nepal is a country with population of 27 million people. 80% of population resides in rural areas, often with limited access to health care and mental health services. In 2014, the World Health Organization estimated that Nepal had the 7th highest suicide rate in the world (24.9 per 100,000), the 3d highest for women (20 per 100,000), and 17th highest for men (30.1 per 100,000). Pesticide self-harm is thought to be one of the main means of suicide in the country.
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 Nepal. The Nepalese pesticide regulatory authority will then consider the data and whether actions might be warranted. We expect that banning of the pesticides most responsible for pesticide suicides will reduce overall national suicide numbers.
Hagaman AK, Khadka S, Lohani S, Kohrt B. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1483-1494.
Marahatta K, Samuel R, Sharma P, Dixit L, Shrestha BR. Suicide burden and prevention in Nepal: The need for a national strategy. WHO South East Asia J Public Health 2017; 6:45-49.