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Sri Lanka

swcRCT to determine whether pesticide vendor training reduces pesticide self-poisoning in rural Asia

Suicide attempts (self-poisoning) with pesticides is a major problem in rural Asian communities. In about 20% of cases where people survive (and 35% of cases where they die) pesticides used in the self-harm act are purchased from a local pesticide shop. We have shown in a pilot study that training pesticide shop-keepers to not sell to non-farmers and alcohol intoxicated people may be an effective way of reducing sales to people who go on to harm themselves. We now aim to formally test how well this approach can work – we hypothesise that this training will reduce the number of patients presenting to hospital with pesticide self-poisoning.

We set up a large-scale study to compare training of pesticide sellers, versus no training, in 71 DS divisions within North Central, Eastern, Northern and Central Provinces of Sri Lanka (population 2.89 million). Over 4 years, the intervention will be rolled out in two zones. In the first zone, of 29 DS divisions within North Central Province, the intervention will be introduced to shops within clusters made up of two DS divisions at 76-day intervals. The clusters within the second zone, of 42 DS divisions in the remaining provinces, will be trained at 58-day intervals. The DS divisions in each cluster will be selected with the purpose of minimising cross-border contamination. The clusters will be chosen for enrolment at random. All the pesticide vendors in the cluster will receive ‘gatekeeper’ training to teach ways of not selling to customers at high risk of ingesting the pesticide, until the training has been introduced into all divisions The training will take two hours in either a central location or in pesticide shops and teach the shop keepers how to observe customer behaviour, check for intoxication, and ask questions for which farmers should know the answer. Brief follow-up training will be provided at regular intervals to reinforce the lessons learnt during training; an assessment of how closely the trained vendors followed the teaching will be taken at these times. We will look for the effect of training on the number of patients presenting with pesticide self-poisoning to all the hospitals in the Province. We will also look for evidence of whether people are switching to other methods when they present with self-harm.

This large study will provide evidence of whether an intervention aimed at pesticide shopkeepers is effective at reducing attempted suicide with pesticides in rural Sri Lanka. If effective, this approach will be spread around rural Asia through discussions with the WHO and FAO, potentially making a substantial contribution to global suicide prevention.