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Comment: Preventing deaths from pesticide self-poisoning – learning from Sri Lanka’s success

This article discusses what we can learn Sri Lanka’s pesticide regulations, which have contributed to one of the greatest decreases in suicide rate ever seen.

Authors: Michael Eddleston, Duleeka W Knipe, David Gunnell
Published in: The Lancet Global Health

Introduction

WHO estimates that over 800 000 people die by suicide each year, with the majority of these deaths occurring in low-income and middle-income countries (LMICs). During the late 1990s and early 2000s an estimated 35% of suicides, or 300 000 deaths, were due to intentional pesticide self-poisoning. These numbers have since fallen, but WHO still considers pesticide self-poisoning to be one of the three most important means of global suicide.

In order to achieve further reductions, prevention efforts will need to be multifaceted and work across three levels: patient, community, and nation. Improved medical management could reduce deaths after exposure; however, clinical trials have shown few benefits and many patients die before accessing health care. Improved storage of pesticides in households or community storage facilities may reduce access at moments of stress; this approach has been tested but has little supporting evidence of benefit thus far. It is also possible that home-based storage schemes will conversely increase access due to farmers shifting their pesticide stores from fields to their homes and the lockable storage devices highlighting the whereabouts of poisons (in boxes that are often left unlocked).