Citation

Dandona R, Gunnell D. Lancet Glob. Health 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/S2214-109X(21)00174-1

PMID

unavailable

Abstract

Highly hazardous pesticides are among the leading causes of death by suicide in low-income and middle-income countries. National bans on these products have led to substantial reductions in pesticide-attributable deaths in many countries and, in some nations, falls in overall suicide mortality. These bans are a potentially cost-effective and affordable intervention for reducing suicide deaths in countries with a high burden of suicide deaths attributable to pesticides. In The Lancet Global Health, Nicholas Buckley and colleagues document not only a decline in overall case fatality of pesticide poisoning from 10·5% for 2002-06 to 3·7% for 2013-19 in Sri Lanka coincident with its nationwide bans, but also how human data for toxicity can facilitate further reductions in these deaths. These data spanning 18 years offer four distinctly valuable lessons to reduce global suicide deaths.

First, Buckley and colleagues highlight the high case fatality (7·2-8·6%) in episodes of poisoning with five commonly ingested pesticides, which together account for nearly a quarter of pesticide deaths in Sri Lanka since 2013. Notably, these five pesticides are class II products according to WHO's hazardous pesticide classification, which is based primarily on acute oral and dermal toxicity in rats. Buckley and colleagues argue that many more lives could be saved worldwide if human data for the toxicity of pesticides after ingestion were used for hazard classification and regulatory action, in addition to the current basis for this classification. They suggest eliminating all pesticides with a case fatality of more than 5%. Such an approach would have averted the many thousands of deaths worldwide from paraquat, a commonly used herbicide classified as class II by WHO, but with a case fatality in humans of more than 40%. These findings exemplify WHO guidance to pesticide regulators to identify and act on the pesticides most commonly used in fatal self-poisoning.

Second, the marked reduction in suicide deaths from pesticide poisoning in Sri Lanka shows the potential of a data-driven approach based on good quality surveillance. The pesticides that were banned in Sri Lanka included those that contributed the most to poisoning deaths at any particular time, in addition to those categorised as most hazardous by WHO...

Language: en