Academic journal article Bulletin of the World Health Organization

Influence of Pesticide Regulation on Acute Poisoning Deaths in Sri Lanka

Academic journal article Bulletin of the World Health Organization

Influence of Pesticide Regulation on Acute Poisoning Deaths in Sri Lanka

Article excerpt


Deliberate self-poisoning is a major problem worldwide (1). However, there are marked differences in case fatality proportions (CFP) when comparing developed and developing countries (1-6). These differences have been attributed to the nature of the agents involved, given that self-harm is tire primary intention and the choice of method is often secondary (7-9). Pesticides, such as organophosphorus compounds (OPs), are a common means of self-harm in the developing world (1), whereas pharmaceuticals feature widely in this respect in the developed world (10).

Pesticides have been used extensively in agriculture since the 1950s, promoted as a tool without which developing countries could not develop and become self-sufficient. However. intentional and occupational poisoning from pesticides is a major problem in these countries, with millions of cases and hundreds of thousands of deaths occurring each year (11-16). Management is difficult--there are few effective antidotes and many patients require intensive care, which is a rare resource in much of the developing world (1).

This situation has caused health authorities and legislators to consider regulating the use and availability of pesticides in an attempt to control their harmful effects. The main impetus to these activities was the publication in 1985 of a Code of Conduct on the Distribution and Use of Pesticides by the Food and Agriculture Organization (FAO) of the United Nations (17).

Several strategies have been implemented. The pesticide industry itself has established "safe-use" initiatives in which people are educated in the safer use of pesticides (18, 19). Governments and nongovernmental organizations (NGOs) have taken other approaches, such as introducing stricter regulations and encouraging the use of fewer pesticide applications within FAO's integrated pest management (IPM) system (20). WHO and FAO have also encouraged countries to introduce legislation to restrict the availability of problem pesticides (17, 21, 22). Although this latter approach appears to have been successful in reducing pesticide-related death rates in some countries, such strategies have not always been found to reduce overall mortality (Table 1). Further studies are needed to assess the effectiveness of this approach.

Poisoning from pesticides is the most common cause of death in many rural districts of Sri Lanka (23), where almost all of the deaths are due to intentional self-poisoning (6). Following publication of FAO's Code of Conduct, Sri Lanka has been actively assessing the role of pesticides and regulating their use (Box 1). This has taken place alongside efforts to implement IPM practice in paddy cultivation. As a result, WHO class I "extremely and highly hazardous" pesticides have been phased out, particular problem pesticides such as endosulfan (a WHO class II "moderately hazardous" pesticide) have been banned and less pesticide has been used for paddy cultivation in some areas.

Box 1. Pesticide harm reduction in Sri Lanka

Legislative restrictions and withdrawals on products for
agricultural use

* Before 1980: chlordimeform dichlorodiphenyltrichloroethane
(DDT), dieldrin, endrin, memyl aarathion, thallium sulfate

* 1980s: 2,4.5-trichloropnenoxyacetic acid (2,4,5-T), aldrin,
arsenic, captafol, etnyl parathion, hexachlorocyclohexane
(HCH), leptophos, lindane, mercury compounds

* 1990s: dichloropropane, aldicarb, chlordane, methamidophos,
monocrotophos, pentachlorophenol, quintozene (PCNB)

* 1998: endosulfan

Alternatives to pesticides

* Integrated pest management


* Campaigns to train farmers, retailers, distributors, and the public
(including schoolchildren) in the safe handling, use, and storage
of pesticides

The purpose of this paper is to record the regulation of pesticides in Sri Lanka and to evaluate the impact of these regulations on the CFP from poisoning; and to record changes in the number of pesticide deaths in Anuradhapura General Hospital attributed to particular pesticides following this regulatory legislation. …

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