Academic journal article Bulletin of the World Health Organization

Acute Pesticide Poisoning: A Proposed Classification tool/Intoxication Aigue Par Les Pesticides : Proposition D'un Outil De classification/Intoxication Aguda Por Plaguicidas: Propuesta De Instrumento De Clasificacion

Academic journal article Bulletin of the World Health Organization

Acute Pesticide Poisoning: A Proposed Classification tool/Intoxication Aigue Par Les Pesticides : Proposition D'un Outil De classification/Intoxication Aguda Por Plaguicidas: Propuesta De Instrumento De Clasificacion

Article excerpt

Background

Cases of acute pesticide poisoning (APP) account for significant morbidity and mortality worldwide, especially in developing countries. (1,2) There are no reliable estimates as to how many people per year suffer from pesticide-related health effects. This is due to several reasons including a lack of standardized case definition. The purpose of this document is to create a standard case definition to facilitate the identification and diagnosis of APP, especially at the field level, in rural clinics and primary health-care systems. The case definition is inclusive of all circumstances of poisoning including suicide, homicide, non-intentional (accidental exposure) and occupational.

Studies in developed countries have demonstrated the annual incidence rates of APP in agricultural workers to be as much as 18.2 per 100 000 full time workers (3) and 7.4 per million among schoolchildren. (4) Yet, cases of APP may be the result of various causes in different regions of the world. In developing countries, where there is insufficient regulation, lack of surveillance systems, less enforcement, lack of training, inadequate access to information systems, poorly maintained or nonexistent personal protective equipment, and larger agriculturally-based populations, the incidences are expected to be higher. (5) The use of pesticides banned in industrialized countries, in particular, highly toxic pesticides as classified by WHO, (6) obsolete stockpiles and improper storage techniques may provide unique risks in the developing world. (7,8) In some countries, such as China and Sri Lanka, (9) self-poisoning with pesticides is a particular problem. Studies from Sri Lanka regarding self poisoning reveal an APP incidence rate of approximately 180 per 100 000. (10)

Studies from developing areas in Central America (El Salvador and Nicaragua) have indicated an overall incidence rate of 35 per 100 000 for APP in the general population (11) and 17.8 per 100 000 occupationally-related APP in Thailand. (12) In Belize, it has been estimated that 17 pesticide poisonings per 100 000 residents and 4142 preventable poisonings occur each year. (13) Previous research has demonstrated that reported occupational and non-intentional causes vary from 10% to 50% in developing countries. (14) The reason for this variation is unclear, but is likely contributed to by inconsistent recording methodology and lack of a standard case definition for an APP. (14) These variations may result in an underestimation of the true incidence of APP.

Since occupational and non-intentional pesticide poisoning require a specific set of prevention and control measures separate from those required for suicidal exposures, it is important to accurately determine the magnitude of the problem through better estimates and identification of cases and deaths resulting from APP. Several challenges exist in attempting to determine the scope of the problem: misdiagnosis by health-care providers, lack of readily accessible health care in rural populations, exclusion of non-hospitalized cases, resigned acceptance by workers that adverse health effects are expected, (15) and the fact that less severe cases of APP may not seek health care. Additionally, suicidal ingestions of pesticides account for the most severe cases of poisoning and consequently hospital-based studies may underestimate the overall (occupational/non-intentional) incidence of APP. (16) Further, many developing countries lack the resources to establish and maintain the necessary surveillance programmes and to obtain confirmatory laboratory testing for all possible cases of APP; therefore, the ability to identify a poisoning may differ between developing and developed countries. A standardized case definition will provide a practical tool for more accurately estimating the incidence of acute pesticide poisoning and identifying where problems exist to stimulate better management and control actions. …

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