Cost to Government Health-Care Services of Treating Acute Self-Poisonings in a Rural District in Sri Lanka/Cout Pour Les Services De Sante Publics Du Traitement Des Auto-Empoisonnements Aigus Dans Un District Rural Du Sri Lanka/Costo del Tratamiento De Las Intoxicaciones Voluntarias Agudas En Los Servicios De Salud Publicos En Un Distrito Rural De Sri Lanka

Article excerpt

Une traduction en francis de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol.

Introduction

A conservative estimate is that at least 258 000 deaths occur from pesticide self-poisoning worldwide each year, (1) most of them in Asia, and this figure is greatly exceeded by the number of self-poisoned patients who seek treatment at health facilities. According to an analysis of hospital admissions in southern Sri Lanka, from 1990 to 2002 the average annual poisoning incidence rate in this southern region was 318 per 100 000, with 64% of this figure represented by self-poisonings. (2) In the North Central province of Sri Lanka, the annual incidence rates in 2002 of attempted self-poisoning and fatal self-poisoning was 363 and 27 per 100 000, respectively. (3) According to a community study, the high number of pesticide self-poisonings was an impulsive response to economically or psychosocially stressful events facilitated by easy access to pesticides. (4)

The cost to government health-care services of treating poisoned patients is probably substantial. In a Sri Lankan study of the cost of treating patients who had poisoned themselves with yellow oleander seeds (Thevetia peruviana), treatment with and without antitoxin cost US$ 691.6 and US$ 58.6 per patient, respectively) However, the overall costs of treating self-poisoned patients are not well documented in low-income countries, where the overwhelming majority of poisonings take place. This is unfortunate, as studies on health costs can inform health policy and guide investment and management at different levels of the health-care system to optimize the use of resources.

The objective of this study was to estimate the direct financial costs to the Sri Lankan Ministry of Health of treating self-poisoned patients in a single district, with a particular focus on self-poisoning with pesticides.

Methods

Study area

The study was carried out in the Anuradhapura district, where most of the 780 000 inhabitants depend on agriculture for their livelihood. The district is served by 1 general and 33 peripheral government hospitals, where practically all cases of acute poisoning are treated. The Anuradhapura General Hospital, with 1300 beds and limited intensive care facilities, is the largest hospital in the district. The 33 peripheral hospitals, which provide in-ward services, transfer all patients needing secondary care to the Anuradhapura General Hospital.

Selection of hospitals

The Anuradhapura General Hospital was selected as the source of detailed information on patient treatment inputs because it is the only secondary-level treatment facility in the district. The peripheral hospitals were listed according to size and distance from the Anuradhapura General Hospital. Three of them had to be excluded from the sampling owing to poor security in the areas where they were located. Of the 18 hospitals located within 40 km of Anuradhapura, 3 were selected at random for inclusion in the study; 2 of the 12 hospitals located beyond 40 km from the general hospital were also included by random selection. The decision to include only 1 of every 6 peripheral hospitals was based on the assumption that representative information on a per patient basis could be obtained at this level.

Patient sampling

Patient treatment input costs were calculated for all intentionally self-poisoned patients admitted to the Anuradhapura General Hospital from 26 June to 26 July 2005. Costs for the 5 selected peripheral hospitals were based on all intentional self-poisoning patients admitted in July 2006. The one-year difference in the period of data collection reflected the availability of research staff.

Ongoing studies within the Anuradhapura district made it possible to obtain patient-specific transfer data on self-poisoned patients who had been transferred from all 30 peripheral hospitals in the district to a higher-level hospital facility from 1 July to 31 December 2005. …

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