These have not been formally quantified and work over the last 20 years with integrated pest management has shown that reduced use of pesticides can be compatible with at least stable levels of crop production. Any analysis of the competing adverse and beneficial effects of pesticides should incorporate the possibility of replacing pesticides which are toxic to humans with less toxic, but equally effective alternatives.
Possible approaches to reducing deaths from pesticide ingestion are outlined in the Table. The importance of broad-based commitment from industry as well as Non-Governmental Organizations NGO , and national and international health and regulatory organizations is highlighted.
The first broad approach is to restrict the availability of pesticides either directly, for example through restricting the import and use of pesticides, or indirectly through ensuring supplies are kept in a secure facility in each geographical locality.
Restricting availability could be achieved by either direct control of particular pesticides banning, requiring licences for use or prescriptions or through the promotion of practices that minimize their use. Such health protection approaches appear to have led to a reduction in serious paracetamol poisonings in England 35 and a decline in barbiturate suicides in Australia. The second approach is to improve public education regarding the dangers of pesticide poisoning and the safekeeping of pesticides—through media campaigns and clear labelling of product containers.
The effects are difficult to predict and there is a suggestion that enhanced knowledge concerning the toxicity of pesticides resulted in an increase in their use for self-harm in some settings. The third general approach is to encourage manufacturers to improve the safety of their products.
This may be achieved by diluting the concentrations of liquid pesticides, incorporating emetics or agents to make them unpleasant to taste or, more fundamentally, to produce pesticides which are non-toxic to humans. Lastly, if the occurrence and lethality of pesticide ingestions cannot be prevented then improved medical management is crucial. Antidotes to pesticides are not completely effective.
In the UK, where paracetamol is the most common poison used for self-harm, a similar situation could be envisaged if all the antidotes became unavailable—the medical wards might once again become filled with paracetamol-poisoned patients with either anticipated or florid liver failure. The problem of death from pesticide self-poisoning is neither new 12, 45— 48 nor unique to a few countries, so reasons for the lack of a global response need to be understood if this continuing tragedy is to be reversed.
Five main factors appear to contribute. First, the pattern of agriculture practised in developing countries—where most people living in rural areas cultivate small areas of land—is quite different from that in industrialized nations where a small number of farmers cultivate large tracts of land. In industrialized countries access to pesticides is therefore largely restricted to the few individuals engaged in farming.
Interventions to limit access in such settings are complex and need to involve most rural adults, rather than a select few. Second, the sale of pesticides is a multi-billion dollar business. In all, 1. There was at that time a contentious debate about actually banning paraquat [ the pesticide ] entirely. We knew however that there were powerful and influential people who had a vested interest in continuing the importation and we did not want to be aligned with a lobby group likely to fail.
Third, the issue of pesticide self-poisoning has never been taken up as a campaign issue by any of the international organizations. Recent WHO publications with major input from the MNH 32, 51 have put greater emphasis on psychiatric and social models of self-harm aetiology.
While pesticide self-poisoning was mentioned in both reports, it received much less attention than its importance warrants. Current IPCS activities aim to increase knowledge of the epidemiology of pesticide poisoning and to encourage the setting up of poisoning information centres.
Fifth, pesticide self-poisoning is ideologically and politically inconvenient. Pesticide use has adverse effects on the environment and human health. Many of the adverse effects of pesticides are considered to result from their overuse and poor treatment of workers and communities due to globalization 58 —in which pesticide corporations are major participants.
In this battle, the fact that the vast majority of severe and fatal pesticide cases are self-inflicted may be inconvenient to the environmentalists. People therefore want to avoid the issue of self-poisoning and deal with issues where the pesticide industry, and globalization in general, can be held responsible.
This need not be true. An overall assessment of public health, environmental and agricultural factors should determine regulatory actions, not simply their political appropriateness.
Pesticide self-harm is just as important as occupational poisoning for regulatory issues and, in some countries, regulatory authorities have been very effective in banning the pesticides that have been problems only for self-harm.
Pesticide self-poisoning is a major contributor to population patterns of morbidity and mortality in developing nations. The use of pesticides for self-poisoning may distort conventional epidemiological features of suicide in these countries and contribute to their excess premature mortality. We estimate there are around self-inflicted pesticide deaths worldwide each year. Research dating back over 30 years has documented the size of this problem and yet contemporary research bears witness to its continuing impact.
Research to identify the most acceptable means of restricting the availability of pesticides within rural communities is urgently required together with randomized controlled trials to determine the best means of treatment and cost-effectiveness of possible interventions. Some of this research is now underway M Eddleston, unpublished. Preventive measures must take account of the local needs and context and should be rigorously evaluated.
Thus far there has been no global leadership to respond to the problem. Commitment from industry and the need for them to acknowledge their responsibility for some of these deaths is vital Table , as is the need to ensure they understand the scale, importance, and preventability of the problem. This is quite possible. Hospital admissions for self-poisoning. Sri Lanka Source: Eddleston and colleagues unpublished data: data are for the two secondary referral hospitals in North Central Province: April —March ; NB data for Sri Lanka are given as numbers rather than rates as there are no appropriate population denominator data.
Age and sex patterns of suicide. Kaniyambadi region, S. India Source: Joseph et al. Deliberate self-harm. Effective Healthcare Bulletin ; 4 : 1 — Epidemiology and patterns of hospital use after parasuicide in the south west of England.
J Epidemiol Community Health ; 50 : 24 — Soc Psychiatry Psychiatr Epidemiol ; 35 : — Medical management of deliberate drug overdose—a neglected area for suicide prevention? Emergency Med J In press. Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry ; : — Pesticide poisoning in the developing world—a minimum pesticides list. Lancet ; : — Suicide attempters in a general hospital unit in India: their socio-demographic and clinical profile—emphasis on cross-cultural aspects.
Acta Paediatrica Scand ; 94 : 26 — Risk factors for suicide in China: a national case-control psychological autopsy study. Changing pattern of acute poisoning in adults: experience of a large north-west Indian hospital — J Assoc Physicians India ; 45 : — Maniam T. Suicide and parasuicide in a hill resort in Malaysia. Hettiarachchi J, Kodithuwakku GC. Pattern of poisoning in rural Sri Lanka.
Int J Epidemiol ; 18 : — Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. Q J Med ; 93 : — Somasundaram DJ, Rajadurai S. War and suicide in northern Sri Lanka.
Acta Psychiatr Scand ; 91 : 1 —4. High rates of paraquat-induced suicide in southern Trinidad. Suicide Life Threat Behav ; 29 : — Cantor CH. Suicide in the Western World. In: Hawton K, van Heeringen K eds. Chichester: John Wiley and Sons Ltd, , pp. Introduction and preliminary analysis for Acta Psychiatr Scand ; 85 : 97 — Deliberate Self-harm in Oxford Suicide rates in China, — Berger LR. Suicides and pesticides in Sri Lanka.
Am J Public Health ; 78 : — Evaluation of suicide rates in rural India using verbal autopsies, —9. BMJ ; : — Changing trends in acute poisoning in Chandigarh zone: a year autopsy experience from a tertiary care hospital in northern India. Am J Forensic Med Pathol ; 20 : — Bowles JR. Suicide in Western Samoa: an example of a suicide prevention program in a developing country.
In: Diekstra RFW ed. Preventive Strategies on Suicide. Leiden: EJ Brill, , pp. Abeysinghe RM. Clarke RV, Lester D. Explaining choice of method. In: Suicide: Closing the Exits. American Association of Poison Control Centers : Merck and Co.
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Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. More Information. Test your knowledge. Which type of snake accounts for the great majority of poisonous snakebites in the United States each year? More Content. Insecticide Poisoning By Gerald F. Symptoms may include eye tearing, coughing, heart problems, and breathing difficulties.
Several drugs are effective in treating serious insecticide poisonings. Carbamates include aldicarb, carbaryl, carbofuran, fenobucarb, and oxamyl.
History of exposure to insecticides and characteristic symptoms. Removal of contaminated clothing and washing of skin. Poison on skin. If pesticide splashes on the skin, drench area with water and remove contaminated clothing. Wash skin and hair thoroughly with soap and water. Later, discard contaminated clothing or thoroughly wash it separately from other laundry.
Inhaled poison. Carry or drag victim to fresh air immediately. If you think you need protection such as a respirator and one is not available to you, call the Fire Department and wait for emergency equipment before entering the area.
Loosen victim's tight clothing. If the victim's skin is blue or the victim has stopped breathing, give artificial respiration if you know how and call rescue service for help. Open doors and windows so no one else will be poisoned by fumes. Skip to main content.
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