The global distribution of fatal pesticide self-poisoning: Systematic review

BMC Public Health, Dec 2007

Background Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. Methods We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning. Results We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm. Conclusion Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://www.biomedcentral.com/content/pdf/1471-2458-7-357.pdf

The global distribution of fatal pesticide self-poisoning: Systematic review

David Gunnell 1 2 Michael Eddleston 0 1 Michael R Phillips 4 5 6 Flemming Konradsen 1 3 0 Scottish Poisons Information Bureau, University of Edinburgh , Edinburgh , UK 1 South Asian Clinical Toxicology Research Collaboration (SACTRC) 2 Department of Social Medicine, University of Bristol , Bristol , UK 3 Department of International Health, University of Copenhagen , Copenhagen , Denmark 4 Department of Epidemiology, Columbia University , New York , USA 5 Department of Psychiatry, Columbia University , New York , USA 6 Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital , Beijing , China Background: Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. Methods: We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990-2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning. Results: We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm. Conclusion: Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved. - Background The World Health Organisation (WHO) estimated that there were 873,000 suicides worldwide in 2002[1] which makes suicide a major cause of premature mortality globally. A central component of suicide prevention strategies is restricting access to lethal means [2]; this is because impulsive acts of self-harm in persons with a low intent to die may, nevertheless, be fatal if high-lethality methods are easily accessible [3,4]. It is therefore important to identify the most commonly used methods of suicide worldwide both to formulate appropriate strategies for restricting access to highly-lethal methods and to improve the ability of health care systems to effectively treat individuals who use these methods Based on studies carried out in Sri Lanka, in 1984 Jeyaratnam estimated there were 220,000 pesticide related deaths every year worldwide, most of which were suicides [5]. Recent extrapolations of data from a few countries in Asia suggest that there may be 300,000 suicides by deliberate ingestion of pesticides annually in this region alone[6,7]. The WHO reports that pesticides are now the most common method of suicide worldwide[8]. The most likely explanation for the high numbers of pesticide suicides in developing countries is the high case fatality associated with pesticide ingestion compared to the relatively low case fatality of many of the substances commonly taken in acts of self-poisoning in the West. For example case fatality among persons admitted to hospital for treatment of self-poisoning in England and Wales is <0.5% [9] but in rural areas of Sri Lanka it is 7%[10]. Selfpoisoning with some commonly used pesticides is particularly lethal case-fatality following paraquat and aluminium phosphide ingestion is in excess of 70% [11,12]. To date efforts to estimate the international burden of pesticide suicides have been based on relatively crude extrapolations from studies carried out in one or two countries[5-7]. The aim of this paper is to systematically review the world literature on the use of pesticides for suicide and, using the data retrieved, to estimate the number of pesticide suicides worldwide and in each of the WHO's six regions. For the purpose of this review we define pesticides as chemical products used for the control of unwanted animals, plants and fungi primarily rodenticides, insecticides, weedi (...truncated)


This is a preview of a remote PDF: http://www.biomedcentral.com/content/pdf/1471-2458-7-357.pdf

David Gunnell, Michael Eddleston, Michael R Phillips, Flemming Konradsen. The global distribution of fatal pesticide self-poisoning: Systematic review, BMC Public Health, 2007, pp. 357, 7, DOI: 10.1186/1471-2458-7-357