AsianScientist (Aug. 15, 2017) – Global policies on access to highly hazardous pesticides—commonly ingested in acts of self-poisoning and suicide in rural Asia—should focus on national bans rather than safe storage, according to two studies in The Lancet and The Lancet Global Health journals.
Self-poisoning using pesticides is one of the three most common means of suicide worldwide according to the World Health Organisation (WHO), and accounts for 14-20 percent of all suicides. Many of these deaths occur in people who live in rural areas in low- and middle-income countries, making it a major public health problem in these regions.
To restrict access to pesticides and prevent these deaths, the pesticides industry advocates for safer storage of pesticides, an approach that has received some support from the WHO and suicide prevention organizations. However, the study published in The Lancet suggests that secure storage has no impact on the rates of self-poisoning or suicide.
In the study, 180 rural villages in Sri Lanka either continued storing pesticides in the usual way (90 villages, including more than 26,000 households and around 110,000 individuals), or were provided with lockable storage containers that were secured in the ground (90 villages, including more than 27,000 households and 114,000 individuals).
The farmers receiving the containers were given a choice to install their pesticide storage container in their fields, home garden or home. In villages using the improved storage, posters were displayed to promote the containers and presentations were given every six months at farmers’ meetings. During this time, suicides and self-poisonings were studied in all people aged over 14 years old.
There were 641 suicide attempts by pesticide poisoning in the control group and 611 in those receiving lockable storage devices, meaning the rate of people self-poisoning using pesticides was similar between the two groups. There was no evidence of people switching from pesticide self-poisoning to other forms of self-harm.
“We found no evidence to say that improved storage of pesticides reduces the incidence of pesticide self-poisoning,” said senior author Professor Michael Eddleston, University of Edinburgh, UK. “While our study only looked at one type of secure storage, our findings run counter to current policy approaches advocating improved storage of pesticides to reduce self-poisoning. Combined with evidence from other countries, the trial suggests that policy makers should focus their attention on withdrawal of the most harmful pesticides from agricultural practice.”
In an accompanying article in The Lancet Global Health journal, researchers conducted the first review of literature on the effect of changing regulations to restrict access to pesticides. These include administrative interventions including restricting sales to licenced users and outright national bans on the import and sale of specific pesticides, thereby removing the most harmful pesticides from farming practice.
The study reviewed 27 studies spanning 16 countries, including five low- and middle-income countries and 11 high income countries. The most common regulations applied were national bans of specific pesticides (12 studies in six countries—Jordan, Sri Lanka, Bangladesh, Greece, South Korea and Taiwan) and sales restrictions (eight studies in five countries—India, Denmark, Ireland, the UK and the USA).
National bans were effective in reducing pesticide-related suicides in five of the six countries where these were evaluated (all except Greece), and were associated with falls in overall suicide rates in three of the countries (Sri Lanka, Bangladesh and South Korea). However, the evidence for the effectiveness of sales restrictions is less clear as the studies did not provide strong enough evidence.
“A worldwide ban on the use of highly hazardous pesticides is likely to prevent tens of thousands of deaths every year,” said lead author Professor David Gunnell, University of Bristol, UK. “Rather than focussing on safe storage, policy focus should shift towards bans on the pesticides most often used in suicide. This will involve identifying those most commonly contributing to suicide deaths in low- and middle-income countries, and replacing them with safer, less toxic alternatives to ensure pest management is still possible and allay concerns that pesticide bans may reduce crop yields.”
Writing in a linked Comment reflecting on the findings of The Lancet randomized trial, Professor Paul Yip, University of Hong Kong, said: “Discouraging though these findings may seem, they are valuable in providing insights into the understanding of the complexities of any suicide prevention effort. There is no silver bullet for suicide prevention and it needs to be understood, implemented, and interpreted in the local context.”
The articles can be found at:
Pearson et al. (2017) Effectiveness of Household Lockable Pesticide Storage to Reduce Pesticide Self-poisoning in Rural Asia: A Community-based, Cluster-randomized Controlled Trial
Gunnell et al. (2017) Prevention of Suicide with Regulations Aimed at Restricting Access to Highly Hazardous Pesticides: A Systematic Review of the International Evidence.
Source: The Lancet; Photo: Pixabay.
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