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How curbing the use of hazardous pesticides will aid suicide prevention in Sri Lanka 

08 Jul 2022

  • Local academic highlights how Sri Lanka prevented close to 100,000 suicides through tighter regulation
BY Ruwan Laknath Jayakody The further removal of highly hazardous pesticides from the agricultural practice is likely to be more effective for suicide prevention in rural Asia. This recommendation was made in an oration on “Saving 100,000 lives from pesticide poisoning through changes in national policy” by Senior Professor in Medicine at the Peradeniya University’s Medical Faculty’s Medicine Department, Pesticide Technical Advisory Committee (PeTAC) Member and South Asian Clinical Toxicology Research Collaboration (SACTRC) Research Director I.B. Gawarammana which was published in Sri Lanka Journal of Medicine 30 (2) in December, 2021.  Worldwide, there are 800,000 deaths due to suicide each year, and of these, 300,000 are due to the self-ingestion of pesticides. Sri Lanka was once known as the suicide capital of the world when 57 out of a population of 100,000 died each year due to the easy availability of highly toxic agrochemicals. At present, the world consumption of pesticides is 2.5 billion kilos. It is estimated that 25 million agricultural workers experience unintentional pesticide poisoning each year. Mortality from intentional poisoning is far worse. The global burden of pesticide suicides from 1960 to 2018 is between 14 to 15 million deaths. Before the green revolution, only five out of a population of 100,000 died due to suicide in Sri Lanka. The widespread introduction of pesticides into the agricultural practice of Sri Lanka during the green revolution of the 1950s and 1960s was soon followed by an exponential increase in the number of cases of poisoning and deaths. At the beginning of the green revolution, when fast-acting, highly toxic pesticides were used in Sri Lanka, many deaths occurred before patients got to a hospital.  Suicide rates increased to 27 out of a population of 100,000 in 1976 and after the economy opened up in 1977, the rates steeped up and plateaued at 57 out of a population of 100,000 per year between 1983 and 1995. This increase was more likely due to the ingestion of less toxic, more slow-acting pesticides in the 1990s that allowed patients to reach a hospital before dying at home. Until the end of the 1980s, pesticide poisoning was not even listed amongst the 10 leading causes of hospital-based deaths in any Sri Lankan district. This changed markedly over the next decade, with pesticide poisoning becoming the sixth most common cause of hospital deaths in Sri Lanka, while in certain districts, it was listed as the leading cause of hospital-based deaths.  The problem of pesticide self-poisoning is not only limited to the agricultural districts of Sri Lanka. The examination of 37,000 death certificates issued in Kandy, which is a semi-agricultural district between 1967 and 1987 revealed that 77% of poisoning deaths were due to pesticide poisoning, while in agricultural districts, the situation was far worse, where the analysis of injury deaths in 2003 and 2004 in the North Central Province revealed that the incidence of fatal pesticide poisoning was four times as many as road traffic crashes.  It has been shown that in most cases of suicides, victims found agrochemicals within their homes.  Further, there was very little planning of suicide; in most cases it was less than 30 minutes. The easy availability of highly toxic pesticides and impulsive behaviour were the two important contributors to the high incidences of fatality from pesticide poisoning in Sri Lanka.  Until 1962, there had been no regulation in Sri Lanka of the import of pesticides. At the time, most of the pesticides were imported for malaria control and the tea industry. In 1963, the Controller General of Imports and Exports Control of Sri Lanka made the first attempt to restrict the use of pesticides by limiting foreign exchange for the import of agrochemicals. This decision was challenged by importers. Concurrently, the then-Department of Agriculture, in an attempt to regulate agrochemicals, submitted a draft Bill titled the “Act on Poisons Used in Agriculture” which however did not materialise.  In 1972, with assistance from the Food and Agriculture Organisation, the Department of Agriculture attempted to regulate the use of pesticides in Sri Lanka, but this too failed. The introduction of more liberal economic policies in Sri Lanka after 1977 called for the tighter regulation of pesticides.  Due to open economic policies, the import of pesticides increased by 240%, from 2,166 tonnes in 1976 to 5,144 tonnes in 1979. Due to continuous lobbying by the Department of Agriculture, the Government finally introduced the Control of Pesticides Act, No. 33 of 1980. This Act provided for the appointment of a Registrar of Pesticides (ROP) to regulate the importation, formulation, packing, labelling, storage, sale, and use of pesticides in Sri Lanka, and also provided for the appointment of a 10-member national committee called the PeTAC to advice the ROP.  This Act made it possible to restrict the use of pesticides in Sri Lanka. In the early 1990s, the import of World Health Organisation (WHO) Class One organophosphates (a group of man-made chemicals that poison insects and mammals) was restricted, to bring about a total ban of such pesticides by 1995. In 1998, endosulfan, an organochlorine associated with status epilepticus (a seizure that lasts longer than five minutes, or having more than one seizure within a five-minute period, without returning to a normal level of consciousness between episodes) and high mortality, was banned in Sri Lanka. The restriction of these compounds was associated with a reduction of the incidence of deaths from self-poisoning with pesticides without any effect on the agricultural output. The SACTRC was established at the Peradeniya University’s Medical Faculty in 2003 with the objective of reducing deaths from pesticide poisoning in Sri Lanka. When the SACTRC started work, the overall case fatality of pesticide poisoning was 10.7%. Some individual pesticides had a case fatality exceeding 50%.  A steady decline was seen in the overall case fatality of pesticide poisoning where it has declined from 10.5% during 2002 to 3.7% in 2019. This drop of case fatality is largely attributable to pesticide bans imposed by the PeTAC based on data provided by the SACTRC. The SACTRC also found that after the bans of paraquat, which was the most popular pesticide in Sri Lanka, dimethoate, and fenthion, profenofos, propanil, fenobucarb, carbosulfan, and quinalphos were responsible for most of the remaining deaths. These have a case fatality between 7.2% to 8.6%, which is more than the 3.7% overall case fatality. The WHO aimed at reducing deaths from poisoning by 10% by 2020. However, Sri Lanka has been able to reduce deaths by 70%, a feat that has been achieved mainly through the regulation of highly toxic pesticides available in the market. These bans have resulted in the prevention of at least 93,000 suicide deaths between 2003 and 2015 in Sri Lanka. By now, these policy changes may have saved 100,000.  The SACTRC’s work has clearly shown that human lives can be saved through changes of national policy. The PeTAC responded positively to data presented by the SACTRC, which enabled the banning of highly toxic agrochemicals. The SACTRC is lobbying with the PeTAC to ban the remaining pesticides with a human case fatality ratio of more than 5%. The SACTRC has also shown through many clinical trials that some methods of treatment, though seemingly beneficial, do not work. The safe storage of pesticides in lockable boxes, though attractive, does not work as a method of suicide prevention. 


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