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Background: In Nepal pesticide poisoning is a common problem and organophosphorus poisoning (OP) is the most common form of acute poisoning responsible for majority of deaths. However, sufficient data is still lacking from Western region of Nepal. The present study analysed the sociodemographic factors of OP poisoning cases, the association of seve...
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The study reports that most of the OP poisoning occurred in younger age group. The mortality with treatment in this study was found to be 6.25%
Citations
... Patients were most commonly: women (n ¼ 2533, 61.3%; unknown gender n ¼ 15), of the Janajati ethnic group ((n ¼ 1063 27.7%) [16], and aged 16-30 years ((n ¼ 2350, 57.5%). Median age of patients was 25 years (IQR [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], with a small difference between sexes (male: 27 ; female 24 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). ...
... Patients were most commonly: women (n ¼ 2533, 61.3%; unknown gender n ¼ 15), of the Janajati ethnic group ((n ¼ 1063 27.7%) [16], and aged 16-30 years ((n ¼ 2350, 57.5%). Median age of patients was 25 years (IQR [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], with a small difference between sexes (male: 27 ; female 24 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). ...
... OP insecticides are a common means of self-harm in the LMIC because they are very widely used in agriculture [7]. The common OPs currently used in Nepal include dichlorvos, chlorpyrifos, dimethoate and malathion [9,[22][23][24]. A hospitalbased study from five major hospitals across Nepal in 2002 showed that OP compounds were the most common agent for self-poisoning, methyl parathion and dichlorvos being the key pesticides involved [25]. ...
Introduction
Intentional pesticide poisoning is a major clinical and public health problem in agricultural communities in low and middle income countries like Nepal. Bans of highly hazardous pesticides (HHP) reduce the number of suicides. We aimed to identify these pesticides by reviewing data from major hospitals across the country and from forensic toxicology laboratories.
Methods
We retrospectively reviewed medical records of 10 hospitals for pesticide poisoned patients and two forensic laboratories of Nepal from April 2017 to February 2020. The poison was identified from the history, referral note, and clinical toxidrome in the hospitals and from gas chromatography analysis in the laboratories. Data on demographics, poison, and patient outcome were recorded on a data collection sheet. Simple descriptive analysis was performed.
Results
Among hospital cases (n = 4148), the commonest form of poisoning was self-poisoning (95.8%) while occupation poisoning was rare (0.03%). Case fatality was 5.3% (n = 62). Aluminum phosphide (n = 38/62, 61.3%) was the most commonly identified lethal pesticide for deaths. Forensic toxicology laboratories reported 2535 deaths positive for pesticides, with the compounds most commonly identified being organophosphorus (OP) insecticides (n = 1463/2535; 57.7%), phosphine gas (n = 653/2535; 25.7%; both aluminum [11.8%] and zinc [0.4%] phosphide) and organochlorine insecticides (n = 241/2535; 9.5%). The OP insecticide most commonly identified was dichlorvos (n = 273/450, 60.6%).
Conclusion
The data held in the routine hospital medical records were incomplete but suggested that case fatality in hospitals was relatively low. The pesticides identified as causing most deaths were dichlorvos and aluminum phosphide. Since this study was completed, dichlorvos has been banned and the most toxic formulation of aluminum phosphide removed from sale. Improving the medical record system and working with forensic toxicology laboratories will allow problematic HHPs to be identified and the effects of the bans in reducing deaths monitored.
... However, Sri Lanka's island identity has probably allowed it to more easily ban pesticides than other countries with contiguous borders with countries where bans have not taken place-eg, Nepal banned monocrotophos and parathion-methyl in 2006 but still has many cases due to illegal importation across the border with India. 25 The striking success of pesticide bans in reducing the overall case fatality of pesticide poisoning is clearly seen in our data. This result has been mirrored in nationwide mortality data for Sri Lanka, which has now seen a 70% reduction in suicides and an even greater decline in fatal self-poisoning over two decades. ...
Background:
Pesticide poisoning is among the most common means of suicide globally, but can be prevented with regulation of the most hazardous agents. We aimed to compare the lethality of pesticides ingested by our cohort, seek evidence on variation between human and regulatory animal toxicity, and establish change over time in the case fatality of individual pesticides in Sri Lanka.
Methods:
We examined the case fatality of agricultural pesticides in a prospective cohort in nine hospitals serving rural populations in Sri Lanka. We included all patients (>11 years) who had presented to a South Asian Clinical Toxicology Research Collaboration study hospital during the study period. Patients were enrolled by clinical research assistants and were regularly reviewed. Identification of the ingested pesticide was generally on the basis of history or positive identification of the container, supported by nested blood analysis.
Findings:
From March 31, 2002, to Dec 31, 2019, 34 902 patients (median age 29 years [IQR 21-40]; 23 060 [66·1%] male) presented with a possible or known pesticide self-poisoning. We identified 23 139 specific pesticides that were ingested. Poisoning was fatal in 2299 (6·6%) patients. Case fatality varied greatly from 0·0% (several substances) to 41·8% (paraquat). The three most toxic agents (ie, paraquat, dimethoate, and fenthion) were banned between 2008 and 2011. Since 2013, the five agents causing the most deaths (ie, profenofos, propanil, fenobucarb, carbosulfan, and quinalphos) had a case fatality of 7·2-8·6%. A steady decline was seen in overall case fatality of pesticide poisoning (10·5% for 2002-06 to 3·7% for 2013-19), largely attributable to pesticide bans. A modest fall in case fatality for non-banned pesticides was also seen.
Interpretation:
Declines seen in case fatalities of poisonings with non-banned pesticides suggest that medical management improved over time. The human data for acute toxicity of pesticides should drive hazard classifications and regulation. We believe that a global benchmark for registration of pesticides should include a less than 5% case fatality after self-poisoning, which could prevent many deaths and have a substantial effect on global suicide rates.
Funding:
The Wellcome Trust and the National Health and Medical Research Council of Australia.
Translations:
For the Sinhala and Tamil translations of the abstract see Supplementary Materials section.
... Maximum number of cases 26 (40.63%) were seen in month of July followed by June and August, while minimum number of cases were seen in month of May ( Figure 4). 14,20 The average number of drugs per prescription is 1.6-1.8 according to WHO which is an important index of the standard of prescribing, In our study it was 4.4 while it was 2.6 in Demeke B et al, study. ...
Background: India is an agrarian country, where pesticides are most widely used in farming. Monsoon dependent agricultural practices are common in India. In present study socioeconomic class and prescribing pattern of commonly used drugs in organophosphate poisoning in indoor setting at tertiary care hospital is evaluated. The aim of the study was to evaluate prescribing trend of drugs and socioeconomic class of patients in organophosphate poisoning in monsoon season.Methods: Prospective observational study was conducted at Medical Intensive Care Unit (MICU) and Medicine Wards for 4 months at 540 bedded tertiary care teaching hospital.Results: Total 64 diagnosed cases were enrolled and analyzed in present study (n=64). Maximum number of cases (57.81%) were male followed by female (42.18%). Most of the cases (37.50%) were from the age group of 21-30 years. 49 (76.56%) patients were of primary intentional poisoning followed by 15 (23.43%) patients of accidental poisoning. Most common drugs prescribed were atropine, pralidoxime, cefotaxime and ranitidine. The average amount of atropine and pralidoxime used per patient/day were 37.89±63.63 mg and 10.07±26.87 gm respectively.Conclusions: Present study revealed that young male adults with low socioeconomic class from rural background were prone for intentional organophosphate poisoning in central India.
Background
Nepal recorded 5754 suicides in 2018–19 - a high number for a relatively small country. Over 24% of these suicides were by poisoning, most by ingestion of highly concentrated agricultural pesticides. Nepal has actively regulated pesticides to reduce their health impacts since 2001. We aimed to analyse Nepal’s history of pesticide regulation, pesticides responsible for poisonings, and relate them to national suicide rates.
Methods
Information on pesticide regulation was collected from the Plant Quarantine and Pesticide Management Centre of the Ministry of Agriculture and Livestock Development. National data on suicides from 1980 to 2019 were obtained from the National Statistical Bureau and Nepal Police. Data on the pesticides responsible for self-poisoning and pesticide suicides over time were obtained from a systematic literature review.
Results
As of June 2020, 171 pesticides were registered for use in Nepal, of which one was extremely hazardous (WHO Class Ia), one other highly hazardous (WHO Class Ib), and 71 moderately hazardous (WHO Class II). Twenty-four pesticides have been banned since 2001, with eight (including five WHO Class I compounds) banned in 2019. Although the suicide rate has increased more than twelve-fold since 1980, particularly for hanging (15-fold increase from 1980 to 2018), fatal pesticide self-poisoning has increased by 13-fold. Methyl-parathion is reported to be the key pesticide responsible for pesticide self-poisoning in Nepal, despite being banned in 2006.
Conclusion
The full effect of the recent pesticide policy reform in Nepal remains to be seen. Our analysis shows a continuing increase in suicide numbers, despite bans of the most important pesticide in 2006. This may indicate smuggling across the border and the use of the brand name (Metacid) for pesticides in general making it difficult to identify the responsible pesticide. More information is required from forensic toxicology labs that identify the individual compounds found. The effect of recent bans of common suicide pesticides needs to be monitored over the coming years. Evidence from other Asian countries suggests that HHPs bans will lead to a marked reduction in suicides, as well as fewer cases of occupational poisoning.
