DEPARTMENT OF INTERNATIONAL HEALTH UNIVERSITY OF COPENHAGEN Suicide with pesticides - a global public health problem Flemming Konradsen University of Copenhagen.

DEPARTMENT OFINTERNATIONAL HEALTHUNIVERSITY OF COPENHAGEN

Suicide with pesticides - a global public health problem

Flemming KonradsenUniversity of Copenhagen

Pesticider i udviklingslandenesundhed og miljø, etiske problemstillinger og

løsningsmodeller

Århus Universitet


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Scale of the Problem

• Approximately 300 000 death per year at global level from pesticide self-harm/suicides primarily in developing countries (Gunnell & Eddleston 2003)

• WHO now estimate that pesticides are the most commonly used means of suicide globally (Bertolote et al, 2006)

• Pesticides the most commonly used means of suicide in rural areas of Asia (e.g. 60% China - Phillips et al, 2002; 90% Malaysia - Maniam et al, 1988; 42% India - Aaron et al 2004); 71% Sri

Lanka -Somasundaram & Rajadurai, 1995) but we fear for the future scenario in Africa!


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Scale of the Problem

• Suicides will have major socio-economic and long psychological impacts on the families

• A burden on the intensive care units and hospital services

• The very high case-fatality from pesticide self-harm makes it difficult for the society and health authorities to target vulnerable individuals (people who repeat)


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A case

A 15 year old girl drank 20% paraquat after an argument and fight with her 11 year old brother… She told doctors she had not known it was paraquat and in her distress had simply grabbed the nearest bottle in the house and drunk it. She died from cardio-respiratory arrest 2 days after admission (Eddleston and Phillips 2004)


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Why is pesticide suicide so common?

• Extremely toxic compounds have become easily accessible as agricultural systems change and pesticides are made available to even the smallest of farming households

• Easy access in the homes has great impact as most suicides are very impulsive, often linked with alcohol consumption or follows sudden emotional distress

• Alternatives to pesticides are far less lethal, less available or require more planning


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Why is pesticide suicide so common?

• The capacity to manage poisoning case limited in most developing country settings

• The hundreds of chemicals sold makes the management very difficult

• Intake of alcohol and pesticides in combination makes case management even more difficult


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Human toxicity of Organophosphate (OP) insecticides

0 5 10 15 20 25 30

new non-OP insecticides

diazinon

malathion

chlorpyrifos

phenthoate

profenofos

quinalphos

fenthion

dimethoate

All OPs

Case fatality ratio (95% CI)

Eddleston et al unpublished


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Pesticides as an underlaying cause of Suicide?

• Insufficient documentation to argue that pesticides increase suicidal behavior

• Pesticide availability will have some but minor impact on incidence of attempted suicides but will increase the overall mortality from attempted suicides


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How to reduce the mortality from pesticide self-poisoning

Short term (immediately!)• Phase out all WHO class I pesticidesMedium term• Restrict the availability of the most hazardous/ difficult to mange

WHO class II products• Develop formulation of current pesticides that are less acute toxic • Increase capacity to undertake case management• Improve domestic and community level storage• Restrict sale of pesticides via private vendors• Support the establishment of community crises ”centers”• Provide significant support to IPM and other farming systems that

reduce the need for pesticides including new plant varietiesLong-term• Support community level activities to reduce alcohol misuse, school

oppression, domestic violence etc.• Support counseling and mental health services


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Safe storage


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The End

DEPARTMENT OF INTERNATIONAL HEALTH UNIVERSITY OF COPENHAGEN Suicide with pesticides - a global public health problem Flemming Konradsen University of Copenhagen.

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