Quick Facts


"Pesticide ingestion is one of the leading suicide methods. Worldwide, an estimated three million cases of pesticide poisoning occur every year, resulting in an excess of 250 000 deaths. This mortality accounts for a substantial fraction of the 900 000 people who die by suicide every year. Reports suggest that it is particularly significant in rural areas, especially in some Asian countries.

It is estimated that in the last decade between 60% and 90% of suicides in China, Malaysia, Sri Lanka, and Trinidad were due to pesticide ingestion. More recently, WHO has received reports of a growing number of suicides due to pesticide ingestion in many other countries in Asia, as well as in countries such as countries in Central and South America."

(Source: World Health Organization Note for the Media, September 2006)

"Pesticides: Facts and Figures

  • Pesticide ingestion accounts for an estimated 370 000 suicides each year, worldwide, more than one
    third of all suicides (6).
  • The proportion of suicides by ingestion of pesticides varies from 4% in WHO's European Region to 56%
    in its Western Pacific Region (6). A disproportionate number of suicides by pesticide self-poisoning occur
    in low- and middle-income countries.
  • In many rural areas of South-East Asia, pesticide ingestion accounts for over 60% of suicides (94).
    Estimates suggest that more than 160 000 people in this region kill themselves each year by ingesting
    pesticides (6).
  • The toxicity of pesticides to humans varies widely; ingestion of paraquat is fatal in over 60% of selfpoisoning
    cases (95), compared with less than 10% for the insecticide chlorpyrifos (96).
  • Pesticide poisoning places huge burdens on health services in developing countries. In 1995-96, 41% of
    intensive care beds in a Sri Lankan hospital were occupied by people poisoned by organophosphates (97).
    The overall estimated cost of treating self-poisoning cases in Sri Lanka in 2004 was about $1 million (98)."

(Source: World Health Organization briefing, Guns, knives and pesticides: reducing access to lethal means)

Issue Summary from the World Health Organization


"Globally, there is a scarcity of information on the magnitude of both intentional and unintentional poisoning, as well as on the relative importance of different pesticides. This information is particularly lacking from most of Africa, and detailed and accurate community-based data on the pesticides responsible for fatal self-harm are not available for most of rural Asia. Sentinel centres, that would need to be identified and supported, could provide this information from across the world.

At any rate, it is known that the pesticides that cause most deaths in rural Asia, and in the world, are WHO Class I and II organophosphorus pesticides - causing an estimated 200,000 deaths (Buckley et al., 2004; Eddleston, 2000; Gunnell et al., 2007b). At any rate, in rural Asia, the variety of pesticides available in communities for intentional or unintentional poisoning is large, reflecting the pesticides used in local agriculture. Studies from Sri Lanka suggest that less than 20% of pesticides used for self-harm are bought for the purpose; the majority are freely available in the home or nearby garden (Eddleston et al., 2006a).

The vast majority of these deaths are intentional; unintentional oral or dermal exposure to WHO Class I OP pesticides can cause severe poisoning but the doses are usually smaller than with intentional poisoning, resulting in fewer deaths. WHO Class II OPs are generally less toxic in unintentional poisoning. Where Class II OPs are the most commonly used insecticides, unintentional poisoning is generally less likely to cause severe poisoning. Class II OPs are highly toxic in intentional overdose.

Other classes of pesticide that are common causes of significant and/or fatal poisoning include carbamate and organochlorine insecticides, the fumigant aluminium phosphide (a significant problem in north India), and the herbicide paraquat. Less common causes of significant poisoning include the herbicides chlorphenoxy acetic acid derivatives and propanil, some pyrethroid insecticides, avermectins, and amitraz (Eddleston, 2000).

The locally available pesticides will also determine how many poisoned people survive to hospital presentation. In areas where highly toxic fast acting WHO Class I organophosphorus (OP) pesticides are used, the onset of poisoning can be so fast that many people die before they can be taken to hospital. By contrast, where slower acting pesticides are used, more patients will survive to reach hospital and medical care (Eddleston et al., 2008a). The case fatality for different pesticides also varies markedly, from around 70% for both aluminium phosphide and paraquat, to close to 0% for many of the newer lower toxicity pesticides (Dawson and Buckley, 2007; Eddleston, 2000). Therefore, hospital statistics, whether from primary or secondary hospitals, must be interpreted in light of this difference.

More than half of global deaths from pesticide poisoning occur in China (Buckley et al., 2004; Phillips et al., 2002), where currently, the WHO Class I OP pesticides are the major problem, but where five Class I OPs (methamidophos, methylparathion, parathion, monocrotophos, phoxim) have been recently banned. This was expected to reduce the number of poisoning deaths in China, and has since been associated with a possible 10-15% fall in overall suicide rates in women. In China, some deaths occur from pesticides that are considered to be generally safe in poisoning.

More recently developed pesticides are generally safer than the older pesticides still used widely in low- and middle income countries. While the main international pesticide industry would be keen to sell the newer pesticides, it is likely that the generics and black market industry that is particularly active in low- and middle income countries would not change their sales.

For different reasons, raising attention to intentional and accidental pesticide poisoning has been more difficult than the importance given to occupational exposure. However, both national authorities, agencies and organizations, and international organizations should consider these three forms of poisoning together, at all opportunities. As the global use of WHO Class I OPs reduces over the coming years, due to the enforcement of international bans, the relative importance any kind of poisoning (including any health hazards) due to other classes of pesticides will increase. By combining all forms of poisoning, it should be possible to keep bettermonitoring and surveillance, broadening advocacy, at the same token. ...

Respiratory failure is the primary cause of death following the ingestion of pesticides, either due to specific anti-cholinesterase effects of OP and carbamate poisoning, or - for all pesticides - the non-specific complications of aspiration (Eddleston et al., 2006b). Also, much aspiration results from poor initial care of the patient and/or unsafe gastric decontamination."

(Source: World Health Organization report, Safer Access to Pesticides: Community Interventions. Please read the full report for more information on policy concerns and initiatives.)

Policy Concerns


"Pesticides: Safer storage, bans and replacement by less toxic pesticides could prevent many of the estimated 370 000 suicides caused by ingestion of pesticides every year.

Members of agricultural communities in low- and middle-income countries are heavily over-represented in the suicide death toll related to pesticides. Controlling access to pesticides is not only critical in reducing self-directed violence, it is key to preventing unintentional poisoning and terrorism. International conventions attempt to manage
hazardous substances; however, many highly toxic pesticides are still widely used. Studies indicate that bans must be accompanied by evaluations of agricultural needs and replacement with low-risk alternatives for pest control."

(Source: World Health Organization report, Guns, knives and pesticides: reducing access to lethal means)

"Pesticides policy
Any actions addressing the impact of pesticides on health should be in principle framed within sound national suicide prevention strategies and pesticide policies, including their implementation at different levels.

Aim i. above includes, more specifically, global efforts towards banning the most toxic pesticides, according to the Hazardous Chemicals and Wastes Conventions, i.e. the Basel, Rotterdam, and Stockholm Conventions (www.basel.int; www.pic.int; www.pops.int; last accessed on 3 April 2008). It is not only crucial for governments to ratify and implement these conventions; they must also work to ensure their enforcement and effectiveness. The effective regulation at the local level is crucial, since ineffective control would result in banned pesticides being provided by the black market with poor quality control and labelling. In addition, efforts need to be made to reduce human toxicity of pesticides used in agriculture.

Regulation of the pesticides used in Sri Lankan agricultural practice has clearly shown that bans of the most toxic pesticides result in a sustained overall reduction in the number of deaths from intentional pesticide poisoning (Gunnell et al., 2007a). Unfortunately, pesticide poisoning due to intentional ingestion has been excluded from the conventions for unclear reasons (Konradsen et al., 2005). However, banning of the most toxic pesticides has clearly reduced the number of significant unintentional poisoning episodes."

(Source: World Health Organization report, Safer Access to Pesticides: Community Interventions. Please read the full report for more information on policy concerns and initiatives.)

Resources


World Health Organization Fact Sheet: The Impacts of Pesticides on Health: Preventing Intentional and Unintentional Deaths from Pesticide Poisoning (2004)

World Health Organization Bulletins:

World Health Organization Reports:

World Health Organization/United Nations Environment Programme: Sound management of pesticides and diagnosis and treatment of pesticide poisoning - a resource tool intended to assist national programmes and those involved in the management of pesticides, and with diagnosis and treatment of pesticide poisoning, in formulating training courses, adapted to specific needs of different target groups.


Peer-Reviewed Articles


Unless otherwise noted, the links below are to article abstracts. 

Gunnell, David and Eddleston, Michael. "Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries." International Journal of Epidemiology 32 (2003): 902-909. Full text.

Konradsen, F. "Acute pesticide poisoning--a global public health problem." Danish Medical Bulletin 54, 1 (2007): 58-59.

Gunnell D., Eddleston M., Phillips M.R., and Konradsen F. "The global distribution of fatal pesticide self-poisoning: systematic review." BMC Public Health. 7, 357 (2007).

van der Hoek, W. and Konradsen, F. "Risk factors for acute pesticide poisoning in Sri Lanka." Tropical Medicine and International Health. 10, 6 (2005): 589-96.

Konradsen F; van der Hoek W; Cole DC; Hutchinson G; Daisley H; Singh S; Eddleston M. "Reducing acute poisoning in developing countries--options for restricting the availability of pesticides." Toxicology. 2003, Nov 5; 192(2-3):249-61. Full text.     

Gunnell, D.; Fernando, R.; Hewagama, M; Priyangika, W. D. D.; Konradsen, F; and Eddleston, M. "The impact of pesticide regulations on suicide in Sri Lanka." International Journal of Epidemiology 2007 36(6):1235-1242. Full text. 

JM Bertolote, A Fleischmann, M Eddleston, and D Gunnell. "Deaths from Pesticide Poisoning: Are we lacking a global response?" British Journal of Psychiatry. 2006 September; 189: 201-203. Full text.

Wesseling C; Corriols M; Bravo V. "Acute pesticide poisoning and pesticide registration in Central America." Toxicology and Applied Pharmacology. 2005, Sep 1; 207(2 Suppl):697-705. 

London, L. and Bailie, R. "Challenges for improving surveillance for pesticide poisoning: policy implications for developing countries." International Journal of Epidemiology. 2001, Jun; 30(3):564-70. Full text.

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