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Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial

BACKGROUND: Agricultural pesticide self-poisoning is a major public health problem in rural Asia. The use of safer household pesticide storage has been promoted to prevent deaths, but there is no evidence of effectiveness. We aimed to test the effectiveness of lockable household containers for preve...

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Autores principales: Pearson, Melissa, Metcalfe, Chris, Jayamanne, Shaluka, Gunnell, David, Weerasinghe, Manjula, Pieris, Ravi, Priyadarshana, Chamil, Knipe, Duleeka W, Hawton, Keith, Dawson, Andrew H, Bandara, Palitha, deSilva, Dhammika, Gawarammana, Indika, Eddleston, Michael, Konradsen, Flemming
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655546/
https://www.ncbi.nlm.nih.gov/pubmed/28807536
http://dx.doi.org/10.1016/S0140-6736(17)31961-X
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author Pearson, Melissa
Metcalfe, Chris
Jayamanne, Shaluka
Gunnell, David
Weerasinghe, Manjula
Pieris, Ravi
Priyadarshana, Chamil
Knipe, Duleeka W
Hawton, Keith
Dawson, Andrew H
Bandara, Palitha
deSilva, Dhammika
Gawarammana, Indika
Eddleston, Michael
Konradsen, Flemming
author_facet Pearson, Melissa
Metcalfe, Chris
Jayamanne, Shaluka
Gunnell, David
Weerasinghe, Manjula
Pieris, Ravi
Priyadarshana, Chamil
Knipe, Duleeka W
Hawton, Keith
Dawson, Andrew H
Bandara, Palitha
deSilva, Dhammika
Gawarammana, Indika
Eddleston, Michael
Konradsen, Flemming
author_sort Pearson, Melissa
collection PubMed
description BACKGROUND: Agricultural pesticide self-poisoning is a major public health problem in rural Asia. The use of safer household pesticide storage has been promoted to prevent deaths, but there is no evidence of effectiveness. We aimed to test the effectiveness of lockable household containers for prevention of pesticide self-poisoning. METHODS: We did a community-based, cluster-randomised controlled trial in a rural area of North Central Province, Sri Lanka. Clusters of households were randomly assigned (1:1), with a sequence computer-generated by a minimisation process, to intervention or usual practice (control) groups. Intervention households that had farmed or had used or stored pesticide in the preceding agricultural season were given a lockable storage container. Further promotion of use of the containers was restricted to community posters and 6-monthly reminders during routine community meetings. The primary outcome was incidence of pesticide self-poisoning in people aged 14 years or older during 3 years of follow-up. Identification of outcome events was done by staff who were unaware of group allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT1146496. FINDINGS: Between Dec 31, 2010, and Feb 2, 2013, we randomly assigned 90 rural villages to the intervention group and 90 to the control group. 27 091 households (114 168 individuals) in the intervention group and 26 291 households (109 693 individuals) in the control group consented to participate. 20 457 household pesticide storage containers were distributed. In individuals aged 14 years or older, 611 cases of pesticide self-poisoning had occurred by 3 years in the intervention group compared with 641 cases in the control group; incidence of pesticide self-poisoning did not differ between groups (293·3 per 100 000 person-years of follow-up in the intervention group vs 318·0 per 100 000 in the control group; rate ratio [RR] 0·93, 95% CI 0·80–1·08; p=0·33). We found no evidence of switching from pesticide self-poisoning to other forms of self-harm, with no significant difference in the number of fatal (82 in the intervention group vs 67 in the control group; RR 1·22, 0·88–1·68]) or non-fatal (1135 vs 1153; RR 0·97, 0·86–1·08) self-harm events involving all methods. INTERPRETATION: We found no evidence that means reduction through improved household pesticide storage reduces pesticide self-poisoning. Other approaches, particularly removal of highly hazardous pesticides from agricultural practice, are likely to be more effective for suicide prevention in rural Asia. FUNDING: Wellcome Trust, with additional support from the American Foundation for Suicide Prevention, Lister Institute of Preventive Medicine, Chief Scientist Office of Scotland, University of Copenhagen, and NHMRC Australia.
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spelling pubmed-56555462017-10-30 Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial Pearson, Melissa Metcalfe, Chris Jayamanne, Shaluka Gunnell, David Weerasinghe, Manjula Pieris, Ravi Priyadarshana, Chamil Knipe, Duleeka W Hawton, Keith Dawson, Andrew H Bandara, Palitha deSilva, Dhammika Gawarammana, Indika Eddleston, Michael Konradsen, Flemming Lancet Article BACKGROUND: Agricultural pesticide self-poisoning is a major public health problem in rural Asia. The use of safer household pesticide storage has been promoted to prevent deaths, but there is no evidence of effectiveness. We aimed to test the effectiveness of lockable household containers for prevention of pesticide self-poisoning. METHODS: We did a community-based, cluster-randomised controlled trial in a rural area of North Central Province, Sri Lanka. Clusters of households were randomly assigned (1:1), with a sequence computer-generated by a minimisation process, to intervention or usual practice (control) groups. Intervention households that had farmed or had used or stored pesticide in the preceding agricultural season were given a lockable storage container. Further promotion of use of the containers was restricted to community posters and 6-monthly reminders during routine community meetings. The primary outcome was incidence of pesticide self-poisoning in people aged 14 years or older during 3 years of follow-up. Identification of outcome events was done by staff who were unaware of group allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT1146496. FINDINGS: Between Dec 31, 2010, and Feb 2, 2013, we randomly assigned 90 rural villages to the intervention group and 90 to the control group. 27 091 households (114 168 individuals) in the intervention group and 26 291 households (109 693 individuals) in the control group consented to participate. 20 457 household pesticide storage containers were distributed. In individuals aged 14 years or older, 611 cases of pesticide self-poisoning had occurred by 3 years in the intervention group compared with 641 cases in the control group; incidence of pesticide self-poisoning did not differ between groups (293·3 per 100 000 person-years of follow-up in the intervention group vs 318·0 per 100 000 in the control group; rate ratio [RR] 0·93, 95% CI 0·80–1·08; p=0·33). We found no evidence of switching from pesticide self-poisoning to other forms of self-harm, with no significant difference in the number of fatal (82 in the intervention group vs 67 in the control group; RR 1·22, 0·88–1·68]) or non-fatal (1135 vs 1153; RR 0·97, 0·86–1·08) self-harm events involving all methods. INTERPRETATION: We found no evidence that means reduction through improved household pesticide storage reduces pesticide self-poisoning. Other approaches, particularly removal of highly hazardous pesticides from agricultural practice, are likely to be more effective for suicide prevention in rural Asia. FUNDING: Wellcome Trust, with additional support from the American Foundation for Suicide Prevention, Lister Institute of Preventive Medicine, Chief Scientist Office of Scotland, University of Copenhagen, and NHMRC Australia. Elsevier 2017-10-21 /pmc/articles/PMC5655546/ /pubmed/28807536 http://dx.doi.org/10.1016/S0140-6736(17)31961-X Text en © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pearson, Melissa
Metcalfe, Chris
Jayamanne, Shaluka
Gunnell, David
Weerasinghe, Manjula
Pieris, Ravi
Priyadarshana, Chamil
Knipe, Duleeka W
Hawton, Keith
Dawson, Andrew H
Bandara, Palitha
deSilva, Dhammika
Gawarammana, Indika
Eddleston, Michael
Konradsen, Flemming
Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
title Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
title_full Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
title_fullStr Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
title_full_unstemmed Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
title_short Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
title_sort effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural asia: a community-based, cluster-randomised controlled trial
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655546/
https://www.ncbi.nlm.nih.gov/pubmed/28807536
http://dx.doi.org/10.1016/S0140-6736(17)31961-X
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