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Background Sri Lanka introduced national bans restricting access to highly hazardous pesticides (HHPs) in 2008-11, and in 2013-16. An immediate drop in pesticide poisoning cases was observed after the introduction of the first ban, but there was a simultaneous rise in hospital admissions due to drugs, medicines and biological substances. However, the long-term trends in hospital admissions and deaths due to poisoning in Sri Lanka have not been investigated. We aimed to determine whether there have been changes in types of poisoning presenting to hospitals and their associated case fatality (CF) following two distinct periods of implementation of national bans of HHPs in Sri Lanka. Methods We conducted a retrospective observational study using routinely collected national-level hospital admissions data from Sri Lanka between 2004 and 2019 to examine trends in hospital admissions, deaths, and CF of different poisoning types. We included the following types: drugs, medicines and biological substances; pesticides; and non-medicinal products; and an additional group for other external causes. We calculated type-specific number of in-hospital cases and deaths per 100,000 population and annual CF, stratified by sex and age group. Results We found a reduction in hospital admission cases from both pesticide poisoning (58.5% between 2012 and 2017) and drugs, medicine, and biological substances following the implementation of the first HHPs bans in 2011. There was an increase in hospital admissions due to non-medicinal products and other external causes, but this did not translate into an increase in hospital deaths or CF. We observed a sharp decrease in CF due to pesticide poisoning following the first ban (50% between 2008 and 2012), with no concurrent rise in CF due to other types of poisoning and non-poisoning substances, which remained low throughout the study period. Conclusions The implementation of national bans of HHPs led to a reduction in number of admissions as well as CF due to pesticide poisoning in hospitals in Sri Lanka, with no evidence of substitution to other types of poisonings. The reversal of the upward trend in hospital admissions due to pesticide and medicinal poisonings suggests that the bans contributed to a reduction in admissions from these types of poisoning.

Background Pesticides in Tanzania are extensively used for pest control in agriculture. Their usage and unsafe handling practices may potentially result in high farmer exposures and adverse health effects. The aim of this study was to describe farmers’ pesticide exposure profile, knowledge about pesticide hazards, experience of previous poisoning, hazardous practices that may lead to Acute Pesticide Poisoning (APP) and the extent to which APP is reported. Methods The study involved 121 head- of-household respondents from Arumeru district in Arusha region. Data collection involved administration of a standardised questionnaire to farmers and documentation of storage practices. Unsafe pesticide handling practices were assessed through observation of pesticide storage, conditions of personal protective equipment (PPE) and through self-reports of pesticide disposal and equipment calibration. Results Past lifetime pesticide poisoning was reported by 93% of farmers. The agents reported as responsible for poisoning were Organophosphates (42%) and WHO Class II agents (77.6%). Storage of pesticides in the home was reported by 79% of farmers. Respondents with higher education levels were significantly less likely to store pesticides in their home (PRR High/Low = 0.3; 95% CI = 0.1-0.7) and more likely to practice calibration of spray equipment (PRR High/Low = 1.2; 95% CI = 1.03-1.4). However, knowledge of routes of exposure was not associated with safety practices particularly for disposal, equipment wash area, storage and use of PPE . The majority of farmers experiencing APP in the past (79%) did not attend hospital and of the 23 farmers who did so in the preceding year, records could be traced for only 22% of these cases. Conclusions The study found a high potential for pesticide exposure in the selected community in rural Tanzania, a high frequency of self-reported APP and poor recording in hospital records. Farmers’ knowledge levels appeared to be unrelated to their risk. Rather than simply focusing on knowledge-based strategies, comprehensive interventions are needed to reduce both exposure and health risks, including training, improvements in labeling, measures to reduce cost barriers to the adoption of safe behaviours, , promotion of control measures other than PPE and support for Integrated Pest Management (IPM).

Background Pesticide poisoning has emerged as a significant public health concern on a global scale. China has a diverse range of agricultural practices and varying pesticide usage across its regions. Nevertheless, there is a paucity of research on the epidemiology of pesticide poisoning in China. To address this research gap, our study was undertaken to investigate the epidemiological characteristics of pesticide poisoning in Zhejiang Province. Methods Pesticide poisoning data for Zhejiang Province from 2008 to 2022 was extracted from the National Occupational Disease and Occupational Health Information Monitoring System. A descriptive statistical analysis had been employed to explore the temporal, demographic, and regional distribution of pesticide poisoning cases. Furthermore, logistic regression models were conducted to analyze the influence factors of pesticide-related death. Results Between the years 2008 and 2022, totally 64,605 pesticide poisoning cases were observed in Zhejiang Province, with a case fatality rate of 5.28%. The incidence rate was estimated as 7.23 per 100,000 population. The poisoning cases number, incidence rates and the case fatality rates all exhibited fluctuating decreasing trends during the study period. Intentional poisoning (suicide) accounted for 64.64% of all poisoning cases, and the case fatality rate of intentional poisoning cases were also significantly higher than occupational and accidental poisoning. In examining the influence factors of pesticide-related death, it was revealed that older individuals, males, and those experiencing either accidental or intentional poisoning had higher risk of death. The analysis also identified that patients treated in township level hospitals exhibited a higher risk of death compared with those in district/county level or provincial/municipal level primary care hospitals. Conclusions The current situation of pesticide poisoning in Zhejiang Province remains severe and the government should further strengthen the monitoring and governing of pesticide. Moreover, it is imperative that mental health education and early psycho-social interventions be given greater emphasis to effectively reduce pesticide-related suicides.

Background Pesticide poisoning in children has been a serious public health issue around the world, especially in the developing countries where agriculture is still one of the largest economic sectors. The purpose of this study was to analyze epidemiological characteristics of acute pesticide poisoning in children from Zhejiang province, China. Methods The pesticide poisoning cases for children were retrieved from Occupational Disease Surveillance and Reporting System, Zhejiang Provincial Center for Disease Control and Prevention, China. The incident cases, deaths, and fatality rate of child pesticide poisoning from 2006 through 2015 were calculated. Results During the study period, totally 2952 children were poisoned by pesticides, with 66 deaths, resulting in a fatality rate of 2.24%. Among them, there were 1607 male cases with 28 deaths, and 1345 female cases with 38 deaths. Most of the cases occurred in preschool children (1349) and adolescent age group (1269). Organophosphate and carbamate insecticides were the cause of most poisonings (1130), leading to 34 deaths. The highest fatality rate (3.13%) was due to poisoning by herbicides and fungicides, causing 14 deaths out of 448 cases. Poisoning occurred mostly in rural areas (78%). And most pesticide poisoning occurred in the summer (896) and fall (811), while fewest poisoning cases in the winter (483) but with the highest fatality rate (3.52%). Conclusions This study shows that pesticide poisoning of children is a major health problem in Zhejiang, suggesting preventive strategies should be conducted to control childhood pesticide poisoning.

Studies suggest that acute pesticide poisonings (APP) may be linked with long-term neurological effects. To examine long-term neurological and psychological distress symptoms associated with having experienced an APP, we conducted a cross-sectional study of 300 conventional and organic smallholder farmers from Zarcero County, Costa Rica, May–August 2016. We collected self-reported data on sociodemographic characteristics, occupational history, pesticide exposure, APPs, neurological and psychological distress symptoms (using the Brief Symptom Inventory (BSI)). Adjusted logistic regression models were fit. A total of 14% of the farmers (98% male) reported experiencing at least one APP during their lifetime. Self-reported APP was associated with neurological symptoms during the 12 months prior to interview (e.g., fainting (Odds Ratio: 7.48, 95% Confidence Interval: 1.83, 30.74), shaking hands (3.50; 1.60, 7.60), numbness/tingling in hands or feet (3.23; 1.66, 6.32), insomnia (2.53; 1.34, 4.79), accelerated heartrate (2.42; 1.03, 5.47), dizziness (2.38; 1.19, 4.72), increased irritability/anger (2.37; 1.23, 4.55), low energy (2.33; 1.23, 4.46), and difficulty concentrating (2.01; 1.05, 3.85)). Farmers who reported an APP in the ten years prior to interview experienced increased odds of abnormal BSI scores for hostility (4.51; 1.16, 17.70) and paranoid ideation (3.76; 0.99, 18.18). Having experienced an APP may be associated with long-term neurological and psychological distress symptoms.

This study aimed to investigate the effectiveness of continuous renal replacement therapy and hemoperfusion in acute severe organophosphorus pesticide poisoning patients. Fifty-eight acute severe organophosphorus pesticide poisoning patients who accepted therapy in Nangjing First Hospital, Nangjing Medical University from January 2018 to December 2022 were chosen as the study participants. They were randomly divided into a control group and a research group. Both groups received conventional treatment, while the research group received continuous renal replacement therapy combined with hemoperfusion therapy. Relative to the control group, the research group had higher total effectiveness rate, shorter coma time, cholinase recovery time, reduced stay in intensive care unit, less atropine dosage, lower levels of inflammatory factors and lower sequential organ failure assessment scores. Our study suggests that continuous renal replacement therapy combined with hemoperfusion can improve the clinical therapeutic effect in patients with acute severe organophosphorus pesticide poisoning, effectively control the inflammatory response, and shorten the clinical rescue and treatment time of patients. Cette étude visait à évaluer l'efficacité de la suppléance rénale continue et de l'hémoperfusion chez les patients atteints d'intoxication aiguë sévère aux pesticides organophosphorés. Cinquante-huit patients atteints d'intoxication aiguë sévère aux pesticides organophosphorés, admis au traitement au Nangjing First Hospital de l'Université de médecine de Nangjing entre janvier 2018 et décembre 2022, ont été sélectionnés comme participants à l'étude. Ils ont été répartis aléatoirement en un groupe témoin et un groupe de recherche. Les deux groupes ont reçu un traitement conventionnel, tandis que le groupe de recherche a reçu une suppléance rénale continue associée à une hémoperfusion. Par rapport au groupe témoin, le groupe de recherche présentait un taux d'efficacité globale plus élevé, une durée de coma plus courte, un temps de récupération de la cholinase plus court, une durée d'hospitalisation réduite en unité de soins intensifs, une dose d'atropine plus faible, des taux de facteurs inflammatoires plus faibles et des scores d'évaluation de la défaillance organique séquentielle plus faibles. Notre étude suggère que la suppléance rénale continue associée à l'hémoperfusion peut améliorer l'effet thérapeutique clinique chez les patients atteints d'intoxication aiguë sévère aux pesticides organophosphorés, contrôler efficacement la réponse inflammatoire et raccourcir la durée de la prise en charge et du traitement.

Background Acute pesticide poisoning is a major public health concern. The relationship between family function and depression in caregivers of patients with acute pesticide poisoning is unclear. Therefore, this study aimed to explore the relationship between family function, coping style, and depression among caregivers of patients with acute pesticide poisoning and to provide a theoretical basis and intervention targets for future research. Methods A cross-sectional study was conducted among caregivers of patients with acute pesticide poisoning in the Department of Toxicology and Occupational Disease of a Grade A hospital in Jinan, Shandong Province, from November 2022 to June 2023. A general data questionnaire, family caring index scale, simple coping style questionnaire, and health questionnaire depression symptom group scale were used to collect the data. Pearson correlation and a structural equation model were used for data analysis. Results The average depression score of the caregivers was 5.66 ± 4.291, and the incidence of depression was 54.7%. The family function may directly or indirectly affect depression in caregivers through coping styles. Conclusion Future health education and interventions should focus on improving the family functioning of caregivers and encouraging positive coping mechanisms.

Intentional and unintentional pesticide poisoning is an important public health problem, especially in low- and middle-income countries. Individuals who have been exposed to toxic pesticides, particularly organophosphorus insecticides, need early treatment. Atropine autoinjector devices offer a potential solution, allowing storage of effective treatment near agricultural workers' fields and homes that could be reached within minutes by the worker or fellow villagers to provide first-line emergency care. Here we present the design of a qualitative, formative study that will constitute the first phase of an implementation science study exploring the introduction of atropine autoinjectors in rural villages.This study will employ a qualitative design to investigate the feasibility and operational opportunities and challenges in providing pre-hospital emergency care with atropine autoinjectors in rural communities in Sri Lanka. We will conduct semi-structured interviews, ethnographic observations, oral history interviews, participatory mapping, and focus group discussions in villages and in hospitals.This study will allow the design of an autoinjector intervention that is tailored to specific needs of rural communities, maximise the potential benefits in the villages where they are placed, and contribute to knowledge related to biomedical technologies designed for use in LMICs. It will also contribute to social science scholarship in the context of pesticide poisoning. Study approvals have been obtained from the University of Edinburgh Medical School Research Ethics Committee (23-EMREC-039) and from Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2023/4).

Background Pesticide poisoning is an important health problem among Chinese farm workers, but there is a paucity of pesticide poisoning data from China. Using the WHO standard case definition of a possible acute pesticide poisoning, we investigated the prevalence and risk factors of acute work-related pesticide poisoning among farmers in Southern China. Methods A stratified sample of 910 pesticide applicators from two villages in southern China participated in face-to-face interviews. Respondents who self-reported having two or more of a list of sixty-six symptoms within 24 hours after pesticide application were categorized as having suffered acute pesticide poisoning. The association between the composite behavioral risk score and pesticide poisoning were assessed in a multivariate logistic model. Results A total of 80 (8.8%) pesticide applicators reported an acute work-related pesticide poisoning. The most frequent symptoms among applicators were dermal (11.6%) and nervous system (10.7%) symptoms. Poisoning was more common among women, farmers in poor areas, and applicators without safety training (all p < 0.001). After controlling for gender, age, education, geographic area and the behavioral risk score, farmers without safety training had an adjusted odds ratio of 3.22 (95% CI: 1.86-5.60). The likelihood of acute pesticide poisoning was also significantly associated with number of exposure risk behaviors. A significant \"dose-response\" relationship between composite behavioral risk scores calculated from 9 pesticides exposure risk behaviors and the log odds of pesticide poisoning prevalence was seen among these Chinese farmers (R 2 = 0.9246). Conclusions This study found that 8.8% of Chinese pesticide applicators suffered acute pesticide poisoning and suggests that pesticide safety training, safe application methods, and precautionary behavioral measures could be effective in reducing the risk of pesticide poisoning.

Human poisoning by pesticides has long been seen as a severe public health problem. As early as 1990, a task force of the World Health Organization (WHO) estimated that about one million unintentional pesticide poisonings occur annually, leading to approximately 20,000 deaths. Thirty years on there is no up-to-date picture of global pesticide poisoning despite an increase in global pesticide use. Our aim was to systematically review the prevalence of unintentional, acute pesticide poisoning (UAPP), and to estimate the annual global number of UAPP. We carried out a systematic review of the scientific literature published between 2006 and 2018, supplemented by mortality data from WHO. We extracted data from 157 publications and the WHO cause-of-death database, then performed country-wise synopses, and arrived at annual numbers of national UAPP. World-wide UAPP was estimated based on national figures and population data for regions defined by the Food and Agriculture Organization (FAO). In total 141 countries were covered, including 58 by the 157 articles and an additional 83 by data from the WHO Mortality Database. Approximately 740,000 annual cases of UAPP were reported by the extracted publications resulting from 7446 fatalities and 733,921 non-fatal cases. On this basis, we estimate that about 385 million cases of UAPP occur annually world-wide including around 11,000 fatalities. Based on a worldwide farming population of approximately 860 million this means that about 44% of farmers are poisoned by pesticides every year. The greatest estimated number of UAPP cases is in southern Asia, followed by south-eastern Asia and east Africa with regards to non-fatal UAPP. Our study updates outdated figures on world-wide UAPP. Along with other estimates, robust evidence is presented that acute pesticide poisoning is an ongoing major global public health challenge. There is a need to recognize the high burden of non-fatal UAPP, particularly on farmers and farmworkers, and that the current focus solely on fatalities hampers international efforts in risk assessment and prevention of poisoning. Implementation of the international recommendations to phase out highly hazardous pesticides by the FAO Council could significantly reduce the burden of UAPP.