Evidence map›Paper›PMID 33901424›Full record

Observational studyThe Lancet. Global health2021

Case fatality of agricultural pesticides after self-poisoning in Sri Lanka: a prospective cohort study.

Nicholas A Buckley, Mohamed Fahim, Jacques Raubenheimer, Indika B Gawarammana, Michael Eddleston, Michael S Roberts, Andrew H Dawson

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The Lancet. Global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 2 pooled it
12.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 71 citations in OpenAlex.

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  14. Lessons from the field: compound-specific management in acute pesticide poisoning.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 3 countries.

Nicholas A BuckleySouth Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Pharmacology, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. Electronic address: nicholas.buckley@sydney.edu.au.
Mohamed FahimSouth Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Faculty of Allied Health Sciences, Department of Pharmacy, University of Peradeniya, Kandy, Sri Lanka; Pharmacology, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Jacques RaubenheimerSouth Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Pharmacology, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Indika B GawarammanaSouth Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
Michael EddlestonSouth Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Michael S RobertsSouth Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Basil Hetzel Institute for Translational Health Research, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; Diamantina Institute, University of Queensland, Brisbane, QLD, Australia.
Andrew H DawsonSouth Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Pharmacology, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
University of Peradeniya · LKSouth Asian Clinical Toxicology Research Collaboration · LKUniversity of Queensland · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPesticide 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.

methodsWe 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.

findingsFrom 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.

interpretationDeclines 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.

fundingThe 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.

Indexed as

AdultFemaleHumansMalePesticidesProspective StudiesSri LankaSuicide, CompletedYoung AdultPesticides

Identifiers

PMID33901424
PMCPMC8131203
OpenAlexW3159885350

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.