title: A community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka: study protocol.
abstract: BACKGROUND
  The WHO recognises pesticide poisoning to be the single most important means of suicide globally. Pesticide self-poisoning is a major public health and clinical problem in rural Asia, where it has led to case fatality ratios 20-30 times higher than self-poisoning in the developed world. One approach to reducing access to pesticides is for households to store pesticides in lockable "safe-storage" containers. However, before this approach can be promoted, evidence is required on its effectiveness and safety.
  
  
  METHODS
  A community-based cluster randomised controlled trial has been set up in 44,000 households in the North Central Province, Sri Lanka. A census is being performed, collecting baseline demographic data, socio-economic status, pesticide usage, self-harm and alcohol. Participating villages are then randomised and eligible households in the intervention arm given a lockable safe storage container for agrochemicals. The primary outcome will be incidence of pesticide self-poisoning over three years amongst individuals aged 14 years and over. 217,944 person years of follow-up are required in each arm to detect a 33% reduction in pesticide self-poisoning with 80% power at the 5% significance level. Secondary outcomes will include the incidence of all pesticide poisoning and total self-harm.
  
  
  CONCLUSIONS
  This paper describes a large effectiveness study of a community intervention to reduce the burden of intentional poisoning in rural Sri Lanka. The study builds on a strong partnership between provincial health services, local and international researchers, and local communities. We discuss issues in relation to randomisation and contamination, engaging control villages, the intervention, and strategies to improve adherence.
authors: Clinical Pharmacology Unit, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK. melissa@sactrc.org
authors: Melissa
authors: M
authors: Pearson
authors: Flemming
authors: F
authors: Konradsen
authors: David
authors: D
authors: Gunnell
authors: Andrew H
authors: AH
authors: Dawson
authors: Ravi
authors: R
authors: Pieris
authors: Manjula
authors: M
authors: Weerasinghe
authors: Duleeka W
authors: DW
authors: Knipe
authors: Shaluka
authors: S
authors: Jayamanne
authors: Chris
authors: C
authors: Metcalfe
authors: Keith
authors: K
authors: Hawton
authors: A Rajitha
authors: AR
authors: Wickramasinghe
authors: W
authors: W
authors: Atapattu
authors: Palitha
authors: P
authors: Bandara
authors: Dhammika
authors: D
authors: de Silva
authors: Asanga
authors: A
authors: Ranasinghe
authors: Fahim
authors: F
authors: Mohamed
authors: Nicholas A
authors: NA
authors: Buckley
authors: Indika
authors: I
authors: Gawarammana
authors: Michael
authors: M
authors: Eddleston
mesh_terms: D016000:Cluster Analysis; D006798:Housing; D006801:Humans; D010575:Pesticides / Q000506:poisoning*; D011041:Poisoning / Q000517:prevention & control*; D019064:Product Packaging / Q000379:methods*; D012424:Rural Population; D013188:Sri Lanka; D000092864:Suicide Prevention
chemical_list: D010575:Pesticides