title: Effects of a provincial ban of two toxic organophosphorus insecticides on pesticide poisoning hospital admissions.
abstract: BACKGROUND
  Pesticide self-poisoning causes one third of global suicides. Sri Lanka halved its suicide rate by banning WHO Class I organophosphorus (OP) insecticides and then endosulfan. However, poisoning with Class II toxicity OPs, particularly dimethoate and fenthion, remains a problem. We aimed to determine the effect and feasibility of a ban of the two insecticides in one Sri Lankan district.
  
  
  METHODS
  Sale was banned in June 2003 in most of Polonnaruwa District, but not Anuradhapura District. Admissions with pesticide poisoning to the district general hospitals was prospectively recorded from 2002.
  
  
  RESULTS
  Hospital admissions for dimethoate and fenthion poisoning fell by 43% after the ban in Polonnaruwa, while increasing by 23% in Anuradhapura. The pesticide case fatality fell from 14.4% to 9.0% in Polonnaruwa (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.41-0.84) and 11.3% to 10.6% in Anuradhapura (OR 0.93, 95%CI 0.70-1.25; p = 0.051). This reduction was not sustained, with case fatality in Polonnaruwa rising to 12.1% in 2006-2007. Further data analysis indicated that the fall in case fatality had actually been due to a coincidental reduction in case fatality for pesticide poisoning overall, in particular for paraquat poisoning.
  
  
  CONCLUSIONS
  We found that the insecticides could be effectively banned from agricultural practice, as shown by the fall in hospital admissions, with few negative consequences. However, the ban had only a minor effect on pesticide poisoning deaths because it was too narrow. A study assessing the agricultural and health effects of a more comprehensive ban of highly toxic pesticides is necessary to determine the balance between increased costs of agriculture and reduced health care costs and fewer deaths.
authors.affiliation: Clinical Pharmacology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK. m.eddleston@ed.ac.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.forename: Sriyantha
authors.initials: S
authors.lastname: Adhikari
authors.forename: Samitha
authors.initials: S
authors.lastname: Egodage
authors.forename: Hasantha
authors.initials: H
authors.lastname: Ranganath
authors.forename: Fahim
authors.initials: F
authors.lastname: Mohamed
authors.forename: Gamini
authors.initials: G
authors.lastname: Manuweera
authors.forename: Shifa
authors.initials: S
authors.lastname: Azher
authors.forename: Shaluka
authors.initials: S
authors.lastname: Jayamanne
authors.forename: Edmund
authors.initials: E
authors.lastname: Juzczak
authors.forename: Mh Rezvi
authors.initials: MR
authors.lastname: Sheriff
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Dawson
authors.forename: Nick A
authors.initials: NA
authors.lastname: Buckley
mesh_terms: D000383:Agriculture / Q000331:legislation & jurisprudence*; D003132:Commerce / Q000331:legislation & jurisprudence; D033161:Government Regulation; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D062025:Organophosphate Poisoning; D009943:Organophosphorus Compounds / Q000600:supply & distribution; D010575:Pesticides / Q000506:poisoning* / Q000600:supply & distribution; D011041:Poisoning / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013188:Sri Lanka / Q000453:epidemiology
chemical_list: D009943:Organophosphorus Compounds; D010575:Pesticides