Bans of WHO Class I Pesticides in Bangladesh—suicide prevention without hampering agricultural output

Chowdhury, Fazle Rabbi; Dewan, Gourab; Verma, Vasundhara; Knipe, Duleeka; Isha, Ishrat Tahsin; Faiz, Mohammad Abul; Gunnell, David; Eddleston, Michael

doi:10.1093/ije/dyx157

Cited by 91 publications

(123 citation statements)

References 27 publications

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“…These are higher rates than those estimated by Nahar et al (2015), and may reflect more careful case finding and diagnostic techniques concerning causes of death in rural areas. Another reason for a lowered suicide rate could be the lack of availability, in later years, of the most lethal pesticides Chowdhury et al 2017). …”

Section: Completed Suicide In Community and Population-based Studiesmentioning

confidence: 99%

“…The majority of the 38 studies reviewed show clearly that removing noxious pesticides from legal sale (as defined by the WHO) does result both in the reduction of the numbers who die by this method of suicide, and in an overall reduction in actual suicide rates. Chowdhury et al (2017) report that Bangladesh passed laws between 1998 and 2007 banning sale of the most noxious pesticides, resulting not only in a reduction of deaths using this method, but in a net reduction of about 10 percent in the actual suicide rate (the lack of availability of the most lethal pesticides did however see an increase in suicide due to hanging, which offset to some extent lives saved by lack of lethal pesticides). This finding could account for the decline in deaths by suicide in Bangladesh reported in the earlier work of Chowdhury et al (2011).…”

Section: An Additional Confirmatory Studymentioning

confidence: 99%

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High Rates of Suicide and Violence in the Lives of Girls and Young Women in Bangladesh: Issues for Feminist Intervention

2017

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Deaths by suicide in Bangladesh have an atypical sex ratio, with higher rates in females than in males-a characteristic shared with several countries in Southern Asia. Reasons for this are explored in this paper. An examination of the social structure of Bangladesh suggests that girls and women are subjected to higher rates of sexual and physical violence compared with males, especially in rural and urban slum areas. This violence is often linked to the enforced marriage of young girls to older men. A systematic review of 24 studies on suicide and suicidal behaviors in Bangladesh has shown that suicide death rates are exceptionally high in younger women, at a rate of about 20 per 100,000, more than twice the rate in males aged less than 49. In girls aged 15 to 17, the estimated suicide rate is 14 per 100,000, 50% higher than in males. Because of problems in obtaining systematic data on deaths by suicide, these rates are likely to be underestimates. Extreme poverty and lack of education have been recorded as factors in deaths by suicide, although there are methodological problems in reaching such conclusions. We speculate that some of the "suicides" (especially those using poison) may in fact be cases of murder. A dowry system (not sanctioned by Islam) is thought to be a major cause of family poverty, and violence experienced by young girls. In proposing solutions, we argue the case (as Muslims) for the support of an Islamic feminism which urges better support for girls growing up in extreme poverty.

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Section: Completed Suicide In Community and Population-based Studiesmentioning

confidence: 99%

Section: An Additional Confirmatory Studymentioning

confidence: 99%

High Rates of Suicide and Violence in the Lives of Girls and Young Women in Bangladesh: Issues for Feminist Intervention

2017

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“…The main food of the country is rice and 75% of the total agricultural land is used only for rice crop cultivation. 1 Pesticides are usually used in agriculture, industries and for domestic purposes 2 ; but these are extensively used in the agricultural field for the better outcome of cultivation. 3 An ideal pesticide should have no harmful effect on human and environment, but perfect pesticide has not yet been found.…”

Section: Introductionmentioning

confidence: 99%

“…5 Around 21 pesticides were banned by the Pesticide Regulation Committee of Bangladesh Government in between 1996 to 2007, resulting in a decrease in the incidence of suicidal death due to pesticide in the postban years (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) than in pre-ban years (1996)(1997)(1998)(1999)(2000). 1 Though more toxic pesticides have been banned, still self-poisoning by pesticides is a serious health problem in our country, which is responsible for about 40% of total poisoning cases admitted to hospital and 8-10% of overall mortality in medical wards. 6 According to government statistics, it is the second most common cause of hospitalization and ninth most common cause of death and about 150,000 deaths occur each year.…”

Section: Introductionmentioning

confidence: 99%

“…6 According to government statistics, it is the second most common cause of hospitalization and ninth most common cause of death and about 150,000 deaths occur each year. 1 Worldwide cases of acute pesticide poisoning account for significant morbidity and mortality, especially in developing countries. 7 Among three million of acute poisoning cases, 220000 deaths occur each year.…”

Section: Introductionmentioning

confidence: 99%

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Management of OPC and Carbamate Poisoning in Intensive Care Unit of Enam Medical College & Hospital, Savar, Dhaka

Khanum¹,

Islam²,

Salim³

et al. 2018

J Enam Med Col

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Background:Bangladesh is an agriculture-dependent country. Organophosphorus insecticides are widely used for the better outcome of cultivation. It is used for suicidal purpose due to its easy availability all over the country. Worldwide, acute pesticide poisoning is causing major health problems with high mortality in developing countries. Objective: The objective of our study was to establish that early management of acute poisoning with organophosphorus and carbamate in ICU along with ventilatory support in severe respiratory distress reduces the mortality rate. Total 84 patients with acute poisoning cases were selected. The diagnosis was confirmed by the history of ingestion of insecticides, observing clinical signs and symptoms and presence of foul smelling of poisonous agent. Management included supportive care, intubation, artificial ventilation in selective cases, administration of antidotes as loading and maintenance dose for atropinization with atropine and pralidoxime, antibiotics, anti-ulcerant, anticonvulsant, inotropic support (in severe hypotension) along with other symptomatic treatment. After stabilization, decontamination was started with removal of contaminated clothes, thorough wash with soap and water, irrigation of eyes with water and normal saline. Gastric lavage was given within 2 to 3 hours of ingestion of poison. Results: Acute poisoning was observed more in male (60.71%) than in female (39.29%) and in age group of 21-40 years (60.71%). Suicidal attempt was present in 97.61% cases and causes of suicidal poisoning were familial disharmony (76.19%), financial loss (14.28%) and failure in examination (9.52%). Organophosphate group poison ingestion was in 77.38% cases and carbamate group poison in 21.43% and both agents in 1.19% cases. Ventilatory support was given in 48.80% cases and 78.05% patients were successfully extubated from mechanical ventilator. Mean duration of ventilatory support was 2-14 days. Out of 84 patients, 75 (89.28%) survived and 9 (10.72%) patients expired. Fifty two (61.91%) patients were discharged within 4-6 days, 16 (19.04%) within 2-3 days, and 7 (8.33%) patients were discharged within 7-14 days. Conclusion: Early ICU admission and appropriate management of patients after ingestion of poisonous agent results in reduced morbidity and mortality.

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Association Between Means Restriction of Poison and Method-Specific Suicide Rates

et al. 2021

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IMPORTANCESuicide is a major and preventable cause of death worldwide. Means restriction aims to reduce the rate of completed suicides by limiting public access to lethal suicide methods. Means restriction of agents used in poisoning is more controversial because there is potential to switch to other lethal methods. OBJECTIVE To identify the changes in suicide rate by the targeted poison and the corresponding changes in suicide by other methods. EVIDENCE REVIEW Five databases (MEDLINE, Embase, Scopus, PsycInfo, and Web of Science)were searched for studies on national means restriction of poison that were published in the English language from inception until December 31, 2019. Of the 7657 articles that were screened by title and abstract, 62 studies were included in the analysis.FINDINGS Sixty-two studies from 26 countries in Europe, the US, Australia, Asia, and the United Kingdom were included in the review. The studies included restrictions on pesticides (15 countries), domestic gas (14 countries), motor vehicle exhaust (9 countries), and pharmaceuticals (8 countries).The median (IQR) change in method-specific suicide rates was −1.18 (−2.03 to −0.46) per 100 000 people after restrictions, whereas the median (IQR) change in other methods of suicide (not the restricted poison) was −0.09 (−2.22 to 1.65) per 100 000 people. Decreases in suicide by the restricted poison were not associated with increases in suicide by other methods. An estimated 57 355 poison-specific suicides annually (before the interventions were implemented) may have benefited the most from means restriction. CONCLUSIONS AND RELEVANCEThis systematic review found that means restriction of poison was associated with decreased method-specific suicide rates without an equivalent shift toward the use of other methods. Suicide prevention strategies need to address both individuals who are at risk and population-level policies.

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Bans of WHO Class I Pesticides in Bangladesh—suicide prevention without hampering agricultural output

Cited by 91 publications

References 27 publications

High Rates of Suicide and Violence in the Lives of Girls and Young Women in Bangladesh: Issues for Feminist Intervention

High Rates of Suicide and Violence in the Lives of Girls and Young Women in Bangladesh: Issues for Feminist Intervention

Management of OPC and Carbamate Poisoning in Intensive Care Unit of Enam Medical College & Hospital, Savar, Dhaka

Association Between Means Restriction of Poison and Method-Specific Suicide Rates

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