Elsevier

Social Science & Medicine

Volume 62, Issue 7, April 2006, Pages 1710-1719
Social Science & Medicine

Reaching for the bottle of pesticide—A cry for help. Self-inflicted poisonings in Sri Lanka

https://doi.org/10.1016/j.socscimed.2005.08.020Get rights and content

Abstract

This long-term study in Sri Lanka explored the complexities behind self-inflicted pesticide poisonings by 166 Sri Lankans. Using or threatening to use pesticides for self-harm has become a response to stressful events and a powerful message towards a specific individual, or to the outside world in general, conveying misgiving, anger, sadness, hopelessness, frustration, or simply a way to manipulate a situation to one's own advantage. The effects of alcohol misuse are especially important in understanding self-harm at the community level in terms of the impact they have on the domestic environment. Also, issues around “love affairs,” arranged marriages and domestic physical, sexual or psychological abuse in the domestic environment are referred to by many self-harmers or their relatives as a reason for ingesting poison. Clearly, easy access to lethal pesticides by impulsive individuals often living under economically or psychosocially stressful conditions, combined with insufficient treatment facilities and limited outreach programs, can be a deadly blend. A strategy aimed at reducing the availability of the most toxic pesticides and improving case management should be implemented, as it is likely to reduce death from pesticides although unlikely to impact on the number of episodes. Support to families plagued by domestic violence and male alcohol misuse is essential to improve the quality of life for the most vulnerable and to reduce the number of self-harm episodes in the long-term.

Introduction

It is estimated that around 300,000 self-inflicted pesticide deaths occur annually worldwide, predominantly in rural Asia (Gunnell & Eddleston, 2003). Studies in Sri Lanka were among the first to document the scale of the problem associated with self-poisoning with pesticides, but from recent studies in other Asian countries it has become clear that the problem is widespread and with very high case fatalities of between 10% and 20% (Aaron et al., 2004; Eddleston, 2000; Gunnell & Eddleston, 2003; Phillips, Li, & Zhang, 2002; van der Hoek, Konradsen, Athukorala, & Wanigadewa, 1998; Yusuf, Akhter, Rahman, Chowdhury, & Rochat, 2000). In Sri Lanka, pesticides are the preferred means for self-harm for both men and women. The majority of cases occur in males, except for the 15–19 age group, where women dominate (Gunnell & Eddleston, 2003).

A number of international conventions and programs are now focusing on the reduction of the risks involved with pesticide use, especially in developing countries (Konradsen et al., 2003; Konradsen, van der Hoek, Gunnell, & Eddleston, 2005; WHO, 2004). However, information is urgently needed to guide the development of appropriate strategies and interventions to reduce the burden from pesticide self-harm. To assist in this process a research project in the south of Sri Lanka assessed the risk factors of self-harm, through epidemiological and qualitative studies, in order to better understand the underlying factors and the triggers of pesticide self-harm. The epidemiological component of the study was based on a case control design involving 239 pesticide poisoning cases and 510 controls. A number of significant independent risk factors for self-poisoning were found, including alcohol dependence, young age (16–29 years), having a close relative with a history of pesticide poisoning, low educational level, having ended an emotional relationship and being unemployed (van der Hoek & Konradsen, 2005). The present paper brings out the findings of the qualitative study, looking in more detail at the underlying factors and complexities behind the specific risk factors of acute pesticide poisoning identified through the epidemiological approach. Also, this study aims to characterize the cases of pesticide self-harm so as to better understand the personal, inter-personal and social conditions under which the patients live. Similarly, the study tried to construct the episodes or the circumstances immediately prior to the pesticide poisoning attempt.

Section snippets

Study area

The study was conducted in the Uda Walawe area, in the Ratnapura District of the south-western part of Sri Lanka, about 110 km south of the capital Colombo. Most people in Uda Walawe are involved in agriculture, which is dominated by paddy cultivation. However, other agricultural activities, including irrigated vegetable and banana production, rain-fed slash and burn cultivation and home gardens, are important to local livelihoods. Small-scale enterprises are found at the village level,

Findings

A total of 205 pesticide self-harm cases were registered in the wards of the two hospitals from November 1998 to December 1999. Case-specific information was obtained for 177 acute pesticide poisoning cases that were above 16 years of age, of which 159 were cases of self-harm; 10 were categorized as accidental poisonings; and eight were cases of occupational poisoning. For this study, only the self-harm cases were investigated. Of the 159 cases, 63 were female (40%), 42 of whom were married, 19

Self-poisoning as a means of communication

Using or threatening to use pesticides for self-harm has become a powerful message to the outside world or towards a specific individual in particular, conveying misgivings, anger, sadness, hopelessness or frustration. Once it is known that a person has taken pesticides, immediate action is required from the family or the community involved, and the person and the life situation of that person is given significant attention. This action may just be a cry for help or may provide an opportunity

Acknowledgement

We appreciate the hard work and dedication shown to this project by Ravi Karunaratne and Roisin O’Kane during the long periods of field work. We appreciate the assistance provided by Ravi Peiris during field work during the latter part of the project. We greatly appreciate the field supervision done by Mala Ranawake and the translations from the vernacular by Surani Neangoda. We appreciate the discussions with Michael Eddleston and Jeanne Marecek, who have helped us in shaping the analysis.

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