A community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka: Study protocol

TY - JOUR

T1 - A community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka

T2 - Study protocol

AU - Pearson, Melissa

AU - Konradsen, Flemming

AU - Gunnell, David

AU - Dawson, Andrew H

AU - Pieris, Ravi

AU - Weerasinghe, Manjula

AU - Knipe, Duleeka W

AU - Jayamanne, Shaluka

AU - Metcalfe, Chris

AU - Hawton, Keith

AU - Wickramasinghe, A Rajitha

AU - Atapattu, W

AU - Bandara, Palitha

AU - de Silva, Dhammika

AU - Ranasinghe, Asanga

AU - Mohamed, Fahim

AU - Buckley, Nicholas A

AU - Gawarammana, Indika

AU - Eddleston, Michael

PY - 2011

Y1 - 2011

N2 - 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/Design. 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. Discussion. 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.

AB - 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/Design. 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. Discussion. 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.

KW - Cluster Analysis

KW - Housing

KW - Humans

KW - Pesticides

KW - Poisoning

KW - Product Packaging

KW - Rural Population

KW - Sri Lanka

KW - Suicide

U2 - 10.1186/1471-2458-11-879

DO - 10.1186/1471-2458-11-879

M3 - Journal article

C2 - 22104027

SN - 1471-2458

VL - 11

SP - 879

JO - BMC Public Health

JF - BMC Public Health

ER -