Ayanthi Karunarathne

Acute pesticide poisoning is a major public health problem among agricultural communities in low-and middle-income countries. Using recent surveillance data, this analysis identifies key pesticides responsible for acute poisoning in Sri Lanka to inform timely, evidence-based policy interventions, with relevance to similar agricultural settings. We analyzed interim data from two prospective studies in rural Sri Lanka: 1) a suicide surveillance system (Oct 2023-Apr 2025) and 2) a community-based cohort of 1,200 pesticide sprayers (Jan-Dec 2024). Self-poisoning deaths were identified through police, coroner, and household follow-up data, while occupational poisoning was monitored through bimonthly cohort follow-up. Descriptive analyses were identified the pesticides and active ingredients responsible for poisoning events. Of 1,040 suicides identified, 236 (22.7%) involved pesticide ingestion; a single pesticide was confirmed in 184 (78.0%) of deaths. Insecticides accounted for 165/184 (89.7%) deaths, predominantly the carbamate carbosulfan (120/184, 65.2%; 95% Confidence Intervals (CI) 58.3-72.1) and organophosphorus profenofos (20/184, 10.9%; 95% CI 6.4-15.4), with a small proportion involving illegal pesticides (13/184, 7.1%) or herbicides (19/184, 10.3%). Pesticide sprayers reported 1,311 incidents of acute occupational pesticide poisoning, with 856 events occurring after use of a single identified pesticide. Insecticides were the most frequently implicated, led by profenofos (167/856, 19.5%; 95% CI 16.9-22.1), followed by herbicides, including pretilachlor (125/856, 14.6%; 95% CI 12.2-17.0) and glyphosate (81/856, 9.5%; 95% CI 7.5-11.5). These findings show that most pesticide poisoning is concentrated in two insecticides: carbosulfan and profenofos. Their continued prominence despite earlier regulatory actions suggests ongoing pesticide substitution and highlights the need for strengthened surveillance and targeted regulation. Carbosulfan and profenofos now account for most pesticide suicides in Sri Lanka, while profenofos is also the leading cause of acute occupational pesticide poisoning. These findings highlight the need for ongoing surveillance and timely regulatory review.

Background: The World Health Organization (WHO) emphasizes surveillance of suicide and suicide attempts as a core component of national suicide prevention strategies. Aims: In Sri Lanka, police registers serve as the main source for national suicide reporting. This study evaluated the completeness of police suicide records by linking them with hospital and civil registration data and examining the extent to which suicide deaths identified across these sources were captured in police registers. Method: A secondary analysis was conducted on a case series of suicides identified through a prospective surveillance system established for a randomized controlled trial in Anuradhapura District, Sri Lanka (April 2019–September 2023). Police records were linked with hospital and civil registration data. Sensitivity and 95% confidence intervals (CIs) were calculated overall and stratified by hospital admission status and method of suicide. Results: A total of 663 suicide deaths were identified across the three sources, with 310 reported by all. Police registers recorded 615 deaths, with a sensitivity of 91.0% (95% CI: 86.8%–93.8%) for hospital deaths and 94.0% (95% CI: 91.2%–95.8%) for nonhospital deaths. Method-specific sensitivity was 93.2% (95% CI: 89.1%–95.8%) for pesticide ingestion (n = 237), 70.7% (95% CI: 55.5%–82.6%) for nonpesticide poisoning ( n = 41), 97.3% (95% CI: 94.8%–98.7%) for hanging ( n = 336), and 77.6% (95% CI: 63.6%–87.0%) for other methods ( n = 49). Limitations: Findings are limited to one district and may not be generalizable nationally. Conclusions: Police registers are a largely comprehensive source of suicide data in Sri Lanka, although some cases are missed, particularly for less common methods. This underreporting suggests national suicide rates may be slightly underestimated. In countries lacking a WHO-recommended robust civil registration and vital statistics system, police data remain an important source for suicide surveillance and public health planning.

One in four of all global suicide deaths occurs in India, yet the epidemiology of suicide mortality in India remains largely undocumented. We analyzed over 20,000 suicides among 829,000 deaths collected from 2001-2019 within a nationally representative random sample of about 1% of Indian homes using lay field reporting with dual central medical adjudication of causes. We applied suicide death proportions to national demographic totals to estimate death rates and used proportional mortality to examine risk factors. While suicide death rates fell by 1.5% annually, the absolute number of suicides remained constant at around 200,000 annually (or 3.8 million from 2001 to 2019) due to rising population. Over this period, 44% and 50% of all suicides occurred at ages 15–29 and 30–69 years, respectively. Suicide death rates declined fastest in women aged 15–29 years, particularly after 2015. Suicide death rates from poisoning, mostly organophosphate pesticides, fell but those from hanging rose. Suicide death risks at ages 15–69 years were about eight times higher in selected southern high-burden states than in selected northern states. Individual suicide risk was highest among sons or daughters’ in-law, rural residents, and men who drank alcohol. Suicide is preventable, but requires accelerating prevention policies to address acute social stress, ongoing efforts to reduce lethality of attempts and reliable epidemiological monitoring.

Anti-personnel land mines are deployed in many regions of conflict around the world. A large number of civilians and militants are affected regularly due to the blasts of such mines. Once set, they remain as silent concealed killers for decades and challenge the safety of the civilians even during the times of peace. A descriptive study was carried out at the Anuradhapura Teaching Hospital during a six month period starting in July 2007. The total number of anti-personal land mine injuries admitted during this period was 89. In all cases, the body part primarily in contact with the mine had been a lower limb. Except for few occasions, extensive soft tissue damage associated with compound fractures necessitated some form of an amputation for those limbs in primary contact with the blast mines. Closed fractures of the calcareous, talus, and the tarsal bones were seen in two cases. Nearly two thirds of the patients sustained either soft tissue or bone injuries to the opposite lower limb. Twelve percent of the victims had compound fractures on the opposite tibia and fibula. Injuries to external genitalia were seen in 8% of the cases. Upper limb injuries were not rare and predominantly found on the contra lateral upper limb (17%). The majority of them were soft tissue injuries. Chest wall injuries were seen among 2% of the cases. Superficial facial injuries were seen among 7% of the cases. In one occasion a gingival injury was detected. Seven percent of the victims developed deterioration in level of consciousness. None of them clinically showed any external physical trauma to the head. In some instances, the Glasgow Coma Scale (GCS) was ranked as 7 in which tracheal intubation and ventilation were needed. It was evident in this study that the majority of the affected patients sustained severe injuries in both lower limbs in contrast to some of the previous available studies.

Background. Although intentional self-poisoning is a major public health problem in rural parts of the Asia-Pacific region, relatively little is known of its epidemiology. We aimed to determine why Sri Lankan self-poisoning patients choose particular poisons, and whether acts of self-harm with highly dangerous poisons were associated with more premeditation and effort. Methods. We interviewed 268 self-poisoning patients presenting to two district general hospitals in rural Sri Lanka. Results. Eighty-five percent of patients cited easy availability as the basis for their choice of poison. There was little premeditation: more than 50% ingested the poison less than 30 minutes after deciding to self-harm. Patients had little knowledge about treatment options or lethality of the poison chosen. We found no difference in reasons for choice of poison between people ingesting different poisons, despite marked differences in toxicity, and between people who died and those who survived. Conclusions. Poisons were chosen on the basis of availability, often at short notice. There was no evidence that people using highly toxic poisons made a more serious or premeditated attempt. Restrictions on availability of highly toxic poisons in rural communities must be considered in strategies to reduce the number of intentional self-poisoning deaths in the Asia Pacific region.

Summary: We investigated the epidemiology of intentional self-poisoning in rural Sri Lanka by prospectively recording 2189 admissions to two secondary hospitals. Many patients were young (median age 25 years), male (57%) and used pesticides (49%). Of the 198 who died, 156 were men (case fatality 12.4%) and 42 were women (4.5%). Over half of female deaths were in those under 25 years old; male deaths were spread more evenly across age groups. Oleander and paraquat caused 74% of deaths in people under 25 years old; thereafter organophosphorous pesticides caused many deaths. Although the age pattern of self-poisoning was similar to that of industrialised countries, case fatality was more than 15 times higher and the pattern of fatal self-poisoning different.