Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning. We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm. Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.

/pdf/the-global-distribution-of-fatal-pesticide-self-poisoning-ulsr1od2bw.pdf

The global distribution of fatal pesticide self-poisoning: systematic review

Poisoning is a common preventable cause of morbidity and mortality in children. Most of the poisoning in children less than 5 years of age is accidental. Objective of the study was to study the clinical profile and outcome of childhood poisoning and intoxication. This was a retrospective study done in patients who were admitted in pediatric wards and pediatric intensive care unit (PICU) of BP Koirala Institute of Health Sciences with history of ingestion of poison or intoxication or envenomation firom January 2005 to June 2008. The data collected were analyzed with SPSS 12.0 software. There were 122 children enrolled in study. Male: female ratio was 1.4:1. The mean age of presentation was 5.8 years. Among 122 patients, 43.4% received pre-referral treatment in the form of gastric lavage, atropine etc. Organophosphorus poisoning was the commonest poisoning seen in 55 (45.1%) patients followed by hydrocarbon 12 (9.8%), mushroom 10 (8.2%) and organochlorine 10 (8.2%) poisoning. During treatment, 50.0% received antidotes. 55.7% received antibiotics, gastric lavage and anticonvulsants were required in 43.4% and 13.9% respectively. Overall survival was 87.4%. The time interval between intoxication and presentation to hospital, mean Glasgow Coma Scale (GCS) and presence of coma (GCS <8) were significantly different between survivors and expired cases. In conclusion, organophosphorus is the commonest agent involved in childhood poisoning. Overall, the outcome is good with 87.4% survival in our hospital. The time gap between the poisoning and presentation to hospital and presence of coma predict mortality.

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Clinical profile and outcome of children presenting with poisoning or intoxication: a hospital based study.

https://spectrum.library.concordia.ca/6606/1/Amir%26Robinson%2DNSL2006.pdf

Thyroidectomy alters the daily pattern of expression of the clock protein, PER2, in the oval nucleus of the bed nucleus of the stria terminalis and central nucleus of the amygdala in rats

Suicide is a major cause of deaths worldwide and is a key public health concern in Nepal. Although routine national data are not collected in Nepal, the available evidence suggests that suicide rates are relatively high, notably for women. In addition, civil conflict and the 2015 earthquake have had significant contributory effects. A range of factors both facilitate suicide attempts and hinder those affected from seeking help, such as the ready availability of toxic pesticides and the widespread, although erroneous, belief that suicide is illegal. Various interventions have been undertaken at different levels in prevention and rehabilitation but a specific long-term national strategy for suicide prevention is lacking. Hence, to address this significant public health problem, a multisectoral platform of stakeholders needs to be established under government leadership, to design and implement innovative and country-contextualized policies and programmes. A bottom-up approach, with active and participatory community engagement from the start of the policy- and strategy-formulation stage, through to the design and implementation of interventions, could potentially build grass-roots public ownership, reduce stigma and ensure a scaleable and sustainable response.

Suicide burden and prevention in Nepal: The need for a national strategy.

Acts of deliberate self-harm (DSH) not only affect the people directly involved, but also have grave psychological and social impact on the family and community. In the present study, a cohort of 173 cases of DSH reported from April 2002 to March 2005 was retrospectively analyzed, by perusing the medicolegal register maintained by the Emergency Department at the Western Regional Hospital, Pokhara in the Western Development Region of Nepal. The data were entered and analyzed using SPSS Version 10.1. More than two-thirds of total cases were females. About 60% of cases were observed in the age group of 15–24 years. Poisoning (89.6%) was the most preferred method of deliberate selfharm. Organophosphate pesticides were consumed in nearly two-thirds of the poisoning cases. The majority of cases were reported during the months of May to July and had occurred during the last quarter of the day. More than a twofold increase was observed in the frequency of cases during the 3-year study period. The said observations were compared and contrasted with the available literature across the globe. The presentation is concluded by highlighting the limitations encountered in Nepal and the scope to overcome the same.

Pattern and trend of deliberate self-harm in western Nepal.

A retrospective study of suicide cases admitted to Emergency Department and latter admitted to Department of Medicine and followed by Department of Psychiatry, Nepal Medical College Teaching Hospital. This study covered a period of 4 yrs. i.e. from January 2000 to December 2003. During this period total 118 cases were admitted. Out of which 39 male and 58 female cases were studied. Suicide was their common motive. The most common poison was organophosphorous compounds. Age group of attempt suicide are between 15-45 yrs. Depression, post-schizophrenic depression and clear psychosocial stress were important cause of suicide in this study.

Retrospective study of suicide cases admitted in Nepal Medical College Teaching Hospital.

Studies on thyroid functions were performed on patients suffering from depression. Thirty four cases of depression were studied for their thyroid function and showed a diminished level of T3 and T4 with concomitant rise in TSH (Thyroid Stimulating Hormone) level. This work showed that depressive patients had been suffering from sub-hypothyroidism.

Thyroid function in depression.

The study of etiological factors on mental retardation was conducted at family counselling and resource school of Association of Welfare of Menta+lly Retarded (AWMR), Hattisar, Kathmandu. A total of 91 mental retarded cases were studied in the year 2000 and 2001 for etiological factors. The present study shows significant relationship of mental retardation and age in both the year. The higher rate of mental retardation in the 0 to 5 years age group in both the year. About 70.0% with mental retardation (MR) are first born babies in both the year. Majority of the families have unfavourable attitude towards the mentally retarded individual.

Kajal Chakrabarti

Papers

Retrospective study of suicide cases admitted in Nepal Medical College Teaching Hospital.

Thyroid function in depression.

Study on etiological factors on mental retardation in Kathmandu.