. Author manuscript; available in PMC: 2007 Oct 8.

Published in final edited form as: Int J Epidemiol. 2003 Dec;32(6):902–909. doi: 10.1093/ije/dyg307

Table.

Possible approaches to reducing deaths from intentional pesticide ingestion

Possible strategy	Advantages	Disadvantages	Who should be responsible for action?
*Reduce availability of highly toxic pesticides*
Introduce a ‘minimum pesticides list’ ⁶ restricting pesticide use to a few, less dangerous pesticides.	Reduced case fatality.	Industry pressure against restriction from companies whose products are regulated.	WHO/FAO National regulatory authorities / National Government
Prohibit sales of the pesticides most lethal to humans after ingestion.	Reduced case fatality.	Replacement pesticides may be less effective agriculturally.	National Government
Subsidise or reduce the costs of pesticides which are less toxic to humans	Reduced case fatality.	Reduced industry profits Costs to national Governments May increase pesticide use	Industry National Government
Ensure all pesticides are kept in a locked cabinet with the key held by the licensed user.	Limited availability in times of acute emotional crisis.	Inconvenience. Costs, difficulty policing legislation.	National Government (legislation) Purchaser of pesticide
Appoint a village elder, schoolteacher, police officer or councillor to hold the locality's stocks of pesticides centrally.	Limited availability at times of emotional crisis.	Inconvenience. Administration costs. Diminished access for farmers.	National Government (legislation) Local Government / community
Reduce the use of pesticides in agricultural practice (e.g. Integrated Pest Management (IPM))³⁹.	Less pesticides around at times of emotional crisis.	Reduced industry profit Possibly reduced agricultural yield – further studies are required.	United Nations National Government
Ensure all remaining pesticides are returned to vendor after application.	Limited availability in times of emotional crisis.	Administration costs. Costs to farmers.	Local Government / community
*Reduce use of pesticides in acts of self harm*
Public education campaigns regarding the dangers of pesticide ingestion.²² ⁴⁴	May lead to reduced quantities of pesticides being taken in self harm. May lead to more rapid help seeking from those who have ingested pesticides, as well as their friends and relatives.	May, by highlighting lethal dose and potential for using this method, lead to increases in suicides. There is already widespread awareness regarding the dangers / toxicity of pesticides. No clear evidence of effect in W Samoa.²²	National and Local Government
Better labelling of products with advice regarding dangers, need for safe-keeping, need for early treatment.	Limited availability. Reduced case fatality because of early help-seeking and treatment		Industry. National and Local Government.
*Reduce the toxicity of pesticides taken in overdose*
Addition of emetic agent / antidote to all pesticide products.	Possibly reduced case fatality.	Costs to industry. Possibly reduced agricultural effectiveness of the pesticide. No consistent evidence of effectiveness.⁴⁴	Industry. National regulatory bodies.
Change formulation of pesticides: reduced concentration or addition of agents that make them unpleasant to taste / smell.	Reduced case fatality.	Costs to industry.	Industry
Industry research to produce agents which are non-toxic to humans	Reduced case fatality.	Costs to industry.	Industry
*Improved management of pesticide poisoning*
Ensure all villages have first aid kits for the immediate management of pesticide poisoning – charcoal; possibly emetics	Possibly reduced poison absorption and therefore case fatality.	Costs of ensuring supplies regularly updated. No evidence of effectiveness	National and Local Government
Improve speed of transfer to hospital.	Ensure patient is in a hospital when deterioration occurs.	Costs to cash restricted health services.	National and Local Government
Ensure all hospitals have adequate supplies of antidotes.	Reduce requirements for transfer, reduce case fatality.	Costs to cash restricted health services.	National and Local Government
Perform research to establish best management guidelines and determine effectiveness of antidotes.	Establishment of agreed best practice.		Major research funding bodies.
Promulgate management guidelines.	Reduced case fatality	Costs of synthesising evidence to produce such guidelines	Major research funding bodies.