Upload
stephanie-walters
View
213
Download
0
Embed Size (px)
Citation preview
Prevention of poisoning – safe storage of pesticides in developing countries
1 Department of International Health, University of Copenhagen2 South Asian Clinical Toxicology Research Collaboration3 Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, England.4 Department of Clinical Medicine, University of Peradeniya, Sri Lanka.5 School of Population Health, University of Newcastle Australia
Flemming Konradsen1,2, Ravi Pieris2, Manjula Weerasinghe2, Wim van der
Hoek1, Michael Eddleston2,3 and Andrew H.
Dawson2,4,5
Rationale for safe storage
The majority of self-poisoning episodes follow impulsive acts of self-harm, where the ready availability of highly toxic pesticides in the farming households will result in a high proportion of deaths from such attempts (Eddleston & Phillips, 2004; Konradsen et al., 2006)
Safe Storage
WHO Pesticides and Health Initiative (point 5.5) “Promote safe storage that limits impulsive
access to pesticides for self-harm”
FAO in the International Code of Conduct on the Distribution and Use of Pesticides
“5.1/5.3.2. Governments should: make provisions for safe storage of pesticides at both warehouse and farm level”
Keeping pesticides under lock and key promoted as one of the key strategies to reduce number of impulsive self-poisoning episodes, examples below:
Safe Storage (cont’d.)
CropLife, in their guidelines for the safe and effective use of crop protection products
“Storage: crop protection products must always be stored securely to ensure that they are kept away from children and unauthorized persons ..” and ”.. store crop protection products separately, preferably in a separate building and under lock and key ..”
Croplife image
Background
• Previous studies in Sri Lanka have shown high community acceptance of in-house pesticide storage boxes (Ratnayeke, 2006; Konradsen et al, 2007)
• Studies in north central Sri Lanka found an increased storage of pesticides in the homes and less in the field following the introduction of in-house storage devices
Background
• Safe storage devices needs to be developed that will allow the farmers to store pesticides in the field during the cultivation season
• Pesticide storage boxes developed during the pilot stage was not sufficiently strong to prevent individuals to gain access to the pesticides when attempting self-harm
• The introduction of storage devices increased safe storage of pesticides in the short term but surveys needs to be made to assess long term use
Baseline – Observations
Objectives
• To determine how different in-house and in-field pesticide safe storage devices influences community acceptance, use and pesticide storage practices
• To assess use of in-house storage devices 24 months after the initial distribution
• To identify ways to improve on the technical design of in-field devices and locking systems
Methods
Two study villages in North Central Sri Lanka
In-house safe storage devices
Device made of metal
Large device made of mango wood
Small device made of mango wood
Safe storage devices
Pine device Concrete device
Methods• Baseline survey
• Distribution of storage devices and promotion of use
• 200 households in two villages received in-house safe storage devices and was followed up after seven months and 24 months
• 195 households in two villages received either an in-house or an in-field safe storage device and was followed up after seven months
• Focus group discussions and transect walks
• In-depth interviews with key informants
Definition of exclusively use of pesticide safe storage device:
All pesticides stored in the device and device locked
No pesticides visible in the home and home garden areas
Household members reporting that no pesticides stored in the field
Findings - use
• Overall storage of pesticides under lock increased from the baseline level of 2-3% to a minimum of 66% after seven months
• A gradual decline was found among the households that were followed for 24 months where, in some villages, only less than half the households used the locked device after two years
Findings – location of storage
• The introduction of storage devices, both in-field and in-house, significantly reduced the storage of pesticides hidden in the field. This resulted in pesticides being stored either in or near the house giving rise to concerns that this shift may increase its availability among vulnerable individuals.
Utilization of safe storage devices among 368 households using pesticides at the time of survey
Type of deviceNo. of households
with device
No. of households using pesticides at the time of
surveyNo. of households with
locked devices*No. of households with
unlocked devices
After 7 months
After 24 months
After 7 months
After 24 months
After 7 months
After 24 months
Large device made of mango wood
39 32 32 25 (78%) 20 (63%) 7 (22%) 12 (37%)
Small device made of mango wood
100 84 73 70 (83%) 42 (57%) 14 (17%) 31 (43%)
Device made of pinewood
56 53 * 38 (72%) * 15 (28%) *
Device made of metal
61 56 56 46 (82%) 27 (48%) 10(18%) 29 (52%)
In-field device made of concrete
112 103 * 68 (66%) * 35 (34%) *
Findings – design options• The preferred design influenced by occupational and
agricultural factors such as land size, distance to fields, crop patterns and types and the quantity of pesticides used and it is clear that one design will not suit all farmers
• When farmers lease land or have land in different locations not feasible to use in-field devices
• Material of devices important for households in relation to protection of costly pesticides (theft) and prevention of easy access to pesticides (self-harm/accidents)
• The in-field design was not sufficiently strong and especially the lock was not adequate to withstand the conditions in the field
Findings – managing the key Some farmers do not consider keeping the device locked to
be important as they think self-poisoning would not occur in their household
Difficult to find a place within the household to keep key out of sight of other household members
Keeping the key away from other family members was a big challenge to farmers: at the 24 month follow-up it was revealed that in 57% (n=42) of the households the children could find key within minutes
Padlocks found to be impractical to use when pesticides was applied frequently
The keeper of the key is vulnerable to easy access to pesticides
Regular access to the hidden key increased the chances of the hiding place being spotted by other family members
Key easily accessible to all Key in the padlock Deliberately hiding the
Acute Poisoning Cases
12 cases of acute pesticide reported Total population in the two villages - around 1900 Four cases at the seven month follow-up and eight cases
at 24 month follow-up
Seven families had received a device [ 2 deaths – key responsible person] [ 1 –
unlocked device] [ 1 – forced and opened] [ 2 – pesticides obtained
from outlets] [ 1 – No clear information]
Four failed attempts owing to device
Conclusions
Provision of in-house safe storage devices had high community acceptance and utilization, especially in the short-term
Provision of only in-house devices appears to encourage farmers to store pesticides at home, which may increase domestic risk of impulsive self-poisoning episodes
The ability of other household members, especially children, to find the key easily is worrying
The person in charge of the key is vulnerable to easy access of pesticides
Hiding the key from other family members was still a big challenge to farmers
Improvement of locking mechanism would be one of the best options to switch non-users to users
Device had posed some barrier for self-poisoning episodes
Conclusions (cont’d)
Acute Poisoning Cases
14 cases of acute pesticide reported
Seven families had received a device [ 2 deaths – key responsible person] [ 1 –
unlocked device] [ 1 – forced and opened] [ 2 – pesticides obtained
from outlets] [ 1 – No clear information]
Four failed attempts owing to device
Poisoning attempts
Conclusions
Provision of in-house safe storage devices had high community acceptance and utilization, especially in the short-term
The introduction of in-field devices was not sufficient to reduce storage in or close to the homes
Storage of pesticides at home, may increase domestic risk of impulsive self-poisoning episodes
Conclusions (cont’d)
The ability of other household members, especially children, to find the key easily is worrying
The person in charge of the key is vulnerable to easy access of pesticides
Device had posed some barrier for self-poisoning episodes
Acknowledgment
We acknowledge the financial support provided by both the South Asian Clinical Toxicology Research Collaboration Research grant (Wellcome Trust/NHMRC International Collaboration Research Grant GR071669MA) and the Danish Development Agency, DANIDA (104.Dan.8-902).
Next applications….
UV resistant plastic design
Modified concrete design
Safe storage website:
www.safestorage.toxicology.wikispaces.net