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Self Poisoning in Srilanka
- Sunny T Varghese, Sapna Ann George, SHO Psychiatry Ninewells Hospital, Dundee, Scotland. (21 December 2005)
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Re: Self Poisoning in Srilanka
- Michael Eddleston, Nick A Buckley, David Gunnell (4 January 2006)
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Sunny T Varghese, Resident, Dept. of Psychiatry All India Institute of Medical Sciences, New Delhi, India., Sapna Ann George, SHO Psychiatry Ninewells Hospital, Dundee, Scotland.
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sunny_tv{at}rediffmail.com Sunny T Varghese, et al.
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Eddleston et al (2005) have provided a glimpse into the epidemiology of self poisoning from a developing country. Self poisoning is particularly common in the agrarian economies of many developing countries of Asia. The study has been successful in bringing out the various demographic details of these cases from Sri Lanka. However certain issues in the study needs further clarification. The study has been described by the authors as a prospective study. The study assessed the epidemiological factors and mortality in self poisoning cases and the patients have not been followed up and no other details are provided. How the study qualifies for a prospective design is unclear. The authors mention that patients who consumed acids, hydrocarbons or alkalis were not analysed as there was no mortality in that group. The reason for this is unclear and it may have affected the case fatality ratio as cited by the authors. It would have been more beneficial if case fatality ratios of individual poisons given rather than an overall fatality ratio. The authors have cited odds ratios for death for each of the poisons.The odds ratio is a way of comparing whether the probability of a certain event is the same for two groups. How the odds ratio has been used in this study with no control group is unclear. Paraquat has been mentioned as a pesticide in the article, while in fact it is a herbicide. It is used to control broad-leaved weeds and grasses, being less effective on deep rooted plants. More studies are needed to assess the psychological factors in cases of self poisoning in developing countries and follow up studies will provide more information about psychological morbidity following such events. References 1.Eddleston M, Gunnell D, Karunaratne A, de Silva D, Sheriff MH, Buckley NA. Epidemiology of intentional self-poisoning in rural Sri Lanka. Br J Psychiatry 2005;187:583-4. |
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Michael Eddleston University of Oxford, Nick A Buckley, David Gunnell
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eddlestonm{at}eureka.lk Michael Eddleston, et al.
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Sir, We note Varghese and George’s comments on our paper.[1] We saw all patients on arrival to hospital and regularly throughout their stay. Data were recorded prospectively and systematically into a case record form as events occurred. A retrospective study would have involved review of case records for self-poisoning patients after their discharge from hospital. Such an approach always results in poorer quality data collection. There were no deaths from alkalis, acids, or hydrocarbons during the study period and this category of poison was therefore not included in the logistic regression. Their CFR of 0.0% obviously affected the overall CFR in the manner expected. As stated in the results section (paragraph 3), the odds ratios were calculated using medicines as the reference (control) category. The term ‘pesticides’ as used by the WHO [2] covers compounds that kill all types of pests, whether insect pests (insecticides), fungal pests (fungicides), or plant pests (herbicides). Paraquat is therefore both a herbicide and a pesticide. This brief report described the epidemiology of self-poisoning in rural Sri Lanka. Space limitations prevented us from presenting further data as suggested. There is little evidence that self-poisoning is more common in agrarian economies of the developing world,[3] only that the consequences of self-poisoning are more serious.[4] Michael Eddleston, Nick A Buckley, David Gunnell References 1. Eddleston M, Gunnell D, Karunaratne A, De Silva D, Sheriff MHR, Buckley NA. Epidemiology of intentional self-poisoning in rural Sri Lanka. Brit J Psychiat 2005;187:583-4. 2. World Health Organization. WHO recommended classification of pesticides by hazard and guidelines to classification 2000-2001. WHO/PCS/01.4, 0 edn. Geneva, WHO, 2001. 3. Eddleston M, Sudarshan K, Senthilkumaran M, Reginald K, Karalliedde L, Senarathna L, De Silva D, Sheriff MHR, Buckley NA, Gunnell D. Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka - implications for estimating the incidence of self-poisoning in the developing world. Bull World Health Organ 2006, in press. 4. Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol 2003;32:902-9. |
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