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BMC Public Health
Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Study protocol

A community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka: study protocol

Authors: Melissa Pearson, Flemming Konradsen, David Gunnell, Andrew H Dawson, Ravi Pieris, Manjula Weerasinghe, Duleeka W Knipe, Shaluka Jayamanne, Chris Metcalfe, Keith Hawton, A Rajitha Wickramasinghe, W Atapattu, Palitha Bandara, Dhammika de Silva, Asanga Ranasinghe, Fahim Mohamed, Nicholas A Buckley, Indika Gawarammana, Michael Eddleston

Published in: BMC Public Health | Issue 1/2011

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Abstract

Background

The WHO recognises pesticide poisoning to be the single most important means of suicide globally. Pesticide self-poisoning is a major public health and clinical problem in rural Asia, where it has led to case fatality ratios 20-30 times higher than self-poisoning in the developed world. One approach to reducing access to pesticides is for households to store pesticides in lockable "safe-storage" containers. However, before this approach can be promoted, evidence is required on its effectiveness and safety.

Methods/Design

A community-based cluster randomised controlled trial has been set up in 44,000 households in the North Central Province, Sri Lanka. A census is being performed, collecting baseline demographic data, socio-economic status, pesticide usage, self-harm and alcohol. Participating villages are then randomised and eligible households in the intervention arm given a lockable safe storage container for agrochemicals.
The primary outcome will be incidence of pesticide self-poisoning over three years amongst individuals aged 14 years and over. 217,944 person years of follow-up are required in each arm to detect a 33% reduction in pesticide self-poisoning with 80% power at the 5% significance level. Secondary outcomes will include the incidence of all pesticide poisoning and total self-harm.

Discussion

This paper describes a large effectiveness study of a community intervention to reduce the burden of intentional poisoning in rural Sri Lanka. The study builds on a strong partnership between provincial health services, local and international researchers, and local communities. We discuss issues in relation to randomisation and contamination, engaging control villages, the intervention, and strategies to improve adherence.

Trial Registritation

The trial is registered on ClinicalTrials.gov ref: NCT1146496 (http://​clinicaltrialsfe​eds.​org/​clinical-trials/​show/​NCT01146496).
Appendix
Available only for authorised users
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Metadata
Title
A community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka: study protocol
Authors
Melissa Pearson
Flemming Konradsen
David Gunnell
Andrew H Dawson
Ravi Pieris
Manjula Weerasinghe
Duleeka W Knipe
Shaluka Jayamanne
Chris Metcalfe
Keith Hawton
A Rajitha Wickramasinghe
W Atapattu
Palitha Bandara
Dhammika de Silva
Asanga Ranasinghe
Fahim Mohamed
Nicholas A Buckley
Indika Gawarammana
Michael Eddleston
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-879

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