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Identification of strategies to prevent death after pesticide self-poisoning using a Haddon matrix
  1. M Eddleston1,2,
  2. N A Buckley2,4,
  3. D Gunnell5,
  4. A H Dawson2,6,
  5. F Konradsen2,7
  1. 1Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  2. 2South Asian Clinical Toxicology Research Collaboration
  3. 3Ox-Col Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka
  4. 4Department of Clinical Pharmacology and Toxicology, ANU Medical School, ACT, Australia
  5. 5Department of Social Medicine, University of Bristol, Bristol, UK
  6. 6Department of Clinical Medicine, University of Peradeniya, Sri Lanka
  7. 7Department of International Health, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to:
 Dr M Eddleston
 Scottish Poisons Information Bureau, Royal Infirmary, Little France, Edinburgh EH16 4SA, UK; eddlestonm{at}


Despite pesticide self-poisoning causing around 300 000 deaths each year in the rural Asia Pacific region, no comprehensive public health response has yet been formulated. The authors have developed a Haddon matrix to identify factors that increase the risk of fatal rather than non-fatal pesticide self-poisoning in Sri Lanka. Many important host factors such as age, gender, and genetics are not alterable; factors that could be changed—alcohol use and mental health—have previously proved difficult to change. Interventions affecting agent or environmental factors may be easier to implement and more effective, in particular those limiting the human toxicity and accessibility of the pesticides, and the quality, affordability, and accessibility of health care in the community. Controlled studies are required to identify effective strategies for prevention and harm minimization and to garner political support for making the changes necessary to reduce this waste of life. Lessons learnt from Sri Lanka are likely to be highly relevant for much of rural Asia.

  • ICU, intensive care unit
  • OP, organophosphorus
  • WHO, World Health Organization
  • Haddon matrix
  • pesticide
  • prevention
  • self-poisoning
  • suicide

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  • See linked article, p 285

  • Contributors

    ME had the idea of developing a Haddon’s Matrix for pesticide self-poisoning and wrote the first draft of this paper. ME had multiple discussions with the other authors both before and after preparing the manuscript and made revisions accordingly. All authors saw and approved the final manuscript.

  • Funding: ME is a Wellcome Trust Career Development Fellow, funded by grant GR063560. The South Asian Clinical Toxicology Research Collaboration is funded by a Wellcome Trust/National Health and Medical Research Council International Collaborative Research Grant GR071669.

  • Competing interests: none.

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