Background Suicide is one of the most common types of injuries in Nepal with recorded 6993 suicides in 2022–23, with intentional pesticide poisoning being the second most common method. Banning highly hazardous pesticides (HHPs) is a cost-effective intervention to reduce mortality from pesticide suicide. Eight mostly HHPs were banned in Nepal in 2019 with one product reformulated.

Objective This talk will provide highlights from the University of Edinburgh study on the use of HHPs in suicides. HOPE GRID study (2017–2019) carried out in select hospitals and the toxicology labs identified the HHPs responsible for suicide and self-harm and provided evidence to relevant stakeholders in decision making. The current study (2021–2024) aims to monitor the impact of the 2019 pesticide bans on pesticide suicide numbers.

Policy Analysis and Results The talk will present the findings of the 2017–2019 study, its impact on policy-making in Nepal, and effects on the current pesticide suicide numbers in the country. In 2021–23 study, there were 1,764 cases reported by toxicology labs in which phosphine gas (48.9%) was the most common pesticides followed by organophosphorus insecticides (29.1%). When compared the preliminary results of 2021–23 data to 2017–19, a smaller proportion of cases were the banned pesticides dichlorvos (n=70/1089; 6.4% and n=273/450; 60%, respectively) and aluminium phosphide (n=304/1089; 27.9% and n= 299/891; 33%, respectively).

Policy Implications of the Study There have been hundreds of lives saved in Nepal as a result of 2019 pesticide bans. The study clearly shows that phase out and ban of key HHPs responsible for fatal poisonings is cost-effective and efficient way to reduce the numbers of deaths associated with pesticides. In the hierarchy of controls of risks associated with pesticides, elimination of hazard is by far the most effective. Based on the experience from Nepal, elimination of HHPs should be considered to reduce poisoning in agricultural LMICs.

Conclusions HHPs bans 2019 in Nepal have reduced the numbers of fatal pesticide poisonings and saved lives. Our study has identified emerging pesticides now used in self-poisoning (chlorpyrifos and cypermethrin combination). The authorities should consider regulating these pesticides to further reduce poisonings and deaths.