TY - JOUR
T1 - Gatekeeper training for vendors to reduce pesticide self-poisoning in rural South Asia - A study protocol for a stepped-wedge cluster randomized controlled trial
AU - Weerasinghe, Manjula
AU - Pearson, Melissa
AU - Turner, Nicholas
AU - Metcalfe, Chris
AU - Gunnell, David J
AU - Agampodi, Suneth
AU - Hawton, Keith
AU - Agampodi, Thilini
AU - Miller, Matthew
AU - Jayamanne, Shaluka
AU - Parker, Simon
AU - Sumith, J.A.
AU - Karunarathne, Ayanthi
AU - Dissanayake, Kalpani
AU - Rajapaksha, Sandamali
AU - Rodrigo, Dilani
AU - Abeysinghe, Dissanayake
AU - Piyasena, Chathuranga
AU - Kanapathy, Rajaratnam
AU - Thedchanamoorthy, Sundaresan
AU - Madsen, Lizell Bustamante
AU - Konradsen, Flemming
AU - Eddleston, Michael
N1 - Funding Information:
The work is supported by the American Foundation of Suicide Prevention (IIG-0-002-17). DJG is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, England. We would like to thank the field researchers for their incredible work recruiting participants at hospitals and in pesticide shops. We appreciate the management and organisational support from SACR staff. We thank the Provincial Departments of Health and Agriculture, and hospital staffs for their support to set-up the study. We also wish to thank members of data monitoring committee for their continuing review and critique. DG and KH are both National Institute for Health Research (England) Senior Investigators (Emeritus).
Funding Information:
Competing interests KH is joint chair of the Prevention of Pesticide Self-Poisoning Special Interest Group of the International Association for Suicide Prevention. He declares having received a small grant from Syngenta for a study of safer storage of pesticides in Sri Lanka. DJG, FK and ME were expert advisers to WHO’s consultation on cost-effectiveness of suicide prevention interventions, including pesticide regulation (Geneva, 2019). They provided technical assistance for the development and publication of Preventing Suicide: A Resource Guide for Pesticide Registrars and Regulators (WHO, May–June 2019). DJG was a member of the scientific advisory group for a Syngenta-funded study to assess the toxicity of a new paraquat formulation (2002–2006); a member of the scientific advisory group for a pesticide storage project funded by Syngenta (2005–2007); and chaired the DMEC for a Syngenta-funded trial of the medical management of paraquat poisoning (2007–2010); he received travel costs to attend research meetings but no other fees. DJG was an expert adviser to WHO’s First Consultation on Best Practices on Community Action for safer access to pesticides (Geneva, 2006). ME is a WHO member of the FAO-WHO Joint Meeting on Pesticide Management and received an unrestricted research grant from Cheminova (2012) and travel expenses from Syngenta to attend study meetings (2005–2006). ME is affiliated with the Centre for Pesticide Suicide Prevention, which is funded by an Incubator Grant from the Open Philanthropy Project Fund, an advised fund of Silicon Valley Community Foundation, on the recommendation of GiveWell, USA.
Funding Information:
Funding The work is supported by the American Foundation of Suicide Prevention (IIG-0-002-17). DJG is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, England.
Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/4/4
Y1 - 2022/4/4
N2 - Introduction: Pesticide self-poisoning kills an estimated 110,000-168,000 people worldwide annually. Data from South Asia indicate that in 15-20% of attempted suicides and 30-50% of completed suicides involving pesticides these are purchased shortly beforehand for this purpose. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such customers. We have developed a ‘gatekeeper’ training program for vendors to enable them to identify individuals at high-risk of self-poisoning (gatekeeper function) and prevent such individuals from accessing pesticides (means restriction). The primary aim of the study is to evaluate the effectiveness of the gatekeeper intervention in preventing pesticide self-poisoning in Sri Lanka. Other aims are to identify method substitution and to assess the cost and cost-effectiveness of the intervention.Methods and analysis: A stepped-wedge, cluster randomized trial of a gatekeeper intervention is being conducted in rural Sri Lanka with a population of approximately 2.7 million. The gatekeeper intervention is being introduced into 70 administrative divisions, in random order at each of 30 steps over a 40-month period. The primary outcome is the number of pesticide self-poisoning cases identified from surveillance of hospitals and police stations. Secondary outcomes include: number of self-poisoning cases using pesticides purchased within the previous 24h, total number of all forms of self-harm, and suicides. Intervention effectiveness will be estimated by comparing outcome measures between the pre- and post-training periods across the divisions in the study area. The original study protocol has been adapted as necessary in light of the impact of the COVID-19.Ethics and dissemination: Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University, Sri Lanka (ERC/2018/30) and ACCORD Medical Research Ethics Committee, Edinburgh University (18-HV-053) approved the study. Results will be disseminated in scientific peer-reviewed journals.
AB - Introduction: Pesticide self-poisoning kills an estimated 110,000-168,000 people worldwide annually. Data from South Asia indicate that in 15-20% of attempted suicides and 30-50% of completed suicides involving pesticides these are purchased shortly beforehand for this purpose. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such customers. We have developed a ‘gatekeeper’ training program for vendors to enable them to identify individuals at high-risk of self-poisoning (gatekeeper function) and prevent such individuals from accessing pesticides (means restriction). The primary aim of the study is to evaluate the effectiveness of the gatekeeper intervention in preventing pesticide self-poisoning in Sri Lanka. Other aims are to identify method substitution and to assess the cost and cost-effectiveness of the intervention.Methods and analysis: A stepped-wedge, cluster randomized trial of a gatekeeper intervention is being conducted in rural Sri Lanka with a population of approximately 2.7 million. The gatekeeper intervention is being introduced into 70 administrative divisions, in random order at each of 30 steps over a 40-month period. The primary outcome is the number of pesticide self-poisoning cases identified from surveillance of hospitals and police stations. Secondary outcomes include: number of self-poisoning cases using pesticides purchased within the previous 24h, total number of all forms of self-harm, and suicides. Intervention effectiveness will be estimated by comparing outcome measures between the pre- and post-training periods across the divisions in the study area. The original study protocol has been adapted as necessary in light of the impact of the COVID-19.Ethics and dissemination: Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University, Sri Lanka (ERC/2018/30) and ACCORD Medical Research Ethics Committee, Edinburgh University (18-HV-053) approved the study. Results will be disseminated in scientific peer-reviewed journals.
U2 - 10.1136/bmjopen-2021-054061
DO - 10.1136/bmjopen-2021-054061
M3 - Article
SN - 2044-6055
JO - BMJ Open
JF - BMJ Open
ER -